DEPARTING BO. . .

There are packs of dogs howling outside in the predawn as I write. Combined with the early calls to prayer, it is quite dramatic.

Bags are packed and the lists are all crossed off. Selena, Jenny and I head off tonight for London. Julia will accompany us to Freetown and we will bid her adieu there (it's nice for me to know that I'll see her in Ojai at Thacher graduation time). It will be good to have a walk on the beach and get some ocean air into our lungs before going to the airport for the long hangout time.

Yesterday was a full and productive day of tying up loose ends. Top of the list was hiring Margaret as the nursing supervisor. We are excited and confident of her abilities to help move the program forward.

Knowing that there would be a river of tears from many of us if we had the usual farewell scene at the hospital comprised of patients, staff and well wishers this morning, we did the goodbyes as we went through the day yesterday. Much better. . .

It was a cosy last evening here at the house. I made a wicked good batch of brownies and we shared photos and perspectives on the highlights of the time here; happiest, saddest, funniest, most frustrating, most bizarre, most rewarding, most challenging etc....we will all have many stories to share.

Jenebah and smilin' baby Dr. Maggi

Two more sleeps…

It’s been another huge day with a wide spectrum of events and emotions. This morning we delivered one of the patients, J.A., who has been with us for 6 weeks, home to spend her last days. She had undergone fistula repair surgery in 2005 at another hospital and had been delivered to our ward by her family for assessment of her urinary issues thinking that she needed another repair. It became clear quite soon, that her issues were more medical rather than surgical. Her case was quite complex and seemed to be a bladder cancer resulting from the parasitic disease schistosomiasis.

Over the past few days she was weaker and expressed a desire to return home to her family and village, which is about two hours from Bo on very rough roads. Jenny and I made the preparations for her discharge, getting her all set and her take home pain medications in order. Joseph managed the dealings with her family and Ernest drove us very gingerly over the rutted roads to not exacerbate her pain.

J's home

Hospice care

Upon arrival at the village, we were greeted by a crowd of her family and friends who were shocked to see J. so ill, but Joseph was able to explain to them the situation and that J. had requested to come home. Getting her out of the vehicle, settled in and comfortable on the dirt floor of her house with a tarp, very thin pad and blanket was very poignant with a large gathering of onlookers. Hospice nursing in a remote village in Sierra Leone is still the same as anywhere else in the world; providing pain management, general comfort to the patient and emotional support for all. Jenny reinforced the administration of injections with a local health care worker and we made her as comfortable as we could by giving her sips of water from the bottle cap and keeping the flies away too. After we said our goodbyes and drove off we knew that we had done the right and best thing for the patient.

The afternoon’s activity was a more happy occasion, when Julia and I attended the elaborate engagement ceremony of Mr. Idriss, our landlord, and Fatmata, our head cook for the program here. It was quite the contrast of family gatherings from the village scene of the morning, but so interesting to observe the rituals of this Muslim ceremony. There were many introductions and speeches, as well as several “decoy” brides who were presented at the altar under veils. Fatmata was the fourth bride and when Mr. Idriss unveiled her, there were boisterous cheers and loud applause.

Engagement unveiling

Now I am in the midst of departure preparations and list making in preparation for my departure. Only two more sleeps here and tonight my mind will swirl with all the images of the day.

Easter Festivities. . .

We had a very successful Easter outing with all the patients today and lots of the staff at a local orphanage. The laden mango trees provided good shade and hiding places for the lollies. There was drumming and dancing which progressed to quite a fevered pitch with dust flying as the patients took turns demonstrating their tribal dances. We flew a kite, sang songs and ate brownies made by Helen, Jenny's chocolate cake, fresh pineapple and popcorn. A good time was had by all.

WAFF volunteers with Home of Mercy children Easter outing

One Person's Trash. . .

Our evening walk is quite a ritual. We go after 6, when it cools down to the 90s and there is a slight breeze. For the past several weeks the fields are being burnt for the next growing season, leaving the land like looking like a moonscape. The air quality is bad with all the smoke and the sun is a brilliant red in the haze as it begins to set. There is plenty to see and appreciate, despite the rather bleak clear cut and smoldering landscape.

