It has been a month now since coming to Segbwema and we think this is a good point to sit and reflect on what we have experienced so far. It’s been a beautiful time, and we thought we would have been bored silly – but we don’t miss TV, nor watching movies. We go to bed on average at 9 p.m. and by then we are well and truly exhausted. The tasks at hand are numerous for all and with the arrival of our shipping (which arrived safely and intact – Thank God!!!) Joey is in the middle of trying to sort the books as quite a few of them are for nursing tutors, higher-level studies, and NHS biased. Some of these will most likely be used in the very near future, as there is a national plan to add to the syllabus nursing research, management and the use of the nursing process. So, with Little J more active than ever, the house hold duties to sort and the ad hoc meetings to attend, Joey is very occupied and often exhausted.
Michael continues to be on demand – as Business manager he needs to oversee the daily running of the hospital, conduct meetings, supervise building work ( current and future), in addition to going to the nearest town to facilitate hospital and personal business. As described in an earlier blog, it takes a good 2 hours one way to meander these roads – so a trip to the town (Kenema ) and back takes the better part of a whole day. It’s a very different stress indeed, but we are learning to deal with it as much as possible. Hopefully we would be able to upload pictures of our house, the hospital, roads and other interesting places soon. To give you an idea of the state of the road and the challenges they pose – Michael and the two doctors once left for a meeting at a town about 47 miles away. They were forced to turn back three-quarters of the way because a vehicle had got stuck in the middle of the road making it impossible for other vehicles to get pass from either direction. Great fun now!!!! But it wasn’t then – think of the man (or is it doctor) hours lost.
Little J continues to be the star of the show. Her best friends (2 ½ yr old F and 3 yr old S) are just so suited for each other. Their temperaments all fall in place, although Little J has become more assertive (or is it aggressive) and F and S have learnt to say ‘please’ and ‘thank you’ – with some reminders- but all in all it’s a good mix. It gets a bit much when the group is joined by 7 yr old P, 10 yr old F and two young teenagers who compete for toys (we shipped a tricycle), but they help with supervising the little ones. It can be a very noisy and overwhelming affair at times, but growing up with brothers and sister and cousins have given Joey enough practise.
We promised to give a picture of the nursing school. There are 117 students presently, and the composition is similar to any other nursing school (1st year/introductory: 2nd yr: 3rd yr). Its good to see a few males (about 24) in the group and the age range would put some of them in the mature student category. The majority of the students live on site in hostels (2 in a room – some of us can just imagine how uncomfortable that can be). Economically it is better for the students because it reduces drastically their cost of living re: no transportation and accommodation cost. Their cooking facilities are coal pots in a huge kitchen – and they have to fetch water on a daily basis -there are no mod cons here, so they are given a generous 2-hour lunch break, as many have to heat up/cook lunch on coal pots.
There are 2 classrooms and 1 practical room. The biggest (and better) classroom has no windows and doors and was used as an eye clinic before being destroyed in the war. It can comfortably seat 50 – 60 students and the ventilation is ideal (as there are no window panes or doors to block the breeze). The second classroom is a ventilation disaster (It is not ideal for teaching and for the fear of keeling over in the middle of the lecture, the management – oh Michael - is exploring ways of making it healthy for lectures) . It seats approx. 30 students, but to do this the blackboard needs to cover the only window in the class – making it dark and hot. The library is a very very small room ( relative to the student population), with only few very old books. This is about to change soon – thanks to all of you who worked hard to secure some books which we presented to the President of the Methodist Church of Sierra Leone on behalf of the School. (Pictures to follow soon).
The practical room has one mannequin/model – a male head on a female body and one attached arm. The only midwifery teaching aid available is a model of a pelvis (though Joey hasn’t seen it yet). Although we have all these limitations, I must say the staff is incredible and passionate. There are only 2 nursing tutors (the principal tutor is blind and has been at the school for over 30 years. He still writes on the board in his lectures and teaches strictly from memory. For diagrams, he gives his very old and tattered notes to the students to reproduce in their spare time. The other tutor does some lectures, all of the practical sessions and supervises students on the wards. They are gems and true saints!! However, this cannot go on indefinitely as the principal wants to retire (for good reasons) and the practical tutor also needs to have some time off. This is where they hope Joey can help…………..in addition to everything else mentioned in earlier posts.
