INTRODUCING JONATHAN PORTNEY

Dear Readers, I am sharing a blog post written by our newest long term volunteer, Jonathan Portney. “JP” comes to us from Loma Linda University, having just graduated with his Public Health degree, with an emphasis in international public health. He, like all our long term volunteers, has taken on his responsibilities with gusto and enthusiasm, or as they would say here, lustfully. I appreciate his post as it shares his thoughts, feelings and reactions to life here in a poor hospital in Sierra Leone. If you want to see his other posts, check out jpinternationaltraveler.wordpress.com. Or you can see his posts on our Waterloo Adventist Hospital facebook page.

JP leading out in stretches at morning worship

It’s 8:00 AM on a Monday morning. Sounds of praise radiate from the chapel located near the front of the hospital where the staff of the Waterloo Hospital gathers every morning to partake in worship. Inside this common area is a nursing station and at any given time a patient can be ushered through the staff worship to the nursing station to receive patient care. This particular morning was emotional for me because a few nights before a child aged 2 years came into the hospital with what was perceived as an untreated case of Malaria. The child was gasping for air, you could hear the fluid gurgling in his lungs. Beneath him, on the bed, there was a pool of blood that he had peed — the child was unconscious. As orders are being shouted by the nurses around me, I do what I can to help “Give me the oxygen mask” one nurse shouts looking at me. I held my headlamp over the child so the nurses could see what they were doing, I had to do this because there was no electricity, this is a common problem at our hospital because the electrical power is hit or miss and we can only run our generators at certain times due to hospital finances. The light I had focused on the patient was shaking, and I began to feel nauseous, I could feel myself becoming very hot, and had to continuously tell myself to breathe so that I would not pass out. For some, experiencing death is a common occurrence. For me, this was my first time seeing anyone on the brink of death, laying right in front of me, and I wish I could say it would be the last. The nurses did everything they could, but it was to no avail, the child aged 2 years died. It was quiet in the room once the child was pronounced dead, some staff cried, and other staff members walked away to be alone because I’m sure we all felt that this should not happen to a child this young. However, here at Waterloo Hospital this is a reality and does happen on a regular basis. We are here trying to do everything we can with the limited education and supplies that we have. Could WE do more? Yes, should WE do more? Absolutely. Unfortunately, we have limited equipment and funds to reach this goal, and this is just a reality.

On Monday morning I decided to take a shortcut to the chapel room which passes by the connecting nursing station. Songs of praise are heard radiating from the building. I peer in the nursing station window and see a child around the same age, if not younger, peering out the window with Dr. Scott, our physician, leaning over the child checking her pulse. The child had a little pink beanie on its head with matching footies and blanket. The child was so young that it still had that baby smell which we all love. The child had her eyes open wide, and her mouth opened as if she were yawning. For a brief second, I smiled because the child almost looked scared, often children this age are afraid of Opotu people “white people” because the encounter is probably their first introduction to someone with white skin. As I entered the chapel, I decide to see the baby because it was so cute. I walk in the nursing station, the child has the same facial expression that I noticed before with eyes big and mouth open. The mother is standing at the door of the nursing station holding back tears, saying a soft prayer, the dad is standing at the nursing station bed next to Dr. Scott with a hopeless almost blank stare expressed across his face. I look at the child and notice she is not blinking. I think to myself, this surely isn’t going to be a repeat of the night before. After this thought passed, Dr. Scott pulls his stethoscope away from the child and looks at the father and says gently “I’m sorry, she is gone.” I crumbled emotionally along with the parents as they wrapped the baby in the blanket and carried her off.

Us missionaries often sit around the dinner table on Sabbath evenings envisioning what it would be like if we had more funding and resources. In Gods power, we hope they will come eventually, and we have faith that He is molding the hospital just as He sees fit. We have fully come to accept that we are powerless over our current situation. Every morning without fail we wake up with a smile on our face to greet the day, staff, and patients. If we come off as defeated, then the whole morale of the hospital would change. While I have a smile on my face, inside, I am pained. While praying, I question if it would be foolish of me to ask God for just one week where a patient doesn’t die from preventable causes. I continue to pray for this, but my prayers are a little different now. I’m asking for strength, not only for myself, but for the other missionaries, the patients who have lost loved ones, and of course my family. I feel like if I pray for no one to die, I’m trying to play God and I know that is not my role. My role is to let God use my hands, body, and mind, stay out of His way and put a smile on my face to make the lives of those around me better. For me, this prayer is manageable and keeps me waking up to greet the day with a positive attitude despite waking up almost every morning to screams from the courtyard from family members who have lost yet another loved one.

Jonathan C. Portney, MPH — Mobile Clinic Director

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KABIA – PART II

Last Sabbath I posted a blog about our lab technician, Amadu Dalton Kabia. Because of the power of the internet and social media, and the faithfulness of Christians everywhere, people were praying for Kabia in homes and churches literally around the world. We received responses from Taiwan, the Philippines, Europe and the Americas. Since then I have received a number of requests for an update.

