Back to Work

My visit home to the UK was brief and hectic but I was pleased to be able to spend valuable time with my nearest and dearest.  Those I did not get to see; I hope will be understanding.  I have exchanged a chilly Liverpool for a humid Freetown where there is a temperature difference of 30 degrees and I am trying, but failing to re-acclimatise to the heat.  The sun has set and it is dark as I make my way down the jetty to board the sea-coach.  Children, still playing on the beach below, shout hello as I pass and the lights of the city glimmer in the distance across the harbour.   An hour later, I arrive at my rented house in Murray-town to find it like the Marie Celeste.  The lights are out, there is no power in the neighbourhood and the water tanks are empty. 

Life here is now settling into more of a routine, the novelty of the commute to work through near stationary traffic is wearing off and on occasion, I admit to struggling a little to climb out from under my mosquito net at 0630 in the morning when my alarm goes off.  Living and working here can be testing at times and I have developed more of an appreciation for the freedom and luxuries that we take for granted at home.  I am also acutely aware that compared to most people in Sierra Leone, we still have it good and I also accept that I will never be a morning person, no matter which country I wake up in.

Monday starts at a frenetic pace, a procession of sick patients arrive at the A&E; we admit a lady in septic shock, barely breathing into the last medical bed.  The next lady is in coma, she is not known to be diabetic but her blood sugar is over 30 and she is severely dehydrated.  The nurses administer insulin and fluid in the corridor while we wait for a bed.  The triage staff are dealing with a patient that has had a stroke with a blood pressure above 200 mmHg and one of the community health officers is assessing another patient with possible heart failure.  It continues past two in the afternoon and I sneak out to do some teaching with our new family medicine doctor who is on placement with us for a month.  I am called back twice in the following hour for opinions on two patients, the first is a man with an enlarged tender liver who likely has an abscess, the second presents with hiccups and turns out to have bowel obstruction due to a massive inguinal hernia.

I rush over to the hospital board room for a meeting with a delegation from the West African College of Surgeons.  They are on an accreditation visit to assess whether Connaught hospital can provide specialty surgical training.  Currently, if doctors wish to pursue specialty training to become a registrar and consultant, they must train abroad and this contributes to the brain-drain from which the country suffers.  I don’t have time to change and arrive a little dishevelled.  I feel a little under-dressed in my scrubs as I look around the table to see all the surgeons dressed in suits.  Fortunately, I don’t think this will have too much impact on the outcome of the decision.  The panel members have spent the day with the hospital consultants inspecting the facilities and will give their report in the next few weeks.  The hospital has come through many tough times over the years and it would be a fantastic boost for the dedicated team of surgeons here if they are given a positive verdict.

   

I then manage to catch up with a couple of my colleagues to discuss a course that we are hoping to run.  King’s have helped the hospital to introduce an early warning score to identify unwell and deteriorating patients on the intensive care and medical admissions wards.  We are now aiming to organise a pilot course that trains nurses, doctors and community health officers how to assess and manage these sick patients with the view to reducing hospital mortality.

   

The final event of the day is a Skype link to a medal ceremony in London for the UK staff that worked with King’s Sierra Leone Partnership during the Ebola outbreak.  The partnership was established by the King’s Centre for Global Health and has been in-country since 2013.  The aim is to help strengthen the health system by working alongside the hospital, College of Medicine and Ministry of Health.  When Ebola broke out, the organisation remained in Sierra Leone and played a major role in helping the country to contain the epidemic.  Despite this being an evening of celebration, it is not the end of the story unfortunately.  A 22-year-old girl that died last week tested positive for Ebola and a relative has subsequently also been diagnosed with the disease.  The organisation continues to support the health system here and one of its many roles will be to assist the country in the containment and eradication of this stubborn virus.  I'm ready for the weekend and it’s only Monday.

