Wednesday, September 24, 2008

Reviving Dora

I had the most amazing experience this week.

On Friday, I donated blood at the children’s hospital, something I’ve been meaning to do for ages. There is a blood bank at children’s, shared with the neighboring maternity hospital, but blood is in chronic shortage – in part because people are reluctant to donate and in part due to difficulties with storage. As a result, patients needing blood are required to replace the blood they use before they’ll be given any from the bank.

What this means in practice is that a severely ill child will lie in a hospital bed – sometimes for hours – while family members run around trying to find someone willing to donate. (A similar scene unfolds in cases of trauma, or when a mother starts hemorrhaging after giving birth, and often to similarly tragic ends.) This process is complicated by local beliefs that only men should donate blood. In addition, families must buy the blood bags from a pharmacy across the street – the hospital itself is out of stock – which for many means trying to beg or borrow the money to do so.

Sometimes the family manages all this in time to save the child.

Sometimes they don’t.

So on Friday, I found myself lying on a worn leather examination table in a dark, cluttered room marked “Bleeding Room”, a needle in my arm drawing my A-positive blood for a little girl named Dora. (And yes, the needle was straight from a sealed package and the technician was wearing gloves.)

Dora’s mom waited outside the room. Dora, an adorable toddler, lay unconscious on Ward 2, watched over by her grandmother. She had malaria and was severely anemic, so much so her hands and feet neared mine in paleness.

My blood was out of my body just long enough for the team to test and label it. Just as the technician told me I could get up from the couch, a nurse hurried off to Ward 2 with a bag of my still-warm blood in her hands. I followed, and watched as they prepared the transfusion, then came back later with a doctor friend to check how Dora was doing. The doctor was worried that her heart might be overwhelmed by the volume of fluids given to her – not just blood but malaria meds and other fluids – but she seemed to be coping. We left her still unconscious and with her worried (but grateful) mother and grandmother at her side. I prayed she’d make it.

On Monday, I arrived at the hospital to find Dora not only alive, but sitting up and smiling at me from a windowsill. She was pink and alert and looked perfectly healthy. We took her photo (see above), though she refused to smile for the camera.

I was positively glowing all day, and kept stopping by to visit my personal little miracle. There were lots of jokes among the doctors about the super-duper powerful blood the little girl had been given – in other words, blood from a white foreigner – but they all knew as well as I that almost anyone could have given that life-saving blood.

The American Red Cross blood services no longer wants my blood, because I’ve been exposed to malaria and other sorts of nasty African pathogens.

No problem, I’ll happily save it up for little girls like Dora.

To learn more about the children’s hospital mentioned here and to find out how you can help, please visit the Welbodi Partnership, which supports paediatric health care in Sierra Leone by partnering with the Ministry of Health and Sanitation to establish the Sierra Leone Institute of Child Health.

Friday, September 12, 2008

Taxpaying as a virtue

Sierra Leone usually struggles to collect taxes, even from the minority of the population that can genuinely afford to pay.

Recently, however, at least some of the city's poorest residents are paying their local tax with pride, as documented in this BBC story.

The untold story in that piece is the enthusiastic collection practices by the local council, which has resulted in the shuttering of many small shops and kiosks for failure to pay back taxes. Many of those shopkeepers walk a very fine line between survival and starvation, and would probably express much less pleasure with the new tax collection regime.

Of highs and lows (again)

I’ve written before about the extremes of life in Freetown. One moment brings exultation, the next, devastation. Though exhausting, the experience can also be oddly intoxicating. My even-keeled life back home often pales in comparison to the roller-coaster ride of emotional and physical and aesthetic extremes here in Sierra Leone.

Sometimes, however, I yearn for an evener keel.

Last week was triumphant and thrilling, filled with hope and possibility. At the children’s hospital, we got the water running through all the wards for the first time in years, thanks to just $800 in plumbing equipment and the hard work and diligence of the hospital’s maintenance team. We found a source of medical-grade oxygen to use on the wards, a first in many years not only for our hospital but for all government health facilities. On Tuesday, I met with the Minister of Health and Sanitation, who was delighted with our successes and looking to replicate them elsewhere. By Friday, I roved the hospital with camera in hand, capturing the faces of our heroes – plumbers and maintenance technicians – and of the oxygen canister connected and ready to use. As we left the hospital on Friday afternoon, a junior doctor put one of his patients on oxygen, and we had visions of young lives being saved.

A few hours later, we settled in with cold glasses of wine at the Hard Rock guesthouse at Lakka Beach, watching the sky turn brilliant shades of orange and red. We awoke the next morning to find a beautiful sunny day, a rare gift in the midst of rainy season, and spent the afternoon soaking up vitamin E and positive energy from the surf and one another. By Sunday night, as I sat with friends along another beach, I was feeling refreshed, rejuvenated, and ready for anything.

