Election Fever

Over the past few months, Sierra Leone had been building up to the national elections, which took place on 17^th November. These were only the 2^nd multiparty elections since the end of the war, and said to be the 1^st which Sierra Leone itself would be responsible for running. With accusations of corruption, vote rigging and tampering with ballots always close at hand, it was also important that there were international observers, including from EU, and an ongoing UN presence (possibly to be greatly reduced if elections go well). People are aware that there is a possibility of violence erupting, particularly as many here are still living in terrible conditions and there are thousands of unemployed, angry young men. However, there is also a strong desire for peace to be maintained, and there has been a campaign of messages to this effect – including the “No Violence” song that seems to have been played on a loop on some of the radio stations!

Campaigning in Sierra Leone is very different from what I have seen in the UK. For a start, there are low literacy levels here and many rural areas lack much communication from the cities. This means that the campaign is not so much about manifestos or debates. Instead, the politicians really get in their cars and tour buses and go around the country, giving speeches and holding rallies to whip up public support (and intimidate their opponents with a show of strength, it looks like). Voting is strongly associated with the colours and motifs of each party. The ruling APC – All People’s Congress- is red colour, with a rising sun.



The main opposition party, the SLPP – Sierra Leone People’s Party
 – is green, with a palm leaf logo.

 The underlying factor in deciding loyalties in politics here often comes down to ethnic and geographical background: Temnes and northern regions voting APC; Mendes and southern regions going SLPP. However, this becomes a lot more complicated in mixed areas like Freetown, and on the “swing states” in between north and south where the main wrangling has been going on. There certainly seems to have been a high degree of community involvement in the campaign, with many of our staff members coming to work in their party’s colours and wearing supporting wristbands. Fortunately, it has all remained friendly inside the workplace!

A campaign timetable was worked out for the 9 parties who had candidates for positions including local councillors and parliamentarians as well as president. It gave each of them “rally days” in each area. This resulted in huge marches through the streets of Freetown on the days that the SLPP and APC were rallying – best not to try to go anywhere at all!

Finally on 17^th November we got to voting day and there was a general curfew: no vehicles allowed to circulate except those with special permits and virtually everything shut down except voting stations. I did have to go out on hospital business, and noticed long lines of people patiently waiting to vote from very early in the morning. Apparently there was a turnout of 87%, which is impressive if it is true! Everyone had been told not to wear party colours and to be peaceful on the day, and that went well.

After the vote was in, the waiting for results started. There were several false alarms when we thought results were going to be broadcast on the radio (small results from each of the hundreds of polling stations were being read out but they were nigh on impossible to keep track of). Then we had the National Electoral Committee telling us that …….some ballot boxes were going to be recounted because of “irregularities”…….still waiting for results. Finally, on 23^rd November – 6 days after the vote – the incumbent candidate Ernest Bai Koroma of the APC was announced as the winner. Cue hundreds of people in red shirts taking to the streets, car horns, burning tyres and fireworks, but thankfully no violence. EBK got sworn in virtually straight away, so although the SLPP has not officially accepted the result yet, it is hard to see what they can do.

For the international community, there is relief that there has been no major violence and we just hope that the government will work for the people and make good use of the revenues that they have from mineral extraction and donor aid.  I personally cannot claim to have much understanding of the workings of Salone politics and just wish that they will go on trying to provide free healthcare for mothers and children and pay the salaries of the few healthcare staff they do have! (I am not paid by them myself but see too many doctors and nurses in the government hospitals whose salaries come late if they come at all and it is a big demotivator).

That is the end of this socio-political post; back to more of my random personal musings next time!

(And the next one will probably be my last as I am heading back to Edinburgh in December and saying goodbye to Salone).

See you all soon!

October Holidays

Sorry again for delay in writing my blog. October was a busy month: discharging patients from our fistula wards, deliveries in maternity and then a break for me as 2 good friends came out to visit (more on that later). Now in November we have been preparing, along with the rest of Salone, for the national general elections (more on that in another blog!).

Thanks to those of you who keep in touch on email and Facebook. It is good to hear about the outside world, as my little world becomes so all-consuming. Some of the small things here that are important to me seem too minor to write about, while some of the big things are just too major. Let me just say that the highs and lows are pretty extreme. Fortunately, I have a good team around me who keep me sane.

