Hospitals in Liberia

I have now had opportunity to visit 2 hospitals in Liberia. One wsa the 'JFK' hospital in Monrovia, which one of our dayworkers invited us to look around. the other was this weekend when we took a day trip on an open train to a place called Bong Mines (up country, and somewhat out of the way at the iron ore mines). Both had quite a similar atmosphere.
The JFK hospital is HUGE! I was surprised at how big it was, and in it's former glory before the war it must have been quite impressive. It was quite a shock to see how much the war has impacted the hospital. They are gradually restoring it floor by floor, but the areas open are by no means at full capacity.
The wards are fairly open with anything from 8 to 20 beds. No curtains, often no sheets on the mattresses. No piped oxygen except for in intensive care. Resources seemed scarce, yet there were labs for testing, and xray area, operating theatres. The accident and emergency department was a little small, but had cubicles as we do back home. The corridors were wide and full of queues of people, the 'checking in' system was intense, with you having to line up in at least 3 different areas to just get your notes and your name on the list, then you just had to wait, potentially all day.
We had arrived thinking our day worker had preorganised our visit, not the case! He just used to work there and asked on the spot if we could be shown round. 2 of the directors were pulled from whatever they were doing to show us around, something that would never happen back home!! We were shown in everywhere, no questions asked...again, not exactly something that would happen at home. There were a few odd things that stuck out for example; the childrens immunisation clinic shared the same waiting area as the kids 'clinic' so basically new babies without immunity, mixed with sick ones, slightly vulnerable situation! The JFK hospital is also linked in some way to China and Japan. We were introduced to several doctors from Japan who did not speak a word of English, they appeared to write in their own language, and their assistants evidently did not speak their language. How on earth any examinations etc took place I will never know.
The hospital up in 'Bong Mines' was smaller but still quite extensive. Be fore the war, you could imagine it being a very busy place, right now it was virtually desolate apart from a few patients. When the mine was running to full capacity, the community was more extensive. Now the staff that work there work for free, not having been payed for months and months. Our Mercy Ministry teams have been out to the hospital to work with the education team to assist in awareness of HIV and Aids as well as nutrition. Again, there was a similar feeling of space but dinginess. There is a generator for the hospital but this only works for a few hours a day, so otherwise no electricity. The systems to sterilise equipment for the operating room were crude but obviously did the job.
I think what was most upsetting about both places, was that there was huge potential for both to have a real impact on the community if they were running and staffed effectively. So many people in the community can't afford their healthcare so just do not go to hospital. As I understand it, a few days to pay for food/general nursing care before even purchasing medicine like antibiotics that might be needed, a weeks wages would be needed. Another problem I discovered was that with reagrd to antibiotics, people are often told the one they need, but because they have to pay for them , they will ask for whichever one is cheapest, or on occasions some donated drugs will be free. Obviously this causes problems of resistance developing, and also prevents illnesses being treated effectively.
This is why our work here is so heavily involved in education. When our patients leave the ships ward, we spend a considreable length of time explaining medicines, why and how they should be taken, and to never share them with others.
Hopefully you can have a look at the photos I've attached to give you a bit of an idea about Bong Mines hospital (this is run by christians I believe, whereas JFK is a government building so we couldn't take pictures).

A nice rest...

Nurses on the ward here have been going down like flies with viruses, sickness, nausea, headaches, so it was nice that this last weekend was the ships holiday. Lots of us have had quite 'tough' patients and several quite hard situations on the ward. Some of us have done extra shifts and pretty much lots of us were at the end of our tethers! On a holiday weekend, we don't do surgery on Friday and Monday and have a long weekend off (though the nurses still work, it gets quieter and more of us are able to have an extra day off). It gives everyone a chance to have a rest and lots of people go up country.
I worked Saturday and Sunday, but had Sunday afternoon and Monday and Tuesday off. I have had the loveliest days! Today, I spent a little time sorting out photos and getting things in order and then my friend katy and I decided on a random trip to the beach. By the tim ewe planned to leave, our little group grew to 5 lovely nurses, all very excited as we hadn't been anywhere alltogether. We hopped in a taxi and went to Whitesands beach. It was just the most perfect day....beautiful blue sky and gorgeous sea (and not so rough that you couldn't stnad up which makes a change I can tell you! Having said that I did end up spectacularly washed up on the shore several times with sand in quite surprising places...!!). We had a great time chatting and playing in the sea then retreated to the shore and we all relaxed, read and napped a little. Absolutely perfect!
This evening I decided to go to the ballroom dancing class taught by the lovely Val (who works in the post office and cafe on board). We had so much fun, even the touch rugby people gave in and joined us. I am now the Tango queen i can tell you.....Hmmm well, lets not get carried away, slow slow quick quick slow. All is well as long as the man leads! Hilarious and so nice to be out at the end of the dock, lightening flashing in the background, a nice cool breeze. Ahhhh...
Some people may think I am just having one long holiday, but really this weekend has been such a blessing particularly for our ward nurses. All of us were at breaking point, and moments like these are what you need to get you through. All I can say is thank God for days like this, and thank the Lord for laughter...

