Working in Sierra Leone has placed me in a position where I come in contact with some of the most, and sometimes, the most, vulnerable children in Freetown. I knew this was going to be the case when I moved so I was half-braced for what I was going to witness and experience; but the reality has been harder than what I expected. The toughest aspect to get my head around has been regarding death and the different ways it has popped up and said hello...
Office
It is a rather unexpected thing to make a phone call with the purpose of inviting a child to an event only to be informed the child has passed away; but it happens here. I have to say that the number of times I have witnessed a call being short and the response of the team member making the call is writing in big letters R.I.P. on the top of the patients notes has been one more than I am happy with. Then there are the times I get notified of a phone call one of the team has received informing them of a child who has passed away; or inviting them to a patients funeral; or during team meetings when notes, with those deathly letters at the top, get handed over to be filed with all the others. I could not bring myself to count through the drawer with the notes of those children who have passed away, I just couldn’t do it.
Community
There was a day I was working in the community and during the visits came across 3 patients who looked unwell. This wasn’t the usual slight fever and runny nose; this was pale, malnourished and gaunt. This wasn’t your child needs to go to the hospital; this was your child should have gone to hospital 2 weeks ago. Through discussing these situations with the team it became clear that one of the reasons the families didn’t go to the hospital wasn’t just because the family wouldn’t be able to cover the cost of treatment (health care is only free for under 5s); it was that they couldn’t even afford the transport. Transport from most places in Freetown to the children's hospital is about 10,000 Leones, the equivalent to 80 pence and this cost is too much for some of our families (I just wish they would somehow contact us if their child was ill). Fortunately, these 3 children all went to hospital, all were admitted, and all survived. But the worrying thing is there are sick children all over Sierra Leone who might not have people in the community go visit them and encourage the family to take them to hospital or health centre, and who knows what sort of outcome they will have.
Hospital
Not that I'd recommend it, but, if you ever want your heart broken go visit the resuscitation room at Ola During Children's Hospital. The children here are fragile and fighting for their lives and the doctors are working (with limited resources) non-stop trying to save them. Thankfully, I don’t have to go in there that often (I have been through there maybe 3 times and each time I have wanted to get out as quickly as possible). However, the physio clinic backs onto it, so most afternoons work is carried out to the harrowing screams of mothers wanting more than anything for their child to be returned to them (it does sound like the mum believes if she can only scream that little bit louder, that will be enough to get the child back). The upsetting part of these screams isn’t really the screams themselves but the level of acceptance, numbness and matter of factness I have developed towards them.
Team
The past twelve months have been hard on the team. One of the team members lost their son; another's wife passed away from an unknown illness, leaving behind an 18 month old girl; while another's partner died from cancer, this time leaving behind a 13 year old son. As well as these deaths, the majority of the team are caring for sick and unwell family members. It is an enormous load to carry and one that is visibly tiring.
Me
A personal struggle I have had is the culture differences to death. When my Granny passed away in December one of the things that entered my mind was that she wanted her body donated to the University of Aberdeen medical school. I understand that isn’t a normal thing that many people think when a loved one dies; but she would talk about how all medical students needed to practice and get their hands on real bodies if they were ever going to learn and be doctors. She was also equally open to her body being used for research because she thought if there was anyway to help improve the life of those with conditions like her then that would be great use of her body. So, because of this my Granny has had a memorial service, not a funeral, and the University are storing her body in their morgue until a time when it gets used.
However, here, culturally, the expected thing to do is to bury the body within 24 hours, if not less. Even if there are questions about the death there is an acceptance that death has happened and its time to let the persons soul go on to its next place. With the amount of death here, in people of all ages, I do just wish and pray that people start investigating what is causing the death and ask the questions and seek the answers, even if not culturally accepted.
Country
At Christmas and New Year there is a song sung here that goes;
‘Happy Christmas/New Year wi nor die-oh, Tell God tenki for mi life-oh’ which does mean ‘Happy Christmas/New Year we haven’t died, tell God thank you for my life’
People are so used to death that they do celebrate birthdays, Christmases and New Years because they have actually survived to see another year; death is that common here.
Covid-19
The health system here is slowly improving but the load on it is high, the number of patients needing it is high, the cost of it is high and the number of doctors and health care professionals is low. Because of this I am genuinely worried about the impact the current bringer of death, CoviD-19, could have.
This is a country that withstood the ravaging of Ebola, however the spread of coronavirus is so fast and the transmission is different. It is by droplets that can be easily passed from person to person, or from door handle to person, or from shared plates, cutlery, or packets of water (all very common practices here). Social distancing is hard, communities are packed, houses are full and crammed together, streets and markets are bustling with people, transport is busy and a greeting without a handshake isn’t considered a greeting at all. Despite not having a confirmed case (at the moment of writing) in the country the government have implemented a number of measures to try and reduce social distancing and have put the country on a state of emergency for the next 12 months.
With all the death that happens here anyway on a daily basis, I say ‘not today’ to coronavirus and will keep on saying it. However, living here and witnessing what the healthcare system is like, and knowing that the majority of the life saving equipment and drugs available in the UK aren’t available here, does make me wonder how Sierra Leone will cope (if me saying ‘not today’ doesn’t work and the country is hit). But as the bible says “So don’t worry about tomorrow for tomorrow will bring its own worries. Today’s trouble is enough for today” (Matthew 6:34 NLT). All I can do is regularly wash my hands, try and inform as many people here as possible of appropriate precautions to take to limit any spread of the disease, pray, smile, laugh and, (the one I'm finding particularly difficult to do) stop touching my face. Throughout it all I still trust in God. I know this thought will be hard for some people to imagine and impossible for others, but I believe He is there, the best is yet to come and that He does give hope when all hope seems lost.
Smile
On a brighter note, my flat now has a washing machine (bought in fear that if there is a lock down I would have to do laundry by hand. Although, if there was a lock down I would likely only be wearing a pair of blue shorts so not a lot of laundry to do anyway.)
Finally, to try and make you smile here is a clip of me being unsuccessful with a dive…..
Thanks for reading, much love and God bless x