After 2 hours more through hills remarkably similar to Rwanda’s, we reached Bujumbura, and drove straight to the beaches of Lake Tanganyika. We found a guesthouse to stay at for the night, and settled in for some sun and beach time.  Sunday morning we awoke to hundreds of young people, mostly men, parading to the beach to play sports, exercise, or just socialize.  Literally hundreds.  They were there for a few hours, but the beaches were mostly clear, except for the tourists, by 11am.

We drove back Sunday afternoon, arriving in Butare slightly sunburnt and refreshed.  On the way out we stopped into a small little store and found “Magic Obama” gum, photo below.  I still get a kick out of all the Obama paraphernalia one comes across in Africa.

I have less than 2 weeks left in Rwanda, which is crazy.  Next weekend we’re hoping to see a bit of the northern part of the country – a last hurrah before heading back to the US.

View of Lake Tanganyika from the Keza Plage

Lake Tanganyika

"Magic Obama" gum. Couldn't resist.

The Brandt travel guide spoke very highly of the different types of birds you can see while in Nyungwe. Andi and I, lucky or not, found ourselves with a bird-expert guide on Sunday when we went for our 3rd, and last, hike of the weekend. During the 3 hikes we did while in Nyungwe, along with multiple drives from one side of the park to the other, we saw 3 different types of monkeys, a variety of birds (one, the turaco, was extremely exciting for our bird-loving guide) and A LOT of ferns (as well as other types of trees and greenery). It was beautiful, and extremely nice to be outside for the entire weekend.

Below are a few more photos. We just returned from the beaches of Lake Tanganyika – photos from there to come tomorrow!

Rwanda is far different than any other African nation I’ve been to. The climate is comfortable and temperate, most days it reaches about 85, and at night it constantly drops to about 60 (read: I find myself very cold, very often). Order & cleanliness permeate the urban centers as well as the countryside. Plastic bags are illegal within the country and garbage is rarely (if ever) seen in public. Thus far, we’ve been able to drive ourselves around the city and in the provinces without any problem, particularly because there are traffic patterns (lots of traffic circles) and lights, and the majority of drivers seem to obey the existing rules.

Last weekend we were invited to a Rwandan wedding, which Andi and I excitedly attended. The reception was on family property outside of Kigali, and was quite the affair. Apparently, there was at least one high-level government official in attendance. As neither Andi nor I brought wedding-appropriate clothes with us, we ended up renting traditional outfits for the occasion…they resembled saris, but were much more simple to put on.

This week, we traveled to Butare, in the south.  To get there, we followed the same road that took us to Kibuye 2 weeks earlier, but turned south when we reached Gitarama (which is about an hour outside of Kigali).  The hills between Gitarama and Butare were not as steep and mountainous as those closer to Kibuye, but were just as beautiful and lush. As we went further south, we saw increasingly more flatlands and rice paddies. The photos didn’t come out as well – but we will be returning there again next week, so I’ll try again. Below are others, that did turn out decently, from the past few weeks.

Here is a view from the main road from Kigali to Kibuye. We drove along the road, over and around mountains, with terraces and villages scattered for miles.

Fields and terraces in the countryside between Gitarama and Kibuye. There exists a government sponsored program entitled, "management of the radical terraces".

A group of 3 young boys were climbing this hill to the main road, and were rather spooked that the 3 of us muzungus (white people) were parked on the side of the road just to admire the landscape and take some photos.

Drainage ditch on the side of the road

The same drainage ditch on the opposite side of the road

Wedding reception

On a hill towards Gitarama

Taking a break on the way up the hill

Happy summer to everyone!

To vaccinate a child against polio: tilt head back, (force) open mouth, 2 drops of vaccine down the hatch.

After vaccinating said child, make sure to mark their left hand pinky finger, so that other health care workers know this child has already been vaccinated.

Polio drops, black fingernails and crying children, oh my!

