“Trying to be fine”

“What are we going to do? People are not coming to help us. We are doomed”. These are words spoken by a bright young Sierra Leonean man to me during my last shift at a hospital in Sierra Leone. A man blessed (or cursed) with the foresight to see what lies in the future for his country and him. A man, whose hopes and dreams have been destroyed and life will be forever changed by one thing.

Ebola.

A virus which has evoked insurmountable fear in everyone and generated mass paranoia outside West Africa has parachuted Sierra Leone, Guinea and Liberia into the eye of the world. Many who have not even heard about these countries, let alone realize that the African continent is much more than just these, are now aware because they are stricken with unfounded fear of people returning from West Africa. We follow the progress of this unprecedented outbreak on the news, we gasp and worry about the statistics showing increasing numbers of positive cases and deaths, we criticize and make judgements on how this outbreak is being handled by the powers that be, we read harrowing accounts about the challenges of being in an Ebola management centre by people on the frontline, we hear touching stories about individuals who have survived Ebola and entire families that have lost their lives to Ebola and we feel sorry for them.

And then we close the newspaper or turn off the television and go back to our normal lives. Our Ebola-free lives. Where bodily contact will not possibly infect you and you are free to hug and kiss your loved ones, where community living is still not endangering your life and you can share your food and a joke and laugh together instead of having to choose to abstain from the normal living practices that you have been used to for generations in order to prevent yourself from getting infected by the deadly Ebola; where your future is not hanging by a thread because you no longer have a job, a job that puts food on the table. Yes, we have none of that.

But what about the West Africans? What if your life is not Ebola-free and you cannot resume living your normal life because Ebola has enveloped your world? What then? How do you go on?

Underneath the “sexiness” and labelled-heroism of battling Ebola, the few touching tales that has caught the journalist’s attention and the fear and paranoia that is being emanated to outsiders, we forget about the remaining population – the local people who have nowhere to go and “leaving West Africa because there is Ebola everywhere” is not an option for them. These are the people who have to try and live their lives as normally as possible, even with the threat of Ebola looming around the corner because life needs to go on. This outbreak is not going to be over in a matter of months, and people cannot put their lives on hold indefinitely. And the uncertainty of the future makes it impossible to have any plans as the country is not going to be the same even after the Ebola outbreak is over. The healthcare system has collapsed and rebuilding it will be difficult with the loss of so many healthcare professionals when there were already not enough to begin with, families have been ripped apart and Ebola has orphaned countless number of young children whose welfare remains in question, business and economical development will be severely stunted and education has come to a halt. These countries will be set back many many years and the West Africans will have no choice but to pick up the pieces and move on, because that is what needs to be done, move on.

I have always thought that if there was an apocalypse or worse yet, a zombie attack, I want to be one of the first to perish, because I cannot imagine being one of the few survivors, trying to face the impending doom alone or left to live in a world that has been destroyed and completely foreign to me. This is only in my hypothetical thoughts. But for my friend, this bright young Sierra Leonean man who had big dreams and aspirations for a better future for him and his family, this is now his reality. And for the rest of the West Africans whose stories we will never ever hear, because not everyone’s story is spectacular or touching enough to be newsworthy, but whose ordinary lives are filled with happiness and pain as real as yours and mine, they are just “trying to be fine”.

Happy 2nd birthday Caleb…good job!!!

