THE ACCIDENT

(I wrote this some time ago, but never posted it.)

The call came in Sunday afternoon, November 27, the call I had been dreading that is. Pa Sanko had been in an accident with the van. I was dreading it because I knew how Pa Sanko drove, like a Sierra Leonean, but more importantly I knew how the others on the road drove. It really was not a question of if but when there would be an accident. This is why we pray so sincerely each time we set out on a journey.

The problem is that the van is our source of transportation, it is how we get people to and from the airport, it is how our mobile clinic team goes out, it is how we get to Freetown. Mr. Fobbie has his car sure, but often both are in use. Plus the van holds a lot of people and a lot of material. It is a true work horse and will make our job much more difficult without it. I had been dreading this day since April.

Sanko had been bringing home a group of women from the yearly women’s retreat at Masiaka. They tell me (I was not invited) that it had been a great weekend, very spiritual, and they were singing and praising as they neared Waterloo. Suddenly an Okada (motorcycle taxi) pulled out from among the traffic waiting to cross the highway. He pulled right into Sanko’s path. Sanko had no time to react or stop, and the van plowed into the moto. The unhelmeted passenger, a woman in her 50’s went flying off the bike. The driver fled, leaving a badly damaged motorbike and an unconscious, bleeding woman on the pavement.

Our poor van with the smashed nose. It is still in the shop, they are trying to find a radiator for it.

A crowd quickly formed around the van and the accident scene. The windshield on the van was smashed as was the radiator. The location of the accident had to be a God thing. It happened a hundred yards from the Emergency Clinic, and the local police station. There is an Italian NGO who has a very nice Emergency hospital in Freetown, and most accident victims are taken there. They have an orthopedic surgeon on staff (the only one in the country), and all care is given for free. They have also established several Emergency clinics, like the one close to the accident scene where accident victims are taken, triaged and first aid rendered, before being taken in their ambulances to the main hospital in Freetown. So the woman was quickly taken to the Emergency clinic where she was found to be unconscious, with an open depressed skull fracture. Fortunately, everyone in the van was fine.

The second serendipity is that the local police station is also located within a hundred yards of the accident. Sanko was immediately taken to the police station and placed in protective custody. At that point it was not clear if the woman would live or die, or how serious her injuries were. Mob justice is alive and very well in West Africa. In Tchad we were taught that if you were in an accident, especially if it appeared someone died, or might die, even if it was not your fault, you do not stop. You drive to the nearest police station. If you stop, the crowd will at best beat you to within an inch of your life, at worst kill you. This is not a joke, it is real. We were driving through a suburb of Freetown and noticed a commotion. Turns out some sap had tried to steal something and had been caught. They were beating the tar out of him, quite literally.

So, although this was a moment I had been dreading, God was way ahead of us. When we had our strategic planning meeting in April, one of the plans was to add a 4 WD vehicle and an ambulance. I, the skeptic, went along with it, thinking maybe in a year or two we would find the money for another vehicle. I really did not believe we had a prayer of getting an ambulance. But then in late September the Loma Linda Auxiliary chose us as one of their projects. That was great, they typically raise enough to give each of their projects $10,000. I was pretty happy. But they typically finish their fund raising by the following spring, and distribute the funds in April or May. Bekki and I had never met these ladies before, so when we were at the Global Health Conference in Loma Linda in October we asked if we could meet them. So it was that Friday afternoon we ditched out of the meetings and had spaghetti and mizithra cheese (not available in SL) with the leadership of the Auxiliary at the Redlands Spaghetti Factory. We got a chance to tell them the story of our little hospital, and they were so touched that they gave us the $10,000 on the spot. Furthermore, they really wanted to money to go for a 4 WD vehicle. They were very specific on that.

Our staff with the new Nissan XTerra, thanks to the Women’s Auxiliary of Loma Linda University.

I let Fobbie and Koroma know the good news. They wasted no time and found a used Nissan XTerra in great condition, never driven in Africa, imported from Germany. It was 4WD, manual and diesel. An unbelievable combination. And they purchased it literally days before the accident.

We were taking Dr. Gaede, our board chairman, to the airport in the new Nissan and were able to stop by the hospital and police station. It was there that I got a first hand taste of how quickly things can get out of hand. Mr. Fobbie, Mr. Abu and I had walked over to the Emergency Clinic to try and check on the woman, but as we got to the entrance her family showed up, and recognized some of our ladies that had been in the accident. I am not sure what was said that acted as the spark, but suddenly I was in the middle of a major fight. The relatives were pushing and shoving and shouting, others were pushing back. Thank God that within seconds the police were there coming between the groups, getting people separated and kept the fight from escalating. I got out of there as quickly as I could. I kind of stand out if you know what I mean. And white skin is often a flashpoint when tempers are already thin.

