Thursday, November 5, 2020

Some not too sad stories

There are things in Sierra Leone that are starting to seem normal, but when we say them out loud it sounds ridiculous. I want to compile a few of those stories here.

The first is a story from Rachel. During COVID all of the outpatient services were constrained to one room in one building: Registration, Payment, Consultation, Minor Procedures and dressing changes, etc. There’s basically no privacy as every section is just separated by fabric curtains. A patient came in with a large laceration on her leg from falling in the market onto some exposed rebar. It became infected and she had to come back daily for dressing changes and wound care. Sometimes she would be screaming so loud with the dressing changes that we’d have to shout to hear our clinic patients. But nobody seemed to mind.

We use honey dressings for their antibacterial properties and this woman really needed it. They keep the honey in a plastic water bottle, but this bottle was running low. Since everyone pitches in, a lady from accounts grabbed the 20L container that we store the extra honey in. She used a scoop to fill up the small water bottle and handed it to the nurse. I watched as the nurse applied the honey to the patient’s wound. But when I looked to my left, there was the lady from accounts, standing right next to the patient, licking the honey from the scoop! (Why waste honey??) Can you imagine being a patient and watching someone eat the very thing a nurse is putting directly into your wound?!

Another instance is regarding our night security, Pa Brima. This guy works very hard. He has both day and night jobs most of the time. When he comes for his shift at our house, he usually changes clothes into something more comfortable for the evening that he doesn’t mind if they get dirty. One night we have other Americans coming over for dinner. As is usual, we decided a time for them to arrive. When Brima came for the evening, I warned him that they were coming at 7 PM. The appointed time comes and I hear a honk at the gate. I go outside and I see Brima opening the gate for the car. His shirt is half pulled on and wadded up around his nipples; thankfully his undershirt was properly positioned. He doesn’t have any pants and is wearing only boxers. Everyone gets out of the car and happily greet him because they know him from another job. Then we all go into the house. Nobody mentions it. It’s somehow normal for our security to be half dressed.

Lastly, a story from a patient in the ward. On one of our mobile clinics, John Max Conteh (one of the midlevel providers, a CHO), saw a child who was 7 months old and weighed less than 3 kg (6.5 lbs). This is the most malnourished child I’ve ever seen. This child’s name is Neneh (a girl’s name) even though he is a boy. The mother had so many baby boys die, that when she saw this one was a boy she gave it a girl’s name in hopes that whatever killed the others wouldn’t effect this baby. I sat next to the woman and baby on the bed and facing us was the husband sitting on another bed. I was asking them questions about their living situation, their other children, this child’s birth, etc. I asked if the mother was breast feeding and she was. I asked if she was making much milk and instead of answering the question, she just pulled her breast out of her shirt and squeezed it. Breast milk came out more like water than milk because of her malnutrition. But when she squeezed it flew out and sprayed all over her husband who was sitting directly across from us! I was the only one who was surprised by this, everyone else carried on the conversation as normal. “See, she’s making milk.” 

Anywhere you live, life can be sad and life can be strange. But the longer you hang around, the more normal things seem. I think this is how cultural blind spots are formed. But for now, I still relish the cartoonish absurdity of daily life.

Tuesday, October 20, 2020

What Kind of Week Has it Been

It’s only Tuesday but this week has already hit me hard with the reminder of how stupid Africa is. It’s stupid that by sheer chance you can be born into a country where death is so common, poverty is rampant, hunger is fierce, and illness is beyond healing. It breaks my heart. And if by sheer chance I was born in Africa it would break me. But these Africans are strong in so many ways. 

Here’s this week’s happenings so far:

A 40 year old man who is quickly on his way to death’s door due to multiple infections ravaging his body. Infections that could be easy to treat if it weren’t for his positive HIV status. HIV is treatable. And in this country the treatment is free. But the stigma behind HIV is so strong that even after meeting with the HIV counselor he denied it to my face that he had HIV. He told me the counselor tested him and it came back negative. I call the counselor to make sure I hadn’t misunderstood her when she told me he was positive. I hadn’t. He still denies it. HIV can tear families apart and leave patients stranded without family support. I hate the stigma behind HIV. It drives people to choose an early painful death over the possible judgment and abandonment they might receive from their friends and family. Africa is cruel. 