A funny thing happened on the way to Manjama clinic last Friday. I had gotten on the back of a motorbike to make the 3-mile-or-so trip to the clinic to drop off some photographs I’d had printed in the US sent over to SL, and about a half mile from the clinic we (almost literally) ran into Kadie, the Manjama MCH Aide, and Edward, one of her primary assistants. They were adorned with lovely “Mama en Pikin Welbodi Week” …coveralls?… (basically a MOH-affiliated village health worker’s uniform – it’s a piece of fabric that goes over their head and ties on either side), and were carrying a small cooler, apparently filled with polio vaccines. I was able to accompany them to 2 villages on Friday, and another 5 on Sunday, to observe the polio vaccination process. There have been recent (and some not-so-recent), isolated cases of measles and polio, so the Ministry of Health and Sanitation has been a bit busy coordinating vaccination efforts.

The polio vaccines need to be refrigerated. This creates a problem, as you can well imagine. However, a small cooler with 3 ice packs seems to work well for a day’s work – Edward or Kadie usually walk into Bo that morning, or the evening before, to pick up the vaccines and other supplies (mainly a permanent marker for recording, physically on the children, the successful completion of the vaccine). The vaccine itself is just 2 drops of liquid, into the mouths of children under the age of 10. Kadie said they are good for up to a year, however, they vaccinated multiple times in the past 12 months because of the outbreaks.

It was obvious from traveling with Kadie and Edward that they are well known to the communities they work in. Along the way certain villagers gave them food and supplies as a thank-you for coming to vaccinate the children. I was told that levels of appreciation, and understanding of what the Community Health Workers are doing, varies from village to village, although most are cooperative.

There were no written records of who/when/where people were vaccinated, just coloring in of the left pinky fingernail (alleged to stay for a few weeks) to ‘record’ that the vaccination had been done. My inner OCD, ‘list-maker’ was aghast at the seeming chaos that would ensure at every village center we visited. Kadie, however, remained in control and very confident at every point along the way. There were lots of crying children, apparently has a consequence of past campaigns in which injections were necessary. Although, if someone came up to me and forced my mouth open so that some mystery liquid could be dropped down my throat, I might be suspicious and fight back too…

My favorite parts of the 2 days was when we’d go off the ‘beaten track’ – upon hearing children, or seeing women with babies on their back doing chores/agriculture work, Kadie and Edward would forge their own path and find a child that needed to be vaccinated and couldn’t be counted on to show up at the village centers. At one point we had to walk through brush higher than I am tall, and came to a clearing in which some villagers were producing palm oil. Within 2 minutes all children under 10 at the site were vaccinated, and the smiles on Kadie and Edward’s faces reflected satisfaction.

Here’s to the successful decrease of polio incidence. Lots of photos below.

Here are some villagers helping to set up for the polio vaccines in the 2nd village we went to.

Welcome to the chaos. At the second village we went to, about 50-60 people congregated in a small, roofed shelter, and Kadie tried her best to maintain crowd control.

This child - none too happy to have the polio vaccine forced into his mouth.

After giving the children their polio vaccines, Kadie and/or Edward had to mark the little finger of each child's left hand so that other health workers would know they'd been vaccinated...wonder how long the marker actually lasts?

Marker. On fingernail. Eliciting SCREAMS.

We were walking between villages, and happened to pass a woman with a baby on her back. Kadie and Edward asked if her child had been vaccinated against polio. Her response - yes. They said, "when? Did you come to the clinic this morning?" Her response - yes. Then they said "You are lying. We were the workers there this morning. Please let us vaccinate your child." And so they did.

Here's Kadie, vaccinating the infant of the wood-carrier

And here's Edward, helping her put her bundle of wood back on her head. Happy, newly-vaccinated baby on her back.

And here's a grandmother with her grandchild, walking between villages, stopped to vaccinate the little one en route.

Village outreach at its best - can you imagine if this was the rainy season?

Oh, the wonder of basic technology. A styrofoam cooler with 3 ice packs and you've got yourself a vaccine storage unit!

In one village mothers actually formed an almost-line to get their children vaccinated. I almost fell off the chair they'd given me to sit in.

