The Farrell Family in Africa

Cambridge

2012-02-15T10:53:00.000Z

We live just outside Cambridge in the UK and so when Natalie came to visit on her way back from the Ship we took a little tour of some of it. Cambridge is a beautiful city and Tommy gets to cycle down past these sights on the way to work each day...

Cambridge is famous for its university and many of the colleges are stunning buildings.

If you come in the Summer we'll take you punting down the river - that way you get to see the backs of the colleges. Being January we opted for the cake shop rather than sitting freezing in a punt, but some people were brave enough!

Natalie outside Trinity College Chapel.

The Great Gate of Trinity College plus bikes - lots of people cycle around here.

The round church.

See its a great place to come and visit!

lego and other things

2012-02-14T20:51:00.001Z

I was thinking there must be a million things to blog about the boys - so much has happened since we got back. The boys are settled in school, Tom has started football training and been in a school play. That was quite strange for us - there are 3 classes of 30 children just in his year group! That really made us miss the ship too - the kids mixing with children of different ages, Academy productions, that you knew your kids teachers...anyway...that wasn't really the point of this. Josh has settled into school too - his a much smaller school and I admit the one I much prefer going to. He has started swimming lessons and I am not sure made much progress yet, but loves his opportunities to be a little fish. Tom has been given a bike so we went for our first family cycle to the park today. There is still a bit of snow on the ground, but much of it has gone now. Josh needs to practice more with his bike as his school are running a session to help them ride without the stabilisers/training wheels soon. We are getting used to him on the tag-along with us though and haven't 'almost fallen off' lately!
We are incredibly blessed to have a nice place to live for these few months. The house has a music room - which the boys have re-named the play-room and which I think we should really call the LEGO room. I'm not sure what Pam and Peter would think of that, but it is amazing to have the extra space - although it does mean the boys are getting used to not having to tidy up everything every night!
looking back over our photos since we got back it seems that they have managed to involve quite a few other people in the Lego...here are some random pics....and thanks to everyone whether pictured here or not who has built Lego with them. Anyone who wants to come and build with them welcome...

Christmas with the Slennetts...brothers building Lego

Christmas in Liverpool - building Lego with Uncle Paul

All dressed up to play Lego

Grandma had a go when she came to visit

And if there is no one else - there is always Daddy! Or Mummy I might add, but despite doing 95% of the Lego building they seem to still think Daddy is better at it. Hmm.

snow

2012-02-13T10:52:00.000Z

concentrating

creating

teamwork

decorating

and that is how you make snow YODA!!!

then we had fun with lightsabers

No snowmen were harmed in the taking of these photos - well except this one lost his nose...

was it all a dream?

2012-01-16T22:27:00.000Z

We're sitting in the same bungalow we rented three years ago before we headed out to the Ship. We're living here for a month before we move around the corner to house-sit for some incredibly generous people. We've had Christmas - twice, been to Ethiopia for a few days, settled the boys in school, caught up with friends, been back to our church, the local parks and to the movies and and it all seems a little strange, like we never left.

We just spent the evening with friends talking about the Ship, friends from our Cambridge based support group who have been through all the ups and downs with us every month - from a distance - who have loved us and supported us for the last three years and to whom we are incredibly grateful.

We have been thinking of the Academy (school) starting the new semester as it goes through a lot of change, thinking about the hospital being set up ready for the patients coming, thinking about the crew exploring in Togo and it all feels a little strange to be sat here, in some ways that we should be there with them, helping them, being part of the community and yet almost like it was all a dream.

I think it is a little early to really have done much processing of the last three years, but we know that we have been blessed beyond what we ever could have imagined being able to serve as part of the Ship's ministry. We are thankful for so many things, people and experiences. So to our Ship friends - we are thinking of you and will keep partnering with you from a distance in whatever ways we can, and to our friends here - thank you for the support you have given us over the last few years and for welcoming us back. It is good to be here for this season and we just keep trusting the details of each crazy day to Him who has a plan for us here for this time.

New Schools

2012-01-05T09:20:00.001Z

The boys started their new schools yesterday. Here they are in their new uniforms

Please pray for them as they adjust to their new schools. They are joining in the middle of the school year and it is difficult for their teachers to give them very much special attention in such big classes. Pray especially for Josh as it is a big change for him in full time school for the first time. Yesterday he didn't go to the toilet all day, only ate his sandwich at lunch because he was scared of the 'big boys' in the dining hall and missed the snack and milk at snack time because he didn't know where to get them from. He was a bit teary as his class went in this morning, so I hope it will be a better day for him today.

Surviving, but not adjusting yet...

2011-12-14T14:10:00.000Z

So the last few days have not gone exactly to plan...after the wonderful birthday celebrations and day with Miriam things have been a bit crazy.

Our priority was getting Sarah's essay submitted (which has gone off this morning :-)) but that took significantly longer than we anticipated. Sarah's sister Amy has found herself a new job for the next three years proof-reading essays as she did such a fab job on this one...

...then began the saga about children's schools. Tom already had his place in the village where we will be living, but we found out that Josh can't go to school in our village as the classes are full. They proposed to send Josh to another school by public transport, apparently that is fine for a 5 year old who has never been to school before. Having seen how little road and person danger sense the boys have after living in such a sheltered place we really could not imagine packing him off with someone else. There was not a place for Tom there either to send them together. So we have the option of a second school for Josh now at Oakington C of E Primary School which should be easier for us to drive him to ourselves (only about 10 mins we think) but we are not quite sure how we are going to do both school runs at the same time. We are waiting to hear if there is a place there for Tom to have them in the same school, but then Tom will not want to move as he has friends at the other school in our own village, so it is going to be complicated and less than ideal either way....

...so with that all taking some time to investigate the different options we finally started unpacking our suitcases yesterday evening. And then we shoved some things back in a suitcase and are off tothe airport headed to Ethiopia. ...

...the boys are excited about decorating the Christmas tree and being taken to the movies by Auntie Amy and Nanny. They have been playing football in the garden, snuggled up in multiple layers looking like the Michelin man. They have been checking out nearby playgrounds and enjoying eating toad in the hole (and a ton of other things)...

... when we get back there will be the small matter of Christmas with the Farrell's in Liverpool before moving all of our stuff from Essex to Cambridge in time for the start of school in January. I think we will be busy for a little while yet.

...we're hoping that they stay settled this week while we're away, pray that Nanny, Grandad and Auntie Amy survive and that we have a useful trip to Ethiopia. We haven't really had time to interact with UK culture yet (besides being overwhelmed with the choice of chocolate when trying to buy some to take to our hosts in Ethiopia) so we are postponing adjusting 'til next week :-)

64 units of blood...

2011-12-12T08:56:00.000Z

Our last weeks on the ship were incredibly busy, so we had blogs in mind to write but that didn't get written before we left. Maybe we'll catch up on some of them....one of the things we were involved with was the blood donation for local hospitals. Staff from the maternity hospital where Sarah has been working this year came to the ship to take blood from the crew to top up their blood bank and that of the children's hospital up the road. Generally patients in Sierra Leone would have to call their relatives to donate them blood when it is required and at times this can prove difficult. If they are lucky a few relatives will turn up and be tested, but many are not suitable donors because of HIV, Hepatitis, anaemia or high blood pressure. It is always good if there are some units in the blood bank for women who have no one else to ask. The women coming for fistula surgery come alone, often having been rejected by their families and the staff often end up being the blood donors when required.

Lara is one of Tommy's high school students students - she has spent some time working in the hospital/lab on work experience so for her birthday she got to help with the blood taking...

Lara was fab, she got the blood from both of us on the first attempts and we had hardly any bruising, she'll make a fab health professional in a few years :-)

I wonder how many teachers let their students stab them with a needle?

Thanks to everyone who helped and to everyone who gave blood. You might have just saved a Mama's life :-)

FIVE!

2011-12-11T21:31:00.000Z

Miss Elizabeth (Josh's pre-school teacher) made this birthday hat for Josh's goodbye/birthday party before we left. This is him wearing it just after we got off the plane - about 6am on his birthday, they are holding up five fingers each for his five years :-)

blessings

2011-12-11T21:07:00.000Z

We have been blessed to have lived on the Africa Mercy for almost three years with our Ship family. We have been blessed to be able to do jobs that we love and be part of the community.

We have been blessed with good travel back to the UK, we were even blessed by being able to store our luggage in a friends car on the ferry as they happened to be traveling over to the airport themselves. [Ok so we nearly lost a child on the escalator once we got to the UK- completely forgetting they have not experienced lots of the things we take for granted - he was reluctant to step on it with his suitcase and the rest of us had all gone down, but we all made it in the end!]

We were blessed to be met by Sarah's Mum buried under a pile of coats so we wouldn't freeze. We went to McDonalds for breakfast - as requested by the boys for the start of Josh's birthday. Some of that considered that a blessing more than others ;-)

We got back and the boys checked out their new bedroom (AKA Sam and Amy's room) complete with new football bedding and rediscovered their toys that we had sent back a few months ago, oh the joy.

We were blessed to celebrate Josh's birthday with family, presents, cakes and party food [thanks Nanny and everyone!!].

We have been blessed to spend today with Miriam, walk along the sea front [and I really am trying not to moan that it is too old after moaning that Sierra Leone was too hot last week, but lets just say that we had numb faces, tingling hands and icy cold feet at the end of our brisk walk], eat cherry tomatoes and baby oranges, yoghurts and so much more. It kind of feels like we are on holiday, rather than the reality that we don't live on the ship anymore, but we are counting our blessings and thanking God for all he has done in the past few years and the past few days - it has been AWESOME beyond words.

things we will miss

2011-12-02T09:23:00.002Z

Magnetic walls and ceilings are so great, we will miss them. It only takes a couple of magnets and a couple of sheets and you have a 'base' according to the boys :-)

West African food - some of us will miss this more than others, but for some of us it is our favourite meal of the week and it will be missed. We'll apparantly try and recreate African Tuesdays - rice with groundnut soup (peanut sauce), fried chicken, onion stew and fried plaintains. You have been warned - you can either come and visit that night or choose another night depending on whether you fancy a bit of West African food or at least our attempt at it.

Dental team

2011-12-01T11:09:00.000Z

Our statistics unofficially stand at:
9138 unique patients
10489 patient encounters
34251 procedures

{Taken from Gini's blog}

Wow!!

lasts

2011-11-30T09:40:00.000Z

The end of the field servie in Sierra Leone is approaching.

There were the last eye patients,
The last dental patients,
The last patients at the HOPE centre,
The last surgeries on board,
The last patients to leave the hospital,
The last day workers finishing, most left last week.

We have had our last family day out,
I have had my last times of sitting in Freetown traffic,
I have had my last day working as a midwife at the Aberdeen Women's Centre.

And it is all a little strange.
I'm going to miss the midwives, the mama's and African baby cuddles.
I'm going to miss seeing all the amusing sights while sitting in the Freetown traffic.
We're going to miss the beautiful beaches and mountains.

Soon we're going to miss the Ship and our friends, but for the next 10 days it is still home. We are so thankful that we had the opportunity to serve here this year, for all the people we met and fun things we have done. And we think of all the lives that have been changed because the Ship came to Sierra Leone for 2011 and that is quite an awesome thought.

our special day out of Freetown - in pictures

2011-11-29T09:00:00.000Z

Josh was able to sit in the back of the truck while we were waiting. Poor Tommy, Joel and Paul had to travel in the back all the way (and Tom chose to sit in the back with them for much of the trip), but they did have a mattress to sit on. Plus Alfa hit a squirrel and put that in the back for his dinner, much to the boys amusement. Then we filled up the back a bit more with lots of vegetables.

After our tour of London Mining we were taken to the village to see the church they are building and stopped at our hosts house to meet his family.

They have paid for the church building themselves, it is still a bit of a work in progress, but they have the roof on now which should help.

We stopped at the hospital for a drink - this was where one of Mike and Vi's children was born.

