Sunday October 30

Another week, another dollar. Well I guess it feels like that sometimes except that it’s also rewarding to be here. New staff have arrived, staff that I’ve worked with before, have arrived and it’s all change again. Probably the more demanding part of the work is the constant change of personnel and yet it also has its rewards as the fresh input of staff brings new conversations, new ideas and different ways of working.

There are several core values that ensure we all work towards to the same goal. These are to love God, to love and serve others, to be people of integrity, and to be people of excellence in all we do.

In trying to work to these core values the crew are usually at the least pleasant, the holding open of doors, passing another and saying ‘Good morning’ asking if someone is well and meaning it. From the work perspective it means giving our patients the best chance that we can by doing the most relevant surgery for them.
During the week I have been working with someone I first met up with in 2008 in Liberia. I have worked again with him in Benin in 2009 so to have the opportunity to work together again is great as it means I know how he works, what he likes and to my advantage, he knows how the department is run so I’m not constantly teaching. We have had fun together as we have worked on the best ways to anaesthetize some of our patients who have difficult airways and so cannot have a breathing tube put down in the most conventional manner. Always having a plan B in mind gives us constant challenges. Just how do you work it out when someone is unable to open their mouth because of noma, a disease that has the potential to destroy the lips and gums and causes tethering of the skin around the mouth. There are ways of doing these things but one does have to be creative at times!

The weekend has given me a little time to relax and as I only go shopping when I need to buy something I actually ventured out to the shopping areas yesterday with another couple of UK ladies. Sherrie-Jane lives in Somerset and is working in the ship shop/Starbucks/snack bar on the ship. She found out about a church that is training young women in tailoring. However they only had a couple of old machines. Having visited the pastor and his church, she decided she would ask her local Rotary club to help fund some new machines. This they have done and along with other monies that she has received since making the ships crew aware of the project 4 new treadle sewing machines and an overlocking machine were purchased and delivered to the church. They are now installed in the building they are using and are ready for use tomorrow morning. I along with a Scottish anaesthetist who is here at present and who was the other member of our shopping trip yesterday, purchased scissors for the training workshop. We bought 3 different sizes and presented them today.



Some of the girls with their tutor and one of the new machines in the picture. Travelling to the church this morning was an interesting exercise as taxis had been book but then the driver wanted to charge double the going rate so we decided that all 7 of us would travel on the poda poda which is basically a 14 seater vehicle. Thankfully we managed to find one quite quickly and we were all able to get on the same one. Much cheaper than the taxi too so the church offering benefitted!

This evening we were privileged to have a group of students from the Wells international music school come to the ship and take part in the community service. They are actually in Freetown for 10 days working with a couple of schools and joined us for the evening. Great music, very talented young people including a tall lad with a deep voice singing counter tenor...

The week ahead sees the last week of big surgeries as we begin to wind down. Time now to start packing up and as I shall be unpacking at the other end in Togo I need to make sure I pack it all so I can find it all when I unpack!

Huge apologies to those of you who read my blog regularly and have been disappointed by the lack of the weekly update. I returned home for 10 days as my mother in law had died and it has taken a while to find the time. And that really is an indication of howbusy life is on the ship. There are always activities out of work hours in which one can become involved as well as the work itself involving working extra hours.
Just before I left for a brief sojourn to the UK I had been working in the plastics room. Tertius Venter as a South African surgeon and workedsolidly for 5 weeks re creating faces, giving function to contracted limbs and restrong the shape of faces. Many of these patients have been the victims of fires of one sort or another. Lamps are often fueled by oil and the subsequent burns from accidents with these can be horrific. Equally, young people can be given the chance to use their hands properly as syndactyls are released (fingers joined together from birth). The work requires patience by the bucket load and certainly is displayed by the surgeon.

However coming back to the ship felt like coming home as I am currently in the lead anaesthetic role and probably know more about the anaesthetic department on the ship than the hospitals where I work in the UK simply because I'm here more often!

Having been working in the rooms where many of the large facial tumours are removed has involved difficult intubation tehniques. We have a variety of 'toys' on the ship which help us with this task. Probably the greatest difference here is that no-one minds how long it takes to pass a tube and have the patient anaesthetized. No-one has pressing appointments. this doesn't mean that we take our work any less seriously, just that there is less pressure of time. This is the place where I have most practice ofdifficult airways, a reflection of the workload. I am also trying to gradually sort through the equipment we have and make better use of the hold for storing some of the items and ths create more working space in the pharmacy in the department.

I was able to leave the ship on Saturday and spend the day with a friend visiting a chimpanzee sanctuary not too far from Freetown. The hunting and killing of chimpanzees is forbidden in Sierra Leone because of the risk of extinction. At one time they were a common bush food. The chimps are rescued from homes where the owners mistakenly buy the babies and then realise that they cannot care for them. The average chimp is 5 times stronger than a human and would wreck a home in no time. Close by the sanctuary are some water falls and my friend and I walked to these falls. As rainy season has almost come to an end the rivers are full and so the falls were spectacular. We climbed over some boulders so we could enjoy sitting out a little way from the waters edge and enjoy the peace of flowing water.



As we walked back to the ship after catching a taxi to the edge of the city, I was able to enjoy drinking straight from a coconut, just as it should be drunk and greatfor quenching thirst after quite some walking. In all I think we walked about8 miles that day and my day had started with a run outside with the ward physician who is a like minded runner....

Saturday October 1

A change from last week as I have been working in a couple of different rooms this week. This situation is quite normal here. Anaesthetic assistance spread between two rooms. I have been working in max fax (maxillary facial) and cranio-facial. There is a difference between the two so let me tell stories about one patient from each.

First in room 4 where Dr Gary Parker works for the most part. He has been on the ship for over 20 years having decided to forgo the opportunity of working in the US when he finally finished all his training. We had an 11 year old girl who was very pretty, all except for a large tumour that she had growing from inside her mouth. It had completely taken over the upper jaw on the one side so that she looked as if she had a grapefruit in her mouth, size wise. Her eye was pushed out of line and she had teeth within the tumour. The tumour prevented her from eating normally and she was underweight. (Again situation normal here). We thought we might have a problem passing a breathing tube but in the end it wasn't so difficult and we weren't too long in putting her to sleep.

During the surgery she needed blood. As a blood donor onboard I had been warned the night before that I might be required to donate a unit and therefore it wasn't really a surprise when the call came. Quite something to give a unit of blood and ten minutes later see it going into your own patient. One of three untis she received that day. There are not the facilities onboard to store blood as there at home and so we keep our blood warm by drawing it from volunteer crew members as its required. It does mean that patients receive whole blood and it does not need warming, but it does need a close match. She's making a good recovery so far.

My second story, although there are several from this room and its hard to choose, is a little girl 15 months old who had a small encephelocoele. (Swelling on her head) When she was seen by the anaesthetist, he realised that she had a problem with her heart. In his normal practice back in the US he works as a cardiac anaethetist. She appeared fit and well so it was agreed to go ahead with surgery. When she came to the operating room he was able to perform ultrasound of her heart and found that she had an enlarged heart. Surgery was performed and again she has recovered well. Her mum knew nothing about a problem with her heart. To talk to mum we had to use another patient who spoke the same dialect/language. Imagine, I'm talking to a translator in English who translates to Krio to the patient translator, who then translates into the mum's language. Now you understand why consultations can take so long! But to also have an anaesthetist onboard who could carry out a cardiac ultrasound and he was only here until yesterday morning. What's more is that I have contacted an organisation I know about through the time I spent in Haiti with another nurse. Truly Father organises these things and I am ever amazed by what He does.

But just one other little one to mention, as I said I've been working in a room with german cranio-facial surgeons and we have placed a V-P shunt in a baby this week. The shunt drains off the excess fluid from the ventricles in the brain and it passes down a tube which is placed inside the body to the peritoneum/abdomen. Not only are these uncommon in Sierra Leone we can prbably say with a degree of certainty it was the only one performed in SL yesterday. A crew member arriving from the States brought the necessary kit over. The baby is 11 months old and weighed 6kg. I'll let you know how he does.

And today - I'm on call and need to do chores, washing, ironing, vacuuming and hopefully later, if it stops raining sit out on a deck and read!