Paediatrics...how do you do it?!

Well, to all those kids nurses out there, I salute you! I am not qute sure how you do it, well I wasn't until a bit of a breakthrough happened.
Because of the nature of what we do on the ship, a large part of my job is giving out pain meds and wound care. Have you ever tried playing and having fun with little ones who know you for the person who comes and makes them drink yukky medicine from a syringe, and pull and tug at things stuck to your skin? Not so easy I tell you!
I had a pretty hard going shift this week where I had to care for 5 kids who had had cleft lip/palette repairs. 4 times a day they have to have their lip and mouths swabbed with cleaning solution (wouldn't be nice for grown ups either, but at least you can explain!). So, I had had a pretty horrid day making grumpy in pain babies, initially even more grumpy by giving them medicine into sore mouths (for the eventual pain relief benefit of course!), then cleaning their mouths while they fought me off for dear life, and then wouldn't look at me for at least 20 minutes. It doesn't exactly make your heart warm and fluffy, what a bad nurse I am...
But then, one of the mammas was in desperate need of a snooze so insisted I 'carry her baby wit me' (fine by me!!). Earlier she had been pretty grumpy with me, having had a cleft lip repair, she had encountered my above described nursing duties. After a few grizzles, she snuggled in and was happily content for an hour and a half as we took a group patients up onto deck 7 for their 'outside' time off the ward. That made all the hours before pale into the background.
Later that shift I realised the same baby had a visitor. I noticed the man had a bolster in his nose and a suture line to his lip. It suddenly clicked to 2 of us, this chap was her Papa and he too had been with us a week previously and had had his cleft lip repaired too!! What an awesome story, daddy and daughter having their surgery virtually at the same time. It stills sends shivers up my spine when I think how special that situation is.

Song time!

This week we had a half hour of really quiet moments on the ward. One of the girls I work with Inneke, plays the guitar, so we decided we'd have a song session!
One of the older male patients (we called 'papa' - a sign of respect to those older then yourself), was a little preoccupied with one of the babies in the bed next to him. Papa Moses is about 75 years old, and such a gentleman, smiling and trying to help all the time, despite his eye problem. The little one in the bed next to him is about 14 months old, a little game ensues...baby Sonnie pushes a new found bright piece of card shaped in a heart over the bed cotside to Papa Moses, then disappears behind the cotside giggling, Papa puts the heart on his head, and sonnie pops up. The heart is grabbed by a little podgy hand, and then Papa hides...the game goes on. I could have watched the interaction all day, but on with the other story...

So with the chairs in the middle of the ward Inneke began playing some songs, many the patients knew, some they didn't . Two of our little girl are very excited by the whole thing, and come really close. So, then it was time for some kiddy songs, back in my old familiar comfort zone for a few minutes!! The songs 'HIgher Higher' and 'Who's the king of the jungle' appear from the depths of some of the nurses hearts! The girls loved the action songs, and before a few times through had passed, we had te adults doing the monkey actions, waves and laughing so much! The atmosphere was fantastic, even those in beds who were newly post surgery, joined in where they could, and made suggestions for other songs. Do you know, I am pretty sure these times are as good if not better than any other medicine they could have.
Between our shift change overs we always have a time to pray, but sometimes we sing or ask our translators (local Liberians who work on the ward) to start singing for us, and we all join in 'African' stylee... Instead we thought we'd get all the nurses to come and join the singing. So for 20 minutes we just praised and sang, and got the little ones to show everyone the actions to the new songs they'd learnt. Sooooo much fun! Now how many times have you done that in a shift change over? In fact, half way through i had to escort a patient down to the OR (check me out getting all American... theatre I mean, clearly!!) and he was still singing 'Who's the king...'
Tee hee!! Can you see why I love it here yet?