This poor little girl did not like (a) the vaccine, (b) getting her finger marked and even more so (c) me. I made more than my fair share of children cry on Friday and Sunday...

This young girl came with her sibling to observe the vaccine session

Palm Sunday activities

Happy Palm Sunday!

Along our way back to the main road, we met with one of the village TBAs - she offered Edward and Kadie rice for their hard work, and was a lot of fun to talk to. Very happy, bright, youthful woman. Apparently she's one of the most respected TBAs in the area.

This is the bundle of goods that the TBA was carrying. Yes, that's a (live) chicken's head sticking out of it.

She got a kick out of me taking her photo.

This little girl was very sweet. While all the boys in the village swarmed me and posed in positions that seemed like they were trying to impersonate pre-pubescent rappers, she kindly, quietly, asked me to snap her. Either she's actually really sweet, or just smarter than the boys....

Vaccinating the older children consisted of far fewer cries. Much appreciated.

This little one wasn't afraid of me. Or my camera. In fact, I had fingerprints all over my lens when all was said and done.

Very cute, shy child.

These two older, slightly-more-precocious children thoroughly enjoyed the bananas Kadie and Edward shared amongst the group --- we'd been given bananas at another village, along with bags of rice and a pineapple, and had run out of bag space to carry them all. My offer to carry them on my head, like a local, elicited a good response, but they didn't take me up on it. Instead, we shared the bananas with the kids (probably a much better use anyways).

I don't know if you can read it - and i really didn't feel like zooming in would be appropriate - but this kid's underwear says "OBAMA" on the band! This, apparently, is the new fashion statement in rural SL. He wasn't the only obama-underwear-sporting-kid I saw on Sunday!

Lets see. Last week, I brought out the Young Adult version of Three Cups of Tea (an all time favorite that is a MUST read if you have not). I am planning on starting to read it with some of the girls at the Child Rescue Center this week, but since I was going to Freetown, a staff member there asked if he could read it while I was gone. “Of course!” I said, as I’m always one to advance the international movement for female education in the form of wonderful, heartfelt literature.

When I got back on Wednesday, I asked him how he liked it. He said, “It is such an interesting book. That guy does wonderful things! And…[this is where my mouth drops open in a shocking stupor]…you know, it was so recent! There is information in there from 2007! Did you know that?”
Recent? I mean, sure, the book came out just a year or two ago, but the story itself chronicles events that happened largely in the 1990’s/2000’s and, last I checked, it’s 2010.

And then I had my daily reality check, stepped back, and realized that barring storybooks about Obama that recent teams had brought for the Child Rescue Center residents, for the majority of literate Sierra Leoneans most books available to read are either (a) decades old or (b) about things that happened decades, if not centuries, ago.

For goodness’ sake, I get frustrated reading academic articles that don’t include at least SOME data from the previous year. Sure, figures from 1996 are great and all, but only if accompanied by figures from 2008-2009 (I concede – slightly academic elitist, but so goes my thought process).

To continue…the morning after I returned back to Bo (and had this refreshing conversation with Uncle Philip), I was doing rounds at the hospital. There were two kids in the pediatric ward with pneumonia, 2 men in the male ward with probable diagnoses of TB and a woman in the female ward with probable cancer. I’ve been shocked at the amount of pneumonia that is treated here. In my health naivete, and what one could term extreme shortsightness, the first time I stepped back and realized how many kids with pneumonia I’d encountered I asked, “Why do you seen so many pneumonia cases here? It’s not a cold climate.” Well, duh, pneumonia is spread through germs…and in a country where many people sleep/live in close quarters, hygiene is difficult to maintain at a population level and children are, in many cases, left to fend for themselves if they have colds or runny noses/chills, pneumonia can easily be spread. Inexperienced future-public-health-masters-student, 0. Common sense, 1.

