Our African Birth

If you have been following my blog for a year or more, you most likely read about the birth I witnessed when Josiah and I visited last September. Africa is not a very labor and delivery friendly continent and Sierra Leone has one of the worst records when it comes to maternal and infant deaths. So, why, many would think, would you voluntarily go to Sierra Leone while pregnant and deliver your 4^th child there. Truth be known, I cannot logically explain it. God has lead our family to minister to the people of Sierra Leone physically and spiritually and He works in mysterious ways.

While there was some trepidation on our part about me delivering a baby in Sierra Leone, we were confident in God’s provision, no matter the circumstances. We also looked back at my previous three deliveries which were quick (2-8 hours long) and uncomplicated. God did provide even though the labor and delivery did not go as we envisioned.

I started labor on the evening of July 8^th with some mild contractions and both Jeneson and I figured that in a few hours (while the kids were conveniently asleep) I would have our newest daughter. Needless to say, it did not happen like that. Hours past and still not much progress. We called Ann Marie, one of the national nurses who was going to help us with the delivery. 12 hours later and still in labor…. By noon we sent the kids over to our neighbors for lunch. It was decision time. Do we get in the truck to start the 2 hour drive to the nearest hospital where I would be almost assured a c-section or just be patient. We needed to make the decision soon since travelling in the dark on the roads is not any fun, especially during the rainy season. Ann Marie and I wanted to stick it out at home, while Jeneson was ready to head to the truck. I decided that we needed some more advice. So, I decided to make a call to my old midwives back in Forest Park, Illinois. Thankfully, the office was open and Shirley was there. An hour after implementing her advice, Rebekah was born! She took 18 hours to enter the world, longer than all her older siblings combined!

Our running joke is that Rebekah truly is an African child as she was born in ‘African time’. In North America we are a very time-oriented people, constantly looking at our calendar or watch. In Sierra Leone ‘tomorrow’ just means sometime in the future, which may or may not be the next day and scheduled events often start hours later than planned

Rebekah was given the middle name ‘Salone’ which is African short hand for Sierra Leone. This way she will always know that she was born in Sierra Leone, Africa. She was also christened with the Mende name Kenyah which means ‘born in another country’.

Jeneson and I were so grateful for God’s provision, even if it was not how we had anticipated!

When it Rains it Burns...and Turns Violet

It is June and already the rains are beginning to pound the coastal countries of West Africa. We have been in Sierra Leone for just over 3 months now. When we arrived in late February, the climate was akin to Chicago or New Orleans at the peak of summer, hot and humid and on some days…very hot and very humid.  The rains are a welcome change for many reasons, the biggest of which is, you guessed it, water. The lines at the water pump tend to be shorter since the rains have begun. The children seem to spend less time at the wells pumping water as the rains can fill all the containers at home to overflowing.  The air is also less smoky now that the rains put an end to farmers who, in the 21^st century, still insist on burning to clear farmland and prepare for cassava planting. But the rains also bring a few hazards with those refreshing showers, and I am not even talking about the cobras and vipers or the surge in pediatric malaria cases. I am talking about purple children. Purple children?? you ask? Well, let me explain.

The rains force the children indoors. The children who spent their entire day and sometimes a significant part of the evening outdoors wandering, collecting water, gathering firewood and sticks, ‘stoning’ mango, plum and other fruit trees for food, and otherwise foraging in the ‘bush’ find themselves having to spend more time closer to home or worse, at home.  It also means getting closer to the fire and being home when the piping hot food comes off the fire. Yes, here the cultural norm is cooking over an open flame. The stove is three rocks and a pot is placed over it. Some houses have a hut they cook in but it is still open flame cooking. The children who get burned often do from either reaching into the pot still on the flame or from the piping hot food spilling on to them. The story often gets lost in translation but the result is still the same – children with first and second degree burns covered in gentian violet.  Yes, that mainstay of wound care in many an impoverished and resource limited setting, gentian violet. While gentian violet has some great antibacterial, antifungal, and antihelmintic properties, there are better (and less messy) things that can be used. But here, if it is skin related then it calls for some purple haze and for burns and blisters, it is a whole lot of Hendrix. We had wounds that have healed long before we were able to wash off all that dye off the skin.

