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An Average Day at the Clinic

Monday

Today we continued our work at the clinic. A typical day goes like this: We arrive around 9:00 am, and there are already patients waiting to be seen. Peacemaker begins seeing patients after they are registered. They are given 2 cards. One is an identification card with a unique number that they use each time they come. The other is a patient record card where diagnosis and treatments are written after seeing one of the nurses. After they recieve their diagnosis and prescribed medicines, they visit the pharmacy (pictured below). Here, they hand the pharmacy technicians (Julie and Mariama) their patient record card. The pharm techs gather the prescribed medications and give directions on how the medication should be taken. Unlike western medicine, detailed information and directions are not given. Instead, they are handed a plastic packet of pills with tick marks on the left middle or right of the packet indicating how many to take at what time of day (morning, afternoon, and night). These days the pharmacy is well stocked because of the many groups of volunteers that have visited the clinic recently. Unfortunately, there is not really a steady supply chain to the clinic.

If as part of the treatment, the patient needs an injection, they come to the "surgery room," where the more invasive procedures are done (bandaging wounds, giving IV's, giving injections). This is where Chelsea has worked for the past few days. In Africa, injections are a very common and popular treatment for anything from malaria to a slight rash, so Chelsea has been busy! Contradictory to its name, the "surgery room" is not a sterile environment, as you might expect. Chelsea has been practicing and teaching basic sterile procedures to staff nurses in order to discourage secondary infections. Because of conditions here and frequent lack of supplies, the staff members often take shortcuts in order to conserve supplies- like administering IV's and injections without gloves. Chelsea is encouraging the use of gloves whenever possible.

"The Surgery Room"

Injectables: B-Complex, CHQ (Malaria Treatment), Novagarin, Gentamiacin, Penicillin, Procain Penicillin, and sterile water.

Wound Care

When little ones come into the clinic to be treated, we try to comfort them with the dolls and cars that we brought. To those who have worked on the dolls, look at the precious smile you have brought to little Brijiana's face!

Lansana and Fatu (twins) with their new toys.

Patients are seen until about 5:00, but usually everyone is still there until 6:00 making sure that patients are taken care of and that they get the medicines they need.

6+ Hours of Thanksgiving

Sunday

Instead of the regular church service, today there was a special celebration of thanksgiving for the CRC School in Kabala. It started with a march that went through the center of town. The children marched in two lines with the proud parents and supporters following. Everyone sang as they marched, and the whole town looked on with curiosity and amazement. The march ended at the community center where a service was held. It was estimated that about 500 people attended. After 6 hours of songs, melodramas, praise singing, statements from dignitaries, dancing, scripture reading, and a message, we happily applauded and went home tired.

Pastor John with Pastor Ezekiel's children: Marvelous, Victor, and Gift.

I'll Take 3 Lappas!

Saturday

Today, we went to the market in the middle of town. We walked there by following the noise. The market is a place where there is a lot of little shops in a row each selling their own items. That could be anything from second-hand clothes and shoes, to fabric, food items, motorcycle parts, and penicillin. We set out to look for some fabric. We went to several vendors, and soon learned the lingo. 3 lappas is 3 yards of fabric, and a reasonable price is around 35,000 Le ($9 US). Some vendors did not think that we knew what we should be paying because we are obvious foreigners, so they would ask for 150,000 Le ($30 - 35 US) for 3 lappas. As we were walking through, we found a stall that was selling various second-hand clothes and blankets. On the top of the stack of blankets was a familiar name! Colorado State University. How ironic to find a CSU stadium blanket for sale half way across the world!

 It got pretty hot walking around the market, but we were lucky to find a shop that sold ice cold coca cola and fanta! I never thought I would be so thankful to indulge in a cold drink!