And then we stopped in the grounds of the eye hospital for a picnic of home made pizza thanks to Vi. Josh managed to fit some in along with his sandwich, crackers, biscuits and none less than 4 bananas...

Tom and Josh made sure everyone got some exercise after lunch by challenging people to race them around the grounds.

This sign reminded me of Cotonu in Benin - where there was a signpost to Nigeria. Here the sign reads Freetown one way and Conakry (Guinea) the other. Still seems strange somehow to think of driving from one country to another when we have only sailed or flown to each place and not crossed any borders.

We had a fantastic day out - it really was a great way of finishing our time here and we really enjoyed seeing life in Sierra Leone outside of Freetown. Thanks Mike and Vi!

visiting the (iron ore) mine

2011-11-24T15:00:00.000Z

Thanks to a ship holiday last Friday we fit in a day of adventure with our friends Mike and Vi, another British guy Joel, who is working here a few months, their friend Pastor Paul and driver Alfa - we drove a couple of hours out of Freetown to the Lunsar area, where Mike and Vi lived many years ago. Our first stop was London Mining - where Mike had worked some thirty-something years ago. We could see the mining area as we approached it in the truck.

We were not expecting to see more than the mines in the distance, but a friend of Pastor Pauls graciously hosted all of us and organised a tour for us within the mining compound. Official badges and all :-)

After a bit of off-roading, we stopped the cars and walked the last bit to the top for some incredible views and a bit of explanation of what they are planning to do there

The views were amazing

There were butterflies everywhere, but our camera is not really fast enough to have any evidence of most of them, but this one stayed still for me :-)

Our guides explained the mining process and the different areas of production. It was really interesting, even the boys really enjoyed it - helped by the fact that they were allowed to collect 'shiny rocks' - bits of iron ore!

More to come on the rest of our day out...

holiday dress up day

2011-11-22T06:55:00.001Z

Mr F turned into a Christmas tree - can you just tell how much he loves dress up days - especially ones where I go off to work and he has to get all three of them ready by 0745. This was our last dress up day on the Ship, so clearly he has survived the ordeal ;-)

Tom, as per almost every dress up day, wanted to wear his England football kit - for St Georges Day this time.

And Josh was a shepherd for Christmas.

one thing we won't miss

2011-11-21T16:53:00.000Z

Cabin inspections.

Meeting local headteachers

2011-11-15T13:44:00.002Z

Recently the ship was host for a visit of 20 headteachers from Freetown. Tommy and Nikki were asked to provide some training about curriculum development. Tommy started with a discussion about foundations by asking what the headteachers thought the purpose of their school was in order to demonstarte that any further decisions the school makes about curriculum need to come from a clear idea of why the school exists.

"What is the vision for students leaving the school?"

Without a good answer to that question schools cannot know whether they are achieving what they want to.

a real Princess came to school

2011-11-07T13:43:00.000Z

Josh and his pre-school friends are in the front row to meet Princess Anne

They were all quite excited to meet a 'real' Princess, although I think the little ones were a little confused because she didn't look like Princesses do in fairy tales ;-)

It was an honour that the Princess Royal took the time to visit and tour the Ship and everyone that met her said she seemed very nice and actually quite down to earth.

Airtel 555

2011-11-07T09:03:00.000Z

Since it's launch the Airtel 555 number has been operational as the fistula hotline in Sierra Leone. The local media have written a little about the launch:

http://www.sierraexpressmedia.com/archives/30702
http://www.sierraexpressmedia.com/archives/30582

I don't know where to start

2011-10-31T09:37:00.000Z

All the blogs I have been meaning to write remain unwritten. There are just not enough hours in the day at the moment and nights of not very good sleep happening.

We are busy with each 'today', the never ending studying, working, family times and daily football playing that form part of each day, spending time with friends before we leave, helping Josh and his friends with their swimming lessons (that a lovely crew member offered to run for them, I'm not actually teaching them given I barely know how to swim myself, they just need another adult in the water because this is not just any swimming pool, this is a wave pool, the water rocks about with the ship) :-). It has been a bit of a shock returning to studying, especially at this time when constantly distracted by clearing out all the stuff we have accumulated, getting ready for an international move and still working at the birthing centre. At the same time I am loving it! The module I am taking is focused on how culture affects midwifery practice (and legal, political and ethical issues...) and is just so relevant and interesting to be studying this while working in West Africa. I am learning so much through both my reading and incessant questioning of the midwives in the birthing unit! I just wish the assignment would write itself though.

We are busy thinking about returning 'home' which is quite a strange thought really. We don't have our house anymore to return to, our boys don't remember much about living in the UK, we don't have work lined up yet, we can't apply for their school places until we have a tenancy agreement....and it is all so time consuming trying to work out the details. But we have already seen a miracle happen with provision of somewhere to live (which we must write more about sometime) and are really excited to have this time ahead. Our boys are generally very positive about the move, we are talking a lot at the moment about different memories we have, things that we will miss and things that we are looking forward to. And there are so many of each. I am excited to be able to make some photo books when we get back to be able to share some of our memories with you :-)

I had wanted to blog about Princess Anne visiting the ship and Tommy showing her around the Academy, but Ali has written about her visit to the hospital which I am sure she enjoyed a great deal:
http://www.alirae.net/blog/archives/559-her-royal-highness.html

I had wanted to blog pictures from our evenings sat out on deck 8 watching the children playing, watching sunsets and strange weather patterns, but Tiffany took some and posted them while we were out a couple of nights ago:
http://bergmansonboard.blogspot.com/2011/10/today.html

I have wanted to find out some statistics about how this field service is going, but you can read about how the dental clinic have treated 8000 people already on Gini's blog:
http://giniporter.wordpress.com/2011/10/28/milestones/

Or the more lighthearted (depending on who you are I'm sure) fork lift truck falling in the water and the subsequent attempts at rescuing it again):
http://jacobsenjourneys.blogspot.com/2011/10/saga.html

There are some great pictures on these blogs and well worth a read - here's hoping none of them mind me linking to them ;-)

would you want to live on a ship?

2011-10-23T09:10:00.000Z

Two of the teenagers from Tommys class have written the reasons why living on a ship is better than on land, and the reasons why living on land is better than living on a ship. In case you were wondering how life is different or if you would want to live on our ship...check it out

http://jacobsenjourneys.blogspot.com/2011/10/teenage-thoughts.html

I'm not sure that living on a ship or land are better than the other, just incredibly different. Certainly there are a lot of things you miss living on a ship in Africa but there are so many great things about it too. But as we start the countdown to leaving we do think more and more about the differences. The boys are excited that they will be able to play football properly soon in a space actually big enough to run around in, we are excited to be able to eat a bigger variety of foods, cook for ourselves and drink fresh milk. We will miss having friends in and out of our cabin all the time and everyone living just one minutes walk away, we'll miss wearing summer clothes all year round and dining room staff doing the washing up. We're excited that soon we'll have so many options of places to take the boys that we won't have time to fit them all in, but we'll miss going up to deck 8 in the evenings and knowing there will always be friends up there to play with and chat to.

a day at home

2011-10-10T22:12:00.000Z

Today was a teacher training day, so the boys were home which was nice after a busy weekend. It's not been quite as productive as a Monday might otherwise have been but probably more fun. For our second breakfast we headed to the cafe for crepes. For our birthdays all crew get given a $2 voucher to spend at the cafe or shop, so with mine we bought 3 crepes and a kitkat for Tommy and they were making the crepes with chocolate chips in them which made the boys especially happy :-) For some reason no-one was hungry at lunchtime....

Since then the boys have played football, firstly outside on deck 7 in the rain wearing shorts and t'shirts and then they played football in the cabin wearing raincoats. Apparantly because they were pretending they are playing in Poland (got to love the imaginations). It would be too hot to wear raincoats to actually play in the rain so they do get the raincoats out to play every now and then. They played outside on deck 8 too, since the climbing frame went back up a couple of months ago, deck 8 has gradually returned to being the area where children and Mums gather after dinner.

I learnt an important lesson today - if you decide to clean the bathroom always be aware of what the resident four year old is up to. Or you might find they are helping you 'clean' (AKA drowning the kitchen with water) and it's quite hard to be cross with them for 'helping'.

Since they went to bed Tommy and I have been brainstorming midwifery essay ideas (mostly me suggesting things and Tommy telling me they won't work). It is suprisingly difficult and restrictive to find something that is relevant to midwifery practice, influenced by culture, legislated either Internationally or Nationally, contains an element of practicing needing to change and that I am actually interested in. But we may have decided on one, we'll have to see if there is enough research out there, but any ideas welcome...

celebrating women

2011-10-08T22:11:00.000Z

This year's nobel peace prize was shared between three women 'recognised for their "non-violent struggle for the safety of women and for women's rights to full participation in peace-building work", this included Liberian President Ellen Johnson Sirleaf, much respected in this region. http://www.bbc.co.uk/news/world-europe-15211861

Closer to home, here in Sierra Leone there are things happening too. We met actress Eva Mendes this week while we were out shopping for fabric. We chatted about missing coffee and such things, told her a bit about what we are doing here on the Ship (and were called freaking rad, if you change the word freaking to something else). Eva was here filming a documentary on a book called 'Half of the Sky'. Their website says 'Half the Sky lays out an agenda for the world's women and three major abuses: sex trafficking and forced prostitution; gender-based violence including honor killings and mass rape; maternal mortality, which needlessly claims one woman a minute'. A few friends have read the book and really recommend it, so I really want to read it now! It sounds like they are doing some great work.

Today I was invited to the opening ceremony of the free fistula helpline. Women suffering from fistula can now make initial contact by phone, which will result in them coming for screening and hopefully surgery. The hope is that this will be another means of reaching the hard to reach, the women hiding away in shame. Even among the poor in Africa few people are without mobile phones, and most people would know someone to borrow one from for a free phone call. Her Excellency Mrs Sia Koroma (the First Lady) declared it open after many speeches as well as testimony from one of the patients who had successful fistula repair surgery. It was a good day, not only to celebrate the new phone line, but also to celebrate the work being done here, the hundreds of womens lives that are changed by successful fistula surgery each year. And even closer to my heart, to celebrate the accomplishments of the maternity unit and to know that by providing good maternity care that fistulas are being prevented from occuring.

The current ladies recovering from fistula repair surgery were there to join in the celebrations at the launch. A few previous fistula patients are also currently staying at the centre as they approach their due date in a subsequent pregnancy. They are really a testimony for the other women, that there can be hope of a new life.

getting the ferry

2011-10-01T11:24:00.000Z

In Sierra Leone the airport is across the water from the city of Freetown so you have to cross by water taxi or ferry (unless you want a really, really long drive). The ferry takes 45 mins + to cross over the the airport side where someone meets people from the Ship and transports them to the airport. We ending up spending 2 1/2 hours waiting for the ferry last week to say goodbye to Sarah's Mum and sister and to help another friend drive one of the ships landrovers on the ferry to transport a patient over by car. I can't say I am looking forward to it much - but I guess an hour on a ferry to get the plane is preferable to sailing for a few days non stop.

80's day

2011-09-30T11:20:00.000Z

Today was 80's dress up day in the Academy. Our boys didn't really understand what this meant and were horrified at the suggestion of wearing luminous colours and me making them bright pink (the only fabric I had) sweat bands. Josh really wanted to dress up as someone from Star Wars so that he could take his lightsaber, but given our lack of those kind of outfits he decided on being a knight. So he is from the 1080's or something like that, while the rest of the class are from the 1980's. The important thing is that this is fun for them right? :-)

Tom has successfully worn football kits for a multitude of dress up days - international day, what I want to be when I grow up day, twin day...and so surprise, surprise decided that he would be player number 80 and go as a footballer. He has varied it though, having worn England and Benin kits before, this one is the Arsenal knock off we bought on the streets here :-)

In case you don't recognize him this is in fact George Michael and his teenage fans. There is even a little silver cross ear-ring which is making it very hard for me to take him seriously when all I can see is that wiggling about.

