Masanga- Weekend respite

It's amazing how luxurious life can feel after having so many things stripped away from your 'normal'. Over the weekend Steph and I went to stay with our friend Anna at Aberdeen Women's Centre in Aberdeen, Freetown. We got to sleep in a huge, air conditioned room, with the availability of hot running water, flushing toilets and amazing food cooked for us- a breakfast of bacon, eggs, pancakes, chopped mango and banana and a hot cup of tea, while also getting to spend time with precious friends, not only Anna, but Tiffany and Greta, who were visiting from the ship for the weekend.
To make the weekend even more amazing, we spent Saturday at Bureh beach. After a somewhat long, bumpy drive from Aberdeen, we reached our destination, hopping out of the car to gaze upon the glistening, blue sea and smooth sand.

 

The last time I was there was 2 years ago and it has changed a little from what I could remember. A river now winds its way from the land through the sand and rocks towards the ocean. The water in that river is deep enough in places to float your way downstream, avoiding the rocks and into the ocean.
 

We spent the day with different people, some ship friends, some new friends from Masanga, some new friends we met that day and a few little African girls from Anna's church group, who hovered around our table and chairs eager for our company and attention.

 

 

 

After a relaxing day, reading, swimming, chatting and watching the sunset over the water, we headed back to Aberdeen with our new friend Steve, but after only driving for about 20 mins we heard a pop and soon it was evident we had a very flat tyre. We piled out of the vehicle and were crowded by a group of children aged from about 2-12 years old from the nearby village. They stood close by us just wanting to watch what we'd do.

While the men sorted out the tyre, we started to sing a song we knew in Krio- Tell 'im Tenki and as soon as those words were out of our mouths, they picked up the rest with their strong, melodious voices. They continued singing songs and each time they ended one, someone would start a new one or one would whisper a suggestion of another into someone's ear and they would begin anew. It was a beautiful sight and sound to behold. I felt so privileged to know some of the Krio songs they sung and to listen to them sing so earnestly in such sweet voices.
It took quite some time getting the tyre changed and battling Freetown's horrible traffic so we stopped to eat on the way back to the AWC and by the time we arrived back to Anna’s and stood in the kitchen chatting with her and eating cookies, we had a bad case of the giggles. Poor Anna stood bewildered as the four of us, Steph, Tiff, Greta and I stood in the kitchen in uncontrollable stitches of laughter.

Sunday came and we made our way to the supermarket to see what we could take back to Masanga to excite our taste buds in the week to come, after spending the past week eating the same pasta and tomato sauce that I unfortunately threw up on the second day.  I had avoided that sauce successfully for a few days, but soon realised I would die of carb boredom if I didn’t start eating it again. Wednesday night is the only meat night at Masanga and the rest of the meals were pasta and the same meatless tomato sauce, except on Sundays we were made rice with peanut sauce. The alternatives are bread, with nothing to put on it. We did have nice fruit options when they were available; mangoes, bananas and pineapple. So at the supermarket, we found some essentials; peanut butter, Laughing Cow cheese, crackers and Ramin noodles.

In the afternoon, our friends from Masanga met us and picked us up from AWC and we made the long drive back to the jungle for another week of learning and experiencing health care in the middle of nowhere.

A random sign on the drive back to Masanga

Masanga- They just keep coming

Day 5 began with the shortest on-call meeting of the week that didn't mention any deaths overnight, except we knew there had been one tiny baby who certainly had breathed his last during the hours we'd been away.

I started the day rounding with the doctors in the paediatric ward, happily seeing one of the small malaria boys from two days before, well enough to discharge back to the village. It felt like a small triumph amidst the constant battle.

Paediatric ward

Back up in emergency the doctors had started a lecture for the medical students in a conference room, taking all but one away. When I headed up to emergency there was a small boy lying in a bed, sick with malaria. From the documentation I could see he had not yet been weighed and before any medications could be given we needed to know this. With permission from a nursing aid, I took the boy and his mama to the paediatric ward, to use the baby scales. While we were there another set of parents came in with their equally small boy, also about 18 months old (11kg), who was clearly very sick and in severe respiratory distress. Realising that they had been sent from somewhere for admission in the paediatric ward, I knew that he need to be in emergency and seen by a doctor immediately.

After weighing him, I took them up to emergency and had the medical student see him while Steph went to get a doctor. The boy was tachypneoic, febrile, lethargic and had a blood glucose level of 0.9mmol/l (16.2mg/dl for the Americans). We needed to raise his glucose level immediately.
As we searched for a vein to give him IV glucose, I ran down to the mini shop and bought a Fanta since we couldn’t find any IV 50% glucose anywhere in the emergency ward or in pharmacy. Using a 10ml syringe I fed him like a little bird and he sucked thirstily.