The usual route is down a dirt road past a few houses where the children cluster at wells to get water and yell “pumoi, pumoi” (“white person, white person”) as we pass by. A few weeks ago some of them were absolutely terrified to see us and now they come to us wanting hugs and caresses. Their grubby hands grab ours and we walk together for awhile and then we continue onwards. We see several women (wives) at one mud hut sitting by the fire with chickens and chicks running around interspersed with a gaggle of children. The man/husband is to be seen sitting off to the side, relaxing and talking on a cell phone. Several young boys go by carrying huge loads of firewood on their heads, some of them carrying roosters too. When they put down their loads to chat, the evidence of their hard labour is etched in their permanently furrowed brows from the weight of their loads.

A few egrets poke around in some rice paddies. Tiny red spiders abound and scurry about in the rusty dirt at our feet. Tonight Julia and Jenny spotted a yellow horn bill and we saw hawks...a relief to see some "nature".

For the past two evenings I’ve felt like Santa Claus as I set out from home carrying an enormous sack full of old tins, bottles, jars, Clorox bottles, cooking oil bottles, etc. which we had accumulated over the past few weeks in our house. One person's trash, is another's treasure was certainly demonstrated as I emptied it in about 5 seconds with a crowd of appreciative adults and children scrambling for the goods.

Recycling at it's best!

Time Like Sand. . .

The sand is really running out of the hourglass now. This time next week I will be exploring Paris and soaking in the reality of being away from Sierra Leone. During this past year I have spent a total of six months here over three different journeys. Despite feeling familiar and “at home” in Bo, Sierra Leone’s “Sweet Salone” slogan will never compete with Maine’s “Vacationland” or Far North Queensland’s “Tropical Wonderland” . It was recently re-ranked from 176 (above Niger) to 177 out of 177 for the UN’s Human Development Index which measures mortality rates and life expectancies etc. It is hard to fathom what people here really have to endure.

Jenny and I went to Taiama for four days this week to work with the V.I.M. team based in Tennessee doing pediatric clinics. We helped them set up a good system for pharmacy dispensing and saw about 450 patients with two other providers. Most of the chief complaints were, “fever, loss of appetite and headache”… Every child received worming medications and vitamins as a baseline treatment. We saw plenty with malnutrition, malaria and skin infections. One baby with a plethora of abscesses around her eyes was especially memorable. She returned the next day for assessment and it was a relief to see the improvement after 24 hours of antibiotic therapy. There were a handful of robust and healthy babies which were a treat to see.

It was good to get “home” to Bo and reunite with Selena and Julia, the staff and the patients. The twins born to our patient Hawa are continuing to do well and are now 10 days old. Hawa wants Selena and Julia to each take one home.

We are on the verge of hiring a new nursing supervisor after completing a series of interviews. Once this happens I will feel that my ‘to do” list for this time here is almost complete.

Easter Sunday afternoon we are planning an excursion for the women to an orphanage run by the sister of one of our drivers. Jenny will bake a chocolate cake in the solar oven and I will make a few batches of brownies for the occasion. We have bags of lollies to hide around and about the orphanage and under the laden mango trees where we will congregate. It should be fun and festive… a good finale for this stint here.

Today was one of those “never a dull moment” days. Upon arrival at the hospital we were greeted with the news that there had been a terrible road accident last evening with 8 fatalities. It was chaotic at the morgue which is next door to our ward with hundreds of wailing mourners. Later in the day there were two other accidents. Bo was in shutdown mode, too, because the Paramount Chief had died, but that is a whole other story….

The generator is off and I will sign off. It will be just a few hours before the rooster with laryngitis begins his pathetic crowing.

Helen with hospital cleaner Elizabeth, a sweet and faithful friend


Helen with new table and bench for new ward extension


Julia & Helen with Hawa and children


Stinky fish in the market

Aminata & Jenny with boy girl twins


Helen listening to young child


Child with periorbital abscesses


Helen with Taiama interpreters Jonathan & Marian


Volunteers Lynne Bosche and Sheila Newton
heading back to California. John, logistician
on left, Joseph, new administrator on right


Helen about as close as she'll get to
a Sierra Leone diamond

'No Place Like Home' van

Winding down. . .