Sanko was held for a couple of days, then had to report daily to the police office for a week or so until the police finished their investigation. The driver of the Okada never showed his face again. Neither did the owner of the motorbike. The Okada’s are usually owned by someone other than the driver, and if it was the driver’s fault the owner never comes to claim the bike, figuring he would be required to pay damages for the vehicle as well. I asked why they couldn’t track down the owner through the motorbikes registration. Ask a stupid question…I was told, yes that is possible, but you have to pay the police extra to do it. We have a saying for that TIA (This Is Africa). Eventually the police decided it was not Sanko’s fault and so he is not in trouble. The XTerra is working out great (I even drove it last Sabbath), and there was enough money left over from the Auxiliary donation to get the van fixed.

What about the injured woman? You will have to wait for the next blog.

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

WHAT I LOVE ABOUT MY LIFE IN SIERRA LEONE

Life is hard here. Harder than I could have imagined from our short 1 month trips to Bere before becoming full time missionaries. Hot all the time, constantly sticky with sweat except when it is just pouring out of my skin, constantly harassed by little kids and adults begging for money, trying to navigate cultural land mines every day, always having to concentrate 110% to make sure I understand what is being said, living in a beautiful land spoiled by trash, these are just a few of the things that make life here difficult for a soft American “glamper”.

But, there are so many things that fill my heart with joy, I thought I would list some of them, no particular order, and not an exhaustive list:

Listening to the staff sing, “When we all get to heaven”, it means so much more here where life on earth ain’t that great.

Having almost all the staff together each morning for morning worship, which starts with British precision at 08:30.

Listening to the morning worship talk as a junior staff member shares what our mission statement means to him, “demonstrating the healthcare ministry of Jesus.” They have caught the importance of our mission and vision and core values.

The blessing of each new item added to the hospital, from blood pressure cuffs, to cars to generators. All are blessed with a special prayer and dedicated to God’s service.

Seeing patients and families attending morning worship.

Being in my office at 4:30 in the afternoon on Wednesday and Friday and hearing the singing start as our call to worship for prayer meeting and Vespers respectively.

Singing “Welcome, welcome, how do you do” to visitors each Sabbath in church and to welcome our new volunteers.
The cheery good morning I get each morning from the canteen staff as I walk to the hospital.

Having a Board of Directors that takes their job seriously and thoughtfully, and supports us.

Having AHI to turn to for help and support, each one of whom is a jewel in their own right.

Having a mission President who is honest, trustworthy and understands the relationship between the church and it’s hospitals.

Having an air conditioner in my office and in my bedroom.

All of our volunteers, short term, long term, they keep us young and going.

Hearing the Muslim call to prayer (yes you read that right), from a distance, as it softly and musically flows through the evening air.

The cool ocean breeze.

The beach

The sunshine

The chance to work with people who have been through so much, suffered so much loss and still can laugh and smile.

Being a part of saving a life.

Having a chance to do something for others that I know they could never do on their own, not for lack of intelligence or skill, but lack of opportunity.

Seeing jaw dropping pathology. I have a saying, “If the locals are taking pictures, you know it is bad.”
Practicing with little fear of malpractice.

Being able to sleep every night.

Being able to do pretty much all your shopping from the car as you sit in traffic in Freetown because all the vendors pass by selling everything from fruit, nuts and popcorn to mops to cell phone cords to cell phones.

A solid administrative team.

Eating roasted cashews and peanuts everyday.

Eating the best pineapple in the world every day, and papaya and mangoes and guava.

Having a cleaner who makes 300,000 leones a month pick up a 5000 leone bill I accidently dropped and putting it on my desk instead of just keeping it.

When a patient who came with necrotizing fasciitis (flesh eating bacteria) in their neck because of a cavity in a tooth, looks you in the eye and says “Thank you for saving my life”.

Praying before every surgery.

Praying before every car ride.

Having friends, good friends, all over the world.

Speaking French

Seeing God perform miracles

“Snapping” the kids and moms in the villages and then hearing their shrieks in of delight when they see their picture on my phone.

Hiking up Mount Erin behind the hospital on Sabbath afternoons with Doug and Julian and volunteers and Africans who choose to join us.

Being able to share this adventure with my best friend and soul mate.

Happy Sabbath.

For more frequent, up to the minute short updates please follow us on Instagram, we are Scott N Bekki Gardner.

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Three Holes

Our mission at AHS-SL (Adventist Health System-Sierra Leone) is to demonstrate the healthcare ministry of Jesus Christ. It has occurred to me that Jesus was actually more interested in healing people’s souls, than their bodies. Consider the story of the paralytic in Mark 2, Jesus forgave his sins first, then healed his longterm paralysis. And it really makes sense, I mean saving someone’s life is great, but what does it really do? It just pushes back the date of death a bit, but we all die eventually. I am all for relieving suffering, but after the treatment most people just get sick again, the relief is rarely permanent. But, if we can save a soul for eternity, wow, now that is something altogether different.

