BLESSINGS OVERFLOWING

The last few weeks have been interesting, challenging and very educative. Since the beginning of

May we have had visits from various people including 2 Community Health Students from the local University in Sierra Leone; two Medical students from a University in England (undertaking their electives); a Doctor in the UK who wanted to upgrade her tropical medicine skills; and a friend of Nixon helping to put together proposals to raise funds for hospital projects. We have learnt a lot from the feedback received from the Community Health students and are in

the process of getting feedback from the medical students. Our experience from these visits confirms that despite its current state, the good reputation of Nixon Hospital is world wide.

It also reassures us that we must be doing something right, for despite all the challenges we presently face, national and international students continue to visit and consequently help to

identify aspects of the daily management of the hospital which can be improved. This fresh insight into the way things are done at Nixon is needed as we tend to forget what the normal standard is, and the evaluations of our visitors have helped us to identify aspects that need very necessary and immediate change.

The rains have started with full force. Thunderous nights with flashes of lightening make one marvel at the wonders of the Almighty. The onset of the rains means the agricultural work is in full swing and everybody has got involved. Both Joey & Little J have their groundnut patch in front of the house whilst, not wanting to be left out, I have my cassava & maize patch at the back. Oh I guess you would want to know whether I am a good farmer – well we’ll see. The crops are doing very well and we are expecting a bumper harvest

Joey has finished teaching her Obstetrics class and is currently taking a well deserved break – though she still has fifty-two exam scripts to mark. Then the students are scheduled to go to the villages ( 20 in all) for 6 weeks of their practical placement. It’s still a busy time and we are trying to combine winding up many of the projects with the daily routine of the management of the hospital and the school. God has been good and He has sustained us through some very, very difficult days...but we are blessed and continue with what we believe is the will of God.

Little J is growing in leaps and bounds and (although still a handful) and she has been blessed with the company of many friends and loved ones. Mentally and socially
(evidenced by the increase in vocabulary – a real talker!!) she has been blessed with friends of all ages – Little E her Salone ‘brother’ and his older female relatives ( her Salone sisters) have provided a combination of experience of age and exposure to the Salone languages. Consequently her Krio has increased (we need translators at times) and her Mende is slowly improving (it’s a difficult language). We look at her and see the blessings in abundance, because her welfare was one of our many concerns when we were preparing to come to Sierra Leone but God has provided so many people looking out for her. Our dear Ma S, A and L (helpers only in the job title) have filled the shoes as her Salone Grandma, Uncle and Aunty. They look out for Little J even more than we do. God has truly blessed us.

Prayer warriors please continue to pray for strength, direction and provision as we come to the end of our contract and prepare to return to the UK. We need the Patience of Job and the Wisdom of Solomon to get through the rest of this time in addition to the presence of mind and heart to identify and grab opportunities - a juggling act which can prove tiring as the combination of dealing with complex personalities on a daily basis only serves to pepper the experience. However, we have seen and know that God is Greater than all these circumstances and we continue to work in His name. Only He alone can bring to fruition this work.

Ottey and Bolt (less)

Last Saturday was a special day at Little Js School as it was their 2nd Annual Sports Meeting.. Sadly for us, she resolutely refused to take part in any activity whatsoever. Not even incentives or cajoling would make her change her mind. Sorry all Jamaicans – but not another Merlin Ottey or female version of the ‘Bolt’ here. Maybe she’s reserving it all for the big days ahead – we can only but dream. Despite it all we had a thoroughly wonderful day. I think Little J’s house won.......

Pupils about to start a balloon 'bursting' race. Yes you sit on it till it bursts before you start running.

A Sweet Experience.............

Mango – sweet, juicy wonderful. Yes, once again we are in the mango season – and what a season!!!!!!! Every available tree is ‘bedecked’ with yellowish/red juicy succulent fruits – that invitingly cries to be picked by all who pass by. This is more so because when their cries are ignored there may be one about to land squarely on your head – especially on strong windy days. Okay – a bit of poetic license here but I hope the point is made. The succulent things are in abundance but sadly not many people eat them, something that baffles me considering the number of malnourished children who attend the hospital daily. Mangoes are – I am told - rich in vitamins, easy to eat and (here in Segbwema) relatively easy to get – especially this time of the year. Why not many are being eaten baffles us a great deal. Countries such as Ghana, Nigeria, Jamaica,- just to name a few - have realised both the economic and nutritional importance of mangoes and have made profitable industry of bottling and canning them. Our desire – to help the mothers attending the clinics realise the nutritional value of this fruit – oh sweet sweet mango – hmmmmmmmmmmm.

