Openness

 Sometimes it takes people asking me questions in order for me to be able to articulate the things that I’ve learned.

Currently we have a medical student volunteer from Germany visiting the hospital. She brought along almost €300 donated to her by her family and friends to help the people of Sierra Leone. Even in just two days of working at the hospital she already can clearly see the desperate need of people. This morning she brought me the money and said “I want to give this to you so that you can help the patients who really need it.” And that prompted me to reflect on the last several months of personal growth in new ways.

I’m finding that living in Sierra Leone is challenging a lot of my cultural habits. When living in the states, I was always reticent to give to the beggars you see by the side of the road. My rationale being that I want to make sure my money goes to the people who need it most. And roadside assistance can be hit or miss with true and actual need. As I bring these habits into Africa, I find myself only wanting to help the poorest of the poor. If I think the family can scrape together enough money, call enough relatives, or sell enough of their assets, they are somehow less deserving of my help. And the more I have stopped to analyze this behavior, the more it seems like I am somehow assigning value or “worth“ to different people. This is exactly the conundrum that our volunteer came to me with this morning. She wants her money to go to where it’s “really needed.”

But today is an unusual day. A week ago we had a patient come to the hospital who couldn’t pay a single cent. He’s a 15-year-old man who for the last six months has had a massive dental abscess. The pus has drained from his face down into his neck and in multiple places he has open wounds that continually drain pus. He’s been on several courses of antibiotics and still his disfigurement remains. Our new dentist in Sierra Leone, Mel Bersaba, saw this boy and rightfully felt pity for him. So he single-handedly pulled as many strings as he could and we were able to get this man to see the top dentist and dental surgeon in the country. He got a CT scan of his face that showed the infection has been eating away at his jaw bone. The specialist recommended surgery as soon as possible. Dr. Bersaba spent hundreds of dollars to get all of this done. But today when it came time for the driver to take the patient to the hospital for a coronavirus test prior to surgery on Thursday, the patient refused to get into the car. I looked him straight in the eye and told him that if he did not have the surgery, which will cost him absolutely nothing, he would be dead in less than a year. After a long discussion I got to the root of the problem: he says both him and his mother had the same dream. During surgery at the hospital he will die.

I begged, pleaded, and explained to him why I was afraid for him. I told him that I believe these dreams are from the devil and the devil is just trying to kill him. If he does not have the surgery, he will die. I told him that I don’t fear surgery, coronavirus, or humans. But I do fear that demons are trying to harm him. I told him the only way to overcome those dark forces is with God, prayer, and courage. He declined my offer to pray for him because he’s Muslim. Just a few hours ago he left and went back to the village.

What am I to think about this? Did we spend hundreds of dollars, waste the time of top specialists in the country, and dedicate our days to a cause that wasn’t worthy? I think a year ago I would’ve thought so. This country has started to change me. If I am truly to emulate Christ, I don’t just dedicate myself to those I deem “worthy“. How often does God “waste“ his love, time, and blessings on me or other sinners like me? The idea of worth is not how Christ sees the world. And I am slowly starting to reframe my ideas around success.

I think there is value in living a life open and generous enough that some of your projects “fail“ by human standards. In the past I have been far too stingy for fear of failure. When I think about God’s continual commitment to an earth filled with failing human beings, I think that’s the kind of love I’m expected to emulate.

If an institution took this approach all the time, it would be exploited to bankruptcy. But I encouraged my volunteer to keep the money she has and continue to observe and learn for a few more days before deciding how to use it. Deciding how to use a limited amount of money is very Sierra Leonean. Do I feed the healthy children that I have, or do I spend money on the child who is sick? Feeling that tension will help her to understand the culture. But I also encouraged her to challenge the idea of that some people are more worthy than others. It’s a very American idea that I have grown up with and has only started to slowly change in the last several months. It’s hard to live an open life where your time in money ends up in “failure,” but it’s something I aspire to do. And daily I try to remind myself that the work we do might not bear fruit in this lifetime, and that’s not my problem. I’m called to live an open and generous life that runs quite counter to my American culture.

 

 

Furlough 2021

 

Wow, it’s been a long time and so much has happened in the past few months. To catch up, let’s go back to March 2021. Buckle up, this is a long one.

 

Rachel’s very pregnant and it doesn’t seem to faze her at all. She’s working full days in the hospital, cooking and cleaning like there’s been no change. A pregnant woman is always an exciting thing in Sierra Leone. Both pregnancy and infanthood are so tenuous that people tend to celebrate every little thing. There’s a nurse at the hospital who’s due date is just a month earlier than Rachel’s. They take maternity pictures together and it’s a very exciting time.

 

Rachel is scheduled to go back to the US about 5 weeks before her due date and thankfully travels without incident. The most memorable ‘amenity’ of being pregnant happens in the Lungi airport. The staff see she’s pregnant and decide that they need to help her move her carry on everywhere. So when she has to go to the bathroom, they follow her in , escort her to a stall, and get to listen to every detail. Privacy clearly means something different in Africa. Thankfully the rest of the trip is uneventful.

 

After her departure I’m left alone for about 3-4 weeks with plans to return to the US about 2 weeks before the due date. She left food for me in the freezer, a list of things to pack and do before leaving, as well as sticky notes around the house with cute little notes. Some of them seem like she can see the future. Sometimes when I’m hungry and too lazy to cook (or even reheat), I’ll just eat peanut butter off of a spoon. When I get to the peanut butter in the pantry I pick it up and there’s a note: “This had better not be your whole meal.” BUSTED in absentia!

 

Later in the week the nurse with a similar due date goes into labor. A nurse is called to perform the delivery and things don’t go well. The baby is tachypneic (breathing too fast) and hypoxic (low oxygen). They call Dr. Kabba and he arrives as quickly as possible, but not before some unnecessary procedures were done. He stabilizes the child who is then reunited with the mother. A few hours later the condition worsens again and Dr. Kabba is called to return. He works on the baby for several hours, even needing to provide positive pressure with a bag valve mask (forcing air into the lungs because the baby is too weak to breath). After several hours he calls me in for backup and we continue to work throughout the night. The condition doesn’t improve and by morning we teach the family to provide the breaths and we go home to rest for an hour or two. After a quick catnap, I return to the hospital to find the baby in worse condition and it’s time to make a difficult decision. Do we keep the baby here where we have good staff but inadequate pediatric supplies or do we send the baby to the government hospital where there are more resources but occasionally they are inadequately staffed? We decide to send the baby to the bigger hospital. At this point my apple watch tells me I’ve stood at least one minute out of every hour for the last 23 of 24 hours. I’m exhausted and the day has just begun and patients are arriving to be seen.

 

I check back throughout the day with both the mother and the baby. The baby’s condition slowly worsens and she dies within 24 hours of transfer. The tradition in Sierra Leone is that you don’t tell the mother about the baby’s death until she has ‘recovered’ from labor. So I’m forced to smile and nod when she tells me, “they tell me the baby is getting better at the other hospital.” The next night I get a call around 11pm and the mother needs help with her breast pump, as she’s excitedly pumping milk for her deceased child. I decide it’s better to not tell Rachel all the details and I give her a vague idea of what’s going on before I go to sleep.

 

At 5AM I wake up to see lots of missed calls from Rachel and the phone currently ringing. I pick up and she tells me her water has broken. It’s only been 10 days since she arrived in the US and a month before the baby is due. I’m not supposed to travel for another 2 weeks! I immediately start to work: buying plane tickets, packing to travel, preparing the house (absolutely everything needs to be put into totes), paying all the bills we owe, preparing for ways to pay our security and house keeper while we’re gone, and the most difficult – get a COVID test. At 7AM I call Emily and Peter Sheriff who know someone at the lab. They pull all the strings, pay all the ‘tips,’ I get swabbed, and after a few hours I’m sitting at the airport without a COVID result. I don’t have any money for transportation or a hotel. I’ve banked everything on this test coming through. And thankfully it does.