And so, at AHS we are trying to make ministry a big part of what we do as a mission hospital. Enter one Samuel Danquah. A diminutive Ghanian who worked in our accounts department. However, it was clear to all around him that his heart and natural gifts were in ministry, not in numbers. He was already one of our district evangelists (read lay pastor), overseeing 8 churches in the area. When it came to spiritual things at the hospital, the staff, even our chaplain, looked to Mr. Danquah for leadership (everyone here is Mr., or mommy, or aunty, or pa, you don’t call anyone except the young people by their first name).

Three months ago I tried to approach him about taking over the spiritual ministries at the hospital and the attempt fell flat. It probably was a good thing, because in the ensuing three months we have developed a clearer vision of where we want our spiritual ministries to go. And so we tried again. This time, it was an all out effort, Dr. Koroma talked with him over a 2 week period, I enlisted Pastor Sandy our mission president to talk with him. And we brought in the big guns, we prayed that the Holy Spirit would speak to his heart and lead Mr. Danquah and us in the right direction. And probably equally important, I stayed out of the conversation. It worked. Around the first of December he accepted the position of Director of Spiritual Ministries for AHS-SL.

He was officially to start the new job January 1, but he has wasted no time in taking on the new responsibilities. He has already found himself a temporary office and outfitted it. We have been able to fill his position in accounts with people already in place, so that transition has been an easy one. And in his first two weeks he has presided over three holes.

The first hole, for a too tiny casket.

The first hole, for a too tiny casket.

Last week I wrote about the first hole. He was the presiding elder at the funeral of the little son of one of our nurses. Fortunately, the next two were much better. In line with our increasing spiritual emphasis at the hospital, and due to the fact that our morning worships are full and overflowing, with not enough seating, it has become more urgent that we have a chapel for the hospital. Oh yea, also staff who are on duty, ambulatory patients and family members cannot attend Sabbath morning services because the school room where the AHS church meets is too far away. No, we need a real chapel, a place to have morning worship, Wednesday evening prayer meeting, Friday vespers and Sabbath School and Church. We need a place anyone can go, at any time and meditate and pray.
Site of our new chapel and the second hole.

Site of our new chapel and the second hole.

A couple of weeks ago Bekki mentioned it on facebook and we received a seed donation of $1000. That was enough to get us started. The second of the three holes was dug, this time for the foundation of our new chapel. We are moving forward in faith that God will bring in the needed funds to get it built. We have set a crazy goal of having it finished by the rains that will come in May.

Mr. Samuel Danquah, preparing to baptize the cornerstone of the chapel with cement.

Mr. Samuel Danquah, preparing to baptize the cornerstone of the chapel with cement.

I have had the privilege of participating in a couple of ground breaking ceremonies in the US, but we don’t do that here, we have a “Laying of the Cornerstone” ceremony. So it was that last Wednesday we interrupted Executive Committee to have the cornerstone ceremony. And of course our own Mr. Danquah led out, along with Pastor Moiba, the executive secretary of the SL Mission. Like everything else here, it was very spiritual and very ritualized. It was really cool. There was singing, prayers, and speeches, including multiple expressions of how long they had been waiting and longing for a real chapel. Then, starting with Pastor Moiba, the various dignitaries deposited some concrete on the stone laid in the corner of the hole for the foundation. Over the last week, work has continued on the foundation, and it will keep rising as money comes in.
Dr. Koroma adding his load of cement.  He got the words right.

Dr. Koroma adding his load of cement. He got the words right.

Yesterday Mr. Danquah presided over the third hole. This one is the foundation of the new physical therapy building. When we first arrived in April, physio was meeting in a gazebo. With the rains they moved indoors to an unfinished ward in an unfinished wing. But they really needed their own place.

In June we were encouraged to apply to the Winifred Stevens Foundation for a grant to help us with one of our projects. I asked Linda Spady, the chairwoman of the foundation, which project she recommended. She suggested we apply for all three, upgrade to our OR, complete the unfinished wing (extension) and construct a physio building, then let the board choose the one that spoke to their hearts. I still get goosebumps when I recall the moment I got the e-mail telling me that the board had not chosen one of the projects, but had agreed to help us with all three. So the theatre (OR) is being upgraded, the extension is being finished which will double bed capacity, and we are beginning construction on our physical therapy building.

The chief of Waterloo adds his comments and blessing to the construction of the new physio building.

The chief of Waterloo adds his comments and blessing to the construction of the new physio building.

Fast forward now to yesterday, it was again the ceremonial laying of the cornerstone, this time for the physio building. Again the hospital leadership, the mission leadership, and dignitaries from the town of Waterloo, including the chief, the press, were all there. The ceremony was very similar, and just as meaningful. Physical therapy is such a blessing to these people. They have such physical lives, lifting and carrying impossible loads, and they have sore muscles, joints and bones. Physical therapy and massage therapy relieves much of that pain.

The third hole, Pastor John Moiba, Executive Secretary of the Sierra Leone Mission, starts us out by placing the first dollop of cement on the cornerstone of the phyiso building.

