Waterloo, Sierra Leone
There are more ideas and thoughts than I can adequately express into words about Sierra Leone. It’s a beautiful, surprising coastal country that is home to incredibly warm and inviting people with a rich cultural background. Iron ore and diamond mines are the largest industries there, and a lot of ex-pats can be found either vacationing or living in or around Freetown. My seat-mate on the plane ride over was a British man who had been working in the iron industry there for 15 years. I never saw the beaches in Freetown, but I was told that they are gorgeous, and the destination of many tourists in the summer. The official language of Sierra Leone is English, but in Waterloo where we were working many only spoke what might have been Krio, an English based Creole language.
Trips like this are always special, and elusive when trying later to explain what it was like. It wasn’t obvious at first to me why I came back with so much love and gratitude in my heart. Why did I stay a little longer now when I hugged, bring more from my heart when I spoke, and be more conscious of eye contact in conversation. It wasn’t a huge difference really, I’ve never been shy to express my thoughts, my favorite of those being what I love about the humans in my life, or what brings me to life. Sometimes that fire dims a little, every now and then, but it was so alive during and after that trip. Maybe it was the feeling of teamwork, maybe it was the new friends and connections we’d made, the surgical accomplishments we’d achieved, or everything in between. We’re complex creatures, motivated by a million different things, and some of my favorite things in life are experiences that make me feel like this one.
I didn’t take enough photos. I regret that slightly, but the rest of the group took more than enough. I think that each minute detail was documented somehow, which is amazing, because everything that happened that week was amazing. Speaking of, I totally pulled a million pics off the share drive, thanks Amy H.! :)
To start the process of eventually getting to Waterloo with a visa, we all needed a Yellow Fever vaccination, which is cheap internationally, but can be pricey in the states, I think $200-300. It’s good for a lifetime though so once you have it you never need to do it again. Then to get the visa we had to mail in our original passports, yellow fever card and a small fee of maybe $165, the embassy in DC stamps the visa and mails it back to you. There are no visas issued on-site at customs like in other countries, so you absolutely need to get it ahead of time. Then, there is the business of flying. I think everyone ended up on the same Brussel’s Airlines flight from Brussel’s to Freetown, with connections coming from places like New York or a few through other airports in Europe.
One of the things that I continued to notice throughout the trip, was how often we all said “thank you”. Every little thing, thank you, thank you, thank you, between our group, the workers at our host hospital, the patients. It was so often that there were many times, due to the language barrier, that a local worker would walk into the OR, and say only a smiling “thank you”, before exiting after completing whatever task it was that they were after.
All were warranted. A million large and tiny efforts came together during that adventure to make it the incredibly successful trip and sense of accomplishment that we all felt upon leaving. Pacific Northwest Surgical Outreach, driven by Dr. Cundiff and Marek Lichota, is the organization which arranged everything, paid for the medical supplies, room and board, and I’m sure other things behind the scenes. Fundraising during the year is one of the ways in which they are able to accomplish this. A lot of effort is put in beforehand in order to make it successful. Everyone in the group took time away from their lives to make this trip, some squeezing it in during a surgical residency, or while summering during med school, one even right after her wedding (that’s love). We all showed up knowing it wasn’t a vacation, that the days would be long, there might be unforeseen obstacles to untangle, and that was all okay.
Once we landed in Freetown after nearly 24 hours of sitting on planes and in airports, it was another 1-2 hour drive via van and Jeep to get to Waterloo. Naps ensued. We arrived at our hotel/compound in the evening sometime, most of us beat and ready for bed. A random array of bread, sardines and mayonnaise appeared, along with beer, which was greeted with varying responses from the group, beer being the favorite. The next morning, and each morning thereafter during our stay, we were served the most incredible and unexpected breakfast. If you ever go to Sierra Leone, please ask me and I will connect you with this wonderful, beautiful hotel that serves this amazing food. You will not regret it.
