Okadas

The okada drivers. There are many, many young men who are motorbike taxi drivers around Makeni. I've been told that the government had a campaign for rebel fighters to trade weapons for motorbikes after the war. The okada drivers are great and this is how we get around the city.

Around Makeni

(1) the old cinema building.... I'm not sure what they use this building for now, I don't think they show films

(2) Rabia at the barbing saloon. I think I'm going to grow my hair;-)

Around Makeni

Rabia, another VSO volunteer, and Mohamed. A lot of people who are affected by polio have wooden wheelchairs that they propel with their hands.

Life as a volunteer in Makeni

There is a great network of volunteers living in Makeni. There are people from all over the world doing work in various sectors. Most of us gather at a restaurant/bar or someone’s house for dinner/drinks every day. We frequent the Apex Hotel because it has a swimming pool, internet cafe, and the generator is always running (we can charge our electronics).
One of the cultural aspects that we all struggle with is the unrelenting attention that we get from the local people whenever we leave our houses. As a white person, you are constantly being yelled at (“opoto!” –white person) and greeted by everyone you meet along the street. The majority of people ask us for money or food, and many of them demand that we give them our personal articles (e.g., “Give me your hat. Give me your skirt.”) I actually miss the anonymity that we have in Canada. The people are very friendly and enjoy talking with us and they are very poor.
I climbed one of the small mountains surrounding Makeni and enjoyed the view of the city.
We hand wash our clothes and hang them to dry in our back yard.
We go to the market every day to buy fresh vegetables, fruit, rice, bread, spices, and eggs because we have no refrigeration. All of the daily activities, such as eating, bathing, and laundry are really time consuming and take up most of my time.
They make fresh ground nut (peanut) paste by grinding the nuts at the market.

Makeni Government Hospital

Photos:

1)The laundry room where the ladies wash the extremely limited linens.

2)The Kitchen where the ladies make tea for breakfast, bread for lunch, and rice for supper for the patients.

3)The operating room where they perform cesarean sections and "minor" surgeries.

4)The femal adult ward. The female ward has 9 beds and the male ward has 19 wards. They put mattresses on the floor if there are more patients. There is also a maternity ward, a paediatric ward, a HIV clinic, antenatall clinic, outpatient clinic, an eye clinic, and a tuberculosis clinic.

5)The only water pump that serves the hospital with the hospital shown in the background. The water must be carried to the wards in buckets.

Nursing and Makeni Government Hospital

The Makeni Government Hospital is unbelievable!! They basically have nothing. They don’t even have running water to wash their hands. The few registered nurses that are “employed” by the hospital actually have to volunteer for the first 2 years of their career because the government says it doesn’t have enough money to pay them! Some of these registered nurses don’t show up to work at the hospital because they work at other jobs (mostly with international NGO’s) where they can actually make money. There’s a Sierra Leone Nursing Board, which licences nurses, but there is absolutely no regulation or anyone to hold the nurses accountable!! The standards of nursing are nonexistent! The hospital I work in has no policies or protocols! The majority of the staff is health care aids who have had no training. They do the job of nurses because there aren’t enough trained nurses. The nursing aids pretty much do anything they want to, which is mostly nothing at all. The nurse manager strolls around the hospital and does nothing that she’s supposed to do. There is no documentation! The nurses/aids perform patient care without recording what has been completed. Many things that the doctor has ordered do not get transcribed properly, if at all, and many things are not carried out, or they are done far too slowly (sometimes a day or two later). The nursing aids are transcribing orders and administering medications without having any training.I am working with a wonderful nurse from England, Suzie. She has been here since May and has spent most of her time trying to fix the problems that exist due to lack of management.... absenteeism, stealing hospital supplies, scheduling, etc. She’s also developed and implemented various tools for the nurses and aids to use (eg. admission assessment form). She’s started doing teaching sessions on how to measure vital signs and other basic nursing care. Together, we are going to develop some nursing protocols for the hospital. We are also going to develop a number of practical nursing care teaching sessions and deliver them to the nurses and aids in the hospital. We really have our work cut out for us but I’m excited about the challenge!

My first day at the hospital

I'm going to be shadowing and observing all the the different departments of the hospital for the first few weeks of my time at the Makeni Government Hospital. The men who work in the lab were great and showed me how they do some of their tests. Currently, the lab is located in an open air verandha (shown in the photo) because the real lab is under repair. They had a table set up where the patient visits for collection of blood, or they deposit other samples (sputum, urine, stool). At the other end of the table, they process the samples for basic tests, such as hemoglobin level, malaria, HIV. They have a microscope to observe for parasites and ova. It was all very basic, but it was interesting to see how they get the results. I'm not sure how accurate all these tests are.
I also observed the area where they do all of the patients' dressing changes. They do not use pain medication (partly due to lack of resources and partly due to cultural beliefs that the patient must deal with the pain). I became very nauseous and broke down in tears after watching a couple of children screaming and a man who was writhing in pain during their dressing changes. I expected this to be really tough, but I'm really going to find it challeging to deal with the conditions and practices here!!

Creepy crawlies and unsitely skin

I’m still managing to stay healthy, but I understand that it’s only a matter of time before you get sick with something or other in Sierra Leone. The majority of volunteers have had malaria at least once and some have had typhoid, bronchitis, and other wonderful illnesses. The only thing I’ve encountered is a wicked heat rash (or what I hope is a heat rash) on my hips, elbows, and eye lids. The temperature here is usually around 35 Celsius, but it’s the beginning of the dry season and the temperatures are on their way up. When it gets to be 45 degrees, I’m going to look like a freak;-) I’m just happy that it’s not bed bugs, which are rampant here.
The cat continues to be a wonderful pest control expert but I had to contend with a monster spider in the bathroom today!! I’ve been told that they can be much bigger but I hope never to encounter one. It was at least 4 inches in diameter (including the legs). AHHHHH!!! I chased it around the bathroom with a can of insecticide, screaming the whole time;-)

Arriving in Makeni

I arrived in Makeni on the afternoon of October 29. The hospital sent a driver to pick me up from Freetown and the road between the 2 cities is really good. It's paved and smooth....no craters right now;-) When we first pulled up to the house, I was greeted by a swarm of neighbourhood children screaming "oputo, oputo!" meaning white person. They all want to touch you, talk to you, and check you out. Apparently, that's the way it is every time you walk outside the house... you have celebrity status and can never go anywhere unnoticed or even unaccompanied by a local person asking to be your "friend" and requesting money. Everyone here speaks Krio or Temne, so I'm going to have to learn as much as I can!
Our house is pretty nice. We live in a place with a wall around the yard for security. One of the other volunteers who lives in another house that's not located in a compound was telling me that she had no privacy at all. There would always be a number of people peering at them through the windows the whole time they were in the house and the neighbours would just walk into the house if you didn't lock the door. I'm also glad that we have a kitten, Gingersnap, in our house because she keeps the mice, rats, and cockroaches away. The other volunteers I live with, Celine (from Vancouver) and Suzie (from England) said that the rodents were pretty bad before they got the cat. Suzie has had a planter built in the courtyard of our house and planted some vegetables there. I'd like to have some more gardens built so we can grow more veggies. The house has running water, so we have sinks, a cold shower and flush toilet. We have to use the generator to pump water from the well into a holding tank, and then the water runs by gravity into the house. The house has 4 bedrooms, living room, dining room, 2 bathrooms, and a kitchen equipped with gas stove. No refrigeration!
There are about 8 VSO vounteers in Makeni and there is also a group of volunteers that work at a Dutch hospital at the other end of town. It's a great group of people and they are taking good care of me.
We took a quick walk to the market but I haven't had a chance to take a good look around yet. I haven't been to the hospital yet. Everyone gets around on motorcycle taxis in Makeni so I'm glad I have my motorcycle helmet for those. We don't need to drive a motorcycle on our own as of yet. It costs 1,000 leones for a one way trip for an ocada (motorcycle taxi). I've been told that Le2,950 or Le3,000 are equivalent to one American dollar. It costs Le3,000 for a local beer. The canned and packaged food is quite pricey and in limited supply at the supermarkets in Makeni. We have to stock up when someone visits Freetown.
I'll try to post some photos soon. We have to go from place to place (hotel, hospital, etc.) and charge our electronics when they have the generators running. We use our generator sparingly because fuel is expensive.

I arrived in Freetown on October 24 after uneventful flights from Toronto to London (6 hrs), a 4 hour stopover, and then London to Freetown (6.5 hrs). The VSO driver transported me to the house I am staying in with other volunteers for a few days while I'm attending orientation. The other volunteers are taking very good care of me. We spent the weekend going to the beach (beautiful beaches!), hanging out at restaurants & bars, and exploring the neighbourhood.
I've eaten at restaurants since I got here because none of us like to cook and the availability of foods that we are familiar with is not great. In Freetown, we can get some things, such as peanut butter, cornflakes, and "herbal essences" shampoo at the supermarkets, which are primarily owned by Lebanese people. These items are about the same price as they are in Canada, so it's really expensive on the limited volunteer budget. The local foods are readily available in markets and stands along the street, but we either don't know how to prepare it or we're nervous about how safe the food is. It's going to be an adventure trying to feed myself;-)
The temperature has been very hot and it's quite humid. Most of the time, I'm sweating while just sitting still. It takes a lot of energy just to walk around. It's no wonder that things move at a slower pace here.
The house I am staying in in Freetown for a few days has electiricity from morning until 6pm, and then we have to use candles and flashlights at night. There's running water and a toilet, but very little pressure. We take cold showers because it's expensive to heat the water. We can cook (if we want to) on a gas stove. Another huge challenge is that there is no refrigeration, so we must eat anything that is perishable right away. The cockroaches and insects are plentiful, but I haven't had to deal with any in the last couple of days. The girls have figured out how to keep them at bay. I'm just waiting to slip into bed with a nice giant cockroach!!
Freetown is very congested with people and buildings. The streets are very narrow and it's treacherous for both pedestrians and motorists. The traffic in the center of town is horrible. This is what I've been most overwhelmed with is the crowding. The roads are made of dirt and in horrible condition. There is a lot of garbage everywhere and a lot of people selling goods at roadside stands everywhere. I don't think they have garbage collection. Many local people don't have running water or electricity in their homes. A lot of people live in little shanty-type houses. Many people use cell phones for communication because the land lines are unreliable and expensive. The internet is pretty widely available and the connections aren't too bad. The electricity flickers on and off all day. The people who live near influential people are lucky because the services are better to those areas.
I've had one encounter where I was very nervous.... another volunteer, Chloe, and I were on taking a taxi to restaurant, and we were stopped by someone who claimed to be from immigration. He asked us to get out of the car and show him our documents. He wanted to see our work visas and to know how much we paid for them. Being new volunteers, neither of us have our work visas yet. We didn't know if he was looking for a bribe or if he was legitimately checking for visas, but he let us go along our merry way after telling us to make sure we have visas. According to my program manager, they are trying to crack down on internationals who are working in the country without visas.