One of my favorite staff at the hospital is a young guy in his 20s that was laid off when coronavirus reared its ugly head. In order to keep his 'job prospects,' he still shows up to work every day. He begs food off of friends. Or if he is asked to get something from the market for work he is given money for transport (20 cents). He takes the money, runs to the market and back to make it the same speed as transport. Then he uses the transport money for food. He came to my house to help fix a leak in my water tank and I saw him take a half rotted orange from my compost pile and put it in his pocket for later. Africa is senseless. 

The second the young man walked into my exam room I knew he had a terrible infection because even with my mask on, the smell was nauseating. He pulled down his pants and I could literally see his intestines and stool coming out of his low abdomen. His scrotum was so inflamed and infected it looked like it could fall off. When further examined, every place his scrotum attaches to his leg is just rotting away. Africans have an amazing pain tolerance. There’s no way I would be walking and talking calmly like him – someone would have to carry me and I would be wailing. I don’t fully understand what causes people to wait so long to seek medical treatment. Fear? Lack of funds? Tried the witch doctor first? Any one of those you pick is directly related to having been born into this country. Africa is unfair. 

A family lost their 3 year old boy at 4 AM this morning. He had a hemoglobin of 3 (normal is >12) and severe cerebral malaria. The peripheral health unit without a blood bank or doctor, kept him for 48 hours before transferring him to us just before his death. Africa is heartless. 

And it’s only Tuesday….

“He will wipe every tear from their eyes, and there will be no more death or sorrow or crying or pain. All these things are gone forever.” Rev 21:4

Can’t come soon enough. 

Friday, September 25, 2020

Camping Degree

I graduated from Union College in Lincoln NE in 2011 with a BS degree in International Rescue and Relief (IRR). It was a great degree for me: international experience, networking with lots of like-minded people, met my pre-medicine requirements, and had exciting classes like ocean survival, high angle ropes rescue, and a semester overseas.

But the thing that sticks out in my mother’s mind is how much time I spent outside of the class room. She affectionately calls it my “Camping Degree.” If I ever come up with an unexpected solution or have some strange trivia at hand she will ask, “Oh, did you learn that from your camping degree?”

There have been several experiences recently that have brought this back to mind.

Prior to COVID, we would carry our laundry to the hospital every Friday and Ami would use those facilities on our clothes. But another solution needed to be found now with the hospital’s functionality limited. So I set out to hang a clothes line on our front porch. The pillars are far apart and maintaining proper tension for an entire wet wardrobe was difficult. So I designed a mechanical advantage system using carabiners, paracord, and some hammock straps. Unfortunately, I was one carabiner short. Here’s a picture of my ultimate improvised locking carabiner:

The Most Secure Clothesline on the Block ™

Access to running water is always a struggle here. The international travel and survival training helped me prepare for living in Sierra Leone. The other night it was raining hard and there was lots of water coming out of the newly installed gutter on the house. So I seized the opportunity and had an unlimited water shower with excellent water pressure.

Lastly, it’s always nice when dreams from the past come true. While I was purchasing gear for IRR it was easy to dream big. ‘I might need a 0 degree bag if I ever climb to basecamp on Everest.’ Or ‘I might need this expensive headlamp if a natural disaster destroys the power stations for weeks on end.’ 
Most of the rationale that I used for expensive gear never (thankfully) came to fruition. But in this instance it did. When shopping for a backpacking stove there were several options. The two I was torn between was the MSR Whisperlite and the Wisperlite International. They are basically the same except the international version can burn more than just camp fuel. It takes camp fuel, or petroleum, or diesel, or kerosene, etc. I thought to myself, ‘Who knows? Maybe I’ll be stranded in Africa somewhere and be super hungry. This could really help!’ And just like that, I bought the more expensive one.
Well, last Sabbath the natural gas for our stove finished and the backup was empty. As I filled the camping stove with fuel from our generator, I happily reminisced about my time at Union. I had proved once again, that my so-called ‘camping degree’ provided me with more than just happiness or meeting pre-med requirements, it performed as promised and prepared me for the future.

Wednesday, September 16, 2020

Six Degrees of Separation

I’ve never had an opportunity to really witness the theory that any 2 random people on earth only have 6 people connecting them. This theory states that if person A knows person B, who knows C, who knows D, etc. there are only 6 connections that need to be made between anyone, anywhere.