Good friends and friendship ...........

Friend - Someone who cares enough to make your problems or concerns, no matter how irrelevant or big, their problem or concern. Some friendships we initiate and work hard to maintain them, others are entrusted upon us, and again there may be some that we absolutely wish we never had made. The fact of the matter is that friendships are an integral part of human relationships.


We have undoubtedly made many friends here, but Little J has formed a friendship stronger than all the others with one particular girl – a girl slightly older than her. Their friendship started about a year ago when Fema could barely speak English and Little J had little or no knowledge of Mende or Creole. But over time their friendship has grown at such a pace, all our family and friends know about ‘our famous Fema’ that they all want to meet her some day. Our hearts warm with the knowledge that lifelong friendships can begin at such an early age and then we remember our own dear lifelong friends and smile – because these are friendships we have made since the cradle. We thank God for these jewels in our lives as we cherish the memories.

Teaching to fish.

My latest task has reminded me of the reasons for us to be taught how to fish instead of being given a fish. Having visited 14 ( deep rural) villages in 2 days (in order to put in place arrangements needed for 52 students’ practical placement), has reminded me of the importance of helping to enhance and encourage the students to work in the rural area of the country.


Many of the Peripheral Health units ( PHU) are manned by young professionally trained health personnel with different levels of experience. They depend on each other (and the efficiency of the referral system) as they strive to improve the health status of their community members – many of whom are not only financially impoverished but also lacking the correct information to make the best choices. At one PHU we met a Maternal and Child Health Aide (MCH Aide) and a Traditional Birth Attendant (TBA) attempting to carry out antenatal duties on more than 40 women. She tried to make it enticing, by not only educating in the traditional way but turning it into a mini – party by providing food, drinks, dancing and singing. She was not more than 30 years old. Her team (including the TBA, a Vaccinator and a Community Health Officer – CHO) was responsible for a community of over 1000 people and answerable to the District Medical Officer and the community leaders. It is imperative their leadership and interpersonal skills are at their best, as the prevailing culture demands that before a decision on an issue is made, it has to be introduced to specific groups: the Paramount Chief; The Section Chief; The Town Chief; The Chairmen of the Village Community; The Ward Counsellors – and if it is medically driven – the District Medical Officer; the community medical team and the TBAs. All have to be adequately informed and agree on the same solution before the issue can be resolved. Now there's a dose of bureaucracy if we ever saw one..................



The health personnel in a PHU needs to be knowledgable, motivating, enhancing and encouraging. Community development is an imperative part of the job as many rely on the health personnel to teach them to improve their health practices, and so better their lives. With the improvement in health comes (on many occasions) an increase in prosperity as people are better able to earn a living. With exposure and encouragement, they will hopefully allow their children to take up the offer of an education thus creating the opportunity of a better future.

In another village there was a MCH Aide – (about to retire) - being shadowed by a younger colleague, and yet another village the CHO who had wanted to retire for the past few years, could actually do so. We were told the student population of all levels of health personnel ( MCH Aides, SECHNs and Paramedical students ) had increased, and the training institutions were sending the students on their practical placements in PHUs which were once considered 'too far'. The message is clear – people are choosing to be trained (many at their own expense) and are taking up positions that were initially not filled.

This is what we try to impart to our students. Many have never lived in a small village and their practical placements in the village setting will be the first opportunity many will have living in small, close knit communities. It is imperative they have a positive first hand experience as community nurses, reassuring them it is possible to survive in a village setting.

We are very encouraged by the last set of students (who are preparing to sit their final exams in May). At the end of their village experience, they were open to the idea of finding employment in a PHU when they qualify. We will continue to reassure and encourage them and will assess the actual numbers who take up their duty in a rural community.

We're encouraged.......there is hope for this our beloved country.

Hut by the sea or 5 star resort!!!

I used to jokingly say, ‘Paradise’ for me is living in a hut by the sea. But on deeper inspection, is it? I always thought the closer I am to the sea the more blissful my life would be, but without the cursory mosquito net, plumbing and electricity the closeness to the sea is minor joy, if any.
Can you imagine getting up in the morning and having to use the space behind the bush (or if it’s ‘developed’, a hole in the ground) as the first place to visit? To get a proper bath may mean walking (even 1/8th of a mile) to the nearest stream. To have some breakfast, you need to lug the water back in a container, catch a proper fire and get it boiled (properly for 5 minutes or more). If not, that hole in the ground will be your best friend for the next few days. You need to get some of that water cooled (in a clean container and properly covered) for drinking later.






