Thursday, April 7, 2011

Weekly Journal: March 28th - 3rd April

Reflecting on the day I’ve found slowly the work schedule is falling into place. A routine beyond the ship meetings and mealtimes will be delightful.  A local doctor, true child of Mercy Ships (not quite born but definitely raised on the ship),  Sandra Lako popped over from the Aberdeen clinic to chatter about her background and how she came across my little treasured gem Namina. Her background is simply presented yet extraordinary in context. After being raised in the bubble ship life (everyone is wonderfully doting on the children and school life is creative and fun) she lived in The Netherlands to go to medical college before eventually coming back to Africa to set-up from scratch a new clinic in Aberdeen.
Believe me. This is no mean feat in Sierra Leone. Freetown was savaged during the war. There has been little development during the post war decades and now everything thrives on the fractured landscape and shattered economy. I can hear a grunt and groan from those readers pondering on the topic of the global economy crunch.  To enlighten you, just enough to pause for thought, there is a radically different concept and reality to a global credit crunch impacting an already flailing and fragmented developing country dragging itself through the post war years than a developed country feeling the pinch. The difference is desperation vs slight discontentment.
Back to the agenda for the day. I took, well actually, I snook, if indeed snook is the past tense of sneak, a little toy car to my boy Ibrahim. He is the quiet soul that everyone overlooks yet there will be an incredibly bright journey in his life. Great things are in store for him. He’s remarkably smart, perceptive and observant. A very serious little chap. That was until I pressed the toy car into his hand. He had the widest cheshire cat grin you could ever imagine. It took me aback as I really didn’t believe he was capable of anything more than a brief smile. Gold dust.
 Despite a rather optimistic day my little bow legged treasure Mariama was in a sorrow disposition. The effect of surgery on both legs is giving her great waves of pain. She was listless in between episodes of aching moans in her crying. I quietly gave her a little bamboo angel in her hand to distract and calm her. This worked in distracting her however only for her to shred the gold from the angel. So I stood and stroked her hair. I was helpless and she was angry that I couldn’t take her away from the pain.  I know in a few days, when the pain dulls, she will bounce back. Still it is tough to watch. Her life is tough enough. Does she really have to suffer this much to change it? Well her fighting spirit at least gives her the determination as well as the bruises on her Grandmother’s arms. Tomorrow my goal, amidst trying to juggle writing three articles, is to find her some shoes for school. I’ll see if Melinda is ready to take a stroll into the oven market streets.
Photographer Marco just left the ship to fly twenty hours to his next assignment. There are many people that are here one week and gone the next. In the blink of an eye the crew changes , seemingly. However, I’m already discovering that there will be some treasured sparks amongst the general crowd. Marco was strangely one of those. There were fleeting moments of intrigue that could lead on to a good old banter or curiously meaningful conversation but before you know it the plan had changed and the moments are gone. I know we will be friends though. It is just a knowing as with Ally, Diane, Jackie and Melinda. Those are friendships that are immensely fun, full of depth and effortless. Goodbye Marco for this week in the meantime I’ll be chattering with Ally via email and penning my farewell thoughts to Diane for her imminent departure on Sunday.
Following patient stories remains hectic although the new communication processes are beginning to bring some value.  We’re now receiving calls in the comms office from excited nurses advising patients are being prepared for discharge. We’re able to capture the end of the treatment story and the beginning of their new life.  These times are filled with confusion. Relief the surgeries and patient care treatments have relished success, an aching sadness as the friendship draws to a close and pure elation that their lives are enhanced with a successful future. For many, it’s a ticket out of the depths of poverty, especially for the children.
Mariama Feika is indeed one of these cases. She is my treasured girl. The bandages have been removed so only light dressings supporting the knees remain. Tomorrow, as the cockerel crows she will leave on a long journey to her home in the North (which is geographically to the East).
 I only discovered her imminent departure yesterday so on her last day I had a mission to fulfil. Her grandmother ‘Mama’ told me Mariama has no shoes for school. Her flimsy sandals are not supporting her feet which are needed to help keep her legs corrected after surgery.
 So, I finally found my local day volunteer friend Arthur and asked him to come shoe shopping at the local street markets. Arthur was thrilled. He could be a leader and protector as well as providing a valuable role in helping the little girl go back to school. So we had a pleasant stroll to the markets until I had to jump into a market trader’s stall on the floor clinging desperately onto his arm to break my fall. A mind-blowing enormous military lorry rumbled by intent on driving over anything in it’s path. There are no pavements so when the vehicles speed or are extra wide in the narrow streets you have to jump into any space nearby.  There is no punishment for hit and run. It’s a regular occurrence accepted as daily life.
Fortunately for me, the stall was a shoe stall. The reference to a ‘stall’ in this scenario is a blanket on the pavement. However, despite the random selection of second hand shoes I found the perfect pair of white Velcro pink flowered sandals.  I will never forget my little feisty girl’s reaction when I asked her to look in my bag; puzzled disbelief, followed by astonishment, and then the breath-taking smile. It is an explosive happiness. She knows these shoes symbolise a future that will leave the misery she has endured for so long. This is quite frankly heaven on earth.