We currently have at least four children aged 1 through 6 that we are treating for burns. Thankfully all have been manageable within our scope and ability, meaning none of them worse than a second degree. And all are slowly healing with the help of frequent dressing changes, silver sulfadiazine, and the occasional application of Surgilube.

Before starting treatment. The burn is covered in gentian violet and black/purple eschar, so it is hard to tell the extent of the burn.

After about a week of treatment. Almost all the gentian violet has been cleaned off and there is good tissue starting to grow. The worst part of the burn is on his shoulder, but is healing nicely.

The Mystical, the Magical, the Miraculous…Surgilube!

Post conflict Sierra Leone. That is how it is still categorized 7 years after the last of the UN peacekeepers have left; many agencies and companies will pay you an extra stipend for coming to Sierra Leone, so I am told. But in the ‘town’ of Mokanji, southeastern Sierra Leone and in the heart of rutile and bauxite mining lands, at least on the surface, the conflicts seem to be confined to the water wells and pumps where some older kids feel the need to ‘flog’ a smaller child in line to fetch water or under the plum tree where 5 kids battle for one or two juicy plums that was knocked down after 30 minutes of stone throwing or ‘stoning’.  But in a society that still holds on to primitive farming techniques and venturing into the ‘bush’ for most necessities, cuts, lacerations and puncture wounds are a daily occurrence and often lead to major infections and even debilitating complications.

Once the word got out that ‘pumwae doctors’ (not sure how I feel about being referred to as ‘white’ although on a few occasions I have wished I was, but that will be for another post) were in town, they seemed to come out of the woodwork. Two week old machete wounds with gangrene, month old wounds with frozen joints and contractures and more than one injection site abscess from local practitioners whose answer to all maladies involve a ‘shot’. They all had the same story, “I having drinking the potion that the local medicine man has been giving me but I not getting better”. Or worse, “if I go the Freetown (the capital city) they will just amputate” The exact truth of this is unclear but I am sure it is somewhere in the middle with someone who went to the capital and ended up getting an amputation and the family’s reluctance to come up with the money needed to pay for the cost of transportation to the city.

It was our second week in Mokanji and my pregnant, yet eager and very OCD, wife decided to tackle and inventory the ‘Men's Ward’. For those who are not familiar with this place (and that would be all of you), it is part of the building that will eventually be the Men’s Ward and where most everything is stored, medical and otherwise, and we were eager to get a handle on what kind of supplies we had on hand. And that is where I discovered the nearly 500 single use packs of …that’s right…Surgilube, that very nectar of the Operating Room, that essence of sterility, that bacteriostatic potion that has saved the reputation of many a wayward surgeon.

Wound care has taken on a whole new dimension in this ‘rustic’ setting. Cleaning and keeping them clean is a monumentous task where ‘keep it clean and dry’ is not only easier said than done, it is often lost in translation. It is cost prohibitive and logistically impossible to do daily dressing changes, and semi-sterile conditions to do dressing changes, well it only exists in my dreams. So… Surgilube to the rescue.

Soak and thoroughly clean the wound as best you can and lather on the Surgilube. Apply dressing and tell the patient to come back in 3 days. It is a beautiful sight to see a clean wound on the first dressing change and granulating tissue with the second dressing change on a wound that was all dead tissue and pouring with pus just a week ago. 

Two inch injection site abscess with tunneling? No Iodoform gauze? No problem. Pack every three to four days with gauze soaked in… you guessed it…Surgilube. Three to six weeks and it is all filled in. Ten days of PO antibiotics doesn’t hurt either.

As my fame spreads to nearby villages, there is a down side...I am running low on Surgilube.

On a more serious note, please be praying for a 4 month old baby girl I am treating with a huge abscess from an injection to the right buttock (administered by local untrained ‘practitioner’ and an inappropriate injection site for a 4 month old) that was initially treated at a hospital 2 hours away but asked to find continuing wound care closer to home.

1 month old infected machete wound

One month later, thanks to a course of oral
antibiotics, frequent dressing
changes and Surgilube

This is just one example of how a round of oral antibiotics and frequent dressing changes can make a difference in a wound. While he has limited range of motion with 3 fingers, at least he still has his fingers and his hand!