Then, ignoring the need for grooming and deodorant, (who am I trying to impress anyway?), the next task is figuring out breakfast. The easiest choice is vegetarian (just eating fruits and drinking water) but a treat would be to have some fish and cassava cake (bammy). Fishing is not my strongest point (unless I beg the fish to jump in the net), then there is the scaling and gutting – I missed that class....The bammy making is no joke as – I’ll need to find and dig the cassava, then grate, wash, squeeze, dry and press into the cake......maybe I should just stick to fruits.

Having a drink of coconut water would be perfect at this point, but then that’s another class I missed.... climbing the tree, and opening the nut. I usually left the climbing to experts and the opening of the nut (by machete) to the men of the household. So, I guess plain water will have to do (when it’s cooled). Is this paradise or major hard work?

The option, for some, is a 5 (or even 2) star beach resort. Here, by the snap of a finger, a meal is served (and this can be without even leaving your room). The task of grooming can be left for others to do. I do so appreciate a good professional hair wash and style; waxing and threading....first impressions and all.A warm bath (or just a shower) is expected and a visit to the toilet may be akin to a luxury tour in some resorts. Now, that’s more like paradise........

I’m happy I have a choice, and can change my mind about that hut by the sea.
But think of the millions of souls living in developing countries without this option? For them the hut by the sea is their reality. Some are even worse off, as their hut may be in a slum in a city surrounded by thousands of other huts vying for very limited natural resources (water, electricity and fire wood). Their reality is only a mere thought for me ( I can choose to think like this in my spare time or dismiss it and think of something more pleasant).
We are blessed in so many ways and don’t even know it.
To be reminded though, try living in a hut by the sea......

NEWSLETTER for March '09

The year started with a review and planning meeting of the entire senior staff of the hospital and the Nursing School and acknowledged the progress that both institutions have made. It also recognised there is still more to be done to bring the institution up to the high standards attained before the war. In line with improving standards at the hospital, the Conference Office has helped us with the recruitment of two additional doctors, one who started at the beginning of March, the second to join us at the beginning of September after he completes his houseman ship in Freetown. We therefore have three doctors working full time, as Dr Hopkins, who last year did six month’s charity work, has joined us this year for another six-months.

With regards to general administration of the hospital – our drug supply situation has improved considerably even though it is not at the level we would like. We presently purchase our stock on the open market which puts a big dent in the hospital’s income – which wasn’t much to start with. The supply of drugs from the district medical stores is patchy and does not always cover the most essential drugs required for the commonest ailments such as malaria, worm infestations etc. We were blessed to receive a consignment of essential drugs (and other materials) for the treatment of haemorrhages in pregnant women and other maternal emergencies from a UK-based charity. These drugs are very important in the hospital’s desire to reduce death among pregnant women. We are very grateful to Hope for Grace Kodindo Charity for their donations.


The hospital in February extended the medical outreach services to cover four villages. This is another key step in the hospital’s strategy of delivering good quality and affordable medical services to a greater percentage of the community. One of the key objectives is to develop a system that would enable, through the outreach programme, to identify cases that need early medical intervention. The programme would therefore supplement other core activities of the hospital such as the immunization programme and the ante-natal clinic whereby the outreach team would follow-up on pregnant women who miss their appointments or may require regular monitoring to ensure safer birth.

The challenges of generating funds to run the hospital are a daily pre-occupation for us at Nixon considering that we operate in an economically deprived area and are always exploring new avenues for generating extra income for the hospital.



Nursing School
Joanna is currently very busy with the second years as they begin their obstetrics module. This year is particularly challenging because the set has over 50 students. The class requires twice the time needed for preparation of teaching aids, and working out placements and duty rota. Happily the progress of the students is positive which makes all the hard work well worth it. The next challenge for Joanna would be to find enough Peripheral Health Units in the villages that would be prepared to accept these students for their four-week obstetrics placements at the beginning of May.


On the family front, Joelle has started attending pre-school and seems to be enjoying herself. There have been a couple of times when she picked up stomach bugs either from the water at the school or the food they give the children. Otherwise she is enjoying school and this has made a tremendous difference as it enables us to focus our mornings on our responsibilities at the hospital and nursing school.
We are looking forward to our furlough in October when we should be able to spend sometime in the UK . It is then we also hope to catch up with family and friends.


Prayer Points.

For continued progress of the hospital and God direction in the plans we have for the hospital.
For strength and wisdom for Joanna as she prepares these new batch of students towards their state examinations.
For protection and strength for Joelle at her school and from the constant illness that have been plaguing her.
Lastly, for God’s will to be done in our lives as we strive to do our best for both the hospital and Nursing school.

Normal, or is it?

