Newsletter Ruurd June 2018

Came back about six week ago in Sierra Leone. In the middle of Ramadan. A true ordeal, even for non-Muslims here. There is almost no hour of the day without the minaret of one of the pieces or ten mosques within hearing distance of our hospital nothing to hear. The first week was not so bad because there was no electricity in Makeni because of maintenance on the net and many of the mosques do not have a generator, our noisy neighbor mosque 100 meters away unfortunately, but then all day a cacophony of noise. In the discussions about aircraft noise (Lelystad), this is called “a high sound pressure” in that jargon. I have wondered about this period when an ordinary mortal can actually sleep when around midnight, at half past three at night and then again for an hour from 5 o’clock in the morning, in addition to the usual calls and songs, there is also a thunder sermon or discussion with the maximum volume is shouted in the air. Anyway, today (Friday, June 15) the weather is over, public holiday, pray day and the start of the Sugar Festival. This morning during a training walk for the four-day many people met in the streets on their way to mosques and prayer meetings in the open air (unfortunately disturbed by a heavy rain shower) in their beautiful new clothes and robes specially made for the occasion. Mostly white with a lot of gold embroidery.

Speaking of training walks, my first on African soil after returning from NL was Saturday, June 2, the first Saturday of the month. Wrong day chosen since the first Saturday of the month from 7 – 12 pm is National Cleaning Day. Now that was always the last Saturday of the month but with the arrival of the new president of SL that has changed in the first. I had forgotten. And where did I hear that that a new president is reversing the policy of his predecessor? Quite nice and quiet on the road, no traffic so nice walk without you have to worry too much by an Okada (motorcycle) of the road to be driven. A few times stopped by police and military personnel that I was in violation: “I have to arrest you until 12 o’clock; orders from above, from the President “or on my remark that I had already cleaned:” then you have to sit until 12 “. But with a chat that you’re training and explaining what the four-day trip is, you’ll get away again.

My training walk a week later went for no meter. Every hour really needed some rest. In itself not as surprising as the next day shows that you have malaria in your body. With a three day pills cure, that is also behind us.

Thanks to all who sponsored me for our project to prevent cervical cancer. For those who want to support this project and want to sponsor me during the four-day event, hereby the link:

In our hospital, City Garden Clinic, it goes its normal way with the usual medical ups-and-downs. It is sad if you lose a young man of 21 years. He had long been admitted because a leg had to be amputated. Initially the recovery went well, however, the cancer had already spread and there was nothing more than pain stilling. That cuts pretty well. It is also sad that family sometimes refuses a necessary treatment and thus breaks the chance of a decent future for the patient into the ground. In this case a young woman with a broken leg. After some time it appeared that the bone parts did not grow together. Most likely because there was something between the bone parts such as muscle tissue. With an operation there is a good chance that it all, especially because the patient is young, is reasonably good and the patient can walk again. But the mother and brother of the woman did not want that, wanted to take her with her, and would actually heal herself (!). Impossible without surgery. Dr Erdi spent hours talking to the family and to the patient and her husband who initially wanted surgery, but refused to sign the “consent form” under pressure from the family. Then you are powerless and you know that this young (adult!) Woman is crippled the rest of her life.

But fortunately, the “success stories” have more than the upper hand. In one of my previous newsletters I talked about a patient who had broken his lower jaw in several places. The lower jaw is tied to his upper jaw with wire, dental wiring. Now this turned out to have been the most difficult patient in years in this hospital. Continuously complaining, running away, trying to pick up the wire, etc. In the end it all got pretty good and he walked around with a big smile (see photo).

Another patient I talked about in previous newsletters is Isatu, a woman who had broken both hips. She is now running a bit again. Here is the story that Dr. Erdi wrote about her with some photos and a video.

As I have noticed a big need for proper (basic) orthopedic care, I have started to provide, even though our equipment is far from what is required to do a good job. But even without better equipment, we can provide some treatment better than the herbalists. Most other hospitals do not do any orthopedics, only refer to Emergency Hospital in Freetown (good Italian run hospital, but now unable to cater for the whole country, so almost always full, so often they cannot accept new patients).
One of my patients is Isatu. On the 27th of January she was involved in a car accident: she was a passenger and the car drove into a tree. When she came she was in severe pain around her waist, so much that she did not even complain about her arm that was broken too.
As we do not have X-ray and clinically I could not assess the problem well enough, we contacted the Government Hospital in Makeni, were we could come for X-ray, despite the late hour. We put Isatu in the back of the pick-up of dr ABD and went to the government hospital. This is not far, but part of it is over bumpy dirt roads – very painful, despite the pain medication we gave her. 
Her left hip was broken in the pelvis (acetabulum fracture) and the right hip was broken in the upper part of the upper leg (pertrochanter fracture). These are severe fractures. (Picture Isatu 1, in the pick-up).
That same night we started traction with placement of Steinman pins, as that also relieves a bit of the pain (Picture Isatu 2)
For 3 months she was in traction. After a few weeks she became able to sit up and slowly she started moving a little more (Pictures Isatu 3, 4). 
The day she was released from the traction, she was sitting outside, but her face told me she was not happy. She was sad, as she disappointed her relatives, as she did not walk immediately. I explained (again) to her: those are wrong expectations, it will go slowly.
Soon she had her optimism back and started practicing.
Today during ward rounds she danced for me: See video.

So far Erdi about Isatu (who has given written permission to use her “story” for PR purposes). If you want to know more about our hospital, our website has been live since the beginning of June: