the word ‘privilege’

I’ve been thinking a lot lately about the word privilege. I know I’ve led a privileged (some might say enchanted) life – for starters, I was born in America! I was not only born in the good ‘ole U.S. of A., a fact which I am constantly reminded of, especially how many liberties and luxuries we’re afforded, but I was also born into a caring, supportive, well-off family, and as a result I have never truly had to worry about any of life’s necessities, food, clothes, housing, education. I consider myself luckier than most to have been able to travel to and work in the places I have, and have been granted access into many intimate, personal settings of people in all corners of the world. As much as I complain about the things that don’t work in the US, we’ve got it good.

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?

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reconnecting with the “human side” of being here

It’s a bit eerie/weird to be going through patient files, without much thought, and suddenly come across one where the patient visited clinic on a date you know well.  For example, my birthday.

Let me back up.  For the latter part of the past two weeks I’ve been completing a task that is far less exciting than much of what I’ve posted about recently – data entry.  It’s one of my concrete responsibilities while I’m here, and I’m sure will lead to some very interesting results…one day…but for now, it means a lot of QT with my computer, headphones and the Mercy Hospital patient files.  I’ve been doing entry of basic intake information for patients seen in 2009, anonymously of course, but this requires me to go through each and every patient file at Mercy Hospital.  And, like other health facilities in this region of the world, files are kept on paper.  Files are kept in boxes (at Mercy, there’s a total of 19 full boxes and a couple of loose piles next to the registration desk).  Files are ‘filed’ by letter, but grouped by last name (because there are so many common surnames here, like Jalloh or Koroma).  Files, if the patient does not return often, are left untouched in their respective filing box and are sometimes found with dead bugs stuck in between the pages. And in the past 2 and a half years, Mercy Hospital has seen well over 4000 patients.  It’s been fun.

Going through thousands of files tends to become slightly tedious, and I pay attention to only the details I need – age, sex, date, blood pressure, etc.  But then I’ll come across a patient visit that happened on my birthday, or St. Patrick’s Day, or Valentine’s Day – dates that are so engrained in my mind – and I am slowly knocked out of my lovely, quiet, sheltered bubble, complete with background music courtesy of my itunes shuffle, and am swiftly faced with the fact that  while I was celebrating my 24th birthday, having cake shoved into my mouth and plastered across my face by my lovely students in Bangladesh (love you all, by the way), Ms. X, who is 40 years of age, came to Mercy Hospital’s outpatient clinic complaining of nauseau, loss of appetite, abdominal discomfort, fatigue and vomiting.  Later that day, while I was probably getting more caked shoved into my mouth by students from another class (miss you too, even though I may have mentioned I’d had enough cake for one day), this woman returned to the doctor with test results and was diagnosed with a case of malaria, among other things.

I really hope she got better.  I don’t know, because she didn’t come back for another visit.

(sidenote: there seems to be a far disproportionate number of people seen in the outpatient clinic on june 23, 2009 – my birthday – than other days of the year.  I did the math and for the number of entries I’ve completed, I should only have seen between 10-11 people for that day…and I’ve seen far more than that.  Procrastination comes in oh-so-many forms.)

Long post short, I was struck by how I was going the patient files, giving them little to no thought. While a very obvious observation, the files represent actual people, and give a glimpse into the heartbreaking, intriguing or run-of-the-mill stories of these individuals’ lives.  This, in turn, reminded me how, through the routines of daily tasks, the human touch is lost from much of what we do.  So I figured I’d post a few photos to humanize and personalize some of things I’ve been talking about.  In the end, that IS why I want to work in public health, and a large part of the reason I chose to return overseas for more experience.

For those that are not aware, Mercy operates as many other hospitals in developing countries in terms of their inpatient care – family members are responsible for feeding the patient and assisting with care.  People staying in the wards have bundles of clothes, linens and whatever else they need/want stored at the end of their bed or on the floor, and each day you will see family members or friends of patients carrying meals into the wards.  There is an area behind the hospital where patients or family members can wash clothing or linens, and lines for drying.  In the rare instance that Mercy doesn’t have saline for IVs, or specific supplies for certain courses of treatment, the family members are responsible for going to buy the necessary items.  The only time, I can tell, that family members are not allowed in the wards is during morning rounds, or sometimes when the doctor is examining the patients.  The nursing staff oversees patient care and makes sure treatment plans are carried out, updates the patient charts, etc. Last year, a waiting shelter was built to provide an outdoor resting area for waiting patients and family, and there are always LOTS of people around.

THIS is Mercy Hospital! Male/Female/Pediatric inpatient wards upstairs (+ admin offices), outpatient clinic and maternity ward downstairs. The concrete structure in the foreground is the defunct well where patients used to get water.

...and this is the lab! Because of ongoing construction, and painting, the other day the gates were open. Normally all you can see front this vantage point is a cement wall, iron gate and the building's roof. There are 2 rooms dedicated to hematology and microbiology/parasitology (the clinical lab tests done at Mercy), and 2 rooms dedicated to research.

Here are some of the patient file boxes that I've come to know oh-so-very well.

This is a close-up of the left 'side' of the filing system. It is incredible to watch the receptionist and accountant/cashier find patient files - it would probably take me 4 times as long, at least.

The male ward has 4 beds - each with its own mosquito net - and not much more room. During rounds in the morning it can get rather tight...

This young girl underwent bone surgery at a nearby facility, and is recuperating at Mercy. For anyone that was here in November, this is the young girl who had the IND for a leg abscess - it did not improve, so she needed to have surgery. She also has one of the loudest, most piercing screams I've ever heard... Bags of sand are used to stabilize her leg. She seems to be improving quite nicely, and has a smile on her face most of the time now.

The female ward has 8 beds - and more room for the nursing/medical staff for morning rounds.

One of the patients in the female ward

Mercy Hospital (nor any other health facilities in Bo, minus a private hospital and the government hospital) does not have radiology facilities, so patients have to be sent to the Bo Government Hospital to get x-rays done. Here is a female inpatient, x-ray orders in hand. She would go later in the day to have the x-ray done, and return to Mercy to have the doctor review it.

Here is the Community Health Officer (what I would consider the equivalent, in terms of hierarchy/training, to PAs in the US, checking on this young girl post-operation.

A happy, pain-free moment, for the young patient.

Alfred, the CHO, and me

This young man, a little shy of 20 years old, was an inpatient for over a week while he was stabilized for nephrotic syndrome.

This older man has been at Mercy for almost 2 weeks. He is suffering from peripheral neuropathy - which means he has lost the ability to walk or move him limbs well. A staff member from the limb fitting center (adjacent to Mercy Hospital) has just returned from 3 months of PT training, and has been helping this patient try to recover control and movement. He can now sit up on his own and move his upper body more easily, however he probably won't regain his ability to walk without a walker or assistance from others.

He is a very sweet older man, and always makes sure to say hello when I happen to join rounds or if I find myself in the wards.

In the background you can see the waiting shelter for patients and family members, built last year (as seen from the upper level).

Here are some of the nursing staff - those in green are volunteer nurses, most of whom are taking their entrance exam for nursing school this month.

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The common cold pales in comparison to what one could be diagnosed with here…

* scroll down for photos *

I am currently suffering from two, self-diagnosed, ills.  The first is a head cold.  It is the one ailment that seems to follow me regardless of what area/climate/ecosystem I find myself in (note to headcold/immune system: not cool).  Luckily, Emergen-C packets with a little bit of watered down mango juice is rather tasty, and thoughts of my constant allergy attacks in Bangladesh do well to remind me that a random head cold, here and there, is truly not the worst of my worries.  Walking about the hospital compound, especially the inpatient wards where patients are currently suffering from a plethora of illnesses – including, but not limited to, kidney disease, cirrhosis, alcoholic encephalopathy, hemophagia, severe anemia and enough combination cases of malaria/typhoid/malnutrition in children to break one’s heart – also reminds me that a head cold is, by far, one of the more coveted diagnoses I could seek.   A nice cup of tea later this evening, and a little taste of home (left, to my surprise and enjoyment, by recent visitors. thanks Derek and Ed!) of JIF peanut butter makes the occasional headache/cold all the more bearable.  Oddly enough, I don’t really enjoy eating JIF peanut butter at home – I normally opt for the organic/natural stuff, of which I have in vast supply in the local markets here.  Nevertheless, it is comforting to have a taste of ‘america’ every once in while.

The second ill I’m suffering from would appropriately be termed ‘writer’s block’…if the situation were that my writing was ever unblocked which, since arriving in Sierra Leone in November, and again in January, is really not a truthful assessment.  Each day I think of at least 3-4 topics, funny stories or cultural phenomena that I could wittily and poignantly describe on my blog, and about 10 times more photos that I could and should be taking to share what my life and the life of locals, respectively, is really like in Sierra Leone.  But that’s where it stops.   I compose posts and photos in my head – and believe me, there they are some of the best written and best shot stuff around – but get stalled when I sit down to write.   I’ve surprised myself, as well, at how shy I’ve been in photographing people in and around the hospital here.  I justify it by telling myself that it’s just because I, as the years go on, become more sensitive to personal privacy and how intrusive and unfeeling photographs can be, especially in resource-poor settings.  In reality, it’s probably a combination of that, and a growing shyness on my part to stick a camera into people’s faces without due explanation or compensation while I’m simultaneously become a ‘regular’ in the community.  Hence, why so many of my photographs are of children.  They willingly oblige to being ‘snapped’, more often than not demanding it.

Truthfully, I’ve been overwhelmed since getting back in January.  There’s so much to see, learn and take in on a daily basis that I find myself actively fighting against that trend and looking for reasons to curl up with a book by myself at night.  This is made slightly more difficult by the lack of power we’ve been experiencing on a more consistent basis since the start of 2010 (and the onset of the really dry season), and the fact that I usually opt to walk to the lab that has some power 24 hours/day than turn the generator on at the MTC (although oftentimes the lab doesn’t have lights, which leaves me as a floating head on my webcam with friends and family – entertaining and slightly freaky).   There’s a lot I’ve been grappling with since getting here in November culturally, socially, and personally, that seems to defy easy explanation, or explanation at all.  This is only exasperated by the fact that many of the thoughts I have about the inequities of health, or the unfairness of poverty, or the whirlwind of culture shock and cultural adjustment, I’ve had before, when traveling or researching/studying about other countries and international issues.  And relaying weird, or fascinating, tidbits of “life in Sierra Leone” at times seems trite in the grand scheme of all that happens here.

I was speaking with a Briton last week who was visiting the continent of Africa for the first time.  He made a comment along the lines of, “Well, I’m sure none of my observations are new to you. You probably have a much better grasp on everything here, and it must be boring to hear my impressions.”  To which I replied, “Not at all. I’m jaded. This is a really nice change.”

I’ve been finding it difficult to frame a lot of my thoughts because I feel like the poverty, the health care issues, the development ‘process’, the cultural surprises/charms/frustrations, aren’t new.  Because, in truth, they aren’t . To me, especially.  Maybe someone can read one to many heartwrenching books on women’s inequalities or maternal mortality, or opeds by Nick Kristof that cover rape in the Congo?

However, I’ve been surfing the internet lately for information on different health-related topics, and have stumbled across a number of blogs of other “flexible”, travel-and-health-loving, socially-conscious people that have moved abroad for various lengths of time, and I’ve been reenergized.  I also was able to recently visit the local West African Fistula Foundation, based out of Bo Government Hospital, and learn about the inspiring work they’re doing — more on that to come.  It’s hard not to be amazed at the impressive strides that are being taken by individual and organization-driven efforts, despite the difficulties on ground.

To any former students of mine awaiting response emails – I promise I am slowly getting to them.  Thank you for being patient.

So, to wrap up the most recent rambling rant, a few photos (featuring many, cute, adorable children – no surprise there).

this is one of the fields about 1.5-2 miles from the Mercy Hospital compound. people, for the most part, are extremely friendly in the rural areas, greeting and waving to me with huge smiles

Manjama Clinic lays about 3 miles from Mercy Hospital, off a main, dirt road that is getting pretty red as the dry season gets hotter and drier

this young girl accompanied her mother and new, young sibling to Manjama clinic on a Friday (clinic day for new moms and newborns), so that the baby could be weighed and given immunizations. older sis was particularly intrigued by my camera.

these two were highly entertaining at Taiama when we were there for the OC Clinic. children are attracted to the same things in every country - necklaces and anything shiny.

this little girl was at the Taiama OC Clinic both days, and had obviously run into some pumoys before --- she would run around, get my attention and then yell, "Hello! Byebye! MUAAAAAH!" and end by blowing a kiss. very cute. the first 25 or so times...

two children waiting for family members to see the doctors at the Taiama Clinic. i think i surprised the little boy in blue.

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