And then, with a crash, came this week: the proverbial Other Shoe.

After spending Monday in the office, we returned to the hospital on Tuesday. We should have noticed the ominous buzz in the air, the palpably chaotic edge, but we did not. We were too pleased with ourselves for the accomplishments of the previous week.

We walked blithely past the packed wards, the hallways filled with waiting mothers and crying children. My colleague, a doctor, went off to check on the oxygen while I roved the corridors with a pile of posters to congratulate the maintenance team for their hard work and introduce our nurse training team. As I hung them, nurses gathered around, murmuring approvingly. “Di white pipul, den sabi mek!” said one. I laughed and then noticed one of the maintenance guys standing behind me. I pointed to his picture on the board. “What do you think?” He grinned.

Then, suddenly, his smile faded and he took my arm, shifting me away from the staircase. I turned and saw two men carrying a body wrapped in orange and yellow fabric. Numbly, I estimated the age: maybe 6 years old, definitely no older than 8.

A few minutes later, my colleague came down from the Special Care Ward, where we’d been delivering oxygen. She was a bit frantic, and we escaped to our office. Turns out she’d just seen a child die, the fourth to die in that ward since Friday, of the five who had been put on oxygen. The nurses were staging a revolt: they didn’t want the oxygen anymore, it just brought them destitute and dying children, and scared their other patients.

The oxygen canister was also empty, a nasty surprise, so we bundled it off to the factory down the street to be refilled. On the way back, sitting in standstill traffic just outside the hospital gate, a poda poda (minibus) behind us lurched suddenly forward, plowing through a crowd of market women and pedestrians and coming to a stop to the right of my car. My colleague, sitting in the passenger seat, recoiled in horror. “There are children under there,” she cried, jumping out of the car and into the melee. “Get the car inside and come back with gloves!”

And so I did, parking quickly and running back with the latex gloves I keep in my first aid kit. By the time I got to the street, a crowd had formed, curious and jostling. Two women sat on the curb, dazed but not seriously hurt. The children had been brought inside. Miraculously, they needed nothing more than a few stitches and some gentle words.

By this point, though, we were deeply shaken. We might have written off the day and headed home, but a delegation from the Ministry was due in an hour. Instead, we opted to hide in our office for a lunch break. I let my colleague and another doctor go ahead, while I returned to the outpatient ward to buy a cold packet of water.

A bad idea.

On my way, chaos found me yet again. Near the entrance to the hospital was a small crowd, with a woman in the middle in a dead faint. She was the mother of one of the injured children, and had been told her daughter had been “mashed” by a poda-poda. When she arrived and heard the truth – that her daughter needed stitches but would be okay – she literally collapsed in shock.

As this calmed down and I snuck past to buy my cold drink, a roar arose outside and I saw dozens – maybe hundreds – of people rushing the entrance of the hospital. Two cleaners in DayGlo orange vests stepped quickly outside and closed the door behind them. The crowd arrived, hungry for blood: if they couldn’t have the driver’s, who had fled immediately to turn himself into the police and get beyond the reach of vigilante justice, then at least they wanted to see the injured children. They milled around outside like the spectators at a rowdy football match. Inside all was quiet, but still with that ominous energy in the air, which I could no longer ignore. My little friend Ibrahim snuck up behind me and put his hand in mind. “Are you scared?” I asked. He shook his head. No. Mentally, I nodded mine. Yes.

Eventually things calmed down, and we even managed a half-normal tour of the hospital for the ministry representatives. By 5:10, my colleague and I were out the door and on our way home, desperate for the day to end.

The week since then has been much less traumatic but no less frustrating. Now, on Thursday night, I am dreading my return trip to the hospital tomorrow. I’m afraid the bad luck of this week is still not spent.

To learn more about the children’s hospital mentioned here, please visit the Welbodi Partnership, which supports paediatric health care in Sierra Leone by partnering with the Ministry of Health and Sanitation to establish the Sierra Leone Institute of Child Health.

Monday, September 08, 2008

Making a Living Part I: Selling Scrap Metal

I've been wanting to do a series on the ways people scrape out a living in Sierra Leone.

My friend ABJ beat me to it with this touching short film about boys making a living by searching for jewelry and scrap metal in the gutters and streets of Freetown.

It is a glimpse of what it takes to survive among the poorest of the poor in this poorest of poor countries – teenagers elbow-deep in filthy gutters just to earn a few pennies for rice and a roof over their heads – and of the energy and ingenuity that allows them to do just that. Survive.