The third hole, Pastor John Moiba, Executive Secretary of the Sierra Leone Mission, starts us out by placing the first dollop of cement on the cornerstone of the phyiso building.

As each dignitary lays cement on the cornerstone it is important to dedicate the stone and symbolically the building to God. For the Muslims it is done in the name of God. For the Christians it is done in the name of the Father, the Son, and the Holy Ghost. Just like a baptism, but with cement rather than water. Last week I messed it up, not realizing that those words are an important part of the ceremony. To my credit, I am a fast learner, and I got it right this time. I only hope that my omission on the chapel will not diminish the blessing. Thankfully God knows the heart, and can overlook a novice’s mistake!

So, 10 days, three holes, and a very busy Director of Spiritual Ministries. But thanks be to God for His comfort in times of sorry, and His blessings on our efforts to emulate the healthcare ministry of Jesus through the spiritual ministry represented by our chapel and through the physical ministry represented by our physio building.

The whole group at the Cornerstone ceremony of the physio building

The whole group at the Cornerstone ceremony of the physio building

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

SHOWERS OF BLESSING?

“There shall be showers of blessing;
This is the promise of love;
There shall be seasons refreshing,
Sent from the Savior above.

Showers of blessing.
Showers of blessing we need;
Mercy drops round us are falling,
But for the showers we plead.”

We closed worship this morning singing that song. We had just been told that the three year old son of one of our nurses had died Saturday evening. After the song Mr. Fobbie, our administrator, told us about the funeral arrangements.

I had seen him Thursday afternoon in consult, to do an ultrasound. Seems that he had not urinated since Monday. His mom carried him into my office and he lay quietly on the table while I did the ultrasound. That was bad sign number one, normal three year olds don’t lay still on an exam table, they kick and scream. Numbers 2, 3 and 4 were the lack of urine in his bladder, his huge kidneys and the fluid in his abdomen. All together they told me this kid was in big trouble, a hemoglobin and malaria test and urinalysis were not going to make the diagnosis for me, and in any case we have no treatment for renal failure.

Dr. Koroma suggested sending him to a pediatrician in Freetown when I gave him the ultrasound results, and I heartily agreed. Friday afternoon he urinated, and Saturday morning he was transferred into Freetown and Saturday evening he passed off (died).

This afternoon we went to his funeral. I have been to several wakes in Africa, where one just visits the family, but this was my first funeral. In many respects, it was very similar to an American Adventist funeral, but with some definite African twists, for instance starting three and a half hours late, and it was held outside behind the little boy’s house. But, food was served while we waited for the arrival of the casket, there was praying and singing, and encouraging words about God’s love and care and our hope of the resurrection, and yes, lots of crying. The hardest thing was seeing his 5 year old cousin screaming and crying, “Cousin, come back; Cousin, come back.”, when he saw the casket for the first time.

In October, the wife of our cashier was brought in unconscious and all swollen after delivering her baby at home. We don’t have OB yet, so the family chose traditional over the government maternity center. My guess is she had eclampsia and crashed after delivery. She died shortly after coming in to the hospital, leaving our cashier a widower with two older children and a newborn. He faithfully comes to work everyday. Bekki thinks he has lost weight, I am not so sure. His expression has not changed in the 8 months we have been here, before or after the death of his wife. I have never seen him smile.

We have a staff of 45 employees, and two of them lost immediate, young family members in the last 2 months. And we nearly lost our head nurse in September. And this morning we sang, “Showers of Blessing.” I don’t know anybody who would equate these losses with “Showers of Blessing.”

Death is universal in this world, it is not unique to Sierra Leone, Tchad, or anyplace in West Africa. And it causes pain and anguish among the living whenever and wherever it strikes. These stories are not unique, in fact I bet pretty everyone reading this has lost a child or spouse, or is close to someone who did. But none of that makes it any easier.

This quarter in our Sabbath School classes (same as Sunday School only on Saturday for the Seventh-day Adventists in the group) we are studying the book of Job and the question of human suffering. And after nine weeks the conclusion I have come to is that there is no good answer. There is nothing you can say to a mother who lost her only child or a husband who finds himself alone with a newborn. There is no explanation, no “greater good”, no “cosmic purpose”, no “reason”. And saying that “God wanted them,” doesn’t sound that great either. It just makes God out to be some selfish Being Who wants a bigger harem of angels.

A point was brought out this week that if a reason or excuse for the evil that exists in this world could be found, then it’s existence would be justified, and it would cease to be evil. There is no reason, no excuse for evil or death. (Great Controversy pp. 492, 493)

It was brought out today at the funeral that Paul admonishes us to “In everything give thanks.” Really? I had never heard that text used at a funeral before. How do you give thanks for the death of a three year old? How do you sing about showers of blessings before announcing his funeral?