This week I had a young woman come to my clinic who had been referred to me by name, which is strange. Doctors in Sierra Leone don’t really know me and wouldn’t refer patients to me anyways. Past patients do spread via word of mouth, but usually they just send patients to the hospital, but not to me directly. She had my name written in a text message.

She presented to me with some longstanding neurologic condition that I don’t fully understand. At the age of 20 she began to have right sided leg weakness that spread to her right arm, then progressed to gross motor tremors. She was diagnosed with hyperthyroid and started on Carbimazole, but since then her symptoms have progressed. Even though going to college, her hands can barely grip the pen due to fine motor deficits. Her right leg can’t fully straighten. When I try to straighten it forcefully, it starts to subconsciously writhe like a fish out of water. There’s other weird stuff too, but that’s not the point of this blog.

After exhausting my medical curiosity, I asked about how she knew about me. She told me about an uncle in the US who knows a woman (whose name I didn’t get). This woman is the daughter of EJ Heisler, who I met at my in-law’s Seventh Day Adventist church in Bismarck ND. I met EJ last year and was thrilled to meet me because he worked in Sierra Leone, at Masanga Hospital, in the 1980’s. 

Let’s count the connections: My patient -> Uncle in the USA -> EJ’s Daughter -> EJ Heisler -> Me. 

Apparently there are only 4 degrees of separation between me and a random person in Salone. That’s crazy!

I was so impressed, that I told my friend CHO Abu about this strange connection that even stretches through North Dakota. His response, “Ah! I know Pa Heisler! He got me the job at Masanga that started my career. He was so kind that every month he would buy all the single men a bag of rice, cooking utensils, even matches to start cooking fires!” 

In the days since Abu told me that story, I’ve been struck with how long lasting kindness is. Pa Heisler has left such a legacy that a random sick patient can find access to an American Doctor. (A doctor who feels way out of his league, but has connections to neurologists in the States) But Pa Heisler’s legacy even extends to my own staff who remember him fondly and tell long stories about the effects EJ had on the country. I heard someone say recently, “There’s no such thing as luck. Only the effects of kindness from one stranger to another.”

Now a bit about the hospital. The government had contracted with us for 80 beds, but since our arrival the number of COVID patients hasn’t exceeded 15. Which leaves the majority of our hospital sitting empty. In a small building separate from the hospital we are running all of clinic, wound care, procedure room for suturing, and only 1 bed for admissions. Because we can’t utilize our facilities, there are no surgeries happening. We have to turn away critically ill patients, and there isn’t enough revenue to pay our staff. Daily, I have staff telling me how they are struggling without salary. But concurrently, almost every week, I see a donation come in through the website. I want to say thank you!

Our hospital couldn’t exist without your support. And whether you see it or not, your kindness has a long lasting effect that will be felt for eternity.

From the bottom of my heart, thank you for your kindness and generosity.

This is a screenshot from a video I helped Abu record to send to Pa Heisler. You can just see the joy on his face that these memories bring. 

Friday, September 4, 2020



Sure doesn’t sound like much, but it feels like a lot. This year we will have spent one complete month in quarantine. Two weeks were paid after traveling back to the US in April and just yesterday we completed our two weeks after returning from Sierra Leone.

It sounds easy: sit at home and do nothing. The first two weeks had their challenges; we really wanted to see our families in person. But these second two weeks came with a whole new set of challenges. Mold, intermittent electricity, intermittent internet, and our water tanks running low. Theoretically, we are supposed to get water from a reservoir maintained by the government. This reservoir routinely runs out of water in the dry season, but it’s still the tail end of rainy season and we aren’t getting any water! Rumor has it that the dam is under repair, and has been for the last 3 months. Nobody knows when the water supply will return.

We had gutters installed on the house to try to regain some control over our water supply. These gutters drain into big blue barrels. When it rains, the huge surface area of our roof, catches quite a bit of water and the barrels fill up in an hour or two. We also have six 20L containers (they are called rubbers here) that I try to fill up while it’s raining. Once the rain has stopped, Rachel climbs on top of the 3000L water tank and I lift up to her the 20L rubbers. Twenty liters at a time we fill up the tanks. So far, we’ve collected about 6000L and are tanks are almost full!