Cancer diagnoses, on top of everything else stacked against the odds of good health in this country, are terribly hard for me to stomach. There’s little to nothing that doctors/health practitioners can do for patients, and I’ve heard (and read from body language/facial expressions) on more than one occasion that cancer diagnoses in Sierra Leone are basically death sentences, and practitioners are left figuring out how best to make a patient comfortable before they’re sent home. I realize this happens with cancer diagnoses everywhere – we have yet to reach the point where screening and prevention allows early intervention in all cases – but at least there’s a good rate of recovery/remission for many types of cancers in developed countries nowadays.

Privilege. I saw a lot of it at a conference I attended last week as well. It was a 2-day biomedical conference, of which one day was devoted to maternal and child health research. Very interesting, very necessary, especially for a country like Sierra Leone. The following points were made over and over again:
- Research NEEDS to be done in Sierra Leone. It is the only way the country can figure out how best to attack/cure the social and health-related ills that continue to ravage the population
- Sierra Leone is ripe for research. It is a microcosm of many public/medical health issues, as well as new terrain for many diseases/subjects
- Effective, internationally-accepted research can’t be done on a large scale at the moment because of multiple inhibitive factors that include, but aren’t limited to, absence of a national ethics committee (this is in the process of being created), government bureaucracy, a crippling national health infrastructure and, (this was said in every single presentation) lack of funds, from anywhere and everywhere. Where there were funds, they weren’t enough.

All the presenters over the 2 days did wonderful jobs, and it was educational, interesting and refreshing to take part in. However, as I traveled to a Ministry of Health Clinic on Saturday, the day after the conference had ended, it did strike me how lofty and far off some of the conversations and topics of the conference seemed in light of the perspective of the people on-the-ground, living the day-to-day realities, and in many cases nightmares, that I had spent 2 days listening to research about and pontificating with others on.

I am fully aware I ‘feel the burden’ of privilege more than many others – I would definitely term myself ultra-aware. Ask my mom about traveling in Europe with me after I spent 9 weeks in Northern Uganda…                                                             But then again, Sierra Leoneans I speak with also often talk about the disadvantages of privilege, mostly those who are educated past high school and are expected to then provide for extended family (even if their salaries aren’t always paid on time, or sometimes at all). There are those who left the country and have come back who are getting involved in governance and building infrastructure, and they must feel it to. It’s part of the world in which we live – the haves and have-nots. Unfortunately, as all research has shown in the past decade or two, that divide is growing larger each and every day, in almost every single country, developing or developed. That’s personally scares the bejeezus out of me.

Having said all that, I must confess I indulged in my ability to access privileges this weekend – namely, taking what is an inordinately large sum of money for most locals, but wouldn’t cause many in the US to turn heads, and spent it on a two-night stay at two of the infamous Freetown Peninsula beaches. Oh, my goodness. They are as gorgeous as everyone, and the guidebook, says. I am unfortunately jaded in this sphere of life as well as others, as Thailand/SEAsia has basically ruined anything short of spectacularly white sand leading to aqua clear blue waters with surrounding beauty that one usually expects to find only in movies that have been digitally altered. But I digress.
I spent a night on Hamilton Beach, and another night on River Number 2 (the expat favorite), and River Number 2 rivals the sheer beauty that I’ve seen in Thailand. Tourism/hospitality/travel ease aside (let’s just say there’d certainly be a market, if only someone can figure out how to move the airport to a more convenient location. Or build a bridge that bypasses all the Freetown traffic…), it was a familiar scene of very white sand, shallow water of almost clear aqua blue waters and, a favorite of mine, countless palm trees. There’s a river (River Number 2, hence the beach name) that flows from the surrounding hills straight into the sea, creating lots of smaller, deep pools inland that younger children were particularly interested in diving into.

The best part for me was that I was at River No. 2 Sun/Mon – Sunday it was JAMPACKED with day and weekend visitors, but Monday, I basically had the beach to myself. Beau-ti-ful. I was somewhat anxious to get back to Bo, because I have just a little work to do before I leave at the end of April, but believe you me, if I had an extra week and a few extra benjamins in my pocket…I know where I’d be.

view of downtown Freetown from the 5th story of a building

A birds-eye view of the street stalls in Freetown, parked right next to the cars. This street had one of the more uniform parking systems in place, as far as I could tell.

stalls selling wares to passer-bys and cars stuck in traffic.