Tababoos go to Kania

Friday

Today we traveled into the bush, and visited a village called Kania. We were going to experience the village life, but also in order to see the clinic there. The village is a lot more primitive and spread out than in Kabala, and their exposure to the outside world is extremely limited. As a result, when white people come to the village, it tends to attract a lot of attention. In Kania, they speak Koranko so we were called "Tababoo." At one point when we got out of the car the children that had gathered to see us, quickly ran away. They peeked around corners but would not come close. We got out our cameras and snapped a few photos to show them, and after that we were all best friends. They love to see their faces on the screen and often break out in joyous laughter as they look at others who have made funny faces. Even the older women of the village wanted us to "snap" them. It seems we made quick friends with Kania.

After a while, they welcomed us with lunch, and we tried our first hand at communal eating. The meal consisted of rice (of course) and palm oil and chicken soup (bones, gizard, feet, etc. in all). The soup is poured over all of the rice, and then is set on a small table that people sit around. In older times, we are told that they would have used their hands to eat, but we were lucky to have spoons.

After lunch, we visited the clinic. It was donated by a foreign country and consisted of 4 small rooms complete with 1 nurse and sparse supplies. There was no running water and no electricity (though there were wires running to the building). Patients were also sparse. Apparently in the villages and other rural places fancy clinics are often not even used becuase they are not sustained and the staff and medicine is not trusted. As a result they usually revert back to native medicine for help.

We returned to Kabala in the afternoon using the bumpy road that we came on. Apparently it has been much improved, but our teeth are still rattling from the ride! 

Sabi Dis?

Thursday

Today, since we could not work at the clinic, we decided to use the time to compile information about the need for first aid education in this area. To help support our theory that first aid education is lacking and contributes to more severe complications of wounds, we took a simple survey. We walked along the roads of Kabala randomly asking school aged children if they recognized a bandaid. ("Sabi dis?") We showed them a wrapped bandaid and an unwrapped bandaid to see their response. We recorded their age, sex and response. After gathering a statistical sample, we found that 76.6% of school-aged children surveyed on the streets of Kabala did not recognize what a bandaid was. The few that did recognize it called it a "plaster." This supports our concept that if they do not recognize what a bandaid is, they have never used one to protect a wound.

We have even realized in our work both in the clinic and outside of the clinic that people are enamored by the sight of a bandaid. When you clean and dress a wound, they stare in fascination of what you are doing. Even when we stopped on the the side of a road to fix a boys foot, a crowd gathered around to watch us clean it, but also pointed and touched the bandaid as if they had never seen anything like it.

In order to support our theory that these simple wounds can develope into complex problems like Jungle Ulcers because of lack of first aid knowledge and access to basic first aid supplies, we want to gather some statistics at the clinic. Starting on Monday we plan to review patient files to gather data on preventable infections. We also plan to conduct short interviews with people to see what would be their first response to a cut or burn. We are told that often native medicine is attempted first, but when it fails they go to a clinic. However, as we have seen, the infections can be major and disfiguring.

A Quiet Kabala

Wednesday

When we arrived at the clinic around 9:00 to start our day of work, things were strangely quiet. We had even noticed that our walk over seemed more quiet than usual. There were not as many "Kushe"'s. The only roadside discussion we had was with the "police." In Sierra Leone, it is tax season, which means that at random places on the road, they run a string across the road to stop any traffic. They require you to pay a "tax" if you want to pass, but if you have a special piece of paper that exempts you then you can go without paying. However, as we reached the roadblock, they demanded that we pay our "tax." They said, "no matter the color, black or white, you still have to pay." Our response was that we are not even residents of Kabala, therefore why should we pay their tax? They didn't care, and when we responded that we were humanitarian aid workers, they didn't care. It was only when we started mentioning the names of the people we were working with and staying with that they reluctantly let us pass. Later we found out that it was outrageous that they were asking us to pay, since our visa fees cover all those sorts of things. It was pretty obvious that they thought that since we were white, they could get a few easy extra dollars for the day.