("Data" meeting at AWC)

Back to my friends and their visit. C and C (they know who they are) were also VSO volunteers in the past, and we met in Edinburgh through VSO groups and other common interests.

Being well-travelled, highly adaptable people, they were ideal candidates for making the “adventurous” (that is a euphemism) trip to Sierra Leone. Fortunately for all of us, late October/ early November turns out to be a good time to visit: weather not too hot and not too wet, some roads newly improved for the election, 1-year volunteers getting to know the good and the bad bits to seek out and avoid respectively!

I had a lovely birthday with small gathering of friends at the beach and the unplanned bonus of presents and cards arriving from home with my visitors. Thanks go especially to my mum for assisting in import of some extra supplies for the hospital and pharmacy!

A trip with my friends was a great opportunity for me to explore some of the thus-far untouched corners of the Sierra Leone map and have a bit of a break from work. (Many thanks to Nad for covering solo while I was away gallivanting).

I had heard that the roads up-country were “a bit bad” and this was a serious understatement – much of them being closer in their topography to a muddy riverbed than an actual byway for vehicles. Fortunately, we had a good vehicle with 4x4 and a good driver in our friend Suleiman, so we made it in 1 piece up to the north-west corner, near the Guinea border, and Outamba-Kilimi National Park. The Park is officially a protected area for wildlife, however unsurprisingly this is not a top priority for Sierra Leone at the moment and visiting there is a DIY experience. We were very happy to find reed huts by the river where we could sleep, and in the daytime a guide appeared to take us on a canoe ride down the river to see the hippo family and a walk up the nearby hill to see the elephant trails and jungle birds. Back at camp, the monkeys came and played in the trees overhead. Far from the noise and chaos of Freetown – there was not even any mobile phone coverage.

Late October is when the harvests start coming in for rice, chilli, and many other crops that are grown during the rain. People are busy in their fields and villages cutting and drying the crops. It is a time of plenty when many ceremonies (all involving rice) will be held, and everyone can eat well. After OK Park, we went to Rogbonko Village, which was the home village of author Aminatta Forna’s father and where she has now been involved in starting a small-scale community tourism project. We stayed in the village and watched their daily work and night-time dancing, bought some of the raffia woven products and played with the children.

For the final part of our adventure, we were back on the Western Area (peninsula where Freetown lies). We visited the beautiful beach and River Number 2 for a night in a beach bungalow and boat trip up the river. Then up into the hills for a visit to Tacugama Chimpanzee Sanctuary to see our close relatives being well looked after in the protected area there. Happily joined by Sierra Leone VSO friends Lynne and Sunil (they have both written better blogs than me, which I refer you to for more information on SL).

I was very happy that my visitors had an enjoyable and interesting stay, and for me it was a pleasure to share some of my favourite spots from the year and enjoy some new sights with them. They met many Sierra Leoneans, who were warm and hospitable, which also gave me great pleasure. Still a few bumps in the road to be ironed out, but maybe there is hope for SL tourism yet! 

September in Salone

Welcome to September!

Everything is going very well in Sierra Leone right now.

I have received back-up, in the form of the wonderful Nad who is now working alongside me in Maternity and also helping out with the Fistula work in AWC. As he says, very different from the NHS or private work in Mauritius, but he is enjoying the challenges. And any problems shared are a problem halved.

We still have some stormy days but I sense that the rainy season is reaching an end, hooray!
I thought that instead of writing at too much length about what has been happening day-to-day, I would give a little rundown on my impressions of Freetown so far.

This is what I call “Senses of Salone”:

The sights:

- People carrying huge baskets/logs/bicycles on their heads. As well as pencil cases or small plastic bags.

- Women with babies tied on their backs, sleeping or watching all around them; men stripped to the waist and working on their boats, on the road or just relaxing under a palm tree; children everywhere: playing, sleeping or working, generally without any adults controlling them!

- Brightly coloured Afrikana prints and fabulous dresses

- Beautiful empty beaches with rolling surf.

The sounds:

- The beeping of horns, from okadas trying to ride the wrong way up the street, to taxis speeding round blind corners, to 4x4s just showing they are the biggest.