Earlier this week I had a chance to sit down with Kabia and hear from him what happened.

As you recall he had been ill for a couple of weeks and just didn’t seem to be improving. Or, he would get better then relapse. Last Friday morning at 5 am, after a difficult night sleeping, his family came to take him home. He just wasn’t improving here at the hospital and it was time to do something else.

Kabia tried to resist, but as he told me, they were his elders and so he really had no choice but to obey. He was told they were going to take him to another hospital, but instead, he was taken directly home. As he suspected, once he arrived home plans were made to take him to the native healer. I addressed the problems with that in the last blog. He flatly refused to go, elders or not. So, they brought the native healer to him.

This lady has a lipoma on her left shoulder that I took off this week. However, notice all the scars. These are cuttings from the native healers, presumably to get rid of the evil lipoma on her shoulder.

At that point, he was not feeling well at all, but was with it enough to resist the power of the witch doctor in his heart. He said they did some kind of ceremony which he was unable to describe. They told him his illness was all due to the man we had fired earlier this year. He told them he didn’t even work with that guy, and had nothing to do with the firing. He told them if they could give him some natural remedies, herbs and such, to make him feel better, that would be fine. Otherwise, he said, forget it. With that, they left, presumably to leave him to his fate.

From that point on, he began to improve. By Monday he was strong enough to come back to the hospital and do a little work but mostly he rested and hung out with his friends. Tuesday, he did a bit more, and so on. I told him to come late, leave early, whatever he needed to do, but make sure he rested. Much of the burden has fallen on Sallie, his assistant in the lab. She has been able to do many of the tests, as they are automated ones, or use test strips. But those tests that require a microscope are harder and she is not really trained to do it. But, here in West Africa, you try anyway, you do your best, you never give up. So, we would find Sallie huddled at the microscope, just shaking as she tried her best to read the slides. She was so relieved when I told her she didn’t have to do that. I told her to Just do the tests she knows how to do.

At this time, Kabia is much better, still a little weak and tired, no doubt partly due to his Ebola history. But he looks bright (healthy), and he has his smile back. I am so proud of our lab, they really went through the testing fires this month and came out shining.

This is our lab crew, Michael on the left, Sallie on the right and Kabia in the middle. A truly indomitable group!

The devil is strong here, but the power of our God, unleashed by the prayers of the saints around the world, is stronger than all the forces of hell for those who submit to Him.

“Submit yourselves then, to God. Resist the devil, and he will flee from you.” James 4:7 NIV

For more frequent, up to the minute short updates, please follow us on Instagram or on Facebook, 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

OUR STRUGGLE IS NOT AGAINST FLESH AND BLOOD

Yesterday at the end of worship the entire staff stood up and held hands, making sure there was an unbroken circle, and we prayed for one of our own. Our lab technician, our Ebola survivor, was ill. He had been ill for a couple of weeks, and wasn’t responding normally to treatment. It could be because he kept going back to work too quickly, and wasn’t getting enough rest, or because he really never let us finish an adequate course of treatment, or maybe he has something else wrong that we can’t diagnose, or maybe it is a result of his Ebola history. There is some thought that Ebola survivors are relatively immune comprised. Whatever the reason, he just wasn’t getting better.

However, that is not why we were praying. We were having this special season of prayer because at 5 am that morning his family had shown up and taken him from the hospital against his will. The staff did not need to be told what this probably meant. When families come and forcibly remove someone from the hospital they typically are planning to revert to the default–take the patient to the natural healer. Every village, every community has at least one natural healer. These are not naturopaths as we understand them. No, these are witch doctors in every sense of the word. I actually had no idea how evil these men and women are until just recently.

The AHS family was upset because just three weeks ago we buried the Seventh-day Adventist wife of a prominent staff member whose family had taken over her medical care. The husband shared with me the story.

Josephine had been ill for several weeks. The labs tests were all normal, and there was nothing wrong on physical exam, except she didn’t feel “bright”, meaning she was weak and tired. Different medications were tried without much success. Now, it has to be said that this happens in the US as well. Patients have some unknown malady that doesn’t respond to treatment. Eventually they get better, most of the time, or something shows up to steer us in the correct direction. However, in Josephine’s case the family was not going to wait. So, they took her home. Her family is not Christian, although to be honest, it really would not have made much difference. I have observed that whether you are Muslim or Christian, when the going gets tough the vast majority of them will revert to their animist roots. And who do they turn to for medical help? The natural healers.