After the IV glucose was finally sourced and given and an action plan written, the boy vomited a dark fluid. Not long later he passed blood rectally and was noted to have bleeding in one eye. Suddenly the two British doctors present looked at each other, eyebrows crossed. Concern for this patient rose as we realised this case would be more complicated than we originally thought.

Dr David in the emergency, writing up a plan of care

After things settled down a little and each patient was getting their treatment, Steph and I walked back for a late lunch and to pack a bag for the weekend in Freetown, visiting with friends. Our ride to Freetown was with these doctors and colleagues. As we sat at the hostel waiting, we knew something must have been going on with this little boy since they were already running late. By the time they arrived, they just drove through to say they had to decontaminate and they'd fill us in after they picked us up.
Putting our bags in the car we waited to hear the story. After we had left emergency, the boy had bled again rectally, begun to bleed from his nose and vomited more blood. After reading a few chapters in the tropical medicine textbook they connected the haemorrhaging to a possible viral haemorrhagic fever.
As the doctors were discussing this small boy's case and he was bleeding from all these places, his little body stopped working and he arrested. CPR was attempted but ceased quickly as he continued to bleed and bleed. Another little life gone...

Now they were sitting in the car looking up viral haemorrhagic diseases to know if it was a true possibility and whether we had all been contaminated by coming into direct contact with him. A blood specimen had been sent to another town, Kenema, for a diagnosis. If the results ever come back we might know for sure. (The results did come back a week later and it was negative for Lassa fever.)
The car ride to Freetown was fun, hearing stories of our new work colleagues and answering a lot of questions about our lives on the Africa Mercy.

We were dropped off in Waterloo and took a poda poda from there to Forebay road, Freetown, just past the corner were we would turn to go down to the port. It was an area very familiar to me after 11 months of walking that street in 2011. From here we walked to the eastern police station until we could find an okada (motorbike taxi) to get us through the horrible Freetown traffic to Aberdeen.
After a successful ride through the city to Aberdeen Women's Centre, we met our friends Anna, Tiff and Greta and dropped our bags, overjoyed to be in more great company and the addition of power, running water and air con.

Masanga- The small ones

Day 4 began with a relatively happy round in the paediatric ward. We looked over a couple of very malnourished children on the ward. One 12 month old can barely even lift his own head. His skin is saggy on his tiny 4.3kg (9.4lb) frame. The Danish nurse told me he’s been on the feeding program since he was one month old and he has barely gained weight past his newborn size, even 12 months later. I wonder how he will survive even if he had intensive feeding. I wonder how detached the mother has become from her youngest son that he is this malnourished and how hard life is for her and the other children at home. What can I, who is only here for 2 weeks, do to help? Is it even possible for me to make any difference?

After the paediatric round I wandered back to emergency and we were called to the delivery room for the resuscitation of a newborn. I was able to jump in and help out after the cord was clamped and cut, to stimulate the baby while we made sure he cried, good and loud. His mother had been in labour for 8 days! He was her fourth child, but until this day, no other baby of hers had survived! Today the victory was won!

After we ate lunch and headed back to the hospital, some patients lying in the emergency ward weren’t doing so well. One small boy admitted with cerebral malaria on the previous day, was having seizures and losing his airway. I don’t think I’d ever seen such a small boy have seizures like this. He was just lying on the table, naked from head to toe apart from the string necklace on his neck and around his small waist. His body was burning up in fever and he just lay there, eyes closed, with shallow but fast breaths. During the seizures we would help to support his airway and give him medications to help him stop seizing, but sometimes it made no difference. His body lay limp on the table. His parents were always close by, waving a piece of cardboard to cool his body and to keep away the flies.

The resuscitation room

Another lady and her sister came with her new baby. She had gone into labour and walked during the night through the village to the nurse. Before the nurse could reach her, she delivered the baby onto the ground in front of the nurse’s house. That was at 1am they said. It was 11am by the time they came to us, saying 'the baby was not breathing fine'. He looked ok to us but further investigation showed he still hadn't breastfed after being born and was lacking the sucking reflex. He hardly cried and began having apnoeic episodes.

After a long, long afternoon of helping with this small baby’s airway and stimulating him to breathe again on his own, many discussions were had about his condition and what it could possibly be and how on earth could we help or save his life, but it was futile. He was going to die. He probably needed heart surgery and he wouldn't survive on his own even overnight. We don't have power past 10pm, so no permanent oxygen device was available to help. The prognosis was explained to the mother and sister and Steph and I sat with them while he stopped breathing and turned a greyish colour and then when we thought he’d given up, he’d breath again. He just kept fighting. The tears of the mother and her sister flowed down their cheeks, dropping onto their precious baby's blanket. This baby was the third and only surviving child, but yet again hopes were dashed for the future. The baby was not even given a name. He died a few hours later.
The elation from saving one baby's life was almost drowned by the passing of another. But still I rejoiced for that mama, for finally she had a baby, alive and well and my heart broke for the other mama, who still had none.