Nevertheless, as we arrived at the clinic, things were still strange. None of the workers were around, but all of the patients were there waiting. So we began to get to work giving injections and seeing patients. But soon there after, Theresa, one of the staff members, came to tell everyone that the clinic was closing until Monday. Apparently, a robbery occured at the guest house where another group of volunteers was staying, and an investigation had to be done. They were so upset that someone in their town would do this to strangers who had come to help them and improve Kabala. Now we understood why our walk was so quiet that morning. The whole community seemed to be ashamed, and when we were walking home a woman shouted to us "So sorry! So Sorry!" We understood, but we wanted to make sure that they knew that we loved them anyway. We continued to greet them on our way home. 

Jungle Ulcers

Tuesday

Today, was more of the same! We arrived at the clinic, and though it was a bit less busy than yesterday, we were still receiving a steady stream of patients that needed medications and injections. Today, a small schoolboy (about 5 years old) who was walking home, was hit by a motorbike. He was brought to the clinic, and was seen by us to bandage his wounds. He was so frightened and obviously traumatized by the whole experience. We tried to comfort him and gave him a car to play with. We have noticed how dangerous some of the drivers of these motorbikes are because they do not even slow down when there is a person on the road. Another case we saw today, was a lady who came to the clinic because she had burned her hand. When she came to us so that we could bandage the wound, we noticed that she had a leaf on it (by the look of it, it had been on the wound for several days). We see this often at the clinic- they try native medicine, which usually consists of leaves and stuffing cotton in the wounds. By the time they come to the clinic, the wounds + leaves + cotton = “jungle ulcer” – a festering wound that looks somewhat like a pussy, swollen, volcano on the skin. (In 2008, I saw this exact injury on an old woman. The wound had been there for 5 years. It is obvious that “jungle ulcers” are a direct result of lack of first aid education. The fact that they are malnutritioned further inhibits their ability to heal). A man also came into the clinic who had a burn between his thumb and his pointer finger. He had stuffed the wound with cotton and then poured some sort of purple ointment all over it. According to Ezekiel, this purple ointment is called “Jibi” and it is a natural/native ointment that people commonly use for burns. By the look and the smell of the wound, the “Jibi” did not seem to have any effect on the staph infection raging in his hand. After a long day’s work, we came home to a meal of cassava leaf soup with goat over rice (yum!).

NEXT!!

Monday


We arrived at the clinic today at 9:00. We did not know quite what to expect, or what kinds of things they would have us do, but we were ready for anything. When we walked up the steps there were more than 70 people in the waiting area. We immediately went into the pharmacy where things seemed to be slow. We offered a helping hand in dispensing medications. The most common medications given were: Paracetamol (Ibuprofen), Flagyl (Anti-Parasitic for worms), ACT (Malaria Treatment), and Amoxicillin and Ciproflaxin (Antibiotics). Among the medications dispensed, almost every person was given an injection of some sort and a seven day regimen of vitamins including B-Complex, Folic Acid, Ferrous Sulphate, and a Multivitamin. After a while of dispensing medications, Chelsea helped Mariama (clinic nurse) to diagnose patients. Diagnosing in Africa consists of writing down the symptoms and writing malaria next to it. The nurses rarely touch the patients (often they don’t even check their heart, lungs, or abdomen), which is different than what we are used to. By far the most common diagnosis was malaria, and then next to that it was some type of infection. Mostly, the nurses prescribe a broad spectrum of medications and send them on their way. The patients then stop in the pharmacy where they receive the medicines and the instructions for taking them. They don’t write out the prescription directions because many are not literate; instead they make slash marks for how many times a day a medication should be taken. After helping Mariama for a while, Chelsea then began giving injections to people. Theresa showed her how once and from then on there was a steady stream of people coming in the door to receive an injection. Because the clinic had been closed for several days, twice as many patients as normal were seen. We stayed until 6:00 until everyone had received their medicine.

