News Letter Ruurd December 2018

Dear people,

It has been a long time since I sent a newsletter. At least for my feeling too long ago. With the end of this year in sight, I thought it would be a good opportunity to hear from me again.
Meanwhile the rainy season is over and the dry and dusty season starts again. Especially here in the hospital that is located in a neighborhood with only unpaved roads with a lot of traffic, especially okadas (motorcycle taxis) of which hundreds pass by every day. Within a day everything is covered in a thin layer of red brown dust and after a week the car is not used you can hardly see anything through the windshield. The dry season also means the “burning season” in which all overgrown pieces of land and verges are burned down, as well as farmland on the surrounding hills. Sometimes it gets out of hand and it is not uncommon for a few houses or a whole village to disappear into a fire. On the photo a burning Wussum Hill that we are looking forward to.

In my last newsletter I talked about the visit of a number of board members of the Smarter Hospital Foundation, I am now also a board member of SHF, where one of the goals of this visit was to develop a five year plan for SHF and City. Garden Clinic. We are convinced that we have a good plan for the future and are now fully committed to giving the plan a handle.

Looking back on the past year, I was mainly involved in “logistics”, although the first half of the year was about 60% of my time in the phasing out of Child Care Center in Yele, of which I regularly reported in newsletters during that period. The Care Center is now in full swing and twenty Ebola orphans have found a good home.
Mainly logistics this year or to create order in the chaos in two 40-foot containers full of donated stuff, the processing of another forty feet that arrived in the middle of this year and a full and unordered drug warehouse that nobody knew what was in store now and what not. Now at the end of the year everything is reasonably well organized and most of the inventory has been made and a system has been set up to keep track of consumption. For the time being on paper, but now I have started guiding our store keeper, Osman Fofanah, in an Exel program to keep track of the entire stock of administration.

In such an exercise you also regularly encounter items that you think, what do we have to do with this? But there is usually always an alternative use to find which also saves a lot of money because you do not have to buy any other stuff. So I came across a large amount of sets for use in kidney dialysis. As far as I know kidney dialysis does not exist in Sierra Leone, perhaps somewhere in Freetown, and we do not have the equipment here in City Garden. But the tubes of those sets are perfectly suited to make probes for stomach feeding. Special infusion bags for food that we can not use for that purpose because we do not have the necessary pump and other materials. With some other parts of infusion sets that we have in abundance and with catheters of a size that we do not use, Dr Erdi has made rinsing bags to be able to rinse the bladder. This is done with NaCl 0.9% infusion liquid (Normal Saline) which is actually just salt water. But that is expensive and after a prostate operation you need a lot of liters. That can also be done just with boiled water with some kitchen salt in it. If a prostate operation is planned, rinse well-washed rinsing bags with boiled water and then fill with boiled salt water, let it cool down and then it can go to the nursing ward. Our kitchen is therefore regularly what I, as Erdi is doing, always call the salt water factory again.

With this kind of creativity, you can also help patients with a stoma on their way. Recently we had a patient who had to have a large bowel stoma permanently. After the operation had been successful and the patient could be discharged, the question was of course how do you get stoma? We do have a nice stock but not to provide someone lifelong for a while and just get stoma bags here in this country, apart from the costs. A cheap and practical solution: the bottom of a plastic drinking mug or cup cut away, two holes for attaching elastic band and ordinary plastic bags that you can buy anywhere on the market through the cut-open cup and then the “stoma” around your waist fastens over the stoma outlet. See the pictures.

Last year we of course had the necessary medical “ups-and-downs”. Fortunately, not too many downs and many, sometimes surprising, ups or cured patients. The child with the open back and water head of which I had it in a previous newsletter has, although it initially went well, ultimately not saved. On the other hand, for example, quite a few patients with neglected bone fractures or amputations who thought that they would never be able to walk again themselves, who could leave the hospital with or without a prosthesis.

Finally, I wish everyone a Merry Christmas and the best wishes in good health for the New Year.

Until a next newsletter