At the Goedrich Health Center, they created their own measuring tape to track growth of patients.

Hamilton Beach, view of Samso's Place

fresh lobster for lunch! (not mine, but i was definitely jealous/salivating)

this duo is a father/daughter pair; unfortunately they lost their wife/mother about a year ago, and the father seems to still be distraught and distracted by the loss. The family has SIX children, five of which still live at home with dad, in the house pictured here, in Hamilton (along the main road, not on the beach side). I can only imagine how that must be in the rainy season!

yes, i spent 99.9% of my time at Hamilton Beach under one of those lovely umbrellas. a-maze-ing.

If I haven't mentioned this before, Sierra Leoneans are crazy about English Premier League football (soccer in american-speak). Take this boat on Lakka Beach, all gussied up with Manchester United slogans and crests.

River two comes down of the mountains (from the left side of this photograph) and creates a smaller 'lake' - pictured here - that then curls round to the ocean

This is a fishing net, cast aside on River No. 2's beach, mid-day.

close-up - fishing net

At one end of River No. 2's beach, there's a small forest of rocks - very beautiful, and a playground haven for children (and/or me).

rocky shallows at River No. 2

this young boy was playing with his friends among River No. 2's rocky edge, and interrupted his sand gymnastics to give me a DOUBLE thumbs-up. I felt kind of special.

Here's a shot of the local community at the edge of River No. 2

There are the huts on the 'river' side of River No. 2's beach. kind of reminded me of lost (not the huts, the landscape...)

River No. 2 Beach

Oh, the bliss of Monday mornings at River No. 2, sans tourists, expats or anyone else.

lobster? yes please. how about three?

At the hospital, the maternity ward delivered FOUR babies last week.  To give some perspective, last year they delivered 38 babies.  So far this year, they’ve delivered 16!  Unfortunately, the most recent one was a stillbirth, and the mother was visibly depressed about it when I met her.  The child had a double cleft palate and would have had an extremely difficult time overcoming that, as well as probable congenital heart defects.  Still, it certainly doesn’t make losing a child easy.

A large part of why Mercy Hospital has seen many more pre-natal patients and delivered more babies so far this year is the recent government mandate that all births must take place in hospitals. On Independence Day this year, April 27th (oddly enough, also the day I fly back to the US), “user fees” will be abolished for pregnant women and children under 5 at all public clinics and hospitals.  The immediate question everyone asks is “Does the government have the money to actually implement this?” … the second, probably more important, question is, “Will this actually help decrease maternal and infant mortality?”  This story from IRIN news addresses the second question, or rather delves into the second question without providing answers.  Only time will tell.

Tomorrow I’m heading to Freetown for a week for a research symposium, as well as to try and make some contacts for Mercy.   Below are a large number of photos from trips I made with the group of visitors from PA – to Pangoma (about 2 hours from Bo, where our hydroelectricity comes from!), to Juro (an ‘area’/larger village on the way to the Liberian border that is located in the fringes of a ‘rainforest’) and Bumpeh (a village about 45 minutes southwest[?] of Bo where we were lucky enough to have a personal tour by a local development worker, dedicated to building up Bumpeh because he did  most of his schooling there).  Sorry for the deluge of photos…but I have attempted to explain them with their captions, rather than writing a novel here.

Pangoma is a village that is settled within larger hills - very beautiful. These two men are residents, and requested I 'snap' them.

This is the local gas station. Gas is funneled from the bottles pictured into individual cars. This, by the way, is not particular to Sierra Leone. I remember seeing, for the first time, gas being sold in old coke bottles in Cambodia and having to do a double-take.

My new photo project: capture as many 'obama sightings' as I can while in Sierra Leone. He's EVERYWHERE.

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Destroyed church in Pangoma. It was attacked during the war, and has only just begun to be renovated. It badly needs a roof - see next photo - but residents still used it for services during the dry season.

Another view of the destroyed church in Pangoma. Can you imagine being inside during the rainy season?

Here you can see 3 bullet holes that struck the outer wall of the destroyed church. Remnants of the war such as these, almost 8 years after the war ended, underscore the vast devastation that still exists in Sierra Leone.

this girl was watching a large crowd of children flock towards the camera of a fellow visitor. So many children here have maturity beyond their years, laden with responsibilities at very young ages.

This young boy, walking with his father, was carrying a load of palm nuts, freshly gathered from palm trees in the forest around Juro. Palm oil is a staple of local Sierra Leonean cooking - one of a variety of products that come from palm trees.

People also eat palm nuts plain, without adding anything to them or altering them in any way. This is the father of the father/son-palm-nut-selling-duo, grabbing a few palm nuts to hand over to our driver, who was eager to buy.

Here are palm nuts BEFORE they are boiled (for the first of 2 separate times)

Large pots are used to boil the palm nuts - beginning to extract the oil from the nuts (i think).

At some point in the palm nut to oil process, shelling occurs. It must be "that time of year" because when we visited this particular village, a majority of children and older adults were surrounded by large piles of nuts, full and deshelled. The most likely case is that this is done all year round, and we just happen to visit when many people at once were working on a similar task.

Step 2(?) of the de-shelling process. I think...

"But Kate, how do they CLIMB palm trees in Sierra Leone?" I am so glad you asked! I have an answer! This photograph shows one of our guides demonstrating how locals use bamboo covered with pieces of cloth to climb up palm trees. Very impressive. Not necessarily something I think I need to try anytime soon, though...

Did I mention that the car I was in decided we wanted a breeze so badly we were willing to 'deal with the dust' from the road? Yea. If only I could get that kind of color naturally....

This is the bridge leading into Bumpeh. We were told that during the war, the rebels used it as an execution site and would hang bodies as a warning/scare tactic.

A clinic in Bumpeh that was built after the war ended by NGOs and private organizations. Their facilities are pretty good, but they suffer from the same maladies as most other clinics in Sierra Leone, lack of staff, medicines and laboratory capabilities.

Bumpeh (privately funded) clinic's stock of medicines. Leaves a bit to be desired...

We also visited a public, government-funded, clinic in Bumpeh. Plastered all over the walls of the waiting area were public health related posters and information about the clinic. This one lists and defines some of the more common diseases one might see.

Government clinic in Bumpeh - statistics for January and February 2009. They didn't seem to have publicly hung the statistics since then.

As you walk through any village or town in Sierra Leone, there's a good chance you'll come across burned out houses, (for the most part, barring the occasional house fire) a constant reminder of damage that was done during the war.

One more for the 'obama' photo album...

An older woman was more than willing to pose for a photo

In Bumpeh, there is an amputee village (this is rather common) - which means an NGO has come in and built houses for amputees. Each organization operates differently, with aspects of skills training and other forms of support available at some, but not all. This man is the chief of the village. To me, he demanded respect in his demeanor, not affected in the slightest by the absence of his left hand and part of his right.

This young mother also lives in the amputee village. From a few feet away, I could not tell she was an amputee.

I can only imagine how difficult it must be to adapt to missing essential limbs - especially for things such as feeding infants. Of course, I also realized how 'public health' oriented I've become, when I first saw this I didn't think of her difficulties, but wanted to ask why she was feeing an infant formula or milk from a cup and not breastfeeding. The young mom was extremely friendly with a beautiful smile. The baby, on the other hand, was a bit fussy.

And, per usual, as a group of pumoys, we attracted quite the crowd as we walked through Bumpeh. This girl in particular caught my eye. She was only over-the-moon when I snapped her. Adorable.

