on 20 March 2020.

Dear people,

Yesterday I returned to the Netherlands. After Erdi’s funeral I went back to Sierra Leone. It was all very unreal to go back to work without her.
First of all, many thanks for all the heartwarming expressions of compassion I received after Erdi passed away. And also for the many advices to take it a bit easy since I was promoted to heart patient in August last year. I have certainly taken that to heart and I am doing well, taking pills faithfully. And that is also the reason that I am back in the Netherlands earlier than planned. Originally, the plan was to return on April 3, but with the expanding corona crisis, the risk of getting stuck in Sierra Leone became a bit too much for me. In itself there wouldn’t have been a speck of air just to stay longer and sit out the crisis safely in SL, were it not that after an extra week I would no longer have heart medicine, while most of the pills I prescribed not available in SL. As it turned out, my ticket could change just in time. A day after this was arranged, the message from Brussels Airlines came that they will suspend all air traffic for about a month from tomorrow, March 21.

The past two months in the hospital in Makeni have been hard without Erdi and I can still hardly imagine that she is no longer there, after more than 10 years of sharing with her love and (especially many Sierra Leoneese). I received a lot of support from a Dutch nurse, Nicoline, who worked as a volunteer for two months. And helped me tremendously to sort out all Erdi’s possessions. Meanwhile, most of that stuff is back in the Netherlands with the family and I am happy that I was able to do something for Erdi’s parents, brothers and sister.

During that time I also thought “the further” and decided to stop in Sierra Leone. The work and conditions there just require too much energy from me and it is time to slow down. Depending on how the corona crisis continues to develop, I plan to go back a few more weeks in June, or later, to hand over and finalize a number of things and then it will be nice after 11 years.
This is my last “newsletter from Sierra Leone”. Thanks for all the reactions, stuff, donations etc that I have received all these years as a result of my stories about my experiences in a poor country in Africa. Everyone is doing well and I will certainly have contact with many of you.

Sincerely,
Ruurd

on 10 January 2020.

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During the morning transfer on January 8 at the City Garden Clinic hospital in Makeni, Erdi was not present, and after a checkup the on-site staff found her in a comatose state in her room. After research in Makeni by a doctor from the Masagna hospital, she was transferred to Freetown, where also Dr. ABD was. Further investigation should show the exact cause and it was decided that Erdi will be transferred from Freetown to the Netherlands on January 10 for further investigation.

The Helping Hand Foundation from the Netherlands has been active in Sierra Leone for several years, mainly in Yele (SDA secondary School) and Yonibana.

A part of the board came to Sierra Leone to visit their projects.

This time they also paid a visit to City Garden Clinic, admired the good work that is being done.

They also visited the Child Care Center in Yele, were they met with Joseph, the manager and the children. In Yele they also met with leadership of the SDA secondary school , including Dr ABD (chairman of the board of the SDA secondary school).

At the SDA Secondary School, the Helping Hand Foundation started this year with a Teach-the-Teacher program which is also implemented at the primary schools via Smarter Hospital Foundation. Both done by Educaid, a British NGO working in Sierra Leone.

It is great to connect and share ideas and support each for the betterment of Sierra Leone!

Thank you for your vist!

In November we had more visitors staying at City Garden Clinic, our good friends Steve and Ricco and their team that assist the polio community to start a soap making business.

They had sent a container before with the needed equipment. Next thing was to teach the people that would do the soap making.

Their stay was concluded with a great opening ceremony honored by the minister of Social Welfare.

The soap smells very nice as it contains lemongrass, so I would recommend any visitor to buy a few of these nice soap in Sierra Leone colors before you leave.

Thank you Steve, Ricco and team for these wonderful developments!

On Sunday 24th November we received the sad news that our colleague doctor for CapaCare at Masanga, had passed away on 23^rd November in isolation in the Netherlands due to Lassa fever.

We have always worked well with Wouter and appreciated him. He was very dedicated to Sierra Leone and the Surgical Training Program of CapaCare. He used to visit us to check on his students and we would meet him at graduation of the STP’s.

We wish his parents, family and girlfriend much strength with his early departure.

We also wish all at CapaCare and Masanga Hospital much strength with this great loss and offer our help where ever we can.

Rest in Peace Wouter

City Garden Clinic aims to subspecialize in orthopedics and urology. We will continue to treat all other conditions to our best ability.

We have experienced a great need of improvement of care in the field of orthopedics and traumatology in Sierra Leone. The only place where proper trauma care is delivered is at Emergency Hospital in Freetown. This means that it is far for those in and around Makeni and that that hospital is often full and can not accept new patients – as one hospital is not enough for this country.

Both dr ABD and Dr Erdi have skills in these areas and put together, many conditions that are often untreated with mayor disabilities as result, can be healed.

Several people have already experienced that: while some might fear they never would walk or function again, they are back on their feet! This tells a story and makes others come to City Garden as well.

At this moment we have quite some trauma/orthopedic cases at the hospital, some on traction, some with POP, some with external fixations. (unto the point that we are running out of external fixation material).

See also the picture of 4 of our patients with external fixation on lower leg, most due to open fractures.

We would like to encourage the Sierra Leone people to come immediately after trauma, as then healing is best. If you try native treatment first, sometimes we can still help you, but it is more difficult, takes longer and is more expensive.

We would like to thank those who provided us with the materials to do orthopedics!

We would like to thank the specialists that we sometimes consult by email for their advises!

Nynke has been collecting and donating insulin to Sierra Leone for many years. Since dr Erdi came to City Garden Clinic, they also supply insulin from Insulin For Life to City Garden Clinic.

Nynke also provided the contact and the support to receive donation to get the conference room ready for use.

From 16 to 19 November Nynke and her friend Geertruid came to City Garden Clinic. Nynke is a diabetes nurse and shared her experiences after morning report to all staff. Later she also met with all clinicians and showed some practical aspects of the treatment of diabetes.

Geertruid is a psychiatric nurse with a great interest in epilepsy. She had worked with her husband in Panguma in the past, so she knows Sierra Leone well. For this trip she even had contacted the epilepsy focal person in Bambali to join us at the next morning report, and they taught more about epilepsy.

Nynke and Geertruid, thank you so much for your visit and teachings!

We hope to see you back one day!

Gerry and Petry two retired midwifes from the Netherlands, who already for years come to Sierra Leone to train TBA’s in Kambia, also visited City Garden Clinic this trip.

From 19^th to 27^th of October they been guest of City Garden Clinic and gave multiple lessons and did practical stations for all staff to visit.

They taught about neonatal resuscitation, drip rates, about proper handing over, proper communication and many more.

The enthusiasm and superb team work between these two friends is contagious!

Gerry and Petry, thank you so much and we hope to see you back!

At a health care innovation event in Bodrum, Turkey Dr Erdi gave a presentation about City Garden Clinic and Smarter Hospital.

A group of enthusiastic innovators in health care were there. It was great to meet and share ideas.

Hopefully some will assist in the future of City Garden Clinic, e.g. digitalizing the patient records in a functional and affordable way.

Dr Erdi also brought some souvenirs from Sierra Leone; the sale of these items and few donations go into the project of Smarter Hospital and Wilde Geese to improve City Garden Clinic.

Thanks to Gert and Sibel, the organizers of the event!

Sustainability of projects in Africa and Sierra Leone specific is very important. Also, Wilde Geese, the sponsor we work with together with Smarter Hospital, has sustainability high on their agenda.

So besides being a co-sponsor fo r improving City Garden Clinic (with renovation, waste disposal area, X-ray room, X-ray, additional laboratory equipment and anesthesia machine), they also want to assist us in becoming more sustainable.

Therefor a training was organized in Sierra Leone by WASCI on local fundraising. Dr Abdul Sesay represented us at this training.

He came back very enthusiast and full of new ideas.

The proprietor of City Garden Clinic is already quite skilled in sustainability, as the running of City Garden Clinic is done from own income. The clinic is running and expanding in the last 10 years, due to own income and some good friends that support the clinic.

For mayor investments, like the X-ray machine, we are depended on donors.

We are very happy with this opportunity for Dr Abdul to attend the training as that helps the future of the clinic.

Thank you Wilde Geese, Thank you WASCI!