Slennetts in Africa again :-)

2011-09-26T13:13:00.000Z

Nanny and Auntie Amy came to visit us. Here are some photos so they can remember the fun we had :-)

hiking to the waterfall

having a party for everyones birthday that we missed sharing together, with home made sausage rolls :-)

playing outside on deck 8...and deck 7...and in the pool...

we visited where Mummy works

we got knocked over by the waves and had fun on the beach

Thanks for coming! See you soon! Tom and Josh x

girl friends - more photos from my camera

2011-09-16T09:40:00.001Z

Story time, all pretending to be going to bed. This is when big brothers come in handy :-)

Tom, Elisha, Sabine, Josh, Sarah, Janice (you can see why the pre-school boys all want to marry them) on Sabine's birthday

Antenatal clinic

2011-09-15T09:30:00.000Z

The women sit outside - you can just about see them lined up on the ground floor of this photo, between about 30 and 65 women come each Tuesday when I am there. They also have antenatal clinic one other day and a couple of booking clinics each week.

The women come inside and get weighed, their urine and blood pressure checked. They then get called back one at a time for their checks. There tends to be two midwives working here, there are two curtained off areas with a couch , although when ward or labour room midwives are not busy they also help out and use any free beds for antenatal checks.

This is one of the clinic rooms. Each has a couch, a trolley with some medicines laid out and basic equipment such as tape measures and fetal stethoscopes. One busy day I did end up delivering a baby in this small space here too :-)

topping up the blood bank

2011-09-14T09:20:00.001Z

We've blogged before, that the crew on board are also a walking blood bank. Until recently I have regularly given samples and been on the list of potential donars but never been called (and quite happy about the fact if I'm honest). My friend Maggie was here working in the lab again this year and she kept saying that as soon as they needed my blood type she'd be sure to call me first. She never did need me, but as soon as she left the Ship they finally had someone with the right blood type and hunted me down on the childrens play deck (there is no hiding from the lab team apparantly). So the proof for Maggie that O Negative isn't totally useless after all...

I might have smiled more if Maggie had still been here though, you can't help but smile when she is around, even when she is sticking you with a needle :-)

interactive maths

2011-09-14T08:57:00.000Z

Josh and I happened to be cooking in the crew galley last week when Tommy AKA Mr Farrell the Math teacher brought his grade 6 class to do some practical maths. It involved talking about measuring rainwater - how you can measure liquid accurately, units of measurement etc. We snapped a photo of them while they were all hard at work.

Mr Farrell and one of his Maths classes (yep that's the whole class)

another pair bites the dust

2011-09-13T08:53:00.000Z

In the tradition of our friends the Peets, somehow I now feel the need to photograph fallen apart crocs. Shoes get a lot of very heavy wear and tear living on board a ship. These are the latest of Joshua's to bite the dust, the trouble is he doesn't actually want to stop wearing them despite their condition, but I think they will need to go soon....

birthday wishes

2011-09-12T09:20:00.000Z

My birthday wishes came in many forms this year (thank you!!). The boys and many of their friends drew pictures and cards to cover my walls, friends made cakes to share on different days, I got parcels from home...and a happy birthday in Tom's homework book of all places...

In case you can't read it, it says
Happy Birthday to you!!!!!
Happy birthday to you!!!!!
Happy birthday to Mum!!!!
Copy spelling
Happy birthday to you!!!
Memory verse

Academy open house time again

2011-09-12T08:52:00.000Z

The open house is when the Academy opens its door for the crew to come and see what goes on. Usually the school on board is off-limits to the rest of the crew.

This is the Grade 2 classroom, you can see crew members learning to write in shaving foam, pipe cleaners, play dough etc to practice spelling words. Miss Amy (Tom's teacher) is the lady at the back to the left of the picture.

Josh trying the shaving foam writing.

baby Sarah

2011-08-31T10:33:00.000Z

Yesterday was a busy day at work. My first lady in the birthing room had a lovely normal birth of a little girl her Husband said they would call Sarah after the midwife :-)

The next lady was an HIV positive mother having her 8th baby! She complained more than most mothers having their first baby, didn't want to try any of my suggestions as to how we could make things easier for her, vomited all over the baby towels and blankets I had just prepared, kept grabbing my scrubs and my arm in quite a painful manner and finally popped the baby out when I had popped out for a sandwich!! She had been pretty hard work and when I came back she was just sitting smiling, amazing what giving birth can do to transform your behaviour!

I had a couple of antenatal ladies to see, both in their first pregnancy. One probably felt neglected as she was our lowest risk woman and it took time for us to get to her. I confirmed that her waters had broken and admitted her to the ward. She was walking around looking like she was in labour, moaning and bending over, but it sounded more like she had symphysis pubis pain than labour pain. Once the waters have broken we admit women and start an induction of labour after 24 hours if labour has not started. The other lady said she had been feeling some fluid coming out for a few hours. She didn't have a pad (lovely), just a soggy colourful lappa tied around her which made it somewhat difficult to really tell what kind of fluid we were dealing with! A short while later we could see that she was bleeding and that her waters hadn't broken. With no obstetrician Katie, the lead midwife, and I took her to see if we could work out where the placenta was on an ultrasound. So she was an interesting case, working through the APH (bleeding in pregancy) protocol to assess and monitor her given the limitations we have.

Another lady came in looking like she was established in labour. Unfortunately we didn't really want her to be labouring as she was for an elective caesarean section because of a previous VVF (fistula) so we 'rushed' her to theatre - meaning we called the theatre staff from home, sent drivers to get them and then took her. The baby caused us a little trouble, he was a poor colour and seemed a little cold so we warmed him with kangaroo care and gave him oxygen, but later he needed a full resuscitation after stopping his own respiratory effort. We had to wake the mother to warn her that he was doing very poorly and we were nearing the 30 minute cut off, where we have to make the decision to stop resuscitating. There are no ventilators here and so there has to be a cut off as we can not indefinately continue breathing for a baby who is making no effort for themselves. I left at the end of the resuscitation time to go with another lady to theatre, but found out when I returned that the baby had just completely turned around and was back with the mother breathing for itself. Hopefully that is still the case today and the antibiotics have time to work. We pray over the babies as we resuscitate them and we do literally see miracles happen here.

This next lady going to theatre had come in having no fetal movements all day. She was given an initial due date of July 1st and then it was amended to August 11th sometime in the pregnancy. It is so difficult establishing when babies are due here as women don't know their dates and don't come to see us until late in the pregnancy. Often we have to make a clinical guess, which for her was probably inaccurate as she was a 'bigger' lady to start with. Her first baby had died, the second was alive having been delivered by caeasarean section for being very big and 'overdue'. The previous caesarean meant she couldn't be induced using the drugs they have here, there are no CTG's (fetal monitoring) so all factors together - no movements, overdue (maybe), big baby, previous caesarean - meant she went for another one. And it didn't look one day overdue judging by the vernix liberally covering it but we are thankful that she has a live healthy baby.

the climbing frame returns

2011-08-29T11:32:00.000Z

The childrens climbing frame was taken down at the end of 2009 (!!) so that there was space for the pool to be installed. It had to be redesigned to fit into a different shaped space before it could be put back to play on, finally it is finished and we can play again (we being only people under 13, so not really 'we' given that some of us are 'old', but the boys and their friends are enjoying playing and getting covered in black dirt from the matting :-))

you can climb up and then cross the bridge to the slide or the monkey bars to the firemans pole

The slightly bigger kids still enjoy it as it makes games of tag more interesting!

The pool is just behind it behind the green netting on top of the white wall

craft shopping

2011-08-26T09:59:00.002Z

when you go to the beach you have the opportunity to purchase bead necklaces...

...pyjama bottoms/trousers, fabric bags and the odd wooden figure

Much as I love shopping, the crafts here have generally been quite few and far between, and the ones that do seem to exist are very poorly made compared with Benin and Togo. If anyone fancies a necklace or two there are plenty of them though...

Abdul Kanneh (patient story)

2011-08-25T16:37:00.000Z

Fatmata, a fourth-grade student, faced some monumental problems that no thirteen-year-old should have to face. She left school to give birth to a beautiful baby boy she named Abdul. The baby was born with a cleft lip and palate. In her native culture, this type of deformity was considered to be a sign that Abdul was a demon child. So, Fatmata’s mother threw them both out of the house.

Fatmata had no way to earn a living to care for her child, so she moved in with Mbalu, her wise and loving grandmother. Mbalu offered to help raise the child so Fatmata could continue her education.

Because the clefts made it difficult for Abdul to get all the nourishment he needed, he was not growing as he should. Worried and anxious, Fatmata brought her two-month-old son to a Mercy Ships screening, hoping that the volunteer surgeons could repair his clefts. Little Abdul was accepted for surgery, but since he was underweight, he was placed on the Infant Feeding Program to help him gain enough weight to undergo surgery.

Under the awning of the Infant Feeding Station, Nurse Jessica King, clinical dietician, explained the techniques to properly feed Abdul. He was weighed and measured each week, and he did very well on the program. In a few weeks, he weighed enough for surgery, but Fatmata was not old enough to be onboard as his caretaker. Mbalu was very happy to take on that role for her great-grandson, and Fatmata came also to nurse her son.

The volunteer surgeons repaired Abdul’s clefts, and the difference was obvious on the faces of both the baby and his mother. Finally, they could both smile. Fatmata and Mbalu were delighted. Now little Abdul would have a life free of physical disfigurement and verbal abuse. “Thank you, thank you, we are very happy,” they both repeated.

Fatmata hopes to save enough money to go back to school in the fall. “I want to train to be a bank accountant someday,” she confided. In the meantime, she is learning how to be a good mother to Abdul.

Story by Elaine B. Winn

A visit to the waterfall

2011-08-24T16:24:00.002Z

The boys visited Charlotte Falls as part of Summer programme. Freetown has some areas which are very green and beautiful as well as poverty and overcrowding that are much closer to where we are docked.

'the gang'

Lovely boys, good friends. Josh and Max.

And some of the waterfalls.

Tom's summer

2011-08-20T10:25:00.002Z

Here are some random pics of Toms summer programme group:

Toms summer programme group spent time visiting the HOPE centre. This was taken just outside the Port gate, between the Ship and the HOPE centre.

Red noses.

They had a lot of fun and played a lot of games. Here is Matts new hair style.

Tom was Elliot's dog 'Bull' in the dog show. The dogs had to manoever around an obstacle course and then perform tricks.

Josh's summer

2011-08-20T09:59:00.012Z

There were just four children in Josh's summer programme group, his friends Max, Janice and Elisha were also here for the summer.

The terrible four looking pleased with themselves after turning Miss Jamie (?) into a mummy

Not sure what this photo was about - but I do love some of the facial expressions

Josh in the photo booth. Nice glasses

Josh loved our beach outings, even the rainy ones

Josh and Max had a lot of fun playing in the sea jumping the waves. They both learnt to swim over the summer without their floatie jackets (in the pool not the sea)

Summer holidays

2011-08-19T11:39:00.002Z

We have finished our summer holidays now, but here are some pictures of what we got up to...

We did lots of crafts and baking inside as it was raining a lot

We made up games like an obstacle course, cowboy hats compulsory

and we made Mummy try it. She got stuck under the chair and we laughed a lot

We played a LOT of football, sometimes with each other, sometimes with Mummy and Daddy, sometimes with the bigger boys and a couple of times with Maggie and Alan which was really fun :-)

We played a LOT of lego too

and had some lego wars

We watched movies, played games, read stories and spent a lot of time chilling out together. It was a GREAT summer :-)

this is no sunny holiday...

2011-08-17T14:51:00.000Z

I took this today - it is the dental team walking to work. Rainy season is well and truly here.

back to blogging...

2011-08-17T09:29:00.000Z

Finally back to blogging after some internet trouble in our cabin which we finally managed to sort out - just about anyway :-)

So what have the last couple of weeks held?? Constant rain, the start of school, new families arriving, a very exciting parcel (thanks Jen and Michael), constant talk about football as the boys prepared their teams for the fantasy football league prior to the season starting, Sarahs Mum and sister booking flights to visit next month, us booking our flights to return to the UK in December...

