Tuesday, March 10, 2009

Some reflection and thank you's

Let me begin by offering my sincerest thanks to Bob and George for their leadership on this trip. It was truly a remarkable experience that I will never forget. I know why you do what you do and am so thankful that I was able to be a part of it. Your passion, your compassion are truly gifts from God used properly - for others. A thank you to my brother Ray for encouraging me to be a part of the team. To be able to share this with you meant so much to me. Your knowledge, your ability to get things done are inspiring. So, thank you, gentlemen, for allowing me to tag along. I see things differently - and that is good.

As for my own reflection I offer this: Change can happen! The people who participated in the workshop assured me of that. On the very first day during introductions George had each participant give their name and what they hoped to learn during the workshop. The most common answer was: everything you have to teach us. And a policeman attending said: 'We don't want any more mothers and babies dying, we want to learn everything to save them." With that challenge, Bob and George proceeded to teach them everything with remarkable clarity and the "students" were like sponges, absorbing their every word. Change can happen! And it will because those who participated can now go back to their hospitals, clinics, and villages and teach others what they have learned and with that Change will happen!

Ray and I were fortunate to be able to visit schools and an orphanage both in Bo and in Kabala. All administrators were most gracious and welcoming as they gave us tours of their facilities. One of my purposes in going to Sierra Leone was to access the education system and determine ways that Lancaster Catholic High School can help. Through our guided tours and personal conversations we found several needs and are now busily working on ways to meet those needs. Whether it is repairing the roof at St. Pius School, or equipping the library at the school in Kabala with books newer than the late 1980's and mid 1990's, we will attempt to do what we can. And Change will happen! Thanks to Father Peter, John, and JU we had a wonderful time meeting the children and older students. Seeing the looks on their eyes when we gave them a few new soccer balls raised our spirits - the thankfulness of the young Sierra