To begin with, we were a group of visitors, basically encroaching on an already-existing clinic.  For the 2 days that Operation Doctor was there, the available healthcare was much stronger and larger-in-scope than normal.  The physicians from Indiana had brought a vast supply of medicines to treat malaria, hypertension, asthma, skin rashes and everything in between.  Even before the clinic began on that Tuesday, questions were being asked along the lines of, “How do we successfully diagnose and treat this population without insulting, undermining or alienating the local clinic staff?”  Apparently feedback from past Operation Doctor teams has included that the local staff resented the visiting doctors if the clinic was free for patients (because the local clinics have to charge to stay afloat and patients, after being seen by foreign doctors for free, would return in the future expecting free care – and would get upset when they were told they would have to pay), local staff was upset that leftover medicines were not left with the local clinic and that the local staff did not seem welcoming, or that they even wanted the visitors there.  

These are complaints that are certainly not particular to OperationDoctor, but to any and all clinics that are staffed by highly-trained, visiting doctors/nurses.  I have heard these complaints regarding work done in all sectors of “development”, especially health.  I know these are issues that many people consider when planning interventions and short-term projects, and have come up when Mercy Hospital goes into communities that have some sort of health infrastructure in place, as minimal as that may be. 

Part of a larger, more complex problem specific to the Operation Doctor endeavor is that the Taiama Clinic in existence right now is understaffed, and a Maternal & Child Health Aide is overseeing all its operations.  She does what she can, but she does not have extensive training to diagnoses or prescribe meds for all types of illnesses, being made all the harder because they rarely have meds they can give out.  They have outreach prevention programs – some, such as Tuberculosis testing and enrollment in DOTS treatment, seem to be more successful than others.

Both sides (local and foreign) seemed to be open to discussions BEFORE the clinic began on the topic of how best to run a visiting clinic with minimal disruption, during and after, to the local situation.  The members involved who had previously helped run visiting clinics declared it the most successful, and I would attribute much of that to the dialogue that took place.   It was noted, though, that for sustainability and long-term positive effects, it would be best if in the future visiting doctors spent a majority of their time training local health providers to increase capacity, rather than basically doing the job for them and elevating community expectations.  

Definitely food for thought. And now, the photos.

Registration with John, a local staff member, where patients were 'queued' (in theory) and charged 3,000 Leones (approx. $0.75). This covered a 2,000 Leone fee to see the doctors, and 1,000 Leones for meds, which we assumed everyone would get.

Here is another local staff member registering people for the clinic. The megaphone was used a lot, especially in the mornings.

This is the walkway between the two permanent structures of the refurbished Taiama Clinic. It served as the waiting area for patients, and was full both days!

Here, at the end of the walkway, local clinic staff were in charge of intake information - they created patient 'files' for each person, and recorded information including chief complaint, health history and vitals.

Pictured here are Patrick, a volunteer nurse at Mercy, and Mr. Koroma, one of our 2 pharmacists, who happily obliged to spend 2 days with Operation Doctor at Taiama. All the meds were brought by the doctors from Indiana, through a program that provides free, or low-cost, medicines to developing countries. It only made me do a double-take a few times when I would walk by and see Rugrats characters featured on child vitamin bottles.

Patrick and Mr. Koroma would fill prescriptions and try to ensure that the patients understood correctly how and when to take their meds - sometimes they were given 3-4 different types of pills. With a high level of illiteracy, as well as unfamiliarity with the 'usual' directions for medicines, I doubt that every patient left with a clear understanding...

Here you can see Sarah, another volunteer nurse at Mercy, and Mr. Allan, Mercy's laboratory assistant, conducting tests for the Taiama Clinic. Almost all tests done were Malaria Rapid Diagnostic Tests...many children were not the happiest when leaving this room.

Pictured here is the young malnourished boy I referenced in an earlier post, his nurse, and the doctor that examined him.

Here are two patients that were waiting to see Dr. Tom

Here is Dr. Tom, with Rose, one of the local staff who would translate for him, and a patient.

This little one, who has been seen on my blog in previous posts, must just be extremely intrigued by pumoys. She came to the clinic on its second day without family or any apparent reason to be there, and just wandered in and out of the waiting area, observing the busy-ness that was going on. She repeatedly was shoo'ed away by local staff, but would eventually find her way back again.