- Hawkers selling their wares: “cold drinks, cold drinks, cold drinks”

- People shouting at each other. Having fights, or just making conversations at top volume.

- The music of P-Square, Emerson or any other groovy tunes.

- Dogs, the midnight barking and then the howling.

The smells:

- (Downtown) rotting rubbish in hot, humid conditions

- The pervading odour of soaked-in sweat from the grubby fibres of the taxis as you sit in the heat.

- (In AWC) bulgar getting prepared from the kitchen; soap suds from the laundry!

- The smell of bleach, blood and liquor from labour ward (applies round the world)

- Fresh, green smells of the earth after the rain.

The tastes:

- Gritty, spicy taste of cassava leaf stew

- Crunchy, fresh fried fish from the sea

- Juicy, sweet pineapple

- Cold and crisp South African cider

- A not-so-fresh semi-fungal flavour in most packaged cereals and biscuits in the shops here

The feel:

- The crunch of suspension-less cars sinking into pot-holes along the Aberdeen Road

- Soft, warm sand on the beach

- Beds that sag in the middle after 1 night sleeping in them (VSO)

- Cool and calm (and scary) in the OR 

- Hot, sweaty and sticky on the wards or just walking out on the street

Rainy season

Well, things are still busy and time is flying by. I’m now in my 8^th month in Sierra Leone, and things are going well despite the rain!

It has been great to have some new international volunteers: Steph and Emma are midwives from Australia and England, who are giving up their holidays to help us out; Iain is a new recruit from Scotland who is working on the logistics/procurement side while Tom is away on leave.

We have also had input from Amy, another Australian midwife who was around at the beginning of AWC Maternity and has been involved again to aid in planning and organising recruitment and training of some new staff. So, new blood and energy, and lots of new ideas, has helped us keep going and get some key projects underway. It’s also helping me to feel a bit more supported, inspired and motivated to keep going at a time when I risked feeling slightly jaded (and homesick, with so much news on the radio and online about all that is going on back in GB for the Olympic season!)

I had been told that August was the peak of the rainy season, and it does appear to be the case. I don’t think we have any days when it doesn’t rain at some point, and there seem to be days when it never stops! However, with the use of dry bags, waterproof shoes, good raincoat and sturdy umbrella, I am managing to survive the times when I am caught out in it – and I am very lucky not to have to brave the flooded chaos of the roads to travel to work every day. At the weekend, the road to the beach is quieter but still quite wet and wild.....

It is still warm, though not as hot as it has been, but there are lots of mosquitoes around. We have been seeing more pregnant women affected by malaria than ever, despite trying to give them all regular prophylaxis. Malaria in pregnancy has several risks, from anaemia and weight loss to coma (cerebral malaria) and miscarriage or preterm labour. Our midwives (and the mums) do very well looking after premature, tiny babies; we don’t have any incubators or other special equipment so have to rely on basics of keeping them warm with mum, giving expressed breast milk down nasogastric tubes and avoiding infection. The smallest baby at the moment was born at about 29 weeks and weighed just over 1kg at birth. She is doing very well, but will be with us for a while!

This weekend, we had a training day for the midwives including new recruits and existing staff. It’s hard to get good attendance for study days, but they were given the carrot of receiving a personal copy of the guidelines each (Amy’s idea) plus a certificate (my idea): this appeared to be a good incentive for them, so there was a record turnout! There was quite a lot of preparation involved to get everything set up, but we had good fun doing quizzes on drug and fluid calculations and then estimating blood loss with mixtures of tomato ketchup and grape juice.

Finally managing to upload photos!

As I said, I have been a bit homesick this month. Lots of the other British volunteers have taken leave to go home and join in OG fever, and the social scene in Freetown is pretty quiet as a result of the rain. However, there are plenty of people around at AWC and I am looking forward to more visitors joining us later this month.

Emails/chat with friends much appreciated as ever J

Until next time,

Carolyn 

From Aberdeen (Sierra Leone)

I apologise for the big gap in my blog, which has not quite followed my progress as intended.

The truth is, there have been some changes in what I am doing and where I am working since my last post.