 

I get to check in and the agent says, “there’s something wrong with your ticket, they’re waiting for you in the office upstairs.” I go to the office and the problem is that I have two layovers in the EU. After the US banned EU citizens from entering due to COVID, similar restrictions were placed on US citizens. Individual airlines and cities negotiated exemptions, but my ticket violated that. I told the agent my story and he looked at me and said, “you’re a desperate man aren’t you?”

 

With the changes, I wasn’t able to fly directly to Bismarck without an 18 hour layover. So we orchestrated a plan where my mother would meet me in Atlanta airport and join me on a flight to Minneapolis. My long time friend, Chris Block, would drive from Bismarck and pick us up in Minneapolis. Mom would drive through the night and Chris would sleep as he had to work at 7AM the next morning. By the time I arrive in the hospital, it’s been 52 hours since Rachel called.

 

I get to the locked maternity unit and my sleep deprived brain says into the speaker, “This is the late husband of Rachel Fernando.” Only the next morning did I realize it sounded like I was dead and not just late for the birth. Rachel sleepily greets me and we had a brief conversation before heading to the Neonatal ICU.

 

Liam was born more than 24 hours prior to my arrival and was tachypneic and hypoxic, so he was admitted to the NICU. Sound familiar? It quickly dawned on me that my son had exactly the same symptoms as the baby I had just worked on for days. But Liam had the luck to be born in the US.

 

The culture shock was like nothing I had ever experienced. As I sat in the NICU, I had absolutely no concerns for Liam. He was in the best hands and improving with ‘simple’ things I was unable to provide to another new born just days earlier. The relief of arriving and the joy of a first born child mixed with the fatigue of travel and grief of losing a different baby just unlucky to be born in different circumstances. I couldn’t help but think that my son lives simply because of our wealth while our friend’s baby is born with identical symptoms and dies. The culmination of those few days left in me a strong understanding of the cruelty of this unjust world. All we truly have to cling to, regardless of our place of birth, is the hope of the second coming and resurrection. What good news it is, but how easily we forget until we are jerked to our senses.

 

Liam recovered quickly and was discharged without incident a week later. We spent some time in North Dakota with Rachel’s parents, then went to Tennessee to spend time with my family. After our arrival in TN, Rachel began to have severe abdominal pain. We did some investigations and found out her IUD had perforated her uterus and was loose in her abdomen requiring surgery. Coordinating all of the imaging and surgical preparation when your primary doctor is in ND and the patient is in TN is quite difficult. Finding someone to perform the surgery took another several days of struggle. Eventually the surgery was scheduled, but it became clear that we would have to delay our return to Sierra Leone.

 

The surgery went off without a hitch and Rachel recovered quickly. But soon another deadline approached. The day after we received Liam’s passport, we mailed our passports to the Sierra Leonian Embassy in DC for visas. Things went smoothly with the embassy but the US Postal service lost our passports in the mail. The tracking showed that they bounced between DC and North Carolina for 2.5 weeks, then went to Atlanta for a few days. We called every number we could find, but nobody could assist us. It came down to Friday when we were scheduled to fly on Monday. Should we get a mandatory travel COVID test on Friday even though we don’t have passports? The mail runs on Sabbath but not Sunday, and our flight leaves at 7AM on Monday. We decided to step out in faith. Sure enough, the passports arrived on the last possible day.

 

We arrived in Sierra Leone two days ago still shell shocked by the last few months. It’s wonderful to be back and every old challenge seems new and different now that we have Liam. COVID is still a huge challenge for Sierra Leone and the 3rd wave has been much more lethal than previous waves. Looking back, it’s easy to see God blessing through difficult circumstances and we believe he will continue those blessings now that our family is just a little bigger.

 

Thanks for reading and thanks for all your prayers and support.

 

 

  

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.

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. 

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.

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!

https://adventisthealthsystem.sl/

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. 

8.3%

 8.3%

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.