I’ve written before about how easy it is for my self-worth to be wrapped up in work. This stands to be further tested as the majority of the hospital’s buildings are a COVID treatment center. Renovations are underway for some other buildings, but currently there isn’t even a location for more than one person to see medical/non-COVID patients. Are we currently living in Sierra Leone without a purpose?

I don’t think we are purposeless, but sometimes it’s hard to see. Just like one 20L bucket doesn’t look like it adds anything to a 3000L tank, I’m sure the Spirit can use us in ways that are imperceptible to us. But man, it sure feels like the default to live by sight and not by faith.

Tuesday, August 18, 2020

The House

 Here’s part two of the story: Arrival home.


We roll up to the gate at 1AM as the headlights glare off of the years of dust, rust, and brown paint. Fobbie honks the horn. No response. He honks again, nothing. 3, 4, 5 times before the gate opens to a bleary eyed Pa Brima. Fobbie jokes, “You sleeping Brima?” ‘No, no, no. I just had the radio on.’


We had heard that the lock was stiff and the rumors were true. It took 3 different people to get the door open. The house was immaculate. Our housekeeper, Abdul Jalloh, works so hard! His skill is obvious but boy does he work slow. I would imagine he spent at least 8 hours cleaning our house. Our first surprise came on changing the pillow cases. The pillows were covered in mold! They felt cool but not wet. Then the mattress cover had mold too! The book on the bed’s shelf didn’t show any water damage, the ceiling didn’t look like water damage. Weird. We put on clean sheets and collapse until noon the next day.


Inside the closet there were more surprises. My shirts were left hanging with the closet doors closed. The ones hanging with some space between them were fine. But where things became bunched there was mold between the shirts. Even inside our filing cabinet (our dresser) the folded clothes had some mildew looking stuff on them. The only thing we can figure is that we were absent during the rainy season. The humidity must be high for so long that even the air can cause things to mold. I haven’t been brave enough to try to use the laptop we left behind.


The most unfortunate thing to happen was the death of our backup fan. We have a battery that runs appliances on 110V so it will easily run the one 110V fan we brought. In our absence, somebody plugged the 110 fan into the 220V wall outlet. Dead. So for now, we don’t have a fan at night if the electricity goes out. Happily it’s super nice weather right now. There hasn’t been electricity for about 36 hours now and we aren’t missing the fans. Also, we haven’t bought any food that needs to be refrigerated yet. So that’s a blessing.


On the topic of food, Rachel has found some really exciting things in her pantry. We moved the majority of our food into totes for safekeeping in our absence. Inside the tote was a gallon ziplock bag, inside the gallon ziplock bag was an unopened brownie mix, inside the brownie mix was moving, living bugs! How do bugs find a tote, get inside the tote, then chew through two layers of sealed plastic to get our brownies‽ She had a mason jar with a screw lid and a few cashews in the bottom: mold city. A spaghetti dispensing tupperware with some dry spaghetti had a whole nest of bugs living inside. There was a tupperware with one of those buttons you push on the top that expands a rubber seal to secure the lid that was filled with nutritional yeast flakes: even a few bugs in there! Luckily they hadn’t set up a home yet, but this still seems crazy! Nature really is less tamed in Africa.


I know that all of this sounds miserable but we are truly happy to be back. We feel like we’ve returned home to our own space, something we (mostly) understand and feel comfortable with. We haven’t seen many people because of 2 weeks of quarantine, but it’s quite a blessing to reunite with the people here. God is good, even if he did make bugs and mold just a bit too aggressive.

The 2020 Return Trip

 We’ve made it back to Sierra Leone safely!

It was quite a trip and we’ve had some surprises on arriving home, so this will be split into two: travel and settling in at home.


It’s always a long journey, but COVID made it even longer this trip. It was relatively smooth, but long.


We left my folk’s house near Chattanooga at 6AM eastern standard time and drove to Atlanta International Airport. We were early because we had 4 checked bags all very close to 50lbs and I wanted to make sure we had time to rearrange if the gate agent was pedantic. He was actually very congenial and we breezed through and had a several hour wait for our flight to Chicago. In Chicago it was a 5 hour layover then an 8 hour red eye to Brussels in Belgium. In Brussels it was another 5 hour layover. Upon arrival we immediately found some chairs without arm rests, laid flat, and fell asleep. The next thing I know we are completely surrounded by people waiting for a flight. Of the roughly 30 terminals in our wing of the airport, we choose one of the two that had departing flights. Luckily, mandatory mask wearing means that you can sleep in public with your mouth open and not even be embarrassed! So I’m quite sure I looked totally cool while unconscious and draped over my luggage.


