Archive for the Gondama Referral Centre Category

No Death, or so it seems…

Posted in Bo, caffeine, cloudy days, doctoring tales, Ebola, Gondama Referral Centre, MSF, penny for my thoughts, Sierra Leone on August 15, 2014 by twotwoeight

25th July 201420140808-115958 am-43198765.jpg

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

Posted in Bo, doctoring tales, Ebola, Gondama Referral Centre, MSF, penny for my thoughts, Sierra Leone on August 15, 2014 by twotwoeight

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.

20140815-111011 am-40211587.jpgThe 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?

ICU

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?