There are many, many limitations, but we are happy to report the willingness of a NGO to help asap, esp. with white boards for the smaller classroom ( thus relocating the black board covering the window), to put windows and doors on the bigger classroom making it a proper classroom and possibly a library from an adjacent room. We have already received estimates for the classroom. They also will possibly donate some models and teaching aids. So, we are hopefully going to make a difference, before next year. Watch this space………. God is faithful and already we are beginning to see the ‘rain’ of blessings on the way.
Prayer warriors, thank you so very much for your constant and faithful prayers. There are signs - ‘a cloud the size of a man’s fist’- before the abundance of rain. We continue to trust God, as He is faithful. So far we are overjoyed to report we are healthy- no sickness of consequence - ;well fed (Little J has joined her father in the love for grass cutter – a bush meat. Joey is yet to be converted); not too hot (some mornings are very cool and foggy) and generally making many friends and professional acquaintances. Pray though, for God to bring peace to the hearts and minds of the people on the hospital team as we try to introduce changes (systemic, professional and personal) which the team have all agreed will be proactive. Some people have been working so long in a vacuum they have forgotten how important and progressive it can be when we pull together as a team. Pray also for the supply of drugs and other medical equipments to come through for us. We are desperately in need of drugs but our location makes it extremely difficult to travel regularly to either the capital or the district headquarters to pursue our supplies. We thank God though as w have recently taken delivery of a small stock of mediation that should see us through to the end of the year.
We miss you all, but we really think you guys need to come to visit. It would be worth it to see how beautiful and peaceful the surroundings and people are. Think about it…..we have an extra room…..
With all our love and with every blessing.
M,J and Little J
Sunday, 18 November 2007
Thursday, 8 November 2007
Settling In - The Task really starts now
Its been 2 weeks since we have been in Segbwema, and we are loving it more and more each day. We had the opportunity to go to Freetown for a few days for a meeting and were longing to go back ‘up country’. We have become comfortable with the night noises and the peace and quiet that comes with a deep rural setting, and were uneasy with the city noises of Freetown. We are well and truly converted.
So, Michael is on full speed ahead at his post as Hospital manager. There’s lots to do here, with challenges similar to regular hospitals, in addition to many other problems. We seem to have a good team to work with, though, they just need to be organised and motivated to develop and fulfill a specified goal. Knowing Michael, the greater the challenge the more exciting the job, so he’s very happy.
Joelle continues to have such a great time. The kids are numerous and we are expecting a few more in December. Our house is always full of children ready to play at all hours (after school ). We have to limit them – once it gets dark everybody needs to find their yard………..
We are still trying to work out child care – the lady we found will need help with house work ( the fetching of water is a day’s work on its own) as well as running after Little J – so Joey needs to be home until this is sorted. Even then she has started her orientation of the hospital and the nursing school. We were pleasantly surprised to find 117 students enrolled – mostly all of them living on compound in addition to some of the hospital staff and their family. So, we feel we are living in what seems like a mini- village. The land space is huge – more than 50 acres - maybe covering more than a mile or two – or more!!!! We haven’t toured it all yet. The problem is that it’s so remote that selling the land would not fetch much, so we have to think of other means – maybe farming to market or to subsidize our needs. I tell you, we are far from being lonely.
The statistics for the country makes grim reading and the midwifery course Joey is asked to coordinate will have to reflect this in its preparation of the students. Death is nearly a daily occurrence here – and one needs to get used to this fact. Delivering macerated babies or watching a mum die from obstructed labour or ruptured uterus is an experience one dreads– so it’s going to take real guts to face a case.
We understand the need to highlight the current situation ( as much as we are aware) of the country, as this will give a somewhat updated picture of the hospitals’ situation.
A networking proposal by Cordaid has described SL as:
‘….from a period of more than 10 years of civil service ..…SL is now one of the poorest in the world with over 50% of the people living in absolute poverty. Large part of the health service infrastructure was destroyed and more than 60% of the health workers stopped working. The health indicators is the worst in the world with maternal mortality 2000 per 100,000 live birth, infant mortality of 170 per 1000 per live birth and an under five mortality of 286/1000 live birth.’