We were about to grab something to eat when they started boarding our flight 2 hours before departure! But don’t worry, we had some snacks still on hand because Rachel is always prepared. The queue was long and as we approached we could see 4 different people checking the mandatory documents: boarding pass, passport, visa, residency cards, negative COVID test less than 72 hours old, and some Belgian public health paperwork that needed to be applied for prior to arriving in the airport. As one might expect, that took quite a bit of time and many people didn’t have their paperwork in order. As the woman 4 people in front of us presented her paperwork and US passport, the gate agent asked her reason for traveling to Sierra Leone.

“For my grandmother,” she said.

‘That’s not a good enough reason.’

“But she died and I’m going to the funeral”

‘Do you have a death certificate?’

“No, she’s in Sierra Leone and I’m a citizen of Sierra Leone”

‘Sorry, it’s not a good enough reason to travel.’

“But I was here in the airport last week and all the paperwork was OK except my COVID test was too old. So then I had to stay in Belgium for a week to get COVID testing. And now you’re telling me that all my paper work is not ok‽”


It was at this point that we were ushered, with much fear and trepidation, to another gate agent. She smiled nicely, reviewed our paperwork, and let us go without any questions. We were stunned. Why is it easier for white people to get into Sierra Leone than for citizens of Sierra Leone to get in? After sitting on the tarmac for 30 minutes, we see the woman board the plane. I guess she was persuasive enough.




The landing at the Lungi Airport in Freetown was impeccable. I took some pilot lessons years ago and landings are tricky. Even landings, like we had in Freetown, without any cross winds take skill. But I think the spontaneous round of applause from the passengers was more motivated by release of anxiety than from appreciation. We walked across the tarmac to the airport where anyone who didn’t use hand sanitizer was denied entry. The immigration queue was socially distanced and calm. The agent was happy to see foreigners returning. We walked down a small hall, handed in our contact tracing paper work (what was your origin airport, seat number, symptoms, etc.), had our temperature checked, all with reasonable social distance. At the next stage was the classic chaos I had expected up to this point.


 Everyone is arriving from internationally so there are just bags everywhere. The space is too small for all the people and bags. So it is literally impossible to walk without pushing into someone. Rachel stands off to the side with our carry on bags and I was only able to bring her things one at a time. First a cart for the luggage. Then I found our Away suitcase. Then I found one of our orange North Face Duffels. I waited and waited but never our trunk or other duffel going around on the belt. I eventually fought my way to the far side of the room and found they had been pulled off the belt by somebody else. Then I realized we had only done the easy part.


The queue to pay for the COVID tests (80 USD each) was, as they say in Krio, Choked Up. The line was made up with people and all their luggage carts and extended right into the middle of baggage claim. If I had to push people with my body to move through baggage claim, a cart seemed impossible. We ended up cutting the line with some nice Italian folks. That line was SLOW! From there we creeped through another line into another lobby where everyone was forced to abandon their luggage carts to join another two queues: one for free SIM cards and one to have the tests performed. The luggage carts really insured that there was no room to social distance. It was wall to wall. Our 3 hour disembarking ordeal came to a close with swabs up the nose. Happily, they were more gentle than the folks from Tennessee.


Now comes a 2 hour drive. Poor Mr. Fobbie had been waiting since 6 PM (our scheduled arrival which was delayed because of paperwork in Belgium) and we were just departing the airport at 10:30 PM. There’s a national COVID curfew from 11PM to 5AM. So at every checkpoint, the police officers are confused why we’re driving and it always takes some explanation. Only once did we have difficulty. There was a small village where the police weren’t letting anyone pass. My speculation is that so many people were forced to sleep in their cars by the side of the road that it helped the local businesses sell their goods. Two different police officers told us to just pull up to the gate and wait. Well, they never came to open the gate and I think they wanted us to wait till morning. But the third time’s the charm and we were able to get around.

We did the math, about 40 hours in transit. The next day we slept till noon.


Part two will be our adventures rediscovering our house.