It takes leaving all that is familiar and living in a different world to help to make the comparison of the haves and the have nots. We've been in rural eastern Sierra Leone for over a year now and it really has grown on us. The days are long, hot and many times 'busy' but the bliss of not having to run for the train, bus or tube; to not have to worry about the people (esp. young ones with vicious looking dogs) or even the worry of what to buy ( latest shoes, clothing or even cd). It can be liberating .....


Then we are reminded of how western we are when we have to light the generator and be subjected to its noise just to get some very cool water or when we spend the equivalent of £2 on a stick of ice cream which needs to be hurriedly eaten before it all ends up on the floor. It begs the question, which is the 'normal' life?
Is it the one where we can access the limited scarce resources at the touch of a button, have the option of 200 varieties of cereal in the 20 or more different neighbourhood supermarkets or corner shops; have the luxury of discarding mountains of food because it has passed the sell by date; your child needing to join a play group or nursery to get some form of socialization; getting grey hairs just trying to keep up with the maddening pace?
Or is it the normal life to eat what is grown ( even if its the same thing everyday); pinch the fuel supply because you may not have the money to get another share for a while; waking up to the singing of the birds and the crowing of the cockerel in the cool of the morning; the option of little
( and not so little) friends to play with Little J at seemingly all hours of the day ?
What do you think?


It seems we have enough time ( sometimes) to ponder on this...... we need to enjoy it, I guess. It won't last long as we are getting ready to go back to the UK for our furlough. We miss our friends tremendously, and all of what's been happening to many ( births; marriages; new jobs in new countries; ending University and becoming working adults). We have a lot to catch up on and we look forward to this when we get back. In the meantime, the friends and happenings here, although more subdued, make for a merry, sane life ( with the occasional hair pulling days).

We thank all who have been praying continuously for us during our journey and we ask you to continue to stand in the gap for us. We hope to complete some projects here – as a personal
( friends and family) labour of love for Nixon Hospital, and that should keep us busy enough until the end of the year. Our blogspot should have updates as soon as we get them.

Life As we know it................. Fantastic!!!

The two Js











The twins - Michael and Joanna with their mum






Fetching water from the water pump









Little J with her Salone brother Emmanuel

The world beyond the bubble

The recent intense (and sometimes emotional)debate about Jade Goody choosing to live her last days (and now her death) in full view of the UK public brings a number of issues into perspective for us here in Segbwema. Is death really as sacred as we make it out to be in Africa or is it just a phase that we all have to go through – as is the attitude of Westerners? That is a question one would have to answer for ourselves – depending on our belief structures and experiences.

However for us, it’s hard to put into words the disparity we experience when we compare living in the UK with our lives here in Segbwema, and hence how we view issues of ‘life and death’. From carrying out the activities of daily living to the challenges of meeting higher needs, the differences are glaring. We have three adults helping us to do such mundane tasks as fetching water and cooking and basically keeping our home in running order. Imagine waking up in the morning, opening the tap and there is water, in fact you expect running water. At the flip of a switch there is light, at the turn of a knob the stove comes on and you can cook breakfast, or flip the switch on the kettle and there is warm water for tea. Here, every thing needs to be planned. Bro A and our dear Mama S fetching water from the pump ( making about 4 – 5 trips) allows us bath etc. If the water is not boiled on a coal stove and stored in a flask the day before, then we’ll have no water for tea in the morning. Try washing your clothes without the luxurious option of throwing them in the washing machine?
If we look at meeting the higher needs - accessing functional medical care in an emergency for example – well, that’s another challenge. We have learned having a doctor at hand is not always enough. If there are no drugs and diagnostic tools at his disposal then he’s actually working somewhat blindly and has to guess the problem from signs and symptoms. We therefore, have experienced the loss of patients in cases where the doctors were unable to diagnose in time and the patients were unable to be referred to other institutions (with more access to diagnostic tools). It’s disheartening and emotionally draining (I never spoke to, or touched the persons or tried to solve the problem – imagine the doctors and nurses). I sometimes wonder how many more silent tears we have to shed. Then I remember the blessings bestowed on people in the developed world who have access to basic health care, food – just having their basic needs met allows them the time and energy to spend on the latest fashion, music or movies, or to rant on about the best way to describe a disability (an issue or subject) without being politically incorrect, or about some simple family issue.



It brings to mind the public’s reaction to Jade Goody’s thrusting in the forefront her battle with and preparation (and eventual) death from cancer. The reactions in the UK are many but mostly of horror and disbelief that a young woman can publicise this subject. This ‘horror and disbelief’ is difficult for us to comprehend in our current context, especially when one experiences and faces death of people of all ages on nearly a daily basis. Babies, children, teenagers young and old adults, there is someone we know who have experienced this grief. It’s made worse when the death is sudden and in some cases avoidable if only there were better diagnostic tools at our disposal.