I don’t think you do. I don’t think you give thanks that an innocent just lost his life. I think you give thanks that Jesus conquered death on the cross. I think you give thanks that God accepts us as we are, and accepts the death of Jesus as payment for our sins. I think you give thanks that Jesus is coming back and that He promised to raise our loved ones back to life. I think you give thanks that Jesus promised to restore us to the perfect state of pre-fall Eden. I think you give thanks for the eternal life He promises.

Those are the showers of blessing that fall around us all the time while our hearts are breaking at the evil and death we see in this world. “Even so, come Lord Jesus.” (Revelation 22:20)

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Koidu Town-Home of the Blood Diamonds

Koidu is the chief city in the district of Kono, in the far eastern area of Sierra Leone. It is home to the mining industry, mostly diamonds and gold. Kono is famous as the site for the documentary movie “Blood Diamonds”. Money from the sale of the diamonds have funded many a war, including Sierra Leone’s own Rebel War of the 1990’s. But others have profited as well, hence much blood has been shed because of wealth generated by these gems.

Diamond Mining in Koidu

Diamond Mining in Koidu

But Koidu and the Kono district is also home to another group of “Gems”, loyal dedicated Seventh-day Adventists who have a burden for their fellow man. This last June the men’s group of the Koidu SDA Church got together and brainstormed. “What can we do for the church and the community? More specifically, how can we impact their health and well-being?”

Our guest house in Koidu.  It was really nice.  Great birding spot too.

Our guest house in Koidu. It was really nice. Great birding spot too.

It so happens that the health and temperance leader of the church, one Boko-Lincoln, is a pharmacist and has his own store. He has been in the community since 1967, so is very well known. As is common here in this country of limited medical resources, he operates a simple clinic out of his pharmacy. So he evaluates and treats patients according to his knowledge level.

Before we get too self-righteous about a pharmacist practicing medicine I must point out that it is a lot better for him to be using the medical knowledge he has to help the overburdened local doctors and nurses, rather than for people to access the health care from the traditional healers. Reference my last post where I described pulling leaves out of my patient’s abdomen, the herbs the traditional healers used to treat Sahr’s perforated ulcer.

Greetings from the Koidu Church

Greetings from the Koidu Church

Bekki reading off the results of the offering competition between the men and women (guys won by about 2,000 leones, 38 cents)

Bekki reading off the results of the offering competition between the men and women (guys won by about 2,000 leones, 38 cents)

So it was that Boko-Lincoln suggested that they open a small pharmacy in the church, and sell the medications on a cost-recovery basis. The goal was not to make a profit, but to make good quality medications available and affordable to the local church first then the local population. Now it is possible to buy pretty much all these drugs at the local market, but the problem is you have no idea what you are buying. Is it really penicillin? Maybe. Maybe not. Who knows, and who cares, except for the family of the patient who just died because they bought and took bogus medications. You get the point.

Koidu Church and their dispensary table with BP cuff, thermometer, and meds

Koidu Church and their dispensary table with BP cuff, thermometer, and meds

The rest of the church was excited about this new health care initiative. I should also point out that as Health and Temperance leader, Boko-Lincoln is not idle, he gives a weekly health talk at church as well as leading out in this small dispensary. Soon the day came to unveil the dispensary. The church invited our mission president, Pastor Daniel Sandy, to attend.

At the grand unveiling ceremony with Pastor Sandy being the keynote speaker, it came up that they would really like to have an Adventist Health System Clinic in their area. Pastor Sandy told me about it as we traveled to the US together for the TAASLA campmeeting. The whole concept fits in very well with our vision to transform the health of all people in Sierra Leone. So as soon as I returned we began contacting the leadership in Kono District. A meeting was set up for Friday and Sabbath, September 9 and 10.

It was a long 5 hour drive over some horrendous roads (well they don’t actually qualify as roads, wide advanced motocross trails is more like it). But we spent a delightful Friday evening hearing what they are doing to evangelize and help the people who live in their community. We worshipped together on Sabbath morning and in the afternoon visited the churches 5 acre property, as well as an unfinished building that would work well for a clinic. We finished the visit with a meeting with the Parma Chief, the top chief in the area.

Meeting with the Parma Chief (on my right) and the other village leaders.

Meeting with the Parma Chief (on my right) and the other village leaders.

The first two criteria any community has to meet in order for us to consider them as an AHS clinic site are:

There has to be a need. We are not going to open a clinic next door to another health facility, be it government or private. There are so many areas without health care, we need to focus on them first.

And, two, there has to be strong community support, not just the church, but the community as a whole. Koidu meets both these qualifications. The nearest health facility is several miles away over very difficult roads. And based on the meetings we had with the church people and the community leaders there is very strong support.

But there is a third criteria. We want to know how the Adventist church community and health care community plan to use the clinic to follow the vision of AHS, to improve the physical, spiritual, mental and social well-being of their communities. These clinics are first and foremost a way to improve the spiritual and physical health of their people. Secondary is an income stream, uh OK, reality is it is probably further down the list.