School started again last week and so far seems to be going well. Tom is now in Grade 2, his new teacher is (another) Miss Amy who we love already and is going to be a lot of fun. He has been so positive about school, he is just a little sad that there are no other boys in the class now that he can talk Star Wars with! Maybe it will help him be a little more focussed though.

Josh is still in pre-school, it is beginning to feel like he's been there forever now, as he was in the same room with the same teacher, Miss Elizabeth last year, and in the same room for some of nursery before that too. He is in a class of 7 children and the older 6 have an extra hour now each day where they start to learn a little and do some group activities.

We have quite a few new teachers who are settling in. Tommy is mentor teacher for the Grade 11 girls and is still teaching Maths and Computers.

I am still working at the birthing centre. Just when I feel like I have got the hang of things I have something that I don't know much about and have something new to read about on my days on the Ship. Yesterday I had my first lady with typhoid so that will be the theme for this week! We also had an HIV positive lady give birth so I got to learn a little about their infection control practices for that. And just when I feel like I have seen it all and significantly less things shock me than might have done a few months ago, a lady showed me her mouldy toes at clinic and said she lives in a swamp. Yep, that might not be the best place to be living in rainy season, but I'm guessing moving might not be an option. I can't stop thinking about it though - I really never thought I would hear the words 'I live in a swamp' outside of the movie Shrek and it all just seems so wrong.

During a quiet part of the day I got to visit and tour Lumley Hospital, a nearby Government Hospital. It was quite small, but the lady giving us the tour made sure that we saw every cupboard, office and room possible! We got to see the wards, delivery rooms, theatre, recovery and sterilising room and pharmacy, along with the sluice and goodness knows what else! We're not sure if the power was off as everywhere was dark, the corridors so dark it was a challenge to walk down them without walking into a bench or something! While it wasn't as nice as the Women's centre where I am based it was better than I was expecting to be honest. All the beds had sheets and the mattresses on empty beds looked clean, they all had mosquito nets and rooms had curtains on the windows. It did need a bit of a paint job and someone to find a store room to put all the random bits of equipment and bits of beds that seemed to be abandoned in various places. The community health officer showed us their immunisation schedules - now that healthcare is free to under 5's the uptake is pretty good. The hospital send people out into the community to offer immunisations as part of their outreach work too. We looked at their birth register - it's funny how these things are very similar between different units and different countries. They have had 25 births this month so far, 3 of which were caesarean sections. The birthing room had recently been done up with the help of some external funding, it was just a little sad that there was nothing besides two brand new narrow delivery beds (complete with stirrups) for helping women labouring and birthing there. I'll take one guess about what position their women give birth in - and I'm guessing it might not be the best one for the women!

Sidiatu Jollah

2011-07-30T16:08:00.000Z

Fatmata sat quietly in the Admissions tent cuddling her sixteen-month-old daughter in her lap. She had been searching for over a year for someone to give her some hope that little Sidiatu might have a normal life. Born with congenital cataracts in both eyes, the baby’s blindness required her mother’s undivided attention. Fatmata’s nine-year-old daughter watched the baby when her mother had to go to the market to sell her home-made soup. Like so many other families in Freetown, Fatmata’s husband is currently out of work.

Fatmata had taken Sidiatu to a local hospital for cataract surgery, but it was not successful. A second hospital couldn’t help, either. Finally, she found a local doctor who referred her to an eye screening with Mercy Ships. After the ophthalmologist examined Sidiatu’s eyes, Fatmata received the precious appointment card for her daughter to have cataract surgery on the Africa Mercy.

Sidiatu had the surgery to remove the cataracts on both eyes. Very active and curious, the little girl kept trying to remove the protective bandage. The nurses wrapped her hands to ensure that the protection remained in place.

Early the next morning, the doctor removed the bandages. Those in the ward held their breath as the little girl surveyed the world around her – for the very first time. Anxious to grasp a balloon, she suddenly stopped. Sitting perfectly still, she stared straight ahead in an effort to take it all in. Then, quickly, she closed her eyes. The doctor said that this was a normal reaction. The child’s senses were overwhelmed, and she was returning to a place of comfort – the familiar darkness.

Soon, Sidiatu opened her eyes again. A toothbrush was set before her, and then a toy that was just out of reach. She stretched out her hand to grasp the red and blue truck. A low gasp was audible in the ward. It was obvious – she could see! Tears welled up in the eyes of those who were privileged to witness this miraculous moment. The doctor grinned. A single tear ran down Fatmata’s left cheek.

About an hour later, Sidiatu was dressed and ready to go home to a life that was now in glorious color. Sidiatu’s young life was forever changed. Her loving mother’s hope had been fulfilled.

“It has taken a long time to find a solution,” said Fatmata. “I walked around to many hospitals to find help. I am very, very happy. Mercy Ships is a very good place. They take care and encourage you. Nothing bad about that.”

Story by Elaine B. Winn

NYT reports on Sierra Leone

2011-07-27T16:51:00.000Z

The New York Times have written an article about maternity care here in Sierra Leone. Free healthcare is making a huge difference for pregnant women and babies, but as they hint at in the article there are not really enough staff in place in many places to cope with the increased demand for care.

http://www.nytimes.com/2011/07/18/world/africa/18sierra.html?_r=1

(you have to click through to the 2nd page at the bottom)

some things you never get used to

2011-07-20T10:25:00.000Z

Well maybe not never, but six months is really not much in terms of getting used to African midwifery, even though Africa is not new to me. Yesterday was just another routine day in antenatal clinic in most respects, but a few things always remind me that this is Africa.

First thing in the morning we all had a good laugh about at shift handover - one of the midwives handed over that one of the woman had a baby boy in the night, to which one of the other midwives said 'are you sure its a boy - its this baby on my lap' and there he was kitted out in bright pink top, bottoms and matching bright pink hat. So we looked and confirmed that he was in fact a boy, probably now with a complex as we all discussed his clothing. That made us all smile, obviously there is kind of unwritten rule here about pink being a girls colour just like elsewhere in the world, I wouldn't have been sure otherwise if they hadn't have said about it!

One of the ladies I saw came into the unit for her second antenatal check - her notes said she was 28 weeks pregnant. I couldn't quite match her size with this information and was unable to find a fetal heart beat. Another midwife came and checked and couldn't find it either. The lady said the baby had not been moving yesterday - so we had a fair number of warning signs that all was not well. We are blessed to have an Obstetrician here at the moment so she took her for a scan wondering if the baby had died- only to discover - she wasn't pregnant (and hadn't been)!! I confirmed this by pregnancy test, just in case we were missing something somewhere but it was negative, so we had to explain to her that there was actually no baby. Quite a bizzarre finding, especially as it wasn't even her first check up!!

Two of us couldn't find a fetal heart beat on another lady, but had she assured us that the baby had been moving about (usually a good sign of the baby being fine). Our Obstetrician did a scan and sadly confirmed that the baby had died and any movement felt was probably related to there being a lot of fluid swishing about. What I can't get used to is that there is no privacy here, there is just not the space for single rooms or anything. We called this lady's family to come and support her, they sat outside with a bunch of other pregnant women waiting for their checks. Later we admitted the lady to the ward to start an induction of labour, and she was just sat on the bed, looking completely shocked, while next to her other Mums were looking after their beautiful babies. I can't really get used to the different way women show emotion here, how there is the expectation that they have to be strong and quiet when things go wrong. Not that I really want them wailing around the unit, given its small size, but it still suprises me that they are not.

One thing that is very different here to in the Uk is that women don't always come the day you ask them to for their antenatal checks. Sometimes maybe for good reasons - some of them have to work hard to earn enough for that days food, some of them because of it being difficult to travel to us, sometimes it just seems like they just decide to come on a different day or at a random time and expect that to be fine. I learnt a lesson the hard way though about not always judging women for coming late. I joked with a woman that she was two months late and her reply was that her three year old had died from convulsions and she had been busy. And that was not the answer I was expecting. I'm not sure how long it will take me to really understand the difficulty women have living here and just how fragile life is.

One lady I met was in her fifth pregnancy, this would be her sixth child. She was very unusual here in that all of them were alive. Looking at women's obstetric histories is actually quite heartbreaking when you see just how many have lost children, but we have to remind ourselves that the unit I am working at is so much better than other's around. It has had many good outcomes with live babies for women that have had two or three stillbirths previously and this is really a reason to be positive amidst it all. Anyway, we are currently able to offer sterilisation (they type where they tie the tubes so that women won't get pregnant again) free of charge so I gently talked with this lady about whether she would want to consider this. I suggested she talked with her husband to see if it was something they would want to consider and that I could give her the paperwork next time. She told me how hard life was, how difficult it was caring for and providing for her 5 children and how she really didn't want any more after this one. She said her husband would be overjoyed to know that this option would be possible and that Praise God, He has answered her prayers - there is a solution to her keep getting pregnant that she didn't know about. She was ready to sign there and then! That made me smile, but I assured her there was plenty of time and that next time would be fine once she had talked to her husband!

Sorry that these thoughts and encounters with women at work are all a bit random and disjointed - much of clinic is pretty dull and I get fustrated with the numbers of women coming. For most of them it is just the same checks, the same medicines, the same advice.... But it is through good, regular antenatal care that we are able to promote better health and pick up any warning signs along the way. I have to remind myself that it is just as important as being a good birthing midwife and when it is my turn run clinic with a smile anyway, just with less jokes about women who come late.

palliative care

2011-07-14T08:00:00.000Z

Harriet is a friend who also works off the ship, doing a job most people really wouldn't want to do. She travels out and about supporting families of people who we couldn't help surgically, often because of advanced cancer. She writes about her work, plus earlier in the year had lots of blogs with pcitures from her driving around so it is a great one to check out and see a different aspect of our work here.
http://harrietinafrica.blogspot.com
Her latest blog is my favourite though, and this will take you directly to the story of one family Harriet has become friends with
http://harrietinafrica.blogspot.com/2011/07/inspirational-woman.html

Summer programme

2011-07-08T21:02:00.000Z

For a few weeks out of the summer holidays the boys are entertained by the summer programme. Our friends from two years ago, the Zupke family, are leading the team and have all sorts of fun happening. Each week they have a day out somewhere, the first week they went to the beach and then last week the chimp sanctuary and a waterfall. They do a ton of crafts, scavenger hunts, pool trips and all sorts. The older children (well all except the pre-school kids) are also spending time each week at the HOPE centre (as mentioned in our previous post) and also on the wards here on the ship. I would love to be a fly on the wall watching them interact with our patients. Tom says they have been doing crafts with them and I found a few pictures of them (taken by the ship photographer as crew are not allowed to take pictures in the wards) in action:

So many families have left or are away this is all the kids in summer programme this year, ranging from Josh (in his stripey Ghana top) and his pre-school friends up to the junior high school

Tom helping with craft work on the ward

This is the other Josh in the school playing Jenga with patients

Josie and Jessica building bricks

Shaun and his friend showing the finished craft work

the Zupke family posted some different pictures:
http://zupkefamily.blogspot.com/2011/07/picture-does-paint-thousand-words.html

You can also check out their other blog posts as the summer programme progresses to see what our boys are up to: http://zupkefamily.blogspot.com

Missing Sam and Amy

2011-07-06T20:11:00.000Z

Sam and Amy (Sarah's brother and Sister in Law) left the ship a few weeks ago. We just found these photos on our camera.

This was just before they left the Ship. We REALLY want to hear if Sam is ever brave enough to ever wear these trousers anywhere outside Africa so let us know if you see them!

This is one we took for Amy - on July 4th we had a BBQ on the dock, (complete with balloons) to celebrate withour American crew! We spent July 4th with Sam and Amy in Texas in 2008, in Benin in 2009 and in Chicago in 2010. We missed them this year!