We functioned out of Waterloo Hospital, and planned on completing at least 35 surgeries that week. When all said and done, we did three better and completed 38. I had sort of imagined there’d be more potential patients than available time, and that proved to be accurate. We weren’t able to help everyone who asked, but we did a whole hell of a lot in the short time we were there. At the hospital they had two OR’s, an instrument sterilizer, O2 condensers, a suction machine, and monitors, among other things. We brought with us huge bags of medical supplies, organized into packs for each surgery, a monitor, airway supplies, and even an ultrasound.
Because it was a hospital, I did make the assumption that there would be things like: perfectly functioning plumbing, heaps of disposable medical items, nearly endless cleaning supplies, and extra medications. There was not always endless supplies of anything, in fact most things were limited and we had to conscious of how we operated. But, between what we’d brought with us, and the things they did have, it wasn’t a problem. It was the opposite of a problem really. Everyone’s attitude was so kind, so positive, so willing to contribute and work hard, that accomplishing things in Waterloo Hospital flowed incredibly smoothly, allowing everyone to do so much work in such a short time.
The majority of the surgeries that week consisted of inguinal hernias and hydroceles. The disease progression of most patients was so large and chronic, that every surgery performed was creating an overwhelming difference in that patient’s life. I don’t think that I can fully appreciate it without having lived their life for the past, sometimes 15, years of dealing with their conditions. These men were stoic, and tough, but clearly happy and grateful to be there, just as we were. Each was unique, if sedation was used sometimes prayers would come from their mouths, sometimes jokes, sometimes offers to come back to the U.S. with us in our hand luggage.
Many were Muslim, most spoke only Creole but some a few words of English. All were kind, calm, and respectful to everyone around them. They lived in houses, shacks, and huts. The sign on the bathroom door at the clinic which read “Please, if you do not know how to use the toilet, please ask” was indicative of how uncommon indoor plumbing was in the area. Laundry was often seen hanging, or laid out in the grass to dry.
Sierra Leoneans are incredible people, and are more often than not very well-dressed despite the lack of plumbing, and the thick, muggy climate. Most would show me up any day of the week in my casual leggings and tank tops. They wear a mix of styles from traditional skirts and dresses, to button-downs with smart shoes, or a blouse you might expect to see at church. Transportation ranged from bicycles, to thousands of motorcycles everywhere, to small old cars w/ very active horns moving through the winding roads and crowded markets. There are still tarp covered buildings on the grounds of the hospital with signs warning of Ebola danger inside, a grim echo lingering from the 2014 epidemic.
The only exposure to surgery I’d had previous to this was nearly exclusively with inmates. I instantly had flashbacks of assisting with similarly massive hernia repairs, rounding on patients hand-cuffed to their beds, and constantly being surrounded by guards, thick doors, and protocol. This time around in the OR I had an entirely different experience, consisting of spinal anesthesia and twilight sedation. I was ecstatic, challenged, overjoyed, and grateful. Seeing and doing both of those things over and over again was everything I could have asked for, and I still can’t believe how fortunate I was to have been able to do that. I adored it, every incredibly moment. There aren’t enough adjectives in the universe to justly depict my state of mind that week.
Similarly, there isn’t a way to describe the individuals that made up the team on that trip. We had with us two surgeons, an ED physician, an operations director, two OR nurses, a pediatric critical care transport team of nurse and respiratory therapist, a scrub tech, and three med students. On site to meet us was the local team that kept the hospital running every day. Everyone amazingly motivated, talented, prepared, and full of positive energy. A chance meeting with Dr. Cundiff in a hallway, who would have ever thought that the person I happened to walk by was this incredibly talented, intuitive, and insightful surgeon who has clearly touched so many lives during his career. Watching him teach in the OR was nothing short of heart-warming. He is so patient, and cares so much about teaching and learning, as did everyone who was present that week.
We left sooner than most of us wanted to, with plans already made to go back, and many friendships across multiple time-zones and nationalities generated in the process. I hope that I never lose this feeling of gratitude for being at a place in life where I can participate in such incredible experiences.