So, these guys were brought in. What I am about to tell you will sound made up,like something out of a horror novel, but it is not, I assure you it is real. First, they found some masses or lesions at various locations on her body. These were removed. Without surgery, without incisions or scars. Cutting, actual cutting with a knife, and blood letting is a very common treatment here. Many of my patients have multiple scars on their bodies as the result of natural treatments. But then they reached into her abdomen and pulled out the real source of the problem, a snake like creature, 8-9 inches long, with a discernable head and tail, that was moving. I have seen the picture of it. It was fortunately destroyed so it would not bother anyone else.

I asked if there was a scar. I was concerned these guys had made a hole in her intestine and not closed it and she had died from sepsis. I was informed that these natural healers have magic and the wound just closes over spontaneously and very quickly, leaving no trace of a wound.

Josephine seemed to recover some after her “natural” treatments. But then 4 Sabbaths ago her family called the husband saying that she was very ill. She was brought to the hospital and died a few hours later, at the age of 39.

Did she die because of the natural treatments or despite them? Did she have some unknown ailment that was to doom her no matter how she was treated? We will never know. But what I can assure you is that as soon as the natural healers became involved with all their magic and potions, God was pushed out. How can God answer the prayers of the church for healing when the devil is involved? Who is going to get the credit if He does work a miracle?

It was with those thoughts in mind that we prayed about our lab tech. I am sure most everyone in the room knew the stakes involved. It is extremely unlikely the family took him from the hospital to try to get him into one of the fancy expensive European hospitals in Freetown, or that they are going to airlift him to France for treatment.
He knew as well, what was in store for him, which is why he vehemently protested leaving the hospital. But individuals here have no say, it is the family, specifically the ranking member of the family who decides for everyone.

So we prayed, we prayed that somehow God would intervene and the family would allow him to come back to the hospital, allow us to continue treating him. We may not have much for diagnostics or treatment options, but we have something greater than that, we have the Great Physician. And in this war, that is worth more than all the soldiers, all the armaments, all the captains and all the kings.

Here, the evil, the darkness is so “in your face”, so blatant it is impossible to miss. But it is just as real in the “developed” world. We just call it by other names, or we rationalize it away with our smart scientific theories and ideas, but the evil is there.

I don’t know how this will end, but I know God will not force Himself where He is not wanted, so ultimately it is up to us, we choose which side we will be on. And that is a decision we all have to make, whether we live in Sierra Leone, Tchad, France, England, the US, or any other country in this world.

I am happy to report that we just received a message from our faithful lab tech wishing us a Happy Sabbath, and telling us that he is home and will not let anyone mislead him. Praise God, but, he will need all the power of heaven to stand against the will of his family.

“For our struggle is not against flesh and blood, but against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.” Ephesians 6:12 NIV

For more frequent, up to the minute short updates please follow us on Instagram or on Facebook, 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

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

Mobile Clinic

We had our first mobile clinic on Monday, August 29, 2016. It was the first step in fulfilling our vision of taking healthcare to people in all of Sierra Leone. It was the fulfillment of a commitment we made after meeting with Counsellor Bangura of Ward 154 at the naming ceremony for the daughter of our head nurse. (See the blog posted August 8, 2016.)

The Mobile Clinic Team, Mr. Abu, Erin, and Paul

The Mobile Clinic Team, Mr. Abu, Erin, and Paul

Once we set a date the community outreach team of Mr. James Abu, our Community Health Officer (CHO), and Erin Acosta, our Public Health Volunteer from Loma Linda, worked furiously to prepare. There is a lot of work involved in setting up a mobile clinic. You have to try to predict what diseases you are likely to see, and then gather all the supplies and medications you will need to treat those ailments. You have to prepare all the little things like a scale, a method to measure height, registration forms, a calculator (we forgot that one), portable exam beds, and on and on. Then it has to be all packed up and organized into bins and suitcases so it will all fit into the van along with the mobile health personnel.

Then we had to figure out how to price our services. I foolishly thought we would just use the prices we have here at the hospital, but no, I was informed we couldn’t do that. No one would come to the clinic. Apparently a $5 consult is too much for the villagers. I learned that in fact we should do the consults for free and just charge for the medications. Finally, a compromise was reached. We would do blood pressure checks for free, but there would be a 10,000 SLL (Sierra Leone Leone) ($1.25) charge to see Mr. Abu, and then the patients would have to pay for the medications.

I have to admit I was a little nervous with that plan. While I believe in the concept of mobile clinics and believe that it is important to take health care to those who can’t access it, I also believe in being able to pay the hospital staff at the end of each month. We simply don’t have the resources to be subsidizing a mobile clinic. It has to pay for itself. And I was beginning to doubt that it was possible, given the poverty in the villages. But I was game to try. However, in the Memorandum of Understanding (MOU) we signed with the local government health officials I made sure we could stop the clinics with just a 2 week notice if we found it was too expensive for us run.

Then last week Mr. Bangura, the counsellor (kind of like the mayor for the whole area) of the ward we were going to pulled me aside.