I have also been home for a while, and had a lovely time being back, seeing family and friends and going to a special wedding.

Now I am back in Freetown, Sierra Leone and working again.

Unfortunately, for a multitude of reasons, my VSO placement at PCMH was not viable for me in the long-term. Those of you who know me will have had more of a chance to discuss reasons for this, but basically I wasn’t doing what I intended to do and was quite unhappy with some of the things I did have to do. I think ultimately PCMH was just too big and dysfunctional for one volunteer to be able to go in and be expected to fix it!

VSO were understanding of the issues and my feelings, and they will (and are) continue to place volunteers in various health placements in Sierra Leone.

For me, meanwhile, there was a period of doubt wondering if it was time for me to go home for good, but also feeling that I had not really carried out what I came to Sierra Leone to do. As it happens, at the same time as I was looking to work, the centre with my original contact was looking for a doctor. Aberdeen Women’s Centre is a charity hospital providing free care for women and children. It is based in the area of Freetown called Aberdeen. There is a surgical unit which assesses and treats obsetric fistula (women who develop a hole between bladder or bowel and the birth canal as a result of problems in labour). They also have a maternity unit which aims to look after women antenatally and during birth so that they don’t develop a fistula! And they have a children’s out-patient clinic seeing up to 90 children per day to diagnose and treat the range of diseases they are vulnerable to here.

I have come to work in the maternity unit, which delivers up to 120 women per month and also has antenatal clinic and in-patient ward. We have access to the operating theatre for emergency surgery whenever we need it. There is a nurse anaesthetist on call available as well.

I am the only full-time obstetric doctor for the maternity unit. I have accommodation provided here onsite along with a few other international staff who work in the fistula unit and children’s clinic. Most of the other staff are national, and we do have a few Sierra Leonean doctors who will cover occasional nights when I can be off.

AWC is a great place to work, and is really trying to provide a good standard of basic care to women who desperately need it. The midwives, who go out looking for pregnant women to book, target the slum areas and pregnant teenagers. The centre has managed to achieve very good outcomes for patients through the use of evidence-based guidelines and protocols adapted to the local setting. It is very interesting to work with all the conditions that you come across in this setting, but I am grateful now to have access to medical and surgical resources to tackle them with.

We are fortunate to be able to limit our numbers and raise our standards in a way PCMH could not do, and do not take outside referrals. We try to treat our patients with respect and it is touching how grateful they are to receive proper care – in this place you never feel taken for granted!

Sorry the blog is more facts than fun today, this is the update, hopefully things now are going to get a bit more settled and I will write again.

Meanwhile, just keep in touch and I will keep on delivering more babies.

  Picture with one of the midwives at AWC.

Our logo and one of our ladies.

Culture Club

Hello again,

Sorry it’s been a while. Busy, changing times. Hopeful of having a proper break soon when I can report more. In the meantime, the update from Salone is that rainy season is getting underway, with impressive thunderstorms and torrential rain every other night. Finally some relief from the relentless heat we had in April.

Babies continue to be born – more than ever. I have been told May was bound to be a top month for births because the rain was almost non-stop last August…..not much to do in waterlogged Freetown except reproduce it seems!

Anyway, I am slowly but surely perfecting my Krio and also getting to grips with local customs which can be very non-evident to outsiders but add a bit of understanding to life here. Eg not allowing people into the labour ward with the pregnant woman even if they are her family or friends – because they may be devils taking on the appearance of those companions, and then they will do juju (black magic) on the baby. Also relatives wanting to wash the baby immediately when it is born (contrary to neonatal advice to avoid cooling them) – but they think the birth matter will stick and give them a bad smell for life! Next they want to tie threads onto the hair over the baby’s fontanelle  (soft part of the head) – because they have realised it is an indicator of sickness (dehydration), it is a charm to stop them being ill…….

Finally, I learned this week what they call the small brown lentils we eat here. “Folic acid beans”. Is that because they are nutritious, I asked? No – because they look like the folic acid vitamins that get given out to pregnant women, apparently!

Well, I am probably just as strange, if not more so, to Sierra Leoneans with all my European habits. Imagine not crunching up your chicken bones to suck the marrow! Plenty “sharing” going on here.

I will be home soon for a visit so hope to catch up with as many of you as possible then.