A speech and language session

The following little situation made me laugh so much but I could have cried just as easily! We have 2 little girls, 7 and 9 in beds next to each other. The younger 'Blessing' has been in the hospital for a long time having a skin flap created in order to use to reconstruct part of her face, due to it being destroyed by a flesh eating disease called 'noma'. It is a condition which can be treated early with antibiotics, but if not, can cause the flesh to be destroyed and eaten away. The older child 'Kadiatu' had a hole in her palette. This has been reconstructed, but she too had been in the hospital for a long time. They have built quite a friendship.
Blessing has to do intense physio (mum is very strict, they are up at 5.30 am starting every day!!), and she also does schoolwork. Kadiatu has to do speech and language therapy because she essentially has to re-teach herself how to speak and swallow.
Picture it... mammas asleep midafternoon (under the beds, blankets over heads!), Blessing and Kadiatu on one bed, cross legged opposite each other, Blessing has her book for 'sounds' in her hand. Then begins the session, Blessing says a word, kadiatu repeats, Blessing corrects her, Kadiatu tries again. Wrong again, Blessing raises her voice, Kadiatu tries again, Blessing repeats in a muffled voice...and this goes on and on for at least 5 minutes. they begin hysterically laughing as they realise Blessing can't pronounce things properly because she can't manipulate her lips, and Kadiatu can't yet quite get her 'new mouth' to do what she wants. Neither are saying things quite right!
But the voices get louder and they try harder. It was a precious moment, one that will stick in my mind as 'determination'. One of the girls went home today,proud as punch, with a whole different life now ahead of her.

Monrovian Taxis

Hmm, ever got in a taxi, closed the door, then thought, might just open the window? Well, that's what I regularly think when I get in taxis here, but we often use the same local chap, who has lets just say a rather old taxi. So when the thought crossed my mind the other day...out he jumped of the drivers seat, whipped open my door, took out a metal rod, then cranked the window open with the inner mechanism of the door! See, most taxis are lucky to have windows stuck together with masking tape, and door handles, and really, seatbelts...?? Not a chance! Many cars you'll see the chassis trailing an exhaust pipe on the floor.
I do however love the 'taxi world' here. standing on the road people give random unfathomable hand gestures (not of the rude kind!), which apparently indicate where they want to go, eventually what I would call a 'full' taxi will pull up and allow the person to hop in, 4 in the back seat at least, and 2 in the front passenger seat. Nice and cosy... I experienced the front seat the other day - gear stick jammed in one leg, and pretty much sitting on a random strangers lap. If you get out of the taxi without the driver asking for your number...?!
What can be a little distressing is that some locals have commented as we have gone past 'oh you carry white people' and assume we don't want to share our cab and step back. It's such a strange and uncomfortable assumption to me, sharing doesn't bother me in the least, but how can I impact on a culture/attitude that appears so resigned to certain things??!!
Yes, life here gets more and more interesting by the day!

A different meal out

Yesterday I was invited to go to a restaurant for some traditional Ghanaian food. I went with a group of girls and a guy who is originally from Togo who works on the ship. He craves his 'normal' diet but invited us to go with him. We were in quite a small darkish room with very little ventilation, in fact we had to move a little to get underneath the fan as two of my friends were pretty close to fainting with the heat! We ordered foo foo (I think that's how you spell it!), I ordered mine with plum nut sauce and 'meat' (a little risky!). Foofoo looks like a big ball of dough, made from casava leaves (spelling??!!). It is very bland and it's consistency is sort of stretchy doughy (not for the faint hearted or blancmange haters), the sauce it came with was quite spicy, and the bowl of meat, although tasty was quite bony. Anyway, we all survived, some ate more than others, and I actually quite enjoyed mine. the foofoo is supposed to be more filling than tasty it appears.
To top off the visit, we went out the back to the landrover, saw them pounding casava manually. I then spotted a little goat leaping around out the back...how lovely BUT NO!
No sooner did I spot the goat than it had it's legs tied up. A hole (I learned, to drain the blood into) was dug, then a knife sharpened, and then the guy just carved it's head off right there and then, all in the space of 2 minutes...well at least I know my meat was freshly made on site...!!
Hmm...not one of my favourite memories I don't think!