HOPE centre

2011-07-01T14:46:00.001Z

You may remember us describing our previous off-ship housing in the 'hospitality centre' in both Benin and Togo. This year we have an off ship facility just a couple of minutes walk from the Ship, they changed it's name from Obama City to the HOPE (Hospital Out Patient Extension) centre. The idea of this is that people who travel a long way to come to us can be housed off ship for a night or two while they wait for surgery or in between their outpatient appointments after their surgery. With limited hospital beds on board, this allows us to use the hospital beds for those who really need them, rather than having people stay in them for weeks on end. The HOPE centre has a/c sleeping areas with beds under mosquito nets and those who stay get to eat local food cooked on site. When our family went last week there was some basic health teaching given to the adults while we were playing play dough with the children. The boys found some other boys to play football with and they all had a good time (despite the combination of Toms competitiveness and his opponents being on crutches which we thought might not be the best combination).

A picture of Tom's summer programme group on the way to the HOPE centre on here:
http://zupkefamily.blogspot.com/2011/06/hope-centre.html?spref=fb

Some pictures of patients at the HOPE centre by one of our photographer friends when he was here:
http://tombradley.wordpress.com/2011/06/29/the-hope-centre/

Tiny, little babies

2011-06-29T20:25:00.000Z

This week I was working on the antenatal/postanatal ward along with a student midwife so I thought I would share a little about some of our tiny babies.

One of the reasons Mums have to stay on the ward for some time is when they have a very early or small baby who needs some TLC. I am not claiming that all early or small babies do well but I think many people would be very suprised at some of the things that are achieved here. While there are no neonatal units, paediatricians or neonatal equipment such as incubators there are some little miracle babies on the ward every week, making it through another day with us. Yesterday we had a couple which I thought I would share about.

The first was a baby weighing 1.28kg at birth, now almost returned to it's birthweight after losing a little weight, and the second 1.08kg at birth, now just 900g. They were 8 days and 6 days old. .These little ones always make me smile as they wear a nappy almost as big as them (as you can't get pre-term ones here) and are either tucked down their Mum's clothes or wrapped in so many blankets that you can hardly seee them. Both had needed some resuscitation at birth, but actually not very much and had adjusted to life outside the womb within a couple of minutes despite their small size. This is testimony in itself to the staff where I am working - when I attended a midwifery conference here in SL a few months ago with midwives from other hospitals and taught some of the neonatal resuscitation as groupwork I was shocked by their complete inability to even initiate basic newborn resucitation (opening an airway, giving initial breaths, maintaining breaths and cardiac compressions). I am sure our midwives are saving many babies through just being competent with basic newborn resuscitation skills - no they can't do everything, drugs wise we are limited and there is not any further support for babies in terms of ventilation or anything, but what they can do they do well.

Once they are born and in the days ahead our priorities are simple - keep them warm and keep them fed, prevent infection and observe them closely. We encourage kangaroo care, where babies are put next to their mother's skin and then both of them covered. This helps keep the babies nice and warm. When the Mum's need a break then we just wrap them well. The feeding is a little more complicated with these small babies, especially the early ones who are not able to breastfeed. We get the Mum's expressing milk and feed this to the babies either by nasal tube or by syringe and gradually increase the amount they take at each feed. The little ones usually need some IV fluids too initially (it is always a big challenge trying to get cannulas into babies that weigh less then 1kg and I was very happy that one of the other midwives bravely took this challenge and got it in first time with the little one yesterday!). There are no pumps here to help with giving fluids so it's back to what we learnt in nursing school many years ago - calculating how much fluid they need for their bodyweight per day, minus the milk they are having, making up the bag with a mixture of dextrose and saline, eventually working out how many drops per minute the drip needs to drip at. This bit becomes quite time consuming - partly because the drip rate often changes when the baby moves and partly probably because of my paranoia that we will overload one of these tiny babies with fluid if it drips too fast and we fail to notice.

Tiny babies don't always make it, but many, many do, and it really is just these simple things and some midwives who know what they are doing who are making it happen. It might not sound like much, but each time I go to work and see these tiny babies tucked down their Mum's gowns it is like seeing a miracle before my eyes and I love it.

life and death

2011-06-24T21:34:00.000Z

Work this week saw more new lives arrive and also reminders that life is fragile here. It was a long day supporting a young mother through her first labour - a real typical stroppy teenage mother for all those midwives who know what I mean! Her bump was tiny and her dates not really known so we were estimating a baby between 33 and 35 weeks gestation. We prepared for a premature birth - which really doesn't mean much here as there are no neonatal services, but I had a second midwife and plenty of things to keep this baby warm once it arrived. It actually was a pretty average size (for here, it would have barely stayed away from SCBU if in the UK!) once it arrived and we just dried it well and kept it with the mother, later we checked and it weighed just over 2.5kg. So all was well.

During an earlier part of this Mum's labour I offered to do the 6 week postnatal check on another lady, not realising that this was going to be someone I know. Only being at the unit once a week I don't really expect a lot in terms of continuity with the women but I had seen this lady for a couple of her antenatals and then had spent time with her again the day after her birth, the day her baby had died. This wasn't the easiest postnatal check I have ever done, 6 weeks is still so early after such a great loss, and it can't have been easy for her to have come back to the unit to see us. But I was glad to see her and chat with her and I'll certainly be praying for a better outcome next time.

Later in the day a family came to collect a baby which had died (prior to labour even starting) which had delivered in the night. It was one of twins, the other healthy and doing fine as far as I know. The poor family, presumably the husband and one of the sets of grandparents came to collect the baby. It was taken away in a cardboard box, which seemed a little harsh somehow. But maybe wrapping it nicely in a blanket would have been culturally inappropriate, especially given that most people don't have their own transport and may have been refused the taxi if anyone had known about the box's contents. I'm not really sure of the rights and wrongs of the way things like this are done. I would say though that the midwives are very nice and fairly sensitive, giving their condolances to the poor families who have to make the walk through the ward full of mums and babies to collect their cardboard box.

It is all in a days work here, seeing new lives born and sadly sharing a small part of the grief for the babies that are lost.

a quieter life

2011-06-20T20:07:00.000Z

We're now just over a week into the children's eight week break. The first day saw a bunch of families leave for their holidays and since then there has been a constant stream of goodbyes as we have seen many friends leave the ship. Last week we said goodbye to Uncle Sam and Auntie Amy along with other close friends and many of the teachers. The goodbyes continue this week (and next) with some of the other families leaving and a couple of other friends to say farewell too. There is a lot of change to cope with as we adjust to this new season of not having our ship 'family' here any more, friends who started their Mercy Ships journey with us three years ago in Texas and have been our biggest support on the ship since then. Tom's teacher of the last two years left and some of his classmates will be leaving soon so there will be some adjustment for him too.

Having the boys home is a challenge - their energy and need to get outside frequently doesn't match particularly well with it being rainy season, living on a ship with only a small amount of space, being limited how often we can get out off the ship and with the rather green looking pool which is closed for the time being. That said we had a great first week overall, we have been working our way through craft kits and things that the boys have been given, played lots of board games, played with their friends a lot and got outside to play each day. This week the load is shared as Tommy has taken some leave and the boys are having fun playing with him and taking him to the cafe for crepes! I'm off to work tomorrow for a break!

what does the last day of school look like here?

2011-06-09T17:12:00.000Z

The day starts with the 'End of year celebration'. Each child graduates to the next grade and is given a character trait which their teacher feels sums them up. Here is Josh with Miss Elizabeth.

Mixed up in between the presentations to each grade of students are a couple of musical numbers, one of which was the song 'hop little bunnies' by the Nursery and Preschool classes.

Tom with Miss Estelle, his teacher for the past two years who we will sadly have to say goodbye to next week.

The afternoon was a pool party and then gathering in the cafe for crepes, then a little football on deck 7 before dinner :-)

So that was the last day of school, the boys are now home for a couple of weeks before Summer Programme starts. We have a few days off together over the summer, otherwise work sort of continues as normal, minus the students! There is still plenty that needs to be done post the accreditation and babies that plan on being born to keep us busy.

Many families have left for their summer holidays today so it is quieter already. A few more families are leaving in the next couple of weeks, along with most of our teacher friends and some of the people closest to us. One week today until we have to say goodbye to Uncle Sam and Auntie Amy. It feels like the next few weeks will be constant goodbyes :-(

Happy survival

2011-06-07T21:02:00.002Z

While working on the antenatal/postnatal ward today I looked after a woman who had a greetings card on her bed. It was from her Aunty. I copied down some of the words:

Happy Survival.

You have made it.
"to God be the glory..."

Congratulations on your survival.

I kid you not, this is actually what it said. It makes you think about the reality of life and death here. I'm pretty sure none of my Aunts would have ever considered the possibility that I wouldn't have survived childbirth and would never have seen a card like this in the shops. Let's hope one day there is no need for cards like this here in Sierra Leone either, that Aunties can stick to the 'congratulations on the birth of your baby' message instead.

I'm pleased to say everyone present at the start of the shift was still alive at the end, plus a few extra little ones who arrived fit and well somewhere during the very busy day. First thing, I looked after a lovely lady called Mabel who had her baby in the antenatal clinic room as the beds were all full. Her first baby died following a difficult birth about 18 months ago and it was a joy seeing Mabel and her proud husband take their healthy baby home.

'our' container came

2011-06-06T09:14:00.000Z

It is fun what you can see out of your window!

our big boy just got a bit bigger

2011-06-04T10:01:00.000Z

Tom is now 7 and the memories of nappies and pureed food seem a little more distant. Our little boy now seems pretty grown up.

In case you haven't seen him lately he is crazy about two things - football (soccer) and Star Wars. The love for football maybe comes from his Dad and Uncle Sam and the constant chatter about football through out the season. He loves playing football, watching games on TV and talking about league tables and things that boys seem to do. His love for Star Wars probably comes from the bigger boys on the Ship and their collective love of Star Wars Lego. He has a slowly growing collection of themed Lego and seems to have a fairly good grasp on the Star Wars story considering he hasn't watched most of the films!

We had a vaguely Star Wars themed party yesterday, the idea being that the kids would complete various games presented as Jedi training exercises. The reality of course, was a little more chaotic than I had planned but a lot of fun. Tom was quite sure that they all needed to practice fighting with lightsabers, so we compromised and said the last game in the training could be using the lightsabers to keep balloons in the air.

Today he has started the day with chocolate shreddies, a treat sent from the UK and then opening his presents. Josh was just as excited as Tom while he was opening the presents, they squealed with excitement at star wars keyrings, t'shirt and lego, talking about who all the characters were (I'm still none the wiser but feel like the day is getting closer when I will have to educate myself and actually watch the films to know what they are talking about)! He is a very lucky boy with some very kind family - thank you!! I took some pictures, but I should have taken a video, he was just so happy and overwhelmed and full of thanks, it was lovely to watch him.

The rest of the day will apparantly be full of building lego, wii football, games and football. Oh and a little bit of eating chocolate cake with our friends, Uncle Sam and Auntie Amy :-) Sounds fun.

walking out of the port

2011-06-02T09:16:00.001Z

Walking out of the port there is always lots going on. People who want to tell you about their health problems, container trucks lining the street to get into the Port, people hanging around the small stalls chatting. Anyway, only a little way up the road there is a painting of the previous mercy ship, the Anastasis from a previous visit to SL! It always makes me smile, thinking back to when I lived on the Anastasis in 1997 for a few months.

rubbish, garbage, trash

2011-06-01T07:29:00.000Z

Sierra Leone lacks decent waste disposal services and so much of the rubbish ends up on the streets. And quite a lot ends up in the water, even more when it has been raining. This causes big problems for the ships intake valves and they are frequently becoming blocked. Divers were going down a couple of times a week to clear the rubbish and more recently a couple of times a day. This is not the most pleasant of jobs as you can see, and we are incredibly grateful to all of the divers for helping to keep our generators working and our A/C on.

