Thursday, 8 October 2009

It's chilly up north (of Sierra Leone)

I'm now waiting in a first class lounge at Euston. The ticket was pretty cheap, so I decided to upgrade. I've never been in first class before so I thought what the heck. I'm waiting for Myroslava to come for a coffee. She's a friend from Canada, met her in Uganda, who's here studying for a Masters in Public Health at the London School of Hygiene and Tropical Medicine - lucky! 

Yesterday's ferry experience certainly wasn't as bad as I'd been preparing for. The usual guys running around you, trying to get commission and tips. The truck that I was getting a lift from only just squeezed onto the ferry deck! The vehicles were packed so close, that two trucks were leaning against each other. I ditched the truck, fearing I wouldn't get to the airport in time as they had a big load of cassava flour to drop off on the way.

I had a barrage of phone calls from friends in Sierra Leone, wishing me farewell which was really nice. I expect them to be 'flashing' (giving missed calls) me on my UK number soon enough. 

Airport faff went mostly very smoothly, even when it transpired that I had overstayed in the country! Oops... my fault really. I was meant to get my passport re-stamped after a month. I'd overstayed by a month! Kinda lucky that I'd learned a bit of Krio, to the surprise of many, and had that meant I'd been put in their good books. They let me off. The lady who was going through my passport recognised me apparently. I just pretended to know her too! She asked for 'a little something' for letting me off, but I said I had nothing but 500 Leones (about 10p). 

The cold cabin on the plane helped to prepare me for the chilliness that refreshed me when I stepped off the plane this morning. Sort of welcome, but at the same time, reminding me of all the layers that I'll have to wear from now.

Wednesday, 7 October 2009

Adventure. All the way to the end.

I'm sat in a truck on it's way to pick up a shipment of yellow fever
vaccines at the airport. I had so much time to spare at the ferry
port, I couldn't resist trying to hitch a ride for the 15 miles to the
airport on the other side!

Tamba the driver has agreed to the lift for free because he likes
medical people, and he says it's a medical truck. Telling people
you're a student doctor gets you favours at times :) The truck's not
that medical looking. Looks more like a goat transporter or something.

Next to the ferry which we're about to drive on to is a huge rusting
hulk of an old ferry being dismantled. The harbour is full of rusting
relics, consigned to a slow watery decay. They could really do with a
ship building industry here. There's a fantastic deep water harbour.

I met a doctor just now. Private and proud. I couldn't believe some of
the shit he was coming out with! Botswana's HIV problem is due to anti
retroviral medication... What a load of crap. High prevalences in a
country that uses so much medicine that treats HIV?! Had he thought
about it, he'd have realised there were so many people with HIV
because they hadn't died yet (thanks to the medicine)! Conspiracy my
arse.

--
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James Chan
--
e: james.chan.uk@gmail.com
t: +44 (0)7886 237 501
b: jamesonelective.blogspot.com

Last day

There are less than 24 hours until my flight leaves the ground. I hope I'm on there when it takes off.

The airport is situated across a huge river mouth from Freetown. It's 187km by road which takes about 5 hours. Bear in mind my flight takes 6 to reach Heathrow.

Options left:

  • Pelican water taxi
    • Last time made me feel horrendously nauseous. I've become more susceptible to motion sickness these days. 
    • Too expensive at $40
    • Takes an hour
    • I can try to swim if it sinks
  • Helicopter
    • It'd be pretty cool
    • Expensive at $70
    • Takes less than 30 minutes
    • I can't fly if it crashes
  • Ferry
    • Tickets start at 1000Le (20 pence)
    • Danger of muggings and theft
    • No lifejackets
    • It's rusty
    • It'll take about 2 hours, but will 2 hours for me to get to the ferry terminus
    • It may or may not run on schedule
In the last few days, I've wound down the time spent in the hospital, and really concentrated on writing up my research. I'm quite happy about what I've got. I had a chance to present the findings to a meeting of health NGOs, and Amnesty International who'd just released a (locally) controversial report on maternal mortality and was met with some raised eyebrows and good questions. It was interesting insight into the NGO world - I find it so interesting!



I spent a good few hours yesterday saying bye to everyone I would miss (some not so much) in Kamakwie. Being in Freetown now really made me realise how lucky I was to be able to live in a rural community, with fresh air, and people who had time to form relationships with. I sometimes felt rude being short with people, but you just have to if you want to do a research project. People will always come knocking at your door to just come in and sit down... and watch you work, or they'd sit in relative silence.

A quick once-around the hospital made me smile. The kid in bed P15 was doing better. The 1-and-a-bit year old had come in with a fever, haemoglobin of around 5g/dL (quite low) and had developed very congested lungs at some point too. He had several convulsions on the day of admission. I made sure he got oxygen therapy (two 30 minute sessions per day), and helped him to loosen his sputum and encouraged him to cough by rolling him onto his side. After 3 days, his chest had cleared and was breathing and breastfeeding fine! Only thing was I suspect he had cerebral malaria. He was a bit rigid, and had poor head control, and had that look in his eyes. He may have ended up with a cerebral palsy and possibly epilepsy as a result of cerebral malaria. But he's alive. I saw so many children die from respiratory failure. Nobody before I encouraged it, put children on oxygen. There's one oxygen concentrator in the theatre which can be used when the generator's on so it's limited, but available. First line treatment is antibiotics and antimalarials. Frankly, I don't consider this to be a good standard even with the resources available.

I've done a lot of thinking whilst here, but not enough blogging so I'll continue to write a bit on here even though I'll be back in the UK soon... ugh, 5th year beckons. Not feeling up to it. At least I can be happy to boast I don't have to fill in the dastardly MTAS form for jobs.

Final few things before bed... I think I'll take the ferry.

Things I'll miss:
  • The sound of intense downpours and thunderstorms directly overhead - awesome!
  • The sound of chirruping insects at night
  • New friends
  • Groundnuts!
  • Red soil
  • Doing things by torch/candle light
  • No electricity
  • Bucket showers
  • The handshake
  • The wrist shake
  • Avoiding emails
  • Trying to carry things on my head
Things I won't miss:
  • Black ants biting all the way up my leg
  • Tripping on big rocks and roots at night
  • My dodgy bed and mattress (and a bad back)
  • Over genial greetings
  • Having to accept food every time it's offered to you
  • Expressions of disbelief/horror that I'm not religious 
    • 'You're not Christian, so you're Muslim?'
    • 'No'
    • 'But you believe in God, right?'
    • 'Err, not exactly'
    • 'So what do you believe in?'
  • Taking malaria prophylaxis
  • Humidity