Josiah's Easter

Easter Sunday started out as any other Sunday: breakfast in the morning, followed by me doing laundry and a 10 am departure to walk about 7 minutes to the local Methodist Church. The church was full of men and women dressed in their Easter Sunday best and filled with singing both traditional hymns and African praise songs. After about an hour the girls had gotten restless enough that I decided to walk home with them. (Man do I miss nursery and children’s ministry!!!). Josiah was complaining of a headache so he decided to walk home with us. By the time we got to our doorstep he was in tears and saying that his stomach hurt also. He had a mild fever so I gave him some ibuprofen and had him lay down in our bed. He would intermittently wake up crying and it would go back and forth between his head hurting and his stomach hurting. He threw up a couple of times and was unable to keep down any fluids.

About 5pm I started to fix dinner and about half way through the beans being done our cooking gas bottle ran out of gas. As luck would have it our neighbors had our spare bottle locked up in their house and they were gone for the weekend! No bread in the house, so I walk the 10 minutes to the local store and discover that they had 2 small buns left and were expecting some fresh bread in a couple of hours. Fatmata is a wonderful lady and must have sensed my disappointment, “I’ll have them drop it by when it comes” she replied. Francis is the local baker who also works at one of the area mines so his baking schedule is somewhat erratic. I returned home to a still sick Josiah and fed the girls PB & J sandwiches with the 2 small buns. After we put the girls to bed we decided that since Josiah had not improved at all and was still not keeping any fluids down that we would go up to the hospital and get the supplies to start an IV on him. Let’s just say that Josiah is not an easy patient! By the grace of God I was able to start an IV on my poor little boy on the first try and knew he was sick because he did not fight us too much. Jeneson and I took turns ‘sleeping’ on the rug in the living room with Josiah.

By the next morning he was not having any stomach pain, only a mild fever and small headache. He started eating and drinking and by the afternoon was almost back to his usual self. We made him stay all day on Tuesday and by Wednesday was out and running around again with all the local kids. Still not sure what caused him to get so ill, but thankful to God for Josiah’s healing. Gave me a little glimpse of what the village mothers go through when their children get ill. I am looking forward to the clinic construction completion so that we can treat some of these children and ease the worry of their mothers.

Freetown Fun!

Yeah right! It has been about a week and a half since we returned from our last trip to Freetown, the capital of Sierra Leone where we go about every 4-6 weeks to restock on provisions. If you are a FB friend you have read more than one post on how we really don’t like Freetown. It is full of congested streets, craziness, and noise, but it is also one of those necessary places we must go.

Our goal this trip was to finally get our Driver’s Licenses. We filled out the paperwork and gave the money to our intermediary our previous trip and were awaiting our residency permits before being able to get our actual license. The trip to Freetown takes about 5 ½ hours with the first 1 ½ hours over dirt/gravel roads through small villages before hitting actual pavement. The next 3 hours is pretty smooth sailing over decently paved roads before hitting the outskirts of Freetown and the horrendous Freetown traffic. It can literally take an hour or more to get from the outer limits of Freetown to the central area where we stay and most of the shops that we frequent are.

Kissy Road is the main road into and out of Freetown. Lucky for us the Sierra Leone Road Authority is located on Kissy Road toward the city limits. So OUR plan was to just stop by there on our way into the city and get our licenses done and out of the way. We phoned our intermediary and he said no problem. We roll into the congested parking lot only to find out that they just ran out of printer ribbon to print the license! And no spare ribbon?!?! We did convince the guy to give us our paperwork so that Jeneson could drive within the city until the next morning when we would return and pray that they had found some printer ribbon. Back onto Kissy Road. On Kissy Road your vehicle can be at a standstill for literally 5-10 minutes before moving another 10 yards or so. It is a two lane road with enough room on either side of traffic flow for motorbikes to squeeze past. One of the good things about Kissy Road is the shops on either side. You are moving so slowly that you can really find almost anything that you are looking for, jump out of the vehicle, make your purchase and not have to walk too far to get back into the truck!

We made the crawl back and forth on Kissy Road the next morning and finally received our Driver’s Licenses. A big thank you to our intermediary, Joe, who made it possible to do all this without standing in one single line! And by the way, Driver’s Licenses photos are horrible the world over!

The rest of the trip consisted mostly of Jeneson staying in the truck with the kids while I ran into various shops and stores to make purchases. We restocked on our food supplies, made some medical and supply purchases for the clinic, bought some household goods on Ecowas Street (big street market), and even bought a computer printer. I’m not sure who had the worse end of the deal: Jeneson in a parked truck with 3 small children or myself running around in the heat and sun, in and out of various shops and haggling with vendors.