My cabin mates are engaged in a rather curious discussion about African aromas. The Freetown aroma is a strong stench of heavy lead smog combined with old trash in a gas mark eight oven. Splendid as a trigger to faint although the intense oven heat tends to create a zombie consciousness so mindlessly repel any urges to wretch.  

After yet another addictive session of LOST with the usual animated jokes, storyline predictions and sweetie treats, it’s time to sleep.
Today, I was advised that many of my patients have returned to the North rather than staying a few days at the patient care unit in The Hope Centre.  It is hard to swallow knowing there were no farewells except for my Mariama. Fortunately I have most of the interviews near completion.
In the morning I popped into Outpatients clinic in the ship hospital. This is becoming a daily occurrence to confirm the dates my patients return for post op treatment. As it happened Namina was due for her first post op dressing changes. She had received three dressing changes in the Operating Room (OR) under anaesthetic so this was the first time without medication. 
Her little hand slid into mine and she hid her face in my trousers in a wave of shyness. Her mother, Wara, smiled but there was heavy apprehension in the air. I was about to discover the reason…
Dressing changes for noma wounds test a pain threshold more than most other wounds. Namina has endured two years of dressing changes since she was three years old. Each time is associated with traumatic memories. Additionally, on this occasion, she was in an alien environment with new nurses. Inevitably, fright took a firm grip of her.
She writhed, screamed, cried with great despair. The doctor needed her to be still to cleanse, assess and re-apply dressings to the wound.  So I took hold of her flailing arms, tucked her little elbows beside her body and gripped firmly.  Her mother held her head in place.  This protected her face from being damaged. As we followed the doctor’s instructions he remained composed and gently attended to the wound.
Namina was wild with fury. It was an explosive mix of fear of new surroundings, memories of previous dressing changes, being restrained (completely unforgiving for most five year olds) and pain. She rocked, writhed and screamed to continually fight to be released. So every now and again we would give her some time to calm down before continuing with the procedure. Altogether it took an hour and a half.
It was a challenging experience. Namina is my little friend so I had to resist the strong temptation to take her into my arms and calm her fears and instead do the practical tasks to help her face heal. It was an emotional test. If I had a top hat I would tip it with a bow to the work doctors and nurses perform in medical clinics. It is a test of endurance that many of us never have an insight to or opportunity to experience.
Upon Pierre’s request I wrote an email to a Minister requesting a meeting with the President of Guinea.  I enjoy writing my presidential letters.  Pierre (a fabulously French Frenchman) embraces the formal English phrases with an abundance of excitement and enthusiasm. We share a passion to achieve a masterpiece in the letters we write. Each time when we read through there is an appreciative nod followed by ‘Ahhh! Perfect!’
 Two patient stories submitted. I’m on a roll.
The only florist in town....(this photo will delight my Mum)...


The shanty town fishing village outside the dock gates...

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