The unfinished clinic building

The unfinished clinic building

Inside the building

Inside the building

They are well on their way to demonstrating a strong affirmative on all three points.
We really don’t know where this will go. The building needs finished and then Adventist healthcare workers need to be recruited. But the great news is that it is God’s work, when He is ready for AHS-Koidu Clinic to open, it will open. We just have to be prepared to march through the door when He opens it.

Mining is still active in Kono District. I don’t know how the profits are used, but it would not surprise me if there are still a few blood diamonds. But for us it really is irrelevant. What matters is there are people who need health care and they need Jesus.

Bekki practicing carrying wood on her head.  Put that woman to work!!

Bekki practicing carrying wood on her head. Put that woman to work!!

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Eid al-Adha

For those of you who may have missed it, last Monday, September 12 was one of two main Islamic holidays, Eid al-Adha, or Feast of the Sacrifice. You guessed it, it commemorates the willingness of Ibrahim to sacrifice his first born son Ishmael. It also marks the end of the annual Hajj to Mecca.

We live in a predominantly Muslim country (60%), so as soon as the Supreme Court in Saudi Arabia set the date officially as September 12, it became a national holiday. So Mobile Clinic was cancelled, but things were pretty much as usual at the hospital. A hospital, like Las Vegas, never sleeps you know, or takes vacation.

That being said it was pretty much an uneventful quiet day until about 4:30 in the afternoon. Mr. Fobbie came to my office as I was starting to pack things up to go home.

“Mr. Abu is going to Mamamah to attend to Mr. Augustine Conteh”, he told me.

“Oh, why is that? What happened?”

“He was on his way home and was in an accident.”

“Is it serious?”

“I think so, they took him to his house.”

I am a surgeon after all, and so I thought I should go along and check it out for myself, plus I figured it would be a morale booster for Mr. Conteh, who is our head nurse.

Mr. Abu and I quickly got together a few supplies, not having a clue what we would find. Afterwards I realized we left the BP cuff and IV supplies behind. Next time we will try to have an emergency kit prepared.

Pa Sanko, our intrepid driver, the man who has no fear, holding Augustine's older girl, Rachel.

Pa Sanko, our intrepid driver, the man who has no fear, holding Augustine’s older girl, Rachel.

We hopped in the van with Pa Sanko and Mr. Abu had prayer. We desperately needed that prayer. I have spent many hours in the van with Pa Sanko at the wheel. He is a pretty aggressive driver. This time it was the Indy 500 and we were making up for too much time lost in the pits. I buckled in tight, and tried to concentrate on my solitaire game and not count the times we passed one or two cars going our direction while being passed by cars going in the opposite direction. These guys have incredible depth perception, they miss each other by millimeters, or sometimes not.
The vambulance

The vambulance

20 minutes later (of the usual 30 minute trip) we pulled into Augustine’s front yard. Abu and I hopped out and followed the sounds of wailing to the little carport behind the house, where they had held the naming ceremony for Augustine’s baby girl, Sarah.

Mr. Conteh was laid out on the cement on a pink lacy sheet. He was surrounded by probably 50 friends and relatives, many of whom were wailing and wringing their hands. One woman was standing over him pointing to a mass protruding from his bare abdomen. At first I thought he was dead, but then I noticed he was breathing. We did a quick primary survey and found nothing imminently life threatening, other than all the noise and commotion. His pulse was full and strong and didn’t feel too fast. I breathed a sigh of relief as we began the secondary survey.
The mass in his abdomen turned out to be an old hernia, apparently this woman had not seen him before without his shirt, so she thought it was new. He was able to talk fairly normally and answer questions. They said his left leg was broken and it had a traditional splint in place. Abdomen was soft and non tender, chest was normal. Glasgow Coma Scale was 15.

OK, this is good. I really didn’t want my head nurse dying on me in front of all these people, actually I didn’t want him dying on me at all. But I did want him back at the hospital where we could watch him in case something did show up.

I suggested we get him moved to the van, so 5 guys got on the right side of the sheet leaving me and one other skinny Sierra Leonean for the left side. I had visions of this not going well, but it was still better than the Tchadien method of transport; 4 men, each one holding a different limb with the head flopping around loose. We got him in the van without incident and tried to reassure the weeping crowd that he was going to be alright. Unfortunately, it is a van, so he had to sit semi-upright on the seat so we could fit all of him inside.

As we headed out I told Sankoh that Augustine was OK and we could go a little slower. I have always been opposed to accidents involving rescue vehicles, especially if I am inside.

I was now able to talk with Augustine and find out what had happened. He had been on his moto and was turning left onto the road going to Mamamah and failed to see the other motorcycle trying to pass him on his left (very common practice). So the left side of his body took all the force.