Yikes, only two more weeks before I am departing Bo and beginning my travels home. The time feels like it is winding down fast, especially since there’s a lot happening. As with any big project the accomplishments and progress get blurry in the midst of it all, but given a bit of a chance to step back, it’s good to see that, in fact, we have been making some forward movement interspersed with a few setbacks.

At times I feel as though I am like a movie director as I try to maintain an overview of the WHOLE program and try to ensure that everything runs smoothly. Given the cast of characters involved and the setting of Bo, Sierra Leone, this has not been without many challenges! Sometimes it feels as though my direct accomplishments have been minimal as I seem to spend a lot of time coordinating comings/goings and activities for those who do get things accomplished.

Coleman Griffith departed last week after his almost three month stay. His final project was working on the refit of the ward extension…ripping out old wire screens and reinstalling new ones on all the windows, as well as doing the lion’s share of the painting. John Bosche got into the act too after completing his waste management report and installed all new louvers for the windows and fitted some of the old glass which was a very tedious process since the window frames were warped and each window was different. This saved WAFF a considerable amount in labour costs.

New ward extension

Thanks to the Coleman and John’s diligence and determination, we were able to move the skills training and school portion of the program into this new ward. The back portion of the ward will be the new residence for some of the longer term patients and some of the staff/patients. Despite it only being a stone’s throw from the main ward, it’s great for everyone to have a change of scene during the day and to open up more space in the ward. Meals are eaten there and it is becoming a good social hub of activity in the afternoon once the morning classes have been completed. Sheila Newton, a friend of the Bosches and a Pediatric Nurse Practitioner, arrived last week with heaps of beads, needles, wire and string and the women have been busy creating lovely jewelry.

Piling into the van for home

Farewell to departing women

We have had a major exodus of patients since the discharge ceremony on the 20th. It’s always such a mixed bag of emotions for everyone. The patients are excited and nervous to be reunited with their families and communities and sad to be leaving the “womb of WAFF”. Monday they loaded up into the van with their bundles of clothes and new found treasures (some bring home empty plastic soda bottles as presents) and there were hoots, tearful wails and waves as they headed off. Sending patients off “into the world” always feels like watching rehabilitated birds take flight to me.

Hanging out on the ward

Now that the census is down for the moment (numbers will begin to climb again after Easter outreach trips go out), it’s quite serene to just have real hang out time with the patients on the ward. They love the one-on-one time with all of us. I just wish that I could communicate with all of them in their own languages and hear all their stories in depth, as we know they all have experienced so much in terms of their fistula experience, but also from having gone through the civil war.

Sunkarie, a long term patient doing some studying

We are fortunate to have found a clinic and a nurse in Bo which administers 5 year birth control implants. The cost is $10 per patient. Seven women eagerly opted for this prior to going home. Upon giving their histories to the clinic nurse, I was aghast when one of our 35 year old patients told her that she had been pregnant 14 times and had delivered 11 children; six children are alive (her chart has different information). She walked out of the clinic looking very relieved and expressed so much gratitude.

Jenebah and Wuyata with implants

The new website www.westafricafistulafoundation.org is a terrific accomplishment by Selena and Zhao. We are very fortunate to have Ray Rogers and Sean Dudley of Butte, Montana assisting us with getting it launched. Adding, editing and updating to the site will be through Sean, but this is still being finessed.

Volunteers with Dr. Koroma

We have hired a new administrator, Joseph Kpakiwah, who begins April 1st. We are also interviewing for a nurse supervisor and hope to have the position filled before I depart. It feels like a lot of loose ends are getting tied up and a new chapter is beginning.

When I arrived in September it was as though program was a jigsaw puzzle which had been dumped all over the table. Now the border is complete and the pieces have all been separated into colours; thanks to a great team of volunteers and staff. The internal part of the puzzle is ready to be put together. There is progress!

Vivian, one of the hospital undertakers in the morgue.
Death is common and quite public here.

Next door 'shop'

Local warning sign

Monkeys and fire. . .