We stay at a Catholic guest house near the downtown area that has reasonable rates, but spotty electricity and water supply. We are ever grateful to get back to our quiet African village with our reliable solar power and well water!

Freetown – one of those necessary evils in the life of a Mokanji missionary.

Laundry day is every day!

For the women of the village, they have to go to the pump or the spring to get the water for their laundry and use a large basin that is on the ground; I at least have the luxury of running water and a large concrete sink outside the house. How does one do laundry for 5 people in Mokanji? The simple answer is that I do laundry every day. Clothes laundry gets alternated with the diaper laundry so that I do clothes laundry on the odd days and diaper laundry on the even days. This helps keep the volume down to a reasonable level.

Once I get the kids up and dressed and started on breakfast I take my bucket, dirty clothes, washboard, laundry brush, and detergent to the outside sink after turning on the water shutoff valve (There is a shutoff valve in our kitchen so that people aren’t using our sink as their water source instead of the pump.) A tablespoon of laundry detergent works well to clean a bucket of clothes or diapers. After clothes, detergent, and water are added to the bucket, my left hand/arm becomes the agitator as I mix things up and then let it soak for a few minutes. The washboard is good for clothes that are only mildly dirty (basically mine and Jeneson’s clothes) and just need a little extra scrub to get clean. Since the kids play in the dirt all day their clothes usually get double duty with both the washboard AND a good scrubbing with the laundry brush. After all the clothes are washed and put aside, I rinse out the bucket, add the clothes back in and turn on the water. They all get a little manual agitation again as a ‘rinse cycle’ before I wring them all out, put it all back in a now clean, empty bucket and take it to the front porch to hang for drying. The diaper laundry gets an extra soap ‘cycle’ and a few more rinse ‘cycles’ to make sure that all the detergents gets rinsed out.

The advantage of the dry season is that the temps are nice and warm and the humidity nice and low so that the clothes and diapers dry quite quickly. This will NOT be the case during the rainy season when it will take a day or two (or maybe even 3) for the clothes to dry out. All told, I spend about an hour total each day doing the laundry from washing the clothes to hanging, folding, and putting them away.

The biggest washing hassle I have is doing my and Jeneson’s pants and the bed sheets and bath towels. They are just a pain because of their size and are therefore more labor intensive.

Makes you really appreciate your washer and dryer and having a laundry day once a week and being able to just push some buttons and forget about it for a while!                                                                                                           One of many statements that I never imagined coming out of my mouth: "I would love a washboard Charles! You have an extra one? Thanks!"

The Kid Life

The children in Mokanji are very friendly and many of them remember Josiah from when we were here back in September. While everybody is still trying to remember our names, they shout Josiah’s name from their houses as we walk down the road. Many kids do not go to school because of the lack of school fees and even if they are in school, I’m not sure how long they are there every day because I often see kids in their school uniforms outside our house well before lunch time.

The boys love to come over and kick the soccer ball around with Josiah and he is also tries to play cricket with them (not that he really knows how to play). He will go out and just hang out on a cut down tree with them throwing stones or use sticks to make some pipe scraps lying around into a drum circle. Lydia is our dirt magnet; she will go outside and play in the dirt for hours if we let her. She also likes torturing all the grasshoppers with sticks and climbing on the cut down trees that are in the compound. She seems to enjoy playing with the boys more than the girls because the girls are seem to be a little more aggressive while the boys are a little more gentle and helpful with her. She is very adventurous and has many a scrapped knee already. Sofia is our social butterfly. She loves using the Mende phrases that the other kids have taught her to make the adults chuckle and has no reservations about the locals picking her up and toting her around. Sofia gleefully pats us on the leg or arm and tells us about every bug, goat, dog, and chicken she sees and also enjoys roaring like a lion at the grasshoppers.

The kid life in Mokanji is not all fun and games. They have work to do; they often help with gathering the wood for cooking, preparing the meals, hauling the water, walking around the village selling food items, and watching over younger siblings. On one hand, they don’t have an easy life, they have to work hard; they have many struggles to stay healthy and get an education. On the other hand, they often seem so carefree and enjoy the simple pleasures of life like playing soccer and throwing stones at the trees.