I know in this blog we try to be as positive as possible but we can’t ignore this recurring ‘theme’. It’s emotionally painful and draining, but for so many people this is reality. They survive – go on to live again – because of a strong spiritual foundation or they become numb to the pain. It’s easier to deal with the loss of a loved one if we believe they are in a better place and not suffering or lacking as they did in this life. Holding on to this bigger spiritual anchor helps us to ride the storms we inevitably experience in this life. It also calms our hearts and minds, and gives us the strength to continue the journey. I’m sorry for those who have no Anchor.

"Flora and Fauna" of Nixon

It is really hot now in Segbwema as now is the dry season. Temperatures are now touching the high 30s (Centigrade – sorry I don’t do Fahrenheit). Earlier in January at the onset of the harmattan season, the mornings were so cold most of the students were walking around with winter jackets on. The nights are sometimes unbearable as we are unable to keep the electric fans going after ‘lights out’. Anyway, we could be in Saskatoon – literally snowed under.

The hot weather obviously brings with it some blessings – the grass on the hospital site needs less cutting so we are able to deploy the grounds men to do other duties such as harvesting the palm fruits on site. Last year we were able to produce nearly a drum of palm oil from the harvest and we look forward to a much bigger yield this year.

Palm fruits

The arrival of many birds is a wonder to behold at this time of the year. The most interesting, in my opinion, is a flock of cattle egrets resident here at Nixon. They visit us twice (sometimes three times) a day - every day. I have tried to take pictures but my photography skills are not that brilliant. The chickens were better subjects– they are not camera shy – but they do make a sensible dash for cover when the odd hawk visits.

Cattle egret

This time of year is not the best for most of our students as they are busy with examinations!!! The recent intake have just finished sitting their Introductory exams whilst the second year students are now sitting their mid course assessment examinations. The experience is especially stressful now that students are expected to achieve a minimum standard before they are allowed to progress to the next level. They have been working hard and we wish them all the best.

The Walkway from Male & Female wards to back of OPD.

Picture 1


The Old Medical Superintendent's House



We recently had a visit from a lady who lived at Nixon during the late 1960s.
Linda had a lot of stories for us to enjoy and enlightened us on the way ‘missionaries’ lived in the 60s and 70s. The stories made us realise that some of the challenges we currently face are not unique – which was a relief. We were able to draw from her huge experience as we grapple with living and working in Segbwema. Linda’s experiences were of great help to us and we appreciate her visit to Nixon.



Little J - really enjoying her meal


.......Little J with our home helpers (L-R) Ansu, Mama Sumbo & Lucy. They make our home running smoothly and we are really grateful for their help and support.

Picture of Segbwema market from Old PZ building

Another view of Segbwema from St. Peter's Catholic Church

Marching On into 2009

Its been a while since we last updated our blog and we apologise to those of you who depend on the blog to follow our progress. The technology here in Segbwema does call for patience as internet connectivity has been a major problem for us. We are blessed now to have wireless internet,- but the connectivity leaves much to be desired. It is still better than having to travel to the nearest town – Kenema – one less stressful journey.


The past few days have been very exciting and challenging. The hospital is planning to increase the villages covered by the mobile clinic and this requires assessment visits to these villages where the elders and members of the Village Dev. Committees are consulted. Michael has visited a few villages recently hoping to start the new visits before the end of the month.




Gathering of some of the village people at a couple of vllages we visited (Apologies for the bad quality)





The students at the school have been very busy too. The final year students were placed in the nearby villages for 3 weeks as part of their public health practical training sessions. Their task involved building toilets, clearing the surroundings, building plate racks. A very serious problem in this part of the world is Lassa Fever – similar to Ebola virus or haemorrhagic dengue.



(Public Health Students on placement at one of the nearby villages - Fejia)

It is spread by contamination of food by rats. The students’ work involves educating the community on the risk of disease and the benefits of good practices to prevent the spread of such diseases.



An additional objective of this 'placement' is to expose the students to ‘village living’ with the hope that a few may choose to work in the villages rather than 'flocking' to the big cities and towns such as Freetown, Bo and Kenema. We are yet to see the results.



The family are all well when we left them and we hope they continue to remain well. We thank everyone who prayed for us as we made our journeys across the globe to attend to urgent family business. Continue to pray that our time here – another few months- will be fruitful. We will endeavour to keep the blog updated regularly.