As indicated in an earlier post, the maternal mortality rate feels similar in this hospital. This is not due – as far as we are told - to health professional mismanagement, but to sheer cultural practice of many women finding it easier and faster(roads to the hospital are atrocious) to go to the village Traditional birth attendant (TBA) who have very limited knowledge and resources to deal with complicated and difficult deliveries. The women are usually ‘rushed’ to the hospital at the point of death ( days in labour leading to ruptured uterus’/ post delivery bleeding). So far we have not personally experienced any of this (and pray we will not have to at all) but Joey personally witnessed a case of eclampsia – the woman was having an eclamptic fit. After helping to settle her with medication ( there is no magnesium sulphate in the hospital - she was prescribed and given diazepam), Joey was informed that this was her first baby, she had no antenatal care ( she didn’t visit the hospital for this ) and her only symptom was very bad frontal headache for a couple of days (her blood pressure was in normal range and there was no sign of odema). She was seen in the community by a MCH who referred her immediately to the hospital. She started fitting before delivery, delivered normally and then fitted again. Happily, she recovered ( however slowly) and when we visited the ward she was reported to be able to care for herself and her baby after a few days of being in an unconscious state.
The health professionals are doing their best – there is only 1 midwifery sister( she works every morning shift – except Sunday – and is on continuous call in any emergency) and student nurses who have done basic obstetrics on the maternity ward. We now have 2 doctors and they are also on call 24/7. We cannot imagine working in this kind of condition and pray the hospital management will look into employing another midwife – fast!!!!!!!!! Sister has already implied Joey takes a few morning shifts on Sat. to allow her to have a weekend off, but that is still to be decided. .
The infrastructure is dire indeed – there are hardly any drugs, one blood pressure machine and stethoscope available for the whole hospital (4 wards – male, female, children’s and maternity- and clinics), mattresses are filthy and flimsy, no running water or electricity (the generator is used on surgery days and alternate nights) and one very small operating theatre for every case.
We have started highlighting the need in emails to friends and have appealed for small groups of people to help. There is so much need here that we believe that it would take more than the public sector/ government to help with alleviating some of the problems .
Even with all this limited resources, the hospital’s catchment area covers 100 or more villages and even see people as far away as Freetown. We believe people visit hospitals mainly because of its reputation/cadre of doctors/level of care, and this somewhat explains them trekking more than 100 miles on very very bad roads to be seen here. It says much about this hospital, but we are not surprised as it was rated the second largest in Sierra Leone before the war. At its peak the hospital had 4 Medical doctors and provided both general medicine and specialized services such as eye clinic, Lassa fever research, ( linked with an institution in Atlanta, Georgia, USA) and had specialist TB and leprosy wards. The reputation of the hospital was such that it drew patients from all parts of the country and from neighbouring countries such as Guinea, Liberia and Ivory Coast. Therefore, it has the potential to regain its reputed form. This is not necessarily our goal, but it is close to what can happen in the next few years. We feel this is enough ( distressing) information for now, so we’ll leave the story of the nursing school for future posts.
Thank you for your prayers, we have felt and seen their effects as God continues to watch over us and prepares the hearts and minds of the people here for change. We are comfortable and happy and are convinced that this is the right move for everyone. Continue to pray, esp. for continued good health and strength. With all our blessing and love.
M, J, and Little J
So, Michael is on full speed ahead at his post as Hospital manager. There’s lots to do here, with challenges similar to regular hospitals, in addition to many other problems. We seem to have a good team to work with, though, they just need to be organised and motivated to develop and fulfill a specified goal. Knowing Michael, the greater the challenge the more exciting the job, so he’s very happy.
Joelle continues to have such a great time. The kids are numerous and we are expecting a few more in December. Our house is always full of children ready to play at all hours (after school ). We have to limit them – once it gets dark everybody needs to find their yard………..
We are still trying to work out child care – the lady we found will need help with house work ( the fetching of water is a day’s work on its own) as well as running after Little J – so Joey needs to be home until this is sorted. Even then she has started her orientation of the hospital and the nursing school. We were pleasantly surprised to find 117 students enrolled – mostly all of them living on compound in addition to some of the hospital staff and their family. So, we feel we are living in what seems like a mini- village. The land space is huge – more than 50 acres - maybe covering more than a mile or two – or more!!!! We haven’t toured it all yet. The problem is that it’s so remote that selling the land would not fetch much, so we have to think of other means – maybe farming to market or to subsidize our needs. I tell you, we are far from being lonely.
