Stress in Sierra Leone

“Hmm, I wonder why Bekki took the screen off the window”, I mused to myself.

It was Monday afternoon and I had come home a bit early. I was in our bedroom putting my clothes away in the closet when I noticed the mosquito screen on our window propped up in the corner. I thought it was strange but figured Bekki had come up to the house earlier and was doing some sort of project. Nothing else seemed amiss.
However, a quick look around and I realized a laptop was missing, then I noticed the hard drive was missing. My nightstand drawers were open, my money belt was on the bed, open, with my passport and credit cards strewn across the bed, and all the money gone. Finally, after nearly 4 years in Africa, we had been robbed. I guess that makes us official now. It took me a while to figure out how they got in as nothing was open. They had pulled out an iron bar in the window and squeezed through an incredibly small space.

They got maybe $150 and the lap top I was going to donate to the hospital anyway and the hard drive with our entertainment on it, but not much else. Nothing we can’t live without anyway. So we count that as a victory. Oh yeah, that morning I had left $540 of donor money on the bed, but came home at noon to put it away, so they didn’t get that money. They came over the back wall sometime in the afternoon. Quick in and out job.

But it still was unnerving. That night we slept (and still do) with a baseball bat at the edge of the bed. I figure I will whack them while they try to wriggle through the tiny gap in the iron bars. We hired a day guard, so the house is never left alone, and now we lock all the door in the house. So, if they break into one room they are going to have a heck of a time getting anywhere else. Even the bathrooms are locked. We kind of hope they break through a bathroom window, only to find themselves locked in a tiny room with just soap to steal.

That started a week that was supposed to be better than the week before which had been majorly eventful and stressful.

The capstone days were Thursday and Friday. As you know we (AHS) have the biggest, baddest autoclave in all of Sierra Leone. But it was not hooked up and there was no way I was going to tackle that job. So with the help of AHI and our grant from Winifred Stevens Foundation (WSF), we brought Rick King out here to hook up the beast and teach us how to use it. He had Wednesday, Thursday, and half of Friday to accomplish these tasks. My African colleagues are often quick to tell me, in an effort to calm me down, “Dr. Scott, this is Africa, relax, it will be OK.” That is all fine and good when there is no deadline, or plane to catch.

At the same time we had an anesthesia team from Western Carolina University, which was a huge blessing because on Tuesday I had to fire our anesthetist, and so had no other anesthesia but Professor Shawn Collins and student Joe Popa.

Back to the autoclave and Rick. We really tried to have everything ready, but literally spent 2 1/4 days of the 2 ½ allotted days waiting for our maintenance guys to get all the piping we needed and fix the mistakes they made on the electrical. Even then it was jerry rigged, or is it jury rigged, I don’t know, and fuses were constantly blowing. Even the autoclave itself was spewing steam from places Rick had never seen, and the fuse in the boiler was bad.

Then too, the hospital had not had water for 2 weeks because the main water line was broken again. Seems that plastic water lines that are buried less than an inch under a dirt road don’t stand up well to cars and three ton trucks driving over them. Even though the break is not on our property, the local government types said we had to pay to fix it if we wanted water, which would also then give them water, but they did not have the money, but we are rich, so AHS can fix it, for the third time this year.

Steam autoclaves need water, and need a consistent source, so we rigged up a 55 gallon barrel in the sterilizer room and hooked that up, and fixed the water line, this time with metal fittings and concrete over it. But the main pipe is still plastic and is still under less than an inch of dirt and still being driven over. Wonder how long that will last?

However, by the end of the day on Thursday the autoclave was hooked up and ready to go. Friday we would run it through a cycle and teach the staff. But Friday was also the anesthesia team’s last day and a lady came in with a nasty breast cancer, but still operable. I really wanted to do the surgery with good anesthesia, oh how I wanted to do it without having to fight off the patient during the case, or telling the anesthetist every move to make. So, I scheduled it for Friday morning.

Friday dawns bright and clear with the promise of a great day. We went in early to get the boiler on the autoclave started. Lights came on and we anxiously watched the temperature and pressure gauges, not move. Finally, a blown fuse (Rick had never seen this before) on the boiler unit was found. We actually had something to replace it with, Praise God. Now the temperature started to rise, the pressure went up. I was in my office and wandered back to see how it was going. I can assure you it is a steam autoclave, our sterilizer room was now a sauna, the glass water level tube was cracked and steam was coming out like a nineteenth century locomotive. (We now refer to it as “Puff the Magic Dragon”.) Rick had never seen that happen either (in 17 years of doing this). He bypassed that so the steam would go to it’s intended destination, and we were in business. Then it stopped, ”Oh, you wanted a 60 amp switch for the autoclave, I got a 20 amp switch.” Yea that is what I wrote down when I told the maintenance crew what to get, 60 amp 380 V 3 phase. 20 amps just doesn’t do it.

Rick has the patience of a saint. I, on the other hand, was assiduously avoiding the area because I had by this time flipped most of my internal breakers.

All the troubles were solved, they bypassed the fuses on the switch (really safe) and we were off and autoclaving. About this time, I was called into the OR to start the mastectomy.

I was happily prepping the patient when the power went off. Word quickly came to us that the generator was on fire. This was worthy of investigation. So, I scrubbed out and dashed up to the generator room. No flames, because JP knew how to use a fire extinguisher. Turns out that the radiator got blocked and so the engine overheated and caught the roof of the generator shed on fire. This is a Perkins (top British brand) 125 KW diesel generator, it is supposed to have safety shut offs for overheating, low oil etc. That is when I was shown the wire bypass someone had done to bypass those safety mechanisms. Wonder who thought that was a good idea?.

Fortunately, about that time state power came on, so back to the OR, and back to restarting the autoclave. Sadly, state power is weak, so the air conditioning did not work and it was like operating at Bere Hospital. (Those guys are really tough.) During the most critical part of the operation the power went off again and I was so grateful to have my surgical headlight, axillary dissections are really difficult to do by braille.

I think maybe that is why on Monday I really wasn’t that upset about the break in. Just didn’t seem that bad. It is all relative.

Good news is the lady with the mastectomy is doing great, the autoclave now has 60 amp switches, and works, we actually sterilized some packs, we have had water all week, and the generator is back in service. God is good.

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

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