As we drove along I reflected on all the people weeping and wailing as they gathered around Augustine as he lay there. I realized that they had seen this before and knew that he was badly injured and for all they knew he was going to die. Augustine is the one who has the good job, so he supports a large part of the family. Their future lay on that sheet. What would happen to them if he died, or was no longer able to work? So it was truly a cry of frightened desperate people who had no control over the situation or the future.

When we got to Waterloo his brother-in law, who had come with us, said he was hungry so we stopped at a favorite cafe and picked up some food. At that point Augustine still looked pretty good, but then he commented that he was tired. I was really hoping that it was all the excitement and the broken leg talking…

At the hospital he was loaded up on a gurney and quickly moved to the private room that had already been prepared for him. I found out later that while we were gone the whole staff had gathered together and prayed for Augustine and for our safety as well. God answers prayer is all I can say.

As we moved Augustine onto the bed I noticed his skin, previously dry and warm was now cool and clammy. Oh boy, direct left side hit, hard enough to break a leg. Hard enough to break a spleen, too? His pulse, once full, regular and slow was now fast and thready. While the staff got things together for starting an IV I got my ultrasound to do a quick scan of his abdomen. I really am not very experienced at these, and frankly not very good, but by God’s grace I quickly found his spleen and it looked pretty good. I didn’t like the black at the end of it though. I looked in the pelvis, a little black around the outside of the bladder. Then I looked at the left abdomen, black in the gutter, and I could see the bowels floating in a black sea. Black on normal mode ultrasound is liquid. In this case blood. Great.

My head nurse has a ruptured spleen. I have no night time OR, yet. I hope and pray he is not one of the few that don’t stop bleeding on their own. Mr. Abu got two IV’s going. I noted that we would need to be talking about the concept of “LARGE” bore IV’s for trauma. But the 22 gauges worked. 500 cc of fluid later he started to look around again and he quit sweating. After a liter he was talking normally and his skin started to warm up. Adequate blood pressure for brain perfusion has always been a favorite of mine.

Augustine feeling much better.

Augustine feeling much better.

I examined his leg and decided he just had a broken fibula, the little bone on the outside of the leg. The main bone, the tibia, was fine. I put a splint on it and then had prayer with him and told him I would be back in a couple hours to check on him.

At home I filled Bekki in and confessed my worries about what I was going to do if he didn’t stop bleeding like the book said he was supposed to. Patients have a nasty habit of not reading the books before coming into the hospital. We are not really set up yet to do surgery outside of regular hours. We are working on it, but it will take some time yet. So she called on her prayer team through e-mail and face book.

About 9:00 pm we went down the hospital and checked in on him. He looked pretty good, awake, alert, pulse good, abdomen soft, no pain except in the leg. I gave the nurses their final instructions and told them to call if he got sweaty again.

I have to confess I did not sleep well that night, waiting for my phone to ring. Praise God my phone stayed silent all night. I hurried down to the hospital early so I could check on him before worship, and was greatly relieved to see him holding court in his room very awake and alert and already busy disobeying doctor’s orders.

The big grin is because he had been eating against my orders.

The big grin is because he had been eating against my orders.

At worship that morning I noticed that Augustine was the scheduled speaker. I told him later that if he really didn’t want to do worship all he needed to do was talk with someone, having an accident was really not necessary. He got a good laugh out of that.

A very relieved Mrs. Conteh holding the baby Sarah, and a shy Rachel standing next to the bed.

A very relieved Mrs. Conteh holding the baby Sarah, and a shy Rachel standing next to the bed.

By Friday he was well enough to go home. Sunday morning at 6:30 my phone rang. Augustine called to thank me for taking good care of him, and to assure me that he was doing OK. I thanked him for calling, but have to confess that my thoughts were more of, “If you really want to thank me, don’t call me at 6:30 on Sunday morning:)”

Intercessory prayer works, it kept us alive during Sankoh’s mad dash to Mamamah, it stopped the bleeding in Augustine’s spleen, it helped us get the IV’s going in time. I cannot praise God enough that I was not faced with doing a splenectomy on him at 2 in the morning. We are not set up to deal with major trauma’s, but by God’s grace our head nurse will be back at work in early October.

It also showed me that we really do need an ambulance. Lights and siren would have been nice. A real ambulance gurney in the back of an ambulance that was already stocked with the supplies we needed would be nicer. As we grow, these kind of emergencies are going to be more common, we need to be ready to meet them. When we do the best we can with what we have, God makes up the difference. When we are just lazy and don’t plan ahead, and don’t work to remedy our deficiencies and ask God for help, it is presumption.

Despite the fact that Bekki did not serve mutton for supper that Monday night, it was an Eid al-Adha I won’t soon forget.

Paul checking Augustine's BP at his home today.

Paul checking Augustine’s BP at his home today.

Epilogue: We visited Augustine today as he lives just a couple hundred yards from our Mobile Clinic in Mamamah. He is doing well. Hemoglobin is stable, he is eating, no dizziness, minimal pain. We praise God for His mercies and healing. sg

A very happy Mr. Conteh on his bed at home, showing off his fancy cast-boot, and sitting up with no dizzyness.