Exorcisms and Playdough

Sunday


We woke up early for church, and when we were ready to go, there was a crowd of people outside the house waiting for a ride to church from Reverend John. There is always room for one more here. Church began with Sunday school at 9:00 am. The passage was II Timothy 3:16 “All scripture is God breathed, and is useful for teaching, rebuking, correcting, and training in righteousness. When Church began at 10:00, the room quickly filled up. The adults were all seated in the right pews, the youths were seated on the left, and the children were in the middle. We started with some praise songs, some of them some old favorites like “Tel God Tanki.” The sermon was on II Corinthians 6:14-15 “Do not be yoked together with unbelievers, for what do righteousness and wickedness have in common, or what fellowship can light have with darkness? What harmony is there between Christ and Belial? What does a believer have in common with an unbeliever?” Reverend Ezekiel (from Nigeria) talked about how when we become Christians we are different, and others should see that we are different from the way we act. He said, for instance in Kabala, there are known to be “secret societies.” These are groups that are typically associated with native religions that bind you for life. Ezekiel was saying that if you are a member of a society, and you become a Christian, that you have to change your behaviors and associations.

After Church, we went to Choices for lunch (that day they actually had 3 choices- ground nut soup, boiled stew, and fried rice). The cold Coca Cola and Sprite we had were amazing! It was the first cold drink (col trink!) we had in a really long time. After we ate, a friend called John with concerns about her son who had been acting strangely. She feared he was being attacked by demons. He had been having strange dreams ever since he had joined a “society.” Possibly some drugs were involved, and he had shamed his family. At night, he had this urge- as if he were being called- to walk to far off villages. Because of this propensity, they attached his ankle to a log with a metal bar that looked like a giant staple. When John arrived and saw that he was calm, he called for the “staple” to be removed. The local carpenter came and removed it with a sledgehammer… (In the US we tend to explain behaviors with mental disease or rebelliousness, but here they explain them as direct control by demons). Pastor John proceeded to exorcise the demons and pray with him.

After all of the excitement for the day, we went home and rested. One of our favorite things to do at the house is to sit outside on the porch with the radio, and listen to the World Cup and BBC. If we are lucky, we sometimes snack on pineapple :) We also showed Victor, Marvelous, and Gift (Reverend Ezekiel’s children) how to make shapes and figures out of play dough. Overall, it was an eventful day, and we were lucky to have some rain in the evening that made sleeping a little bit easier.

There's Always Room For One More in Swit Salone

Saturday


The new clinic building for Nar Sarah opened. A grand opening ceremony was held complete with traditional African dancing and singing. There were contributions from many tribes including the Temne and the Mende, and even the Bush Devil made an appearance. Many prominent people attended including Paramount Chief Sengbeh, Paramount Chief Wara Wara, and several other dignitaries. As we sat down, I started to get the feeling that this would be another situation like “The Engagement Ceremony.” (Africa 2008 Team, you know what I’m talking about). It was hot, and just when you thought the seating was full, a few more would be added. Soon, we found ourselves sharing a chair. Of course, we didn’t mind that much at the time, but after about 3 hours of sitting on the corner of a chair, we were ready to stand for a while. About half way through the program, we heard the news that a pregnant woman who came to the clinic early that morning had given birth to a healthy baby girl. Is there any better way to open a clinic?! Everyone in the crowd donated money to the baby, and said she should be called NarSarah. Since all of our means of transportation were busy that afternoon, our only option was to take the 45 minute walk home. We weren’t exactly sure of the route, since John had taken us many different ways to the clinic, but we knew that a friendly person along the way would help us if we needed. It turned out that we found our way just fine, and we even made friends with the workers at the carpenters’ shop along the way.

Our first days in Africa

We arrived safely in Freetown with all of our luggage on Monday! Tel God Tanki! Zack A. who is living in Freetown this summer and working for an new NGO met us at the airport with Bilalie, our faithful driver. It was good to see Zack doing so well! I can only hope that we will be as comfortable in Freetown as he is some day!