The statistics for the country makes grim reading and the midwifery course Joey is asked to coordinate will have to reflect this in its preparation of the students. Death is nearly a daily occurrence here – and one needs to get used to this fact. Delivering macerated babies or watching a mum die from obstructed labour or ruptured uterus is an experience one dreads– so it’s going to take real guts to face a case.
We understand the need to highlight the current situation ( as much as we are aware) of the country, as this will give a somewhat updated picture of the hospitals’ situation.
A networking proposal by Cordaid has described SL as:
‘….from a period of more than 10 years of civil service ..…SL is now one of the poorest in the world with over 50% of the people living in absolute poverty. Large part of the health service infrastructure was destroyed and more than 60% of the health workers stopped working. The health indicators is the worst in the world with maternal mortality 2000 per 100,000 live birth, infant mortality of 170 per 1000 per live birth and an under five mortality of 286/1000 live birth.’
As indicated in an earlier post, the maternal mortality rate feels similar in this hospital. This is not due – as far as we are told - to health professional mismanagement, but to sheer cultural practice of many women finding it easier and faster(roads to the hospital are atrocious) to go to the village Traditional birth attendant (TBA) who have very limited knowledge and resources to deal with complicated and difficult deliveries. The women are usually ‘rushed’ to the hospital at the point of death ( days in labour leading to ruptured uterus’/ post delivery bleeding). So far we have not personally experienced any of this (and pray we will not have to at all) but Joey personally witnessed a case of eclampsia – the woman was having an eclamptic fit. After helping to settle her with medication ( there is no magnesium sulphate in the hospital - she was prescribed and given diazepam), Joey was informed that this was her first baby, she had no antenatal care ( she didn’t visit the hospital for this ) and her only symptom was very bad frontal headache for a couple of days (her blood pressure was in normal range and there was no sign of odema). She was seen in the community by a MCH who referred her immediately to the hospital. She started fitting before delivery, delivered normally and then fitted again. Happily, she recovered ( however slowly) and when we visited the ward she was reported to be able to care for herself and her baby after a few days of being in an unconscious state.
The health professionals are doing their best – there is only 1 midwifery sister( she works every morning shift – except Sunday – and is on continuous call in any emergency) and student nurses who have done basic obstetrics on the maternity ward. We now have 2 doctors and they are also on call 24/7. We cannot imagine working in this kind of condition and pray the hospital management will look into employing another midwife – fast!!!!!!!!! Sister has already implied Joey takes a few morning shifts on Sat. to allow her to have a weekend off, but that is still to be decided. .
The infrastructure is dire indeed – there are hardly any drugs, one blood pressure machine and stethoscope available for the whole hospital (4 wards – male, female, children’s and maternity- and clinics), mattresses are filthy and flimsy, no running water or electricity (the generator is used on surgery days and alternate nights) and one very small operating theatre for every case.
We have started highlighting the need in emails to friends and have appealed for small groups of people to help. There is so much need here that we believe that it would take more than the public sector/ government to help with alleviating some of the problems .
Even with all this limited resources, the hospital’s catchment area covers 100 or more villages and even see people as far away as Freetown. We believe people visit hospitals mainly because of its reputation/cadre of doctors/level of care, and this somewhat explains them trekking more than 100 miles on very very bad roads to be seen here. It says much about this hospital, but we are not surprised as it was rated the second largest in Sierra Leone before the war. At its peak the hospital had 4 Medical doctors and provided both general medicine and specialized services such as eye clinic, Lassa fever research, ( linked with an institution in Atlanta, Georgia, USA) and had specialist TB and leprosy wards. The reputation of the hospital was such that it drew patients from all parts of the country and from neighbouring countries such as Guinea, Liberia and Ivory Coast. Therefore, it has the potential to regain its reputed form. This is not necessarily our goal, but it is close to what can happen in the next few years. We feel this is enough ( distressing) information for now, so we’ll leave the story of the nursing school for future posts.
Thank you for your prayers, we have felt and seen their effects as God continues to watch over us and prepares the hearts and minds of the people here for change. We are comfortable and happy and are convinced that this is the right move for everyone. Continue to pray, esp. for continued good health and strength. With all our blessing and love.
M, J, and Little J
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