“You should give a small gift to each child who comes,” he told me.

“What kind of gift?” I asked.

“Just a small amount of food, or a small toy is all.” He answered.

Well, I thought he had a good idea. So did the other team members. But where were we going to get the money to buy a small toy for the children, and how were we going to keep from having a riot.

On Wednesday I was sitting in my office mulling this over when I heard the whoosh my phone makes when I have a new email. I opened it up to find a note from Norma Nashed, the President of Restore A Child(RAC). We had worked with them a lot in Tchad, but had had a hard time reconnecting since moving to Sierra Leone. But here was Norma telling me that RAC was sending $5,000 to Waterloo Hospital to help with Children’s programs. Wow, there is not a better program than giving rice to hungry, sick kids. Problem solved, we had money to buy rice to give the kids who came to see us. Moms are happy, we are happy, RAC is happy.

Monday I was up early, for me that is, we were leaving for the clinic at 0800. On the way we picked up the rice and arrived at the village in good time. We then waited for an hour before the man with the key opened up the building we would be using for the clinic. Fortunately, Erin is very organized and so the unpacking and set up went off without a hitch. Soon it was time for Mr. Abu to give the gathered villagers a welcome and health talk, and then, time to see patients.

Moms with their sick kids gathered in the Palava Hut, waiting to see Mr. Abu

Moms with their sick kids gathered in the Palava Hut, waiting to see Mr. Abu

Now, I have to be honest. I really did not want to be there, at the mobile clinic that is. And there was a very practical reason, I didn’t have a job. Everyone else had jobs, Erin would register the patients and collect money, Mr. Abu would see them, and Paul would dispense the meds and give shots. Even Julian had a job as official photographer and videographer. What was I going to do? I had images of sitting in a corner all day, staring off in space.

Little Rachel with one of the dolls Bekki found hidden away in a storage area.

Little Rachel with one of the dolls Bekki found hidden away in a storage area.

Promptly at 10:45 we began with our first patient, and all the job descriptions went flying through the proverbial window. We had two volunteers from the village who helped us out, and it would have been a nightmare without them. We quickly filled new roles as Paul and Theresa registered people and took their vitals, Erin and I became the pharmacy and took the money, and Abraham kind of filled in everywhere, but mostly translated. Only Mr. Abu and Julian kept to their assigned roles.

Another problem soon surfaced. Mothers were bringing their sick children. That was not the problem, the problem was they had no money, or very little money to pay for the needed care. Often the mom would run outside to her husband to get the 10,000 SLL ($1.25) for the consult, but then when it came time to purchase the needed medications they would only have 5,000 or 10,000 SLL for a 20,000 or 30,000 SLL ($2.50 – $3.75) pharmacy bill. The look on those faces would be giving me nightmares if the Holy Spirit had not given me an idea.

Two little girls with their bags of rice already perched on their heads.

Two little girls with their bags of rice already perched on their heads.

I realized that we had money, for children, for sick children. So very quickly we developed a plan. We would ask for the 10,000 SLL for the registration/consult, and another 10,000 SLL for the meds. That way they paid something. It is generally not good to always give things away, people value things they have paid for. Then we would use the RAC money to make up the difference. Most people were able to pay the $2.50, but not everyone.

Two year old Hawa came in with her grandmother from a village a few miles away. Grandma was able to pay the 10,000 SLL, but when she came to the table for the medications for Hawa’s week old cough and fever she had no more money. Now there was no way we were going to turn a little child away without treatment for a lousy $1.25. So we told them the meds were free. Then we gave Hawa her 1 kilogram (2.2 pounds) bag of rice and a little doll, and she was happy and grandma was happy.

Hawa with her grandmother.

Hawa with her grandmother.

It was such a joy to be able to treat these children, and the moms were so grateful for the rice. But we really had no idea what an impact we had made, until the end of the day. After we saw our last patient, a little 4 year-old girl, Mr. Abu shared a story with me.

It seems that this little girl, Princess, had been in the Palava Hut with her mom most of the afternoon. They had been waiting because mom could not get up the courage to go into the clinic because she did not have any money. And so they watched as people came and went all afternoon.
After we saw Hawa, Mr. Abu happened to hear Hawa’s grandmother talking with Princess’s mother. When grandma found out why the mother had not gone into the clinic this is what she said.
“Go to the clinic,” she said, “they have compassion, they will treat Princess even if you don’t have money. Don’t wait.”

And so we had the privilege of caring for little Princess and sending her home with needed medicines and a bag of rice to fill her tummy, because of the compassion and generosity of people who have never met her, and will never meet her, people who live half a world away, but have the love of Jesus in their hearts.

“Let the little children come to Me, and do not hinder them, for the kingdom of God belongs to such as these.” Mark 10:14 NIV

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