Can you spot Olly and Dan?

an unexpected birth

2011-05-31T22:23:00.000Z

One of my patients today had an interesting birth. She had not attended for any antenatal care so we weren't expecting her, she didn't know her dates so she wasn't really expecting anything at any particular time either.
This was her first pregnancy and when she arrived we could already see the top of the baby's head so we expected to see a baby soon at this point at least! We had very little time for doing a thorough check, just enough to know the mother and baby were both doing fine. She was very calm, she came in alone having been contracting a few hours.
She delivered her baby boy easily and the cord was so short I couldn't actually do anything except to hold the baby in mid air so I called for some help. Wanjiru came to help me, the first thing she said to me as she walked in when I said the cord was short was 'is there another baby?'. I moved from 'what?' to 'oh, my word, there is another baby' in a split second after looking up from the baby to the mothers abdomen! It wasn't the right shape! So we informed the mother, confirmed that the next twin was coming feet first and waited. And waited. And then helped it along with some drugs to get some contractions back. And it finally came a couple of hours after its brother, a footling breech delivery!
Thank God for such a great outcome considering all the factors! And thank goodness for such a great midwife in charge today who supported me through the surprise breech birth. Although not my first breech delivery it being an undiagnosed twin pregnancy, with an undiagnosed breech presentation, needing augmentation and with some fetal distress in a small unit in Sierra Leone was certainly a first for me and one to remember, although I fear (and am kind of excited about too if I'm honest) that it won't be the last!

A visit to the Chimp Sanctuary

2011-05-30T15:06:00.004Z

Only an hours drive from the Ship is the Tacugama Chimpanzee Sanctuary, so we thought we'd pay them a visit. Admittedly this was a few weeks ago, but there has not been much time to blog recently. They do tours twice a day, have a quarantine area, nursery enclosure and then a couple of large enclosures for the older chimps (the largest is 8 acres so we couldn't even see any chimps in that one - they are still fed, but they partially fend for themselves too). We saw some of the chimps being fed, some stealing food from anothers mouth, chimps playing, grooming each other, one threw a stone at us and one had a baby on her stomach. There are currently 96 chimps living there, all rescued, mostly from people keeping them as pets. They do have an opening for one named Samuel, but Sam wasn't able to come so no danger of getting him confused with the chimps :-)

The nursery enclosure where young chimps can stay for a year or so before they move to one of the larger enclosures

not quite sure if they are cute or ugly!

helpful instructions about how to talk chimp!

Our little chimps had a lovely visit. It is quite suprising to find this kind of place in Africa.

Accreditation update

2011-05-28T20:56:00.003Z

The accreditation team representing ACSI (Association of Christian Schools International) and MSA (Middle States Association) arrived on Monday night, this week. They were in school through until Friday looking at lessons, examining paperwork and meeting with administrators, teachers, parents and students to see whether we have met the standards necessary to become an accredited school.

On Friday afternoon (after the President's visit - more on that another time) they presented their initial findings to the school. We have been recommended for full accreditation by both ACSI and MSA. This recommendation will go to the boards of both organisations within the next few months to be ratified.

It has been the culmination of years of work by the teachers and leaders of the school. I have been privileged to be part of the team that has put together the school improvement program that gained us accreditation while also physically moving the school twice in the last 9 months. This team was clearly brought together for such a time as this. Well done everybody!

Tommy.

Angella's birth (and pics of the birthing room)

2011-05-26T12:11:00.000Z

Angella's baby was the first that I have had the privilege of delivering here. It was her first baby, she came in alone and laboured extremely well. There are no pain relief options beyond paracetamol and so she was completely in control and open to ideas about changing positions to make the birth easier. She prayed throughout most of the labour, for strength to get through it and for a good birth. She had a lovely calm birth of a baby girl who at 3.88kg was pretty big compared to the average baby here. She was kneeling for the birth, and although this is my favourite position too, she had decided for herself after we'd tried a few positions that this was most comfortable. What struck me most was her reaction afterwards though. She wanted to know how much the baby weighed, she wanted us to take pictures and for her to have the baby nearby and we had the baby feeding pretty quickly. The mother's here do generally seem a bit more distant from their babies somehow and not as interested as Angella was about her little girl. She called her husband, but told me he wouldn't be coming in to visit, but I did meet Grandma who was full of thanks and praise. And rightly so for another little baby made it!
To give you an idea of where this all took place, I took some photos at various times when the birthing room was empty:

So on one side of the room there are two delivery beds which can be separated by a curtain

and on the other side there is a mattress on the floor, either used if the other beds are full or for more active births if the woman/midwife don't want to use the bed. This is where Angella had her baby :-)

this is the room from one doorway to the other. You can still see the mattress on the floor in the back left corner of the picture and the curtains on the right where the beds are. Through the doorway is clinic - you can just see blue curtains where the antenatal women come and we check them. The corner of the room nearest to the baby scales in the picture is storage and drug cupboards etc.

And through the doorway the other side is the ward. You can see 4 beds on the right and there are 4 on the left of the ward that you can't see in the picture too. This can be antenatal or postnatal women. I took it when they were mostly outside eating dinner, it was actually full it just doesn't look it! It is pretty much always busy.

So you can see that it is pretty small, but actually pretty nice considering where we are. They could do with some more equipment (just more of the basic things like BP machines, tape measures, fetal heart dopplers that work, thermometers etc) but it is set up pretty well.

Tom got his yellow belt!

2011-05-25T09:13:00.001Z

After a few months of Tom learning Karate we finally got to see a performance and then presentation of belts.

The presentation of the yellow belt

Once they all had their belts

All the karate boys. Tom is the only yellow belt in the front - the other's have all been learning for a while longer than him and so got a mixture of other belts, blue, green and brown I think. Well done boys! And thanks to Montez and Peter for instructing them.

the wait is over...

2011-05-24T08:12:00.000Z

The accreditation team arrived last night and the school accreditation will take place this week. The feedback will be given on Friday so watch this space! Thanks for all your support during the accreditation preparation phase. It has been a LOT of work over the last two years, everyone will be glad to have it 'done' and to move on to other projects in the school. Keep us in your prayers this week. Thanks.

our lovely boys and their friends AKA school photo time

2011-05-23T15:09:00.000Z

Here you have the whole school on the dock, Tom then Toms class (L-R = Libby, Anna, Miss Estelle, Megan, Tom, Daniel, Andre)

then you have Josh, Josh's class (Top-bottom, L-R = Miss Elizabeth, Josh, Luke, Max, Elisha, Nathanael, Janice) and then Tommy's staff shot, all alone as the kids in his mentor class (same as a tutor group) have left :-(

best and worse places to be a mother

2011-05-19T17:49:00.003Z

The 2011 list has come out of the best and worse places to be a mother. So the best:
1. Norway
2. Australia
3. Iceland
4. Sweden
5. Denmark
6. New Zealand
7. Finland
8. Belgium
9. Netherlands
10. France

and the worst:

153. Sierra Leone

154. Equatorial Guinea

155. Central African Republic
156. Sudan
157. Mali
158. Eritrea
159. DR Congo
160. Chad
161. Yemen
162. Guinea-Bissau
163. Niger
164. Afghanistan

It is good to see that Sierra Leone is not right at the bottom!
For more info and to be able to view the complete list:
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6748295/k.BE47/State_of_the_Worlds_Mothers_2011_Statistics_and_Facts.htm

more thoughts about midwifery in SL

2011-05-11T11:24:00.002Z

I had hoped to write a really insightful blog about work each week, help you 'experience' a little of the world of West African midwifery, but I am finding words to explain my long days off the ship hard to find.

I am trying not to continually talk about the taxi frustrations, which I desperately hope are over now, this weeks driver actually turned up and on time. Thank God for that. I am also trying not to be critical of the ways things are done here, as the midwives on the whole are doing their best in a tough environment.

There are many challenges for the midwives, some of which would even be the same in the NHS, but some unique to low resource settings. I realise how much I took for granted in the NHS - I really miss all the ready made sterile equipment packs containing everything you might need for a birth or to suture and the maternity care assistants always around to help you find things!

There is not enough equipment here so we are constantly moving blood pressure machines, fetal heart dopplers and other things between clinic, the birthing room and the ward. There are not enough beds, so some of the women end up in an overflow area in one of the VVF wards.

There are not enough midwives, yet the midwives here are responsible for everything, whether low risk or high risk (there is actually an Obstetrician here temporarily, and usually one who is on-call for caesarean sections, but this is not a permanent position so the midwives can't learn to rely on her too much).

Yesterday the midwives on the ward were looking after a one day old baby who was very unwell. They helped him breathe for 30 minutes, at which point a line needed to be drawn and the decision made to stop. We were joining the Mother's prayers for a miracle, but really a miracle would have been the baby's only hope. There is no paediatrician, there are no neonatal units, no ventilators. We just get to do our best.

Some days it doesn't feel like it is enough.

everyday life through the car window

2011-05-10T12:00:00.003Z

Anyone wanting a white t'shirt? It amazes me that anyone would choose to wear white living here, it is so dusty everywhere.

Lots of the 'shops' are little huts like this where you can buy drinks, bread, phone top up, have a haircut or get clothes tailored.

Most people here would do their shopping in markets like this one. There are a few supermarkets on the other side of town to where we are, but we've not ventured to them yet. My friends tell me you can buy everything in the markets that you would want, the tricky thing is finding it!

Tom enjoyed seeing poda podas (minibus taxis) and huts like these with the UK flag or Premiership football teams emblems painted on them. They seem to all like the same big teams though - Man United, Arsenal, Barcelona etc

patriotism through the car window

2011-05-09T11:48:00.004Z

A few weeks ago before the anniversary of Sierra Leone's independance tree trunks got painted

and walls

and stones by the road

and anything and everything really. All in the green, white and blue of the Sierra Leone flag.

work experience

2011-05-08T20:01:00.000Z

Recently the high school students got to try out a job on the ship for a weeks work experience. We were going to write a blog to show how varied and cool some of their experiences were but it seems Estelle has done that for us :-)

For lots of photos of Tommy's students at work around the ship see:
http://estellesmiles.blogspot.com/2011/05/work-experience.html

Happy (American) Mothers Day!

2011-05-08T08:58:00.003Z

Tom has learnt to email, he went to the internet cafe by himself this week and sent me this:

Happy mother day I know it is amarcon but we can still selbrat.

I Love you

Love From Tom Farrell

So lovely! I'm all for celebrating all Mother's Days, I only wish my Mum was a bit closer to celebrate with her too. So Happy Mother's Day Mum. Again :-)

boys making fire

2011-05-07T11:46:00.000Z

One of the fun things the boys got to do at the beach was help make a fire and watch Raul gut and cook some fish for our lunch. I can't say I understand it, but there is something about boys finding playing with fire fun! I enjoyed eating the fish so it was good all round! Thanks Raul!

They collected sticks

then lighted the fire

and poked it a bit while the fish cooked

and then we ate it with rice and mango :-)

a day off school

2011-05-07T11:22:00.000Z

Unfortunately the teachers still had to work, but the rest of us enjoyed a day at the beach with some lovely friends. It is such a contrast driving through the busy, dusty streets and then arriving at a deserted, beautiful beach. Here are some random pics from our day:

The view of a banana islands

completely empty :-)

I took some pics of these grasshoppers for Tommy as he wasn't there to take them himself!

The place to come for relaxation!

Josh covered in sand

Photo of a random lump of wood, knowing Tommy would have tried something like this if he'd have been there!