My dearest nephew,

Thank you for brightening our lives with your smiles and cheekiness and filling us with love. Yiyi loves you very very much, and thank you for waiting for yiyi to come back for your party!!! 😁

…
Caleb : Yiyi’s iPad at Mama’s (grandma) place
Caleb’s mum : Yes, Yiyi’s iPad. Not Caleb’s iPad. When Yiyi comes back, must give back to Yiyi yah. And to tell Yiyi good job because Yiyi go Africa to do work.
Caleb: Yiyi not good job. Caleb good job.
Caleb’s mum : What work did Caleb do?
Caleb : Caleb do art work at Mama’s place.
Caleb’s mum : Oh…okay. Good job Caleb. 😳
…

Hehehe!! You never fail to make me laugh! Good job indeed Caleb!
Love you to bits! 🙂

No Death, or so it seems…

25th July 2014

The last hour — sitting at the porch outside the doctor’s office in Gondama Referral Centre (GRC), sipping hot “Starbucks Americano” and listening to Jacky Cheung on my iPod shuffle while writing down hand-over notes from the night. The last hour of my first night shift in GRC. No deaths. Dare I count my chickens before they hatch? After all, there is another 55 minutes to go before 8am. And anything can happen. Keeping my fingers crossed.

Most of the doctors and nurses who work here have attended more resuscitations, or rather, witnessed more deaths in the few months of working here compared to in their entire working lives. Judging from previous years, the numbers are expected to rise in the rainy season as this brings a surge of severe malaria and pneumonia cases, but on the contrary, the wards are quieter than ever this year. Under normal circumstances, this would be something good. A quiet hospital with low bed occupancy rate…who wouldn’t want that?

Unfortunately, this unnatural apparent peace does not reflect a healthier population or availability of better health facilities at this point in time. Admissions are significantly less because the people are not seeking treatment – not at hospitals, at least. Why? Because they are terrified of the deadly Ebola. There are many myths and rumours related to this disease; some don’t believe the virus exists, some say it is an act of with craft or supernatural in origin, some say it is a conspiracy designed by the authorities for population control, some say it is purely a scam of healthcare workers and scientists for research – the list is endless. The worst of them all, is that many of them believe that if you go to a hospital, you will get injected with the Ebola virus there.

Whichever the story, the devastating outcome is that these beliefs keep them from bringing their children to the hospital, even when their child is critically ill. They’d rather let their children die at home or go to traditional healers than risk coming to the hospital. As a result of this, they die from potentially treatable diseases like malaria, pneumonia or gastroenteritis which are so prevalent in this community. It is tragic to know that there are so many preventable deaths out there – that every empty bed we see in the ward could mean that there is a child out there who is denied proper treatment because of false beliefs.

Ebola is a deadly virus indeed. Once infected, the mortality rate is high. But the destructive path it leaves behind without even needing to infect the individual is more terrifying, and this deadliness grows silently, unseen and unheard. When will this destruction end? Only time will tell. Until then, we continue to pray for the number of admissions in our wards to increase, so that less lives will be lost unnecessarily. Ironic, I know.

 

Co-habitating with Ebola

15th July 2014

The lights go out and the fan slows to a complete stop within minutes. It’s 5pm. That’s the time that the generator goes off every day for an hour and a half in the evenings, and 2 hours in the morning. Today the sweltering heat doesn’t bother me because it has been raining steadily almost the entire day, and the breeze that accompanies the pitter patter of raindrops is much welcomed. Sitting at the terrace behind the house, listening to Phantom of the Opera and sipping hot coffee – this almost feels like home. Except that the very visible barbed wires all around the perimeter of the house is a stark reminder that I’m continents away from home.

The first week working at Gondama Referral Centre here in Bo has been interesting, notwithstanding the ominous presence of Ebola that is creeping too close for comfort, overshadowing everything in its path. Talking about Sierra Leone at present time without mentioning Ebola would be like ignoring the elephant in the room but I am going to do just that. For underneath the wave of chaos and feelings-of-impending-doom that Ebola brings, the normalcy of the original needs of the hospital persists — providing acute healthcare to children stricken with diseases endemic to the region. Practicing medicine in the local context is going to be a new experience and somewhat of a challenge – not only because of the difference in severity and types of diseases here, but more of facing the brutal reality of our limitations here. The old adage “You cannot save everyone” has never been so true. What remains is, who can you save?