Bye for now,

Carolyn

Easter holidays

Easter holidays

It was a great treat for Easter to have my dad come out to Sierra Leone to visit me and spend a bit of time doing semi-touristy stuff (as much as you can do here!). He claims that he was only coming to be a courier for the things I needed which I wasn’t able to get posted out here, but we know that’s only partly true……the fact is that he found out there are some species of bird which are only found in Sierra Leone, so couldn’t resist the challenge to come and see them for himself!

In the event, setting up and doing trips into the forests here was certainly very challenging, and conditions cannot be described as anything but rustic, however with good measures of patience and perseverance (and plenty help from my friends) we did get out and see Tacugama Chimpanzee Sanctuary, Guma Valley Dam walk, Tiwai Island and the Gola Forest – the last being a new national reserve that just became protected in December; it is on the Liberian border and many of the animals and birds were being lost as “bushmeat”. Several conservation groups, including EFA (Environmental Foundation for Africa) are trying to work with local communities to introduce more sustainable livelihood activities such as keeping domestic animals, growing coffee or cocoa and selling honey. We had joined forces with my friends Ruth and Paul, volunteers based in the east of the country, and with contacts in the Gola area. The accommodation in the forest where we stayed for 3 days was basically a hut without electricity or running water, but we managed to cook decent meals over a campfire and at night we watched fireflies and then a thunderstorm! Ah yes, forgot to mention our 6-hour extended journey to get round the river to the campsite after the 1 ferry sank on Friday the 13^th. But we made it.

It was very interesting to see a bit more of life outside Freetown, where the pace is definitely slower and people are living a much more simple life. Huts are built from mud bricks, most of what they eat comes from the ground on their compound, and days are governed by the sun and the rains. You can understand why they come to the big city for more education or work opportunities, but in some ways Freetown is so crowded and dangerous that life seems better in the countryside. Of course, water and sanitation are major issues contributing to many health problems, and I think access to maternity health services is pretty impossible from somewhere like the Gola forest, so all the work ongoing to help development is important and admirable.

This is a post about holidays; I will blog again soon to update re the work situation but thanks again to all friends and family for keeping in touch, and especially those who sent things out via Dad-post!

IF GOD GREE

Blog month 3 (March)

  

The poda poda are the little minibuses which provide transport for maximum passengers in minimum space on the roads of Freetown. In structure, they are quite comparable to sardine cans, and it is doubtful whether any of them have seen the inside of a garage since they were assembled, however they do have a bright and cheerful array of designs and logos on their front.

The words above are equivalent to “God willing” – gree is agree in Krio. Other good mottos I have seen include: “Pray for the Travellers”; “Allah is in Charge” (you would have hoped the driver had some control!); “Pity the Children” but also “Nor Moless Pikin” (do not molest children) and the more self-centred “God bless Mr K”.

I have not quite managed to get a picture of these good logos – they are normally whizzing past at high speed on the wrong side of the road – but do have some photos taken from a car of how busy and how laden the poda podas get.

Life is very busy in Freetown – big city pace – but I was happy to get out and visit the 2^nd city of Bo last week. There was a workshop for all the health volunteers in the country there, and it was lovely to meet up with everyone and enjoy a slower, more peaceful way of living (no 2hr commutes).

Work at PCMH in Freetown is still pretty tough and I haven’t managed to work out if they have or could have any system for getting the work done more efficiently. True, “African time” means that all appointments are pretty flexible for the timing, but my hospital takes that to the extreme. Clinics, theatre and scans do not proceed in any organised way but just seem to happen at random (I don’t know who is deciding – it’s not me!) There are no internal phones but I get called on my mobile to ask me to go here and there, quicker just to do it and see what comes next. But I promise this random arrangement is not coming with me back to the NHS…..it will be no good at all for all our colleagues with OCD (you thought that was me, didn’t you?). The teaching schedule I was trying to put in place is quite disrupted by all the time-keeping problems and I’m not getting through what I hoped to do but just remember: high standards, low expectations. There is a very fatalistic approach to everything – I think they feel that “Allah is in Charge” here too!