A very happy Mr. Conteh on his bed at home, showing off his fancy cast-boot, and sitting up with no dizzyness.

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou, and now we are adding videos of Sierra Leone. Watch a real Ebola survivor tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Is A Human Life Worth $200?

I happened to glance out my office window yesterday to the front parking lot of the hospital. I watched bemusedly as a yellow cab pulled in, the front seat passenger got out and opened the right rear passenger door. My curiosity was piqued as I watched him pull out a young man by his arms. As if out of nowhere a crowd appeared and several pitched in to help carry the patient up the steps into the hospital.

It didn’t look good, but it also didn’t look surgical, I hoped. We had just cancelled my one case for the day because the young lady had eaten breakfast so I was looking forward to being able to get caught up on paperwork and other administrative stuff. Not long after I ventured out of my office and ran into Mr. James Abu, our CHO (Community Health Officer, basically a nurse practitioner).

“Doctor”, he said with his usual sly smile, “Doctor, I just admitted a patient with a bowel obstruction I would like you to see.”

“OK, no problem.” This is my usual response whether it is a problem or not, always hoping the lilt in my voice would put a smile on my otherwise sour face (those of you who know me will understand).

I asked if this was the young man they had just brought in. Sure enough it was. So much for being nonsurgical.

We went to the mens ward and found a young man, Sahr, in his early twenties laying on his side facing the wall. He had little ulcers on his right leg. I found out he had fallen from a mango tree some years back and has been paralyzed since.

The history was three days of abdominal pain, nausea and vomiting. Indeed, he looked like a bowel obstruction, distended abdomen, tight, tympanic (sounded like a drum when I tapped), no evidence of an incarcerated hernia and no peritonitis.

Here, our only non-invasive diagnostic is an ultrasound done by a rank amateur (me), so the only real decision is does this patient need an operation and if so, when? Well, he needed an operation, and since the crew was there and anesthesia was present, now was good.

As I walked back to the OR, Mr. Abu stopped me and said, “Doctor, his family has not paid anything yet. What should we do, who will pay the 1.5 million leones ($200) for the surgery?”
My response was simple, “He needs surgery and he needs it now, we will worry about the money later.”

I am done with not treating someone with a life threatening or emergency condition simply because they cannot pay. We will get what payment we can from them later. But as a hospital it is our creed to treat everyone regardless of ability to pay. God will either make up the difference, which so far He has, or we will go under. But I am going home if I have to turn someone out because they don’t have money.

Back to the story. In the OR, I was explaining the necessity of being careful when opening the abdomen on cases like this to the surgical team. Because the abdominal wall is stretched thin and the dilated bowel will be just underneath it is easy to slice into the intestine. (Most teaching of this nature is from personal experience, this was no different). This time though, as I gently opened the peritoneum there was a rush of odorless air. It was followed by thick yellow fluid, 5 liters of it. The surgery people among you know exactly where I am going with this. No bowel obstruction, but instead a 1 centimeter (1/2 inch) hole in the duodenum, just below the stomach. Diagnosis, perforated ulcer.

As I repaired the hole and cleaned him up, I marveled at how far God had brought us in such a short time. A month ago I would never have dreamed we would be ready to do a case like this, but with our new suction and cautery and OR Table and the reorganization of the OR, we were ready. The case went well, and I am happy to say that today he looked as good as anyone can look with an NG tube hanging out their nose. He has a long way to go, and many bad things can happen, but so far a life has been saved by God’s grace.

Sahr the morning after surgery.

Sahr the morning after surgery.

After surgery I met with the family and explained what we found and what we had done. I also shared with them that Sahr was still very ill and needed lots of prayer, and that God is the One that would need to heal him.

In worship this morning Mr. Abu shared the “rest of the story”. In the days since he became ill the family had taken him to traditional healers and other clinics and hospitals. Sahr had been treated with herbs and other local remedies, which I can attest to as I suctioned out a number of pieces of leaves from his abdomen. The family had spent all its money before coming to AHS. They had only enough to pay the 30,000 leones ($5) for the consultation.

Sahr and his nurse.

Sahr and his nurse.

If we had insisted on some payment yesterday before treatment they likely would have put him back in the taxi and driven off, and he would be dead today, instead of being on the mend. And we would never have had the opportunity to point them to Jesus as the Source of healing.

Will Sahr fully recover? Remains to be seen.

Will the family pay? Probably something, although not likely the entire amount.

Will it hurt us financially? Maybe.

Is a human life worth $200? Definitely.

For those of you who are new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year. On the “Videos” page watch a real Ebola survivor, Dalton Kabia, tell his story. Watch our community health officer explain why the staff agreed to work in the Ebola Red Zone even after they lost 2 staff members to Ebola. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. On the Projects and Donations pages you can find the projects we are working on and how to donate to the project that touches your heart. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner