I was up this morning at 4:30am with my body clock and stomach not quite acclimated to the time zone difference and real potable water from the tap. Africa seems simultaneously both so far away and so close by. Despite some “real” meat and cheese my body is craving cassava greens and ground nut stew. Words do not do justice to describe how wonderful and amazing our mission was. The purity of providing needed health care without interference from 6+ layers of supervisors was transcendent and a clear reminder of why we went to medical, nursing, CRNA school.

The wit of Robert Heinlein is most true when speaking about modern health care, “A bureaucracy the only entity in the universe with hundreds of bellies and no brain”.

This ironic juxtaposition of Kabala vs. the USA was no more evident when I returned to find an e-mail basically accusing me heinous patient safely practices by using a non-sterile but lean 3 liter IV bag as a temporary abdominal coverage in an open abdomen in a severely injured trauma patient. The exact verbiage is priceless and was…

Forgive my ignorance, but I'm not sure why we wouldn't give an abdominal trauma patient a sterile dressing after surgery. We apply sterile dressings for major contaminated/dirty cases on a regular basis, and I am fairly certain we use aseptic technique during these procedures. The reason for the investigation was that an unsterile bag was used for a dressing (apparently OR staff believed it to be an actual or potential patient safety issue). Performance Improvement Manager

I wonder what she would think about well water in a perforated ulcer….. It is sooo nice that I remain in African mode and merely shut out the yipping barks of these people. They are a distraction and an impediment to our true mission in providing health care. I only hope that some of this serenity will last until the next mission.

To think we provided surgical care to 67 patients in 5.5 days, most days starting at 9:30 and finishing at 5 with breaking for lunch is a feat that cannot be matched in my (and possibly most) hospitals. Go ISHI team and take me back to Kabala!!

Other moments that I close my eyes and see include: our first Star Beer on the ferry to Freetown before we all knew what would transpire; the smiles and shouts of the children saying “Hello, snap me next” during our walks to and from the hospital; Marina, Ben and Leah alternately performing Sierra Leone step class to provide suction for Z an Anastasia; Kabala Hill at sunset and coming done in the dark; the transformation of a dark and dreary maternity ward into one of light and beauty; the smoke from the generator meaning we would at least have light and AC in the OR; the village visit; talking about trying to deliver health care with Peacemaker, chickens in the hospital; sunset over the Atlantic; much laughter at the awards night dinner….. and so much more.
 

Continued peace and happiness to all Until our next mission
 

David Livingston, Surgeon, Volunteer

Blog entry posted after return from mission in Sierra Leone