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.

The Mokanji Life

Really I am enjoying it. The people are friendly and Sierra Leone is a very social culture of greeting everybody and just sitting around and talking. Since there are only 6 North Americans in Mokanji and we are the newest transplants and the only ones with kids we seem to get our fair share of visitors, although most of our visitors are kids. They eagerly wait for the kids to come out and play with them and during the afternoon while the kids are taking their afternoon quiet time/nap, they will hang around our porch and just watch Jeneson and I read or be on the computer. When they aren’t being social they are working. They have to work to get water from a hand pumped well every day, they have to gather wood to cook over a 3 stone fire or use coal in a coal pot, they do their laundry by hand; almost every task that Americans use a machine or appliance to do, the people in Mokanji do it the ‘old fashioned way’, by hand.

We are only about 150 yards away from one of the two hand pumped wells in the village, so during the day we get to hear a lot of talking, a lot of hand clapping and singing as the girls wait their turn in line, and the occasional fight. We also get the frequent visitors of ladies and kids selling various food stuffs out of buckets precariously balanced in their heads. There is even this sweet girl who walks from the next village over to sell me woven baskets that her Daddy weaves. These are great, quality baskets and she sells them for 1000 Leones ($1 ~ 4300 Leones). I usually give her 2000 Leones and don’t ask for change in addition to giving her a cup of water and a muffin if I have one around.

Less than 300 yards from our house is the Old Skool Nite Klub (yes, that is how it is spelled!). There may be no village electricity in Mokanji, but at least 3 or 4 times a week we hear the generator get fired up at about 8pm and instead of hearing native African drumming in the distance, we get to hear the latest in popular music in Sierra Leone.

Our evenings, after the kids are in bed, are often spent out on our front porch enjoying the cool, breezy Mokanji evening. Here we can process any events of the day, evaluate how we are adjusting, or just enjoy each other’s company. I usually get my chocolate fix in the evenings with a nice cup of hot chocolate.

Our first week

     Not quite sure how to sum this all up in one blog post that doesn't go on and on. We arrived safely in Freetown on Friday, Feb 24th and spent the next several days gathering supplies and getting some paperwork stuff done. We stayed at a family resort that was right on the beach, had free internet, free breakfast, and free laundry. While this was a little more than we planned on spending, it did allow us to get quite a bit accomplished since we didn't have to worry about those things. We were very thankful for our Sunday day of rest and the kids enjoyed playing at the little playground and splashing in the pool.

     Tuesday morning we set out for the drive to Mokanji. Thankfully it is the dry season and some of the local mining companies had graded the roads, so what was a 7 hour drive in September was now a 5 hour drive.

     Our house looks beautiful! It is roomy enough for all of us and quite functional. We are lacking in some furniture/shelving so unpacking was basically  reorganizing into specific suitcases. We are waiting on getting some shelves/bookcases built so that we can get a little more settled. Our furniture now consists of a nice table and 6 chairs, a bed frame and mattress for Jeneson and I, a bed frame and mattress for Josiah and a mattress on the floor for Sofia. Hopefully by the end of the month we will have steel bunk beds made for Josiah and Lydia and some shelving put up. Right now all of Josiah's clothes are in one suitcase, my clothes in another, etc...

     My pressure cooker from Freetown is my new best friend and I hope to be start blogging about some of the meals that we are eating. Right now it is quite basic, but nutritious and filling. Even Lydia, my picky eater, says "Mommy this is sooooo good" at almost every meal. I think that she realizes that her options are limited.

     I do laundry by hand every morning; clothes one morning, diapers the next and hand them to dry on our porch. The kids are always out playing and there is usually no shortage of playmates.

     Jeneson and I have been able to see a few patients in an unofficial capacity and have, unfortunately, witnessed the cold, hard, reality of the poor health statistics in Sierra Leone and Mokanji.

     There is a short-term team arriving tomorrow that includes 2 pediatricians that we will be able to work with. We are also hoping to meet with the District Medical Officer, the President and Director of Development for Global (they are coming with the team), and the local Community Health Officer to discuss the start of our medical services and how that is going to look. Please pray for these meetings, that all will go well with them.