Celebrations

Happy New Year!  The festive season is drawing to a close and 2016 is now upon us.  Twelve months previously, I could not have imagined that I would be spending Christmas 2015 in Sierra Leone but the journey of life takes some unexpected turns.  My best present from Santa this year was the Christmas rota; for the first time in a decade, I had been given Christmas Day and New Year’s Eve off work.  How ironic that family and loved ones are thousands of miles away.  The wonders of modern communication make contact easier but a patchy Skype chat is not the same as sitting round the same table or sharing a kiss under the mistletoe -options here are much less appealing!;-).  

 

I look forward to catching up with everyone at home later this month, most especially my girlfriend Alice.  There is a great crowd of people here, however, and I thought that I would focus this post on what has been going on in excursions away from the hospital over the last couple of weeks.  To stick with the Emergency Medicine theme though, it’s based on ABCDE.

       

A is for Adventure

Picket Hill, at just under 900m elevation, is the highest point of the Peninsula Mountain range.  My house-mate and I decided to tackle this after Boxing Day as part of a group of six with a couple of guides to lead us to the top.  We set out from a small village of a few dwellings on the east of the range at the end of a dusty bumpy track, only negotiable by 4-wheel drive vehicles.  The trail took us quickly into jungle, past several settlements established in the early 1900s which have now been abandoned and reclaimed by the forest and up through dense vegetation towards the summit. 

The path was overgrown in several places and required clearing with machetes but after 3 hours we reached the top.  The view is a little hazy at this time of year as the Harmattan, a dust-laden wind blows across the country from the Sahara into the Gulf of Guinea, but it is still possible to feel a dramatic sense of elevation looking across the wooden hills that descend to the coastal region and meet the Atlantic Ocean.   

Clearing the way to the top of Picket Hill

B is for Beaches

In stark contrast to the UK, there has been no rain here for well over a month now as we enter the dry season.  In the dry season, the most popular destination in Freetown is the beach and Sierra Leone is home to some of the most pristine in the world.  Lumley beach, perhaps the least pristine due to its location, is a two-mile stretch of sand on the western aspect of the city.  It is fairly quiet in the mornings, aside from the occasional early morning stroller and the fishermen dragging in their nets but by most afternoons over the holiday season, thousands of revellers descend to dance, play football, bathe and generally have a good time.

Working down the peninsula the beaches get gradually more spectacular from Lakka and it’s freshly caught lobsters, through the white sands of Tokeh down to Bureh and its mountainous jungle back-drop, the best place to catch a wave on this section of coast.  A trip to the beach makes being away at Christmas a little easier to manage. 

Fishermen on Lumley Beach

Lobster at Lakka

C is for Carnival

The majority religion in Sierra Leone is Islam with a significant Christian minority.  The constitution provides for freedom of religion and there is a religious tolerance and harmony between faiths here that is seldom found amongst other nations in the region.  Whatever the faith, Christmas is a time to celebrate here and carnivals have been held regularly across the city.

Streets have been decked with decorative bunting, small stages set up for performers and loud speakers rigged to play everything from local pop to Justin Bieber, from the early evening into the ‘wee wee hours’ as one banner stated.  Needless to say, I have been impressing the locals with my dance moves on more than one occasion.

D is for Dinner

There were 14 of us present for dinner on Christmas Day and it was a splendid affair with oven roasted chicken (prepared and plucked that very morning by some of the team), stuffing, vegetables and roast potato.  Everyone contributed and I was allocated responsibility for snacks, crisps and Christmas pudding – perhaps an indication of how little my colleagues trust my culinary skills.

 

The chefs did an excellent job and as a result of the fine food and after effects from the Christmas Eve carnival, there was little energy left after dinner other than to sit back and enjoy a traditional festive movie.  Die Hard gets better every time I watch it!

Christmas Dinner

E is for End of Ebola

On 29^th December, the WHO announced Guinea to be Ebola Free.  Guinea therefore joins Sierra Leone in ending transmission of the disease and it is the first time since the start of the outbreak that there have been no cases in West Africa.  That is worth celebrating for sure!