After having breakfast with Dr. Joanna K., who is working on the education system in Freetown, and having a slight bout of nausea (that turned out to be the result of taking our malaria pills on an empty stomach) we traveled to Kabala. The ride there was bumpy (as expected) but safe! It took 2 hours just to get out of Freetown because the traffic has become increasingly difficult there. There is only one road going out of town and more cars and motorbikes every day. Plus, the UN secretary general was in town, so that did not help  the traffic much. On our way out of Freetown we stopped to get a cell phone from a vendor. Here, you purchase an open network cell phone, then buy a SIM card from one of three networks available. Then you purchase a "top up" which credits units to your phone via text message. It is quite an interesting system. I left the electronics shop with a cell phone, a SIM card, and no less than 3 marriage proposals. My friend Reverend John P. assured them that I was not Muslim and that I was well protected :)

On the way to Kabala we stopped in McKinny and met up with Bangali, a friend from last time. He is now attending secondary school there. When we finally made it to Kabala we were greeted by many children, friends, and neighbors. The familiar call of "White man" rang frequently, as well as a new greeting of "White woman!"

On Wednesday, we took a tour of the clinic and became familiar with our surroundings as we took a tour through the town. A visit to the market proved to be interesting once again. The sights and smell are much different than your average grocery store or even farmer's market in the US. The fish stand is particularly "intense."

On Thursday, we began work at the clinic. They are preparing for the grand opening of a new building on Saturday. They have recieved medicines in addition to our donated supplies. To our surprise, they already had an autoclave... I guess the communication about that particular need was confused. However, the supplies we did bring are much needed, and we were happy to see that by the end of the day, the shelves were well stocked up with medications and supplies. After organizing the supply room, we began to put together packets of common dosages of some medications. These packets provide a efficient and sanitary way to dispense medicines. As you might expect, they struggle to maintain sanitary conditions in this environment. While we were working on the medicines, a woman came with her 1 year old daughter and needed help. The little girl had a fever, vomiting, diarrhea, dehydration, and "coughing." After examining her a bit, we were able to give her some basic medicines to help symptoms, but we saw first hand how difficult it is to determine the underlying cause of the illness without certain diagnostic tests etc. We hope to see her on Monday to see if there is improvement.

So far, everything is going well, and we are blessed with good health and many new and old friends. On Monday, when the clinic opens, we will begin tracking some patient statistics and information regarding common health problems and treatments.

Mosomiyu (goodbye for now)

~ Chelsea and Julie

Blankets and Booties

My Grandma Opgenorth, Melvina R. and Jan K. worked hard to make over 20 pairs of booties for the babies at the clinic. Each pair was hand-knit. In addition, my grandma also made over 20 fleece baby blankets. Thank you so much for your hard work that you put into these wonderful gifts!

Goal Reached!

100 dolls have been made for the young girls of Sierra Leone! Thanks to Becky M., Nicole L., other friends of West Grace at VCU, and STAND members of VCU for their help in decorating.

Thanks to the Van Stelles!

Thanks to the Van Stelles for donating many matchbox cars for children in Kabala, Sierra Leone. The children there do not have many toys, so I am sure they will love them!

Sincerely,
Chelsea and Julie Olson

CRWM appoints Chelsea and Julie as CRWM Volunteers to Sierra Leone

Praise God!  Christian Reformed World Missions has appointed us as volunteers to Sierra Leone.  CRWM is a wonderful organization and we are pleased to be a part of the work they do all over the world.  In addition to providing logistical support for our trip details, they have also set up a mechanism by which people can provide financial support for our work.  We have personally funded our entire trip this year but pray that donations can be made so that more supplies and assistance can be provided as we work to help the community and the Nar-Sara Clinic in Kabala.  For example, we would love to raise $800 for an autoclave which is desperately needed at the clinic to insure proper sterilization of medical instruments.  In addition, we plan to bring basic medical supplies such as Hydrogen Peroxide, basic first aid materials, an otiscope, an automated blood pressure monitor, and more.  Please visit:  www.crwm.org/donate and use our funding code WMAF 803761 in the description.  Or you can mail a check to CRWM noting WMAF 803761 in the memo line.  Thank you and please pray for us as our preparations enter the final stages!  Our departure is only a week away!