In case you think this is some kind of perfect holiday destination - the toilet was just a mounted seat sitting directly on the sand and there were only 'walls' on two sides. Still it was clean and I could only see one person while I was sitting and he looked pretty busy doing something else. Haha

So it was a fun day relaxing and playing with our friends (thought it best not to put pics of other peoples children in their swim wear on here, so take my word for it they were there and we had a lovely time playing together!).

another dress up day

2011-05-05T13:54:00.000Z

Life has been quiet lately, not much blog worthy happening. Most of us have been sick and really not doing very much. Tommy is working all the time in preparation for the accreditation, which is now this month! Sarah is still having major taxi troubles getting to and from work, but the problem has changed from taxi's being late to not coming at all. So nothing exciting really, but the boys did get to dress up as a character from a book:

Tommy: Mr Sneeze from the Mr Men
Tom: Obi Wan Kenobi from Star Wars (his fav book in the school library!)
Josh: a generic Knight, just because he wanted to dress up and take his new sword to school, made kindly for him by one of the other Dads to protect his princesses :-)

Happy 50 Years Sierra Leone!

2011-04-27T18:04:00.000Z

Today marks the 50th anniversary of Sierra Leone becoming independant. The people in Freetown have been painting everything green, white and blue, holding marching band parades for weeks, celebrating for days and will hold a lantern parade tonight. For us it is a normal workday, but for the locals a national holiday. I did ask one of my taxi driver friends to take some pictures of the parade, but he said it is too dangerous to take a camera, all the bad men are out! Hopefully someone will take some pictures.

Happy 50th birthday Sierra Leone!

Simple things

2011-04-26T11:33:00.000Z

When I worked in admissions in our on board hospital a couple of years ago I remember that asking patients when they last had malaria was routine, not if they had ever had it but when, it is a given here that everyone has malaria from time to time. Before I came here the issue of how malaria affects pregnancy had not really entered my radar, it is just not something I ever needed to worry about. Every day at work here malaria is mentioned - women are given preventative treatment, sleep under nets and we are there to diagnose and treat active cases as part of the much wider antenatal care we give. But why is it such a big deal?

Malaria in pregnancy increases the likelihood of the woman becoming anaemic (or more anaemic), there is a large increase in low birthweight infants (which is the greatest single risk factor for neonatal and early infant mortality and also a risk factor for developmental delay, so you can see why we prefer bigger babies), it accounts for about 5% of infant deaths (in this part of the world), it also increases the likelihood of the mother dying, of sponatneous abortion (miscarriage), stillbirth, growth restricted babies and pre-term births.

I know that all sounds very depressing - the good news is it can largely be prevented with just a couple of simple measures. The WHO approach which we follow is to recommend all pregnant women sleep under Insecticide Treated Nets and be given Intermittent Preventative Treatment. Women who present with symptoms should be treated aggressively, although often malaria during pregnancy has no symptoms (besides possibly anaemia) because of the woman's acquired immunity so the other two measures are vital. So the next time you get one of those alternative gift charity forms where you can buy a mosquito net for someone in Africa just remember it might actually save some lives. It is the simple things that can make a difference, but here not everyone can afford something so simple.

The Resurrection

2011-04-25T10:55:00.002Z

Yesterday billions of Christians around the world celebrated a man rising from the dead. In this they did not celebrate the resuscitation of a man, as happens in hospitals every day, but that a man who was dead is no longer dead and never will be again.

Tim Keller expresses why Easter is absolutely central to the Christian faith:

Sometimes people approach me and say, “I really struggle with this aspect of Christian teaching. I like this part of Christian belief, but I don’t think I can accept that part.”

I usually respond: “If Jesus rose from the dead, then you have to accept all he said; if he didn’t rise from the dead, then why worry about any of what he said?

The issue on which everything hangs is not whether or not you like his teaching but whether or not he rose from the dead.”

[...] we can’t live our lives any way we want. It also meant we don’t have to be afraid of anything, not Roman swords, not cancer, nothing.

If Jesus rose from the dead, it changes everything.

[(emphasis mine) Tim Keller, The reason for God]

"If Jesus rose from the dead, it changes everything," that was my conclusion a little over 13 years ago - what's your?

Happy Easter - He is Risen!

Happy Easter

2011-04-24T20:08:00.000Z

I don't really know where to start or what to tell you about Easter on board. Reflecting on our Easter this year, it has been a mixture of sickness, our plans cancelled and some of our family missing out on the activities on board.

Yet it has also been a time of quiet relaxing, easter egg hunts, movies and sharing time with people. We have celebrated together and remembered the day that changed the world. Happy Easter! Christ is risen!

colouring eggs

2011-04-23T12:22:00.000Z

The kids gathered in the dining room to dye some eggs

Josh and Max dunked nearly all of theirs in the green

Then you check when they are ready

And admire the variety of colours. Tomorrow we get to eat them as part of our Easter brunch :-)

big and small babies

2011-04-20T10:59:00.000Z

Another day of midwifery. A few of the women hadn't gained any weight, and the odd one had managed to actually lose weight (this idea of weighing the women is a whole new one to me I must admit - beyond a body mass index calculation at the first visit we don't weigh women during their pregnancy back home. Here though I can see that it might be a more useful indicator of how things are going). A few babies growth was not what I would have expected either, given the gestation or just considering growth since the last visit. One woman fit both of these scenarios so I talked to her about the importance of eating well and how we would really like the baby to grow bigger. Lots of the women say they have no appetite or are reluctant to eat because of acid reflux and helping them to understand the importance of eating well can help. But this lady told me if she gets money during the day (presumably from selling some kind of produce or something) then she can eat, and if she doesn't then she can't. It's hard to know what to say to that really. I checked if there was anything else we should do given the lack of growth, but the other midwife said we just give diet advice and check it again in a few weeks. Still it's something to think about and to check out what the policy is or should be for such women (I couldn't find it at the time but am pretty sure they do have one already).

After clinic I worked on our overflow ward, we have an 8 bedded antenatal/postnatal ward but had managed to have 10 extra mums and babies on one of the VVF wards as it had been so busy. When I arrived on the ward the Mums were all outside eating dinner. The babies were all wrapped in their multiple blankets lying in the middle of the Mum's beds. I wished I had a camera. One of the babies I was checking was 3.6kg, the same birthweight as Josh. He looked quite out of place amongst all the tiny little scraps on the other beds, it reminded me of when Josh was in NICU and had looked like a giant compared with all the prem babies around him. The Mum was so proud, and rightly so, that is quite an achievement here where the average birthweight is about 2.5kg.

I could write on and on about yesterday's taxi saga's, but I'll just say I have had the true African experience now and please pray I find a new, reliable one!

a trip to the beach

2011-04-17T10:33:00.001Z

Yesterday some friends came and took us to Bureh Town Beach about an hour away from the Ship (on a good journey). We had a lovely time getting to know a couple of families who have lived in SL for a year or two and hear about their experiences. The boys had fun playing, Tommy had fun taking pictures too.

It was really quiet until a bunch of people came in the last hour or so that we were there. They brought the biggest speakers you have ever seen and were all dancing. Tommy said it reminded him of Southend Seafront :-)

A real live man in the maternity unit and other stories

2011-04-13T16:30:00.002Z

Some observations and thoughts from this week...

Another day in Antenatal Clinic, now not so unfamiliar or strange. Sixty five women came, many of them were already sitting outside waiting before I arrived at 06:30. It was a long day, clinic went on until almost 17:30 and then there was 65 sets of notes waiting to be put into the computer.

While the other midwife was engaging the women in some lively antenatal education I was able to watch and wonder about them all. It seems to me that pregnancy is a great leveller, everyone at the clinic in the same boat - a shared, common experience. The women chat and laugh together as they respond to the midwife and then between themselves while they wait for their turn to see one of us. Some come in their Sunday best or their business attire (no mistaking the lady who is a banker!), others in holey, slightly grubby t shirts and a lappa tied around their waist, but I wonder how much that matters to them while they wait? They all want a live healthy baby at the end of the pregnancy and they wait their turn to be seen, some for hours on end (I might add unlike the women of the antenatal clinic I used to work in when I trained who used to moan to the receptionists if the midwife was running 15 minutes behind!). The outfit that made me smile the most was on a lady who looked like she was covered in hairdryers and somehow it didn't look that strange, although I did wonder if anyone here actually has a hairdryer.

We split the patients up for their checks between Ami, the other midwife and myself on the basis of whether they spoke English, (figuring I was going to be up a creek without a paddle otherwise). This worked pretty well and meant I could largely just get on with my own cases. I can do the antenatal checks no problem. I've got the hang of the worm meds, antimalarials and tetanus vaccines, giving out iron and folic acid but today I learnt some new things (as I am sure I will every week!). We also give HIV positive women nutritional build up milkshake powder, multivitamins and prophylactic treatment against opportunistic infection. These poor women must rattle from all the pills (they get HIV treatment from somewhere else too) but it is a blessing that we can improve their health and that of their baby through providing this aspect of care- free of charge.

Another noteworthy moment was when a man came into the labour ward - "belly woman" business is truly a woman's realm here. I did see one other Dad visit two weeks ago when his wife and newborn were on the ward. He was very sweet and very proud of them. But the 65 women came to clinic all alone today, will probably give birth alone (except for the midwives - most don't seem to even have a female relative with them from what I have seen) and stay on the ward without seeing their husband until they can return home! Somehow I must have accepted it as I was quite suprised to see him and was almost suspicious as to why he was there. But he held his wifes hand and they walked around together as she quietly laboured, and then he left again.

So these are a few thoughts - so much happens in 12 hours that it would be too long winded to mention it all and there are some things I don't feel I can blog about yet. One of the biggest challenges in clinic is trying to solve the puzzle of when women are actually due to have the baby, but that will have to be a post all of its own sometime and just amuse me in the meantime :-)

millionaires

2011-04-10T15:44:00.000Z

I withdrew a million from the bank this week :-)

A million Sierra Leonean Leones. Actually only about £143. It should keep us going for a while though - you can't actually fit this much in your wallet to spend it all at once anyway!

water everywhere, but not in the fresh water tanks

2011-04-09T20:43:00.000Z

Yes we live floating in the ocean. Yes we have a lovely view of plenty of water everywhere, but we are having some trouble on board having enough fresh water. Please pray that we would resolve this, that we would be able to load more water soon and more importantly find out why our water useage has been so high - particularly if there are any leaks or problems in the system that are affecting this. We haven't been able to do laundry since Thursday (which was when we were due to do ours) and now we are not able to use the showers either. We still have some water at the moment for drinking and hand washing but even when water is loaded it takes a couple of days for it to be treated so it is safe to use so it will take some time before things are back to normal (and normal for us is still restricted laundry slots and strict 2 minute showers, not really normal in most peoples definitions). Think of us all getting stinky and enjoy your shower tonight :-)

Hobbies

2011-04-07T11:33:00.002Z

People ask me if I think our kids miss out on things by living here. Most of the time despite living on a Ship in Africa it doesn't feel like our kids are really missing out on much, the only thing that really comes to mind is the people they love in England that they don't get to see often. But one of the challenges is that there is not the usual array of hobbies, clubs and after school activities to choose from that really suit different kids. Tom has now stopped learning the recorder, much to the relief of our ears and taken up karate. I'm not sure how long that will last either, but he's giving it a try! He would really like a football (soccer) coach or swimming teacher if anyone fancies it?

Tom in his borrowed Karate outfit!

This week running club started again, something both our boys LOVE! They just run up and down the dock with their friends for about 45 mins getting filthy in the process. Some pictures here:

http://tvedtfamily.blogspot.com/2011/04/running-club.html

Antenatal clinic

2011-04-06T09:35:00.000Z

This comes with a warning that more of our blogs are going to be about midwifery but I'll try and keep them in English so that you don't need a midwifery dictionary to read them. Yesterday we saw 52 women in clinic which made for a busy day! I have been writing down my thoughts when I get back, so here are just some short random thoughts from what I wrote to give you some glimpses into what it is like...

