ISHI Blog

Hello everyone - A short video about ISHI mission to Sierra Leone is posted on the home page. We hope you enjoy it.

http://ishiglobal.org/component/content/article/175-sierra-leone-video-2011

Many thanks to all those helped and contributed to the mission.

Charlie Khoury

A short timelpase video of one of the surgeries done during our mission in Sierra Leone is posted on the website.
It encapsulates in little over 2 minutes what ISHI is all about: Surgery and its delicate complexity.

You can view it here  and you can find its link on the home page.

If you like it pass it forward

Regards to all!

Charlie K.

Vulture on the thin tin roof top of a house in Kabala. These birds are part of the scenery throughout the area.

Driving along the road to the village of  Yagala where a ceremony was waiting for us. Marina (with hat) and Peacemaker on the motorbike.

Street scene in Kabala during the team morning walk from the guesthouse to the hospital.

Group photo in Yagala with District Chairman Peter Konteh (right) and village chief (left).

The modest interior of a house in Yagala .

Tammy and Memuna a very gifted and very hard working OR nurse from Kabala . ISHI worked with and trained almost 25 people during the period we operated in Kabala.

Placing a mesh to repair a large groin hernia.

Vishnu and Vely preparing a patient for surgery. ISHI was operating on two tables in the same OR simultaneously

A patient with a perforated stomach due to a bad ulcer waiting to be admitted as an emergency case. The man had walked 3 hours from his village hoping someone will be able to take care of him at the hospital. On a normal days this patient would have unlikely survived as no one would have been able to operate on him.

Stephanie placing an IV and preparing patients for the OR.

The team is continuing operating at full steam; ISHI has completed 51operations in the past 4 days. Staying late at night finishing cases, despite the efficiency and the support of the local staff.

The surgical supplies are running low faster than expected due to the

large number of major surgeries. I never expected that one day I would

be running in Kabala, Koinadugu district, from “Pharmacy” to
“Pharmacy” trying to gather 40 one liter of LR and carrying them back
on a motorcycle to the Hospital. A good portion of the IV fluids is
being administered to dehydrated patients who have come to the
hospital walking long distances.

Also unexpected is the number of emergency cases. The OR schedule is
interrupted regularly with emergency cases, some life threatening.
ISHI has done 4 emergency cases so far and all are still alive. The
patients are arriving ready to collapse.  There are no ventilators in
the OR, the anesthesia team (Vely and Lea) are manually hand bagging
these patients the entire cases.  Something they have never done
before but learned to do very quickly given the circumstances.
Stephanie  (ER nurse) bagged on of the sick patients for an hour
because Lea had to use the manual suction as we lost power after the
generator broke down during the operation due to over heating.  The
generator dilapidated state keeps me on my toes constantly. Leaking
diesel, and fluids of all sorts, it has no way of knowing if it is
over heating. I have been desperately trying for two days to get a
small contingency generator ready, just in case. The medical team
checks their patients; I check the generator. There are no shortages
of exciting drama.

Some patients that have been registered had to be sent home as we will
not have time to operate on them. We had to send a request to
broadcast a radio message asking the population to stop flocking to
the hospital as we are running at full capacity and we cannot accept
any more cases.  It is extremely difficult to tell them away. We are
hoping to come back the next dry season to offer our services.

There are nevertheless the constant cases of a baby with a large
abscess on the neck that needs to be sorted, or one who needed a blood
transfusion that got donated by one of the volunteers, many cases of
massive goiter that the team had to send home, cleaning the occasional
elephantitis wound, handing various drugs…

The protein shakes that got donated by Bariatrix, are getting fed to
the OR patients and distributed to many of the lactating mothers in
the pediatric ward. ISHI volunteers are also getting their servings as
snacks between meals.

Zeina has the food and beverage under control, which was a challenge
by itself ex: there is only one paved street in the whole town, the
rest are all dirt roads that get carved by water every rainy season,
the only taxis available are motorbikes: try to get soup transported
on a motorbike. We were able to secure a government car for some part
of the day.
We have set up a small table outside the OR with coffee, tea,
biscuits, and protein bars. This has helped to prop up the hearts a
little bit.

Had ISHI came with, pediatric team, orthopedic team, infectious
disease team, and surgery team, they would have all been overwhelmed.
Every specialist is needed. Everything is needed. Life in Kabala is a
mix of 19th century lifestyle level but with nylon bags and a feeble
cellular network.

The team has been challenged like never before and has come together
and is adapting.  We are getting an awesome support from the local
staff, Levan and Connie the two British GP that have been working in
Kabala for over a year, and the district chairman Peter Konteh.

In 2009 we went to Guatemala and witnessed an acrid level of poverty. The 2010 Haiti missions showed us what abject misery could do.

The UN world development index has stirred a lot of controversy, but 3 days in Sierra Leone are enough to give it some credits. If I remember correctly SL ranked 180 out of 187 countries. Be it 160 or 180, misery is just another shade of grey at this level.

Our introduction to Freetown, the capital, was through the ferry that carried our crammed bus the across the Sierra Leone river estuary. Freetown is poor. 24h electricity, running water, street lights are evidently unheard of. Hotels are barely 2 stars and because of their scarcity and the high demand generated by the mining companies, charge between $120 to $250 per night.

Anything can get done in SL, except it takes a lot of time, something we do not have a lot on our hands. We were slightly under stress the first 3 days as many items on our original plans kept changing: the bus originally booked was smaller than the one agreed upon, the two land cruisers that were offered dropped to one, cel phones were difficult to acquire, meeting times with some locals and officials were not respected, most cases turned out to be major surgical cases… Ziad is doing his best to keep the team constantly updated and that is helping keeping everyone on the same frequency.

It took us 7 hours of bus ride to get to Kabala. The road was not as bad as we expected. Upon reaching Kabala we went directly to the hospital to download the 18 boxes of medical supplies we brought with us. We had a bumpy night and some issues at the Senghbe hotel after our arrival.  The next day the, district chairman, Mr. Peter Konteh graciously offered us his guesthouse that we moved into. That made a huge difference from the squalid state of our first hotel.

Our mission had been announced many days prior to our arrival on Kabala local radio station. And on the night of the 4th, Ziad, Vishnu, Anastasia and Marina were invited with Mr. Peacemaker (one of our local contact for this mission) to come and talk on the air to the Koinadugu population about the mission. The team mentioned the fact that the surgeries are free and that everyone is welcomed, and highlighted that we do not have the capacity to treat everyone and do all type of surgeries. The next day patients coming for screening and triage overwhelmed us. Some had walked 50-60 miles to get to Kabala and many are walking as this blog is getting posted. It is unfortunate that we will not be able to help them all. Many will be told to come back next year. The stoicism of the people is only surpassed by the scarcity of what modern life is offering them.

The team has been having long days from our day 1 in Kabala: From establishing the electrical need of the OR, buying the necessary plug converters, connecting the newly donated Mindray monitors we brought with us, setting up the OR, getting to know who does what at the hospital, understanding the decrepit state of the electrical generators, coordinating the workflow with the local staff, operating with scarce surgical resources, every step came with its difficulties.

ISHI team has an incredible spirit, and is keeping up with its original schedule. The medical team did 25 major surgeries on its first two days, despite the many challenges faced (dubious electrical supply, no ventilators...). Everyone is impressed by our efficiency, pace and dedication. By now we have learned to adapt and circumvent the constant small obstacles our schedule faces.