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. . .

Far From the Maddening Crowd. . .

Just back from the second 24 hour break since I have been in Sierra Leone. Simply lovely to be at Tiwai Island again in the Moa River, yet made me realize how much I miss the realms of home. The rainforest noises remindful of the Tablelands and being in the little outboard made me excited to be on the Damariscotta again.

Helen taking it easy

It was great to introduce Jenny Bennett, John and Lynne Bosche to the place and have them share the appreciation of the spot. Coleman returned with the hope of seeing the pygmy hippo, but alas it remains elusive. Julia and Selena had just returned from a few day jaunt to Freetown and decided to opt out.

Coleman, Jenny, John, Lynne & Helen

Lynne and John arrived a week ago from the Bay Area. They are Thacher parents who “came aboard” after meeting at Thacher’s October Family Weekend in October ’08. John is an environmental civil engineer who is helping with consulting/advising on the hospital’s waste management system. He was also very helpful being on the panel for interviewing our new administrator. Lynne is a nurse practitioner who will be doing family planning teaching, blood pressure clinics, as well as some other projects. It’s great having them here.

We have 17 patients slated for the upcoming discharge ceremony. The week is filling up already and it feels like the hour glass sand is beginning to run out rapidly towards departure in a month.

Riverside gardeners

Fisherman in dugout

A ‘Typical Day’. . .



It’s hard to describe a typical day as it seems as though many different events occur, yet each day does have certain regularities.

I am awake before dawn, about 5, as it is my usual habit. Instead of my usual routine of walking and swimming, I lie in bed for a few moments and just soak in a bit of the silence which is punctuated by neighbouring dog howls and barks, as well as buckets clanging at the well. It’s good to have some semi-meditative moments. Soon the calls to prayer from distant mosques begin and I soak these into my psyche. Though a bit eerie, I find them quite soothing.

Then dealing with the computer and internet begins. The connectivity seems to be much faster at this time of day and I am fresher to deal with the frustrations of the regular “dropouts”. It’s also the best time to “chat” with Robert due to time zone synchronization. If emails seem garbled and misspelled, it is often because I am rushing to write between drop outs and I am in dark too. To see “Your message has been sent”, always feels like a triumph, especially if it has gone through on the first try.

Safula, our cook, arrives as the dawn breaks about45. She gets the breakfast going and then I hear the various alarms of my housemates begin. We gather for breakfast and then head off in the van with the nurses by 7:45.

On the 15 minute commute to the hospital from our guest house, it’s good to see the world of Bo pass by. There are many images and scenes: children dressed in their crisp uniforms (with hats) walking to school; children carrying bundles of goods on their heads heading to market; the Barack Obama Construction Company truck heading out of the parking lot; vendors along the road selling eggs, bread, oil, fruit; wood shops with the carpenters sharing from the same pot of food before the workday begins, a plethora of motorbikes with passengers hanging on tight to their goods. Often there are two adults and two children on one bike and the woman in the back will have a baby on her back too. The obligatory passenger helmet (a recently enacted law being enforced) can sometimes be a lightweight plastic bucket…whatever. Women working in the fields; women doing laundry in puddles; women plaiting each others hair on the front door step; children and men peeing on the side of the streets; billboards with public health messages or ads for the various cell phone carriers are ubiquitous.

When we arrive at the office, the first assessment of the day is to see if there is power. If so, computers get charged. If the ‘fast” hospital internet is working too, then it feels like we have won the lottery.

The day continues with a series of unpredictable and predictable events. Snapshots of images and phrases swirl through my brain at the end of the long days:

*A 20 year old patient sobbing and hugging Darius as she greets him at the ward wearing pants for the first time in goodness knows how long. She is finally dry!

*Giving children ice cream for the first time. A friend of Darius’s in Texas gave Darius $ to buy ice cream for children. The other evening we gathered about 60 neighbourhood children and told them there was a surprise coming. They were very patient as the soft ice cream had to be made and then delivered. It was quite an exciting event which they will remember forever.



Attending Musa’s funeral and witnessing collective grief as we marched in the funeral procession. Musa, the 43 year old bookkeeper for the program, died suddenly of a massive stroke March 5th. He was being treated for hypertension, but his sudden death really shook up everyone. When the news hit the staff and the patients, the collective wailing was very intense, as many fell to the floor and pounded their fists. We have observed this when other patients at the hospital die and their family and friends congregate. The people here seem so stoic and resilient, but the expression of their grief is immense. It’s like a boil has been lanced and the emotions pour out. The whole country

seems to have post traumatic stress disorder.

All of these events could have their own novellas written about them, each with their own dramatic story, characters and significance. Phew. . .

Coleman and Julia's birthday

We are heading off to Tiwai Island in the Moa River again tomorrow for 24 hours. A welcome respite awaits. . .