My first day in AN clinic, it was sort of like AN clinics I remember - urine checks, BP checks, palpations (assessing the position of the baby), giving advice, and yet somehow it was quite alien. This new world includes routinely giving worm medicine, antimalarials, tetanus vaccines and iron tablets/folic acid to every woman....the day started with the women attending clinic singing and praying and the midwife reminding the women about the danger signs in pregnancy, which included more singing and clapping and laughing as she dramatically acted out each one...
...Its a world where a large proportion of the patients have suffered loss of a newborn, some have lost one baby after another...they take it all very matter of factly, it seems a bit harsh at times but I guess it is a part of life they are more familiar with than I am...
...I learnt my first maternity Krio today: "de pikin du shake?", "fine, fine shake?" (is the baby moving? moving well?)...I managed to amuse quite a few women by my poor attempt at one sentence along with some interesting body wiggling...
...There seems to be different thresholds here for referring to a doctor, admitting patients for observation or acting on the findings of the antenatal check. It was hard to decide whether this was because there are less options here, less that can be done, or whether the midwives didn't really understand or acknowledge the warning signs at times...
...my first assessment by myself (having done a couple with another midwife there) and I think the baby is breech. It has been years since I palpated a breech and so I reluctantly asked for a second opinion - waiting for someone to tell me that I had my very first palpation wrong, but alas it was truly breech! Sort of to my relief and sort of disappointing given that the lady was near term and would have been happier with a well behaved cephalic (head down) positioned baby...
...the other lady that I'll remember was 26 weeks pregnant and the midwife seeing her couldn't find the fetal heart beat. Once I had the same trouble as did a third midwife we were trying to decide a plan. I must admit I have never had this trouble before, but knew that back home we would just scan to check if we had any doubts. I asked whether this was possible, otherwise suggested we get her to walk around for a bit to see if the baby moved position and try again. It turned out that the doctor was already at the ultrasound scanner with someone else from clinic so we took here there. That was quite a horrible moment for a minute, wondering if we would find it ok. It was like a flashback to when I was scanned at work and they didn't find the baby's heart beat, it is not a nice way to find out something is wrong. It was such a relief that the heart beat was fine, just apparantly hiding from three different midwives....

So there was another day at work, and another week ahead trying to make sense of it all and read up on some of the things that came up before more midwifery fun next week!

Goat soup to watch football?

2011-04-02T09:49:00.000Z

Forget all the usual foods you might associate with watching sports and try something new ....goat soup....available near the Freetown National Stadium! I thought this was quite random and liked the bright colours :-)

missing midwives

2011-04-01T20:56:00.000Z

Save the Children have just put out a new report on the 'missing midwives' and the implications that result from a lack of midwives. A quote from it:

The global shortage of 350,000 midwives means that many women and babies die from complications that could easily be prevented by a health worker with the right skills, the right equipment and the right support. There are 358,000 maternal deaths annually, and more than 800,000 babies die during childbirth each year. Millions more newborn lives are lost in the first month of life. If births were routinely attended by midwives and skilled birth attendants with the right training and support, the lives of 1.3 million newborn babies a year could be saved.

Good to know someone values midwives :-)

Link: http://www.savethechildren.org.uk/en/docs/Missing_Midwives.pdf

riding African style

2011-04-01T11:31:00.001Z

Toms first ever ride in the back of a pickup. Another half dozen people climbed on after I took this so Tom was pretty well wedged in!

lizards on the beach

2011-03-30T09:27:00.000Z

Tom helped his Daddy take pictures of lizards this weekend while we were waiting for a ride. Now we have ten times as many pictures of lizards as we might really want and some random ones of African dogs lying in the shade. It kept him happy while we waited though, while Josh made a new friend and played games on her phone!

on the beach

2011-03-29T10:15:00.000Z

These are some views from where Grace Community Church had their baptism service on Sunday.

We had to hop over the wall you can see and then we were on the beach by the sea

It was a bit grey and overcast which was a blessing. None of us turned into lobsters despite a few hours outside.

baptisms on the beach

2011-03-29T09:00:00.001Z

We were invited to the beach this weekend to join friends at Grace Community Church for their first ever baptism service - and it was in the sea! Baptism is an outward sign that people have become Christians and want to follow Jesus. Going under the water is symbolic of death and then having new life in Jesus.

We weren't the first or last church group to be having a baptism that morning! And there were tons of people on the beach enjoying their Sunday, as you can see here, some just floating by the action!

driving around

2011-03-28T11:12:00.000Z

These were a couple of shots I took last week while Tommy was driving. This is a two way road believe it or not. I thought about doing a video of driving like we did in Benin, but the speed of traffic is so slow it would be pretty dull, you hardly move anywhere!

Although a little quieter further on there are still people everywhere! There are big ditches on each side of the road too hidden by the people.

Screening

2011-03-27T09:25:00.000Z

Screening has gone really well. Tommy finished work early on Friday to go with the security team on Friday afternoon to set up the lines and came back aboard on Saturday after working the night.

By 10pm on Friday night there were already a couple of hundred people in line, with many more having been sent away who we were unable to help. People kept arriving, and continued to be pre-screened to send away people we can't help. The security team worked hard all night walking up and down the line to make sure that everybody was calm and kept informed. Tommy had a great time interacting with the many people he met, both those we could and couldn't help. He saw some heartbreaking conditions that we don't have surgeons to help with and hundreds of hernias when our hernia list is already full for now. By the morning there were a couple of thousand people in line and the nurses in the screening team began to screen around 7am. The line was so calm and moved so smoothly that the line was gone by around 8:30 and everybody we could help was in the compound beginning the long process that results in an appointment for surgery.

It was a very long day for Tommy, but also a very enjoyable one. It was a fantastic opportunity to see a different side of the Sierra Leoneon peole than what we saw at the Stadium screening. Alongside the desperation, this time we were able to bring hope that with an orderly line we would be able to see everybody in the line.

screening again

2011-03-25T16:29:00.000Z

Tomorrow is the repeat patient screening day that so many have been waiting for -many people from around the country have stayed in Freetown since the last screening because it would cost too much to travel a second time. There have been people returning regularly to the stadium in the hope that we would be there again, and people outside the dock every day hoping someone will help. We hope the right people will come tomorrow and get the slip of paper to come back and have surgery. Please pray for a successful and calm day. Please pray that people will have heard which problems we can and can not help. Even this week I still met a lot of people on the streets who asked me about screening and when questioned about their health problems reported general back pain or heart problems and things we can't help or just wanted medication for something. Tommy left at 2pm today (after finishing work at 1.59pm), along with Sam and some other crew to set up the lines before it gets busy with people arriving. It might be a long night for them, but we hope that an early coordination of the lines of people, helped by local police will mean a calm night for the desperate people waiting.We'll write more soon.

On another note here is an article about the ship:
http://www.telegraph.co.uk/health/expathealth/8355009/Floating-hospital-arrives-in-Sierra-Leone.html

fun times travelling

2011-03-23T08:23:00.000Z

Yesterday I went to the Maternity clinic for a few hours of meeting staff and orientation prior to starting working there next week. Trying to get there involved some fun and games, but this is Africa after all, and some things you just expect to be different. The taxi driver I phoned said leaving at 8am was too early so we found one who agreed to meet me at nine. He had assured me that he was nearly there just after nine so I explained that I would walk out of the Port to try and meet him the other side of all the trucks lining to road down to our Port Gate. I spent the next hour meeting the whole of Freetown, or so it seemed, advising them about which day to come to have their teeth sorted out, telling women with goiters and men with hernias to come to screening on Saturday, explaining to people that I really did not have any bread or sodas on me, and fending off lifts to all sorts of places from all sorts of people heading around Freetown who thought I might like to go with them. Having white skin sure makes you stand out in a crowd, although somehow the taxi driver manages to walk past me and get to the port gate on foot. He had arrived shortly after 10am, but his car was parked somewhere else because of the container trucks all trying to get in the Port. So his first suggestion was to get a taxi to his taxi (!!) but then we decided to walk it. So we finally set off about half past ten heading towards Aberdeen at the usual painfully slow speed in Freetown. So other than being a little bit hot and bothered all was well until the car cuts out. Actually the first time it cut out and wouldn't turn back on the driver just called some men over and they pushed it so he could restart it so that wasn't too much drama. The second time was more fun as he kept asking people and they all said no, yelling something at him, I think because he was holding up the traffic. It involved people waving arms and hitting the car until finally someone did come to our rescue. The other times it cut out we were on downhill stretches and got it going again. One other thing to mention is they don't have traffic lights here, they generally just have traffic police at every junction, who direct you and pull you over at random (or so it appears to me). My driver had to show his documents to one policeman, then was asked to get out of the car at another junction and had a chat with the police lady, about the passenger tyre or something, anyway in the end he told her he was late, and so off we went again. We finally did arrive in one piece and the journey home was uneventful, he had apparantly sorted out the problem with the starter plugs, or whatever it was and the traffic was actually not too bad considering the time of day. Next week though we're testing whether he will actually arrive at 6am to get me to work by 7am, should be fun!!

you should read this blog

2011-03-21T20:44:00.001Z

I will be working at the Aberdeen Women's Centre this year alongside a fantastic midwife called Kate and by the sounds of it a really great team - a couple of other international midwives and 10 or so local midwives. They started a birthing centre at the fistula hospital last year which they really want to become a centre of excellence in the area. Since they started they have had over 700 births and not a single maternal death - and yes, by the average numbers in Sierra Leone they should have had a fair few by now. If you read the blog it does sound like an incredibly challenging place to work yet in a different league in terms of care to some of the other units locally, they have up to date policies and protocols in place and are actively striving to be practicing the best possible care within the limitations they have. I'll keep you posted once I have started there, but until then it is really worth reading stories from Kate:
http://blogs.news24.com/KatieChristie

up and running

2011-03-20T19:38:00.000Z

This week saw the start of surgery in the hospital, the start of eye screenings and eye patients being seen and the first full week for the dentists. Screening was done in the North of the country before the ship arrived and a few hundred people were scheduled for surgery and a few hundred more on a waiting list, so while the next local screening is being planned we still have plenty of work to get us started here in Sierra Leone. The dentists had a very busy week, seeing over 400 patients and extracting about 1100 teeth! The dental and eye screenings are going to be weekly, so although they are busy they are much smaller than the mass screening that took place at the stadium and there has not been any trouble. There is a lot of need here, I was out a lot last week and every time I walked backwards and forwards to the hospital just 10 minutes walk away I was stopped by at least one, usually a couple of people to ask about screening and sharing details of their health problems. We are planning another screening event soon, please specifically pray that the people who come will be those who we can help. There are so many conditions that sadly we are unable to help with and we don't want these people to come hopeful that we can help, just to go away disappointed. The local radio stations will be giving the details of the screening along with some details of what the ship is and is not able to help, so pray that people will take this on board.

beach frisbee against a local team

2011-03-20T13:18:00.000Z

Yesterday we loaded up a few cars and headed for Lumley Beach to meet a bunch of guys who wanted to play frisbee. They were a youth team, incredibly fit, really good natured and won every game, but our players had a lot of fun anyway! The little boys played in the sand and the sea with some friends from the Ship and some other bigger boys who they met on the beach. I bought a couple of necklaces from the mobile craft market. A few women just walked up, almost buried underneath all the things they were carrying, they didn't say anything to us but just simply unpacked and laid out all their crafts on the sand and then sat down and waited to see if we wanted any. Later on we met the beach security and lifeguards came and said hello, and then another craft seller who gave the boys bead necklaces in the Sierra Leone colours. I was with my friend Natalie, who was dressed in long sleves and longish trousers, at the time reading a book with a t'shirt over her head to protect her skin from the sun. When our new friend discovered she does not yet have a husband he was quite sure she would find one in Freetown and then told her he liked what she was wearing!! This is quite a common event here - being asked about your husband and then having a proposal if you admit not having one yet, but we did laugh afterwards because of Natalies 'highly attractive' attire.

frisbee on the beach...

...while the little ones splashed...

...and dug holes...

...then we had lunch - while wearing the necklace my new friend (and Natalies future husband) gave Tom...

...we watched a ton of people pull this boat out of the water and all the men from our group push a car out of the sand...also a few people walking past with fruit in baskets on their head and the same craft laden ladies come past...and we waited for our lunch, remembering that we are truly back in West Africa and nothing happens very fast around here...