Blog week 4

Here I am still alive in Freetown after 4 weeks – and at the start of my stay that seemed a bit unlikely! I have to say that living and working here is among the most challenging things I have ever done. Life is just not easy for the majority of people living here. I have to say, of course, that I am fortunate compared to most, but the conditions of life mean that you seriously have to curtail your plans for getting anything done, whether on a professional or personal level.

The first weeks at PCMH hospital where I have my placement were quite difficult. The house officers, who make up half the medical staff and do most of the practical work, had not been paid for 3 months and they decided to go on strike as their complaints were being ignored. This was understandable, but unfortunately the midwives decided that if there were no house officers to review the patients, they would not do the initial triage and assessment although they were still in the clinics and emergency rooms on duty. So they just shut the doors and the waiting areas filled with patients, including those coming in by the one hospital ambulance. The consultants are not around much after the morning review as they go to see their private patients. So in the week I should have been getting my induction and orientation, I ended up down in clinics and triage with one other doctor, trying to see 30 patients (and they do live up to their name of patient here – no complaints like we would be getting at home!) Actually the problems are similar to those at home and many of them could be helped with basic things like IV fluids or antibiotics, or admitted to the labour ward. I have seen lots of interesting cases from a medical point of view, but it is an exhausting way to work. Fortunately the situation with pay seemed to get resolved after a week so the house officers have come back to work. I still need to get my job plan sorted out, and I’m hoping that there will be some way to fit in sessions for the house officers as well as medical students and midwives, but it will take a bit of time to work that out.

The other main issue for me is transport across the city to the hospital. It is in the east end, pretty much among the slums, and public transport doesn’t go across the big market that is in the middle of the city. Plus there is terrible congestion on the roads and in the public transport at peak times. It’s been taking me about 2 hours each way to go from my house to the hospital and is not very safe. VSO don’t automatically provide any transport but hopefully they will be able to do something to help out as I don’t think I can carry on in this way.

At least I have had my weekends off and that has given me a bit of time to buy some food in the market and do some cooking, also to find a swimming pool where I can cool off from the constant sweaty heat (and have a shower) and a few walks out of town to escape the craziness. Everyone is different, but I’m not a big city person and I think I will be spending some time out of Freetown when I can.

That’s all for now, there’s no electricity tonight so will try to post this while I still have power on my computer.

Carolyn

Week 2

Sierra Leone Blog No 1

Hello everyone and welcome to Freetown.

Addy-do? As they say for hello, or how do you do. People are very friendly and keen to talk – but for the first week I have been rushing around trying to do all my VSO stuff and admin, and hardly had time to take breath! We were brought in on Sunday night, after a 6-hour flight and 4-hour slog through airport immigration, baggage, customs and exit via the water taxi,  to finally arrive in Freetown city and be dropped at our accommodation. VSO does provide basic facilities, which I am glad to have, however on the first night there was no electricity or running water and it was a bit difficult to get my bearings! Things are improving slightly on the electricity front but still need to get water from a standpipe in jerrycans (and up the 2 flights of stairs!) I have 2 great flatmates who have been helping me out with food and explaining how to get internet access via a dongle, but am yet to make it to the AirTel office to buy one of those.

Work so far has been in the VSO office sorting out all our papers etc and getting general induction.  There are 10 new volunteers working in different projects around healthcare and secure livelihoods. I’m going to go to one of the small women’s health units to meet some midwives tomorrow, but my base hospital is further across town and I’m not going there til next week. I will try to keep you posted!

PS The above post was written on my first weekend but I couldn’t manage to get it uploaded. Now a few days further down the line and a few more experiences under my belt: met the Salonean Minister of Health (an impressive woman with a history of activist work); found a swimming pool nearby which has good showers(important for my general cleanliness!) and – not so good – had my phone nicked somewhere between the VSO office and home, don’t even know how it happened but here I am Week 2, phone 2…..can’t let this become a trend.

So…..messages and texts from home very important. Anyone who has time, drop me a line. Number is on my Facebook or just PM me.

I’ll see if I can upload this now and be in touch again soon.

Carolyn

Arrived in Freetown

I have safely arrived and have a post I'm trying to upload.....internet connection has been very difficult so thank you for your patience and I will hopefully get it uploaded soon.
Carolyn