August 2013 archive
Sierra Leone: a wonderful place full of colour and life. An incredibly religiously tolerant society but nevertheless suffering a recent civil war which devastated the various communities. Also interesting to know that Freetown was built as a home for slaves freed from the British Empire. How the colonial history has followed us down the West Coast!
Day 23 Flight For Every Mother: a very early start for a live interview on the ‘Tea Break’ breakfast show at the Sierra Leone Broadcasting Corporation. What an opportunity! I spent an hour between an Imam and a drug’s counsellor discussing teenage pregnancy, my experiences at our school visit and what we hope to achieve with the Flight For Every Mother Project! To promote safer pregnancy for mothers everywhere! Quite nerve wracking to be interviewed live, and somewhat strange to talk into a microphone instead of to someone’s face!
We’ve got the DVD; still trying to work out how to share it!!
Next stop – the Princess Christian Medical Hospital and a very warm welcome from the medical superintendent and midwifery matron. We taught 18 midwives from all clinical areas: a lecture about the causes of maternal collapse and a practical session about how to deal with Obstetric haemorrhage and a baby not breathing well after birth. Very interactive and a great deal of interest, not least for the introduction of regular practical updates covering emergency skills to maintain good clinical practice – an idea which we very much supported.
Our donations went down really well too, both at PCMH and at the district facility at ‘Ross Road’ that we visited afterwards. You would have thought the midwives at Ross Road had won the lottery when they were presented with a new electronic blood pressure cuff. That was a nice feeling.
Wow, what a day!
First stop, after a traditional Sierra Leonean breakfast of course, was St Joseph’s Secondary School in Freetown where many pupils were attending a summer school programme during the school holidays. The head teachers were really pleased to see us:
and they loved our idea of a motivational talk about education and economic empowerment leading to delayed and more successful childbearing:
I had lots of questions from the excited group, including how to avoid teenage pregnancy, what are my biggest challenges as a female pilot and what i experience when i am up in the air!
Stanley from the Sierra Leone Broadcasting Corporation was filming throughout; infact he became a familiar face in the days that would follow!
As most will know, medicine and politics are closely linked and this applies in particular to sub-Sahara. Often funds are controlled by the Ministry of Health, as well as overseas partnerships including new training projects and the new use of particular medications as examples. We were lucky to have an opportunity to address the Minister for Health and Sanitation in the afternoon and it was wonderful to meet a dynamic young woman clearly passionate to improve women’s reproductive health as a priority:
She wished us luck on our quest to promote safer pregnancy and made particular reference to the issue of teenage pregnancy, which would be the topic of our breakfast radio interview the following day.
Here is another interview from Sierra Leone, this time with a front line midwife called Elizabeth, focusing on the particular challenges she faces on the labour ward.
In this short interview from Sierra Leone, Mrs Beatrice Y Tommy, District health Sister from the District Health Management Team, Moyamba talks about the importance of clinical skills training in Obstetrics.
And finally we could leave Bissau!
My overriding thought was of the honesty, generosity and demonstrable happiness of the people that we had met during our short stay. Contagious.
Interesting sights, though, at the airport on departure:
And then we had the unwelcome surprise of a leak, which had soaked most of our medical supplies and medical bag. Luckily most things were salvageable! I guess we shouldn’t have been too surprised; it is the rainy season and apparently unusually heavy…
It was a bumpy flight to Freetown on account of cloud; when we did get a view of the ground over Bissau and most of Guinea it was of waterlogged areas full of mangroves and rivers:
Further South the land became generally more cultivated:
And we overflew the elusive Conakry, frustrated somewhat that other flights were clearly permitted to land!
Freetown’s airport, at Lungi, is built on flat land approximately 10 miles from the city BUT there is a large river – the Sierra Leone River – between the two. And when I say large, a mean very large, especially with the rains:
We took the water taxi option:
Ross had his risk management hat on as he listened to the engine:
And there we were – finally in the city! Betty Sam of Liverpool School of Tropical Medicine’s Making it Happen Programme met us off the boat at Aberdeen and took us to our accommodation, kindly gifted to us for four nights by Health Poverty Action. We caught the end of LSTM’s latest course, a course that is very familiar to me as a member of their faculty. They had trained almost 70 front line health workers in life saving skills (such as airway management and cardio-pulmonary resuscitation) and Emergency Obstetric Skills (such as the recognition and management of pre-eclampsia, and how to manage a baby in the breech position) and Newborn Care (resuscitation of the newborn) that same week. In fact, it was to teach with them that I had first visited Freetown in 2009 as my interest in global Obstetrics started to really develop.
The group had developed a song ‘Don’t let our women die when they come to deliver:’
For sure the message is getting through.