The ICU, which is lined by ‘couches’ (name given to a small high cot) on one side for the more ill children, and ‘beds’ on the other side for those less critical is filled with semi-comatose children. Juggling a few diagnoses of severe malaria, severe sepsis, severe acute malnutrition, severe anaemia, severe pneumonia and herbal intoxication each, these children are cheating death for every single day that they manage to pull through, and those who survive, do, because of the right combination of strong will and lots of good luck because medicinally, there is not much that we can do for them. Other than antibiotics, antimalarials plus a cocktail of other drugs and supportive treatment, we have no ventilators, no means for dialysis, no monitors, no scans and only a handful of fundamental laboratory investigations available. Meaning other than relying on your good clinical acumen, you are left with a whole lot of guesswork. Which also means, when the CHO (Clinical Health Officer) calls you to review a patient because he is critical and is in respiratory failure, instead of securing the airway, taking over the work of breathing and connecting the child to a ventilator to ensure there is adequate oxygenation to his vital organs while you treat the infection, you can only pray that either the child has a fighting spirit that is unbeatable and defies the odds, or that he dies soon, and as peacefully as possible. Mostly, it’s the latter that happens. I silently cringe on the inside and gulp down an uncomfortable feeling of helplessness after I examined the boy and told the CHO that I have nothing more to add to the current plan. LGD – Let God decide. I remember we had laughed about this ‘plan of management’ one of the consultants wrote in the case sheet when we were interns. Well, never has it been more real than now.

I watch as one young mother sitting at the side of her child calmly shakes his scrawny limp body intermittently with great force, trying to prevent him from drifting into a permanent sleep – her boy, who is semi-conscious from the severe malaria that has affected his brain and causing him to have seizures despite the repeated doses of anticonvulsants lies in a fetal position on the couch with a dazed look and grunts weakly only occasionally.

I marvel at how the mothers take it all in. They remain unshaken when watching their child moan in pain from the severe skin infection that is eating away at their flesh leaving huge gaping wounds on their tiny bodies, they remain strong and resolute when sitting vigil at their child’s bedside watching while their child is struggling to breathe with each shallow breath, they watch in a helpless surrender as their child’s life slips away in front of their eyes and although visibly upset, they show tremendous strength and maintain such a calm façade that it is unfathomable.

Life is cheap. It’s disgusting but it’s true.  Death is a common occurrence here that a day with no mortality is a rarity. It is ironic that somewhere, someone is complaining that their doctor’s manners was less than satisfactory or is demanding for a private hospital room, when at that exact moment, maybe not even halfway across the globe, a child is fighting to survive despite the odds, weakened from the start by severe malnutrition from the impoverished state of living, denied of what the ideals of basic healthcare needs is to the more privileged and leaving it all up to fate. What is deemed to be a basic necessity for some that it would be absurd to be without, can, and is indeed a dream which may be forever unattainable by another. Sadly, this is not a touching story with a happy ending. This is a tale of two worlds which ideally should be one, and a witness of the continuous struggles of humanity in trying to narrow the gap between the two. A couple of months ago, I laughed when my houseman said during a case presentation that the patient is from Utopia (it was, in fact Ethiopia) and I had to explain that Utopia is an ideal that does not exist, but in retrospect, wouldn’t it be nice if I was wrong, and that there is a Utopia after all?

 

of wind and apples — Jomsom and Marpha (AC Day 11)

Day 11 — Destination : Marpha

Woke up bright and early today and went down to order our breakfast.  While waiting for breakfast, ventured outside for a short walk.

The weather was great and the view from just outside our guesthouse was breathtaking.

Horses strolled about the streets in a leisurely manner and some were having their breakfast too.

No surprises what we had for breakfast — fixed breakfast set and vegetables noodle soup.  But that morning, our noodles came in a goblet! For a moment there, we felt like royalty. 😉

After breakfast, we left at about 8am and made our way to Jomsom.  We had discussed the idea of taking a jeep to Jomsom but in the end, we decided to walk and I’m glad we did, or we would have missed the chance to go ‘fossilling’ in the Kali Gandaki river!  Our trail followed the Kali Gandaki valley and many a times, we were walking by the river which was lined by thousands and thousands of pebbles and rocks of different sizes and patterns.  If your eyes were sharp enough, you might even be lucky enough to find fossils among them!  Needless to say, we spent a longer time than anticipated ‘fossilling’ (or in my case looking for ‘zero’ rocks) so we only reached Jomsom at about 11am.

As we neared Jomsom, it was also getting windier and windier, living up to its reputation, for Jomsom was famous for its strong winds.  In fact, there is even a Jomsom wind song!  Jomsom was a huge town, compared to the little towns that we have been passing through and bustling with activity.

We went to a local place for lunch and while waiting for our food to come, we killed time by snacking on Pringles (first luxury of the trek!!), channel surfing and the three of them became obsessed with looking for the hidden picture in the 3D art hanging in the dining hall!! Unfortunately, even with adopting a ritualistic-prayer-like stance, none of them could find the hidden picture in the end!

Lunch of fried chicken with chips and vegetables finally came! PW had curry chicken with rice.  You can tell we miss meat!!

After lunch, we made our way to the Eco Tourism Museum which was at the edge of town.  The exhibits were very unique and interesting but sad to say, maintenance of the place needed upkeeping.  This was a painting of Ekai Kawaguchi.  He was one of the pioneers who trekked in Nepal and wrote books about his travels that subsequently made Nepal known to the international community.

Blue sheep skin on exhibit.  No explanation needed.

Whoever who named this exhibit must have had a great sense of humour!!! What would you expect when you see a name like this?

Well……….literally what it described!!! 😉

Part of traditional healing methods carried out by traditional herbal doctors.  Bloody.

Animals featured prominently in ancient beliefs.

The walk from Jomsom to Marpha took about an hour and a half and it had started to drizzle as we left Jomsom.  The winds picked up again and at one point while crossing a wooden bridge, I was almost blown away!!  Luckily the windy bits did not last long.  As we neared Marpha, Dev started singing the Marpha apple song — which was what Marpha was famous for.  Apparently, there is a folk song for every village!  We reached Marpha at about 3pm.

After we passed through the entrance to Marpha, we noticed these fruits which resembled durian, but only much smaller.  Wanted to ask Dev what they were…but never found out the name of the plant.

Marpha is a pretty small village with one main street where most of the guesthouses and shops were.  There were a few bookstores, but they were mostly closed by the time we were there.

We walked around to look for the the apple farm and found a cobble-stoned lined path leading off the main street.

We followed the path and came to a garden orchard dotted with flowering apple trees.  Pretty was the right word to describe the scenery.

Flowers of the apple tree blooming — would have loved to see the apple trees heavy with apples, unfortunately it was too early in the season.

Soon after, it started drizzling again and we made haste.

We walked past this gompa and were contemplating whether to go up or not but after looking at the number of steps, we decided to just take their word that the view from the top IS really beautiful!  No more climbing steps for us!

We went back to the guesthouse as the rain was getting heavier and ordered some snacks as it was too early for dinner.  Being in the apple village, we had to try the apple lassi which to our disappointment, was rather weird tasting, and not in a nice way.  The chocolate apple crumble and vegetable tempura were nice though!

We sat around the dining area and did a bit of reading and then it was dinner time.  PW had yak steak as it was our last chance to eat it before we left the mountains.  This one was nicer than the one we had in Manang, less chewy! 😉  Dev let us try the famous Marpha apple brandy which was very strong!! But this stuff is supposed to be really good and people bring it back by the boxful! Well it was definitely good for inducing sleep…we knocked out shortly after dinner. 😉

Today would be the last day of being on our feet and trekking.  Tomorrow would be a whole day of bus and jeep ride to Tatopani.  I haven’t even left, yet I am already missing the mountains. 😦