On Tuesday 20th we made the decision to fly directly to Sierra Leone and abandon our prior plans to go to Conakry; luckily our local contact in Conakry understood, although everyone concerned was disappointed…
Monday 19th August – we had already planned to be in Conakry, Guinea by now with only the briefest of stops in Guinea Bissau en route. But our landing permit didn’t come, and didn’t come and still didn’t come. So we wandered back to our plane at the international airport (it really was that easy!) and wandered back out again with clean clothes and a bunch of donations for the local hospital.
A taxi back from the airport was harder to come by. I think we looked a bit of a sight standing at a roundabout with posters and bags and boxes, and we started to be hassled. First from the one side and then from the other too. And then a big 4 by 4 pulled up and beckoned for us to get in. It turns out our new friend’s sister worked in maternity at the local Simao Mendes Hospital and we were dropped right at her office door!
Mrs Maria Guilhermina Mendes. She was a midwife trained in ultrasound scanning and, as it turned out, desperate for paper on which to print pregnancy pictures for her patients. Unfortunately i didn’t have any in my bag!
We were joined by the medical director and his assistant, and finally by a very busy Obstetrician/Gynaecologist, Dr Alfredo Claudinoalves, one of only 3 specialists in the entire country. All four personnel were very overwhelmed by our donations of basic midwifery equipment, teaching posters, pregnancy tests and a pulse oximeter courtesy of Lifebox (www.lifebox.org). This latter piece of equipment is vital to ensure the safety of seriously ill patients and also patients undergoing anaesthesia, and in this hospital delivering approximately 7000 babies per year ( +/- 16% caesarean section rate) they have a huge need for more than the one existing pulse oximeter in their operating theatre areas.
The hospital itself was made up of many different buildings – not so well connected to each other, especially given the rainy season. We were driven to the maternity department from the main entrance, such was the distance! A two story building; cool inside. Each ward had about 10 beds. Three particularly interesting things to me as an Obstetrician were 1. that the patients with postnatal infections, like caesarean wound infections, were all warded together, 2. eclamptic (‘fitting’) patients were cared for in a two bed room, very small, very dark and very quiet – these attributes thought to improve the disease progression, and 3. the neonatal unit housed premature babies together with their mothers, because staffing was such that the mothers were relied on to call for help if the condition of their babies appeared to change.
The labour room was for women in advanced labour, and had 3 beds:
The room was scrubbed as clean as possible and the beds functioned to a degree but I did think hard about the rooms in which my patients deliver in the UK, and about what a privilege that they would be for these women from Bissau.
And so we left the maternity block past happy, smiling women, all sharing food and childcare and stories, and headed back to our hotel, past the armed vehicles, to wait another day to leave Bissau.
Guinea-Bissau. A country about which I have been curious for a while. Finally we arrived after an easy visual approach to the runway (when air traffic control finally let us through!), and to an empty parking area:
We were wondering who the smart black car is for (certainly not us!!):
So, a country of 1.6 million, previously colonised by the Portuguese and with a recent history of conflict. A very high maternal death rate at 790 / 100,000 live births, or thereabouts. Less than half of all births attended by a skilled practitioner and a high rate of teenage pregnancy – about 1 in 10 girls.
Bissau, the main city and where about a third of the total population live, seemed busy and full of life:
Kriol – a Portuguese creole – is the most widely spoken language. That should make my hospital visit interesting (just as I was getting used to speaking French!)
And so after a short taxi ride we arrived at our hotel, the Azalai 24 de Setembrio (presumably named after the official date of declaration of independence) and an old army barracks. Little did we know we would be ‘captive’ here for so long…
Today we left Banjul, destination Bissau. Infact we made a slight detour to Zigunichor in Southern Senegal, not because it has a cool sounding name, but because we were initially refused permission into Bissau’s airspace! All sorted thanks to our great friend Mike and off we went to Bissau.
See our flight from Banjul to Zigunichor here:
So one of the goals of Flight For Every Mother is to deliver Obstetric and Newborn skills training to doctors and midwives that I encounter along my route, including basic resuscitation of the newborn and resuscitation of a mother who is bleeding heavily – for which I sourced and packed 2 purpose-specific mannequins.
Imagine the scene: arrival at X International Airport, met on the apron by a team of enthusiastic airport employees keen to help such an unusual and ‘special’ flight, whisked through passport control to customs. Bags go through the X-Ray machine. Problem encountered – ushered to a tiny room with 5 customs employees.
I had been expecting questions about why I was carrying a lifelike baby doll of course.
What I hadn’t been expecting was this when her head was unscrewed:
I think this is a case of a picture saying a 1000 words! Could a mannequin billed for overseas teaching really be thoughtfully constructed like this? Needless to say we were rather shaken, the manufacturer has been contacted and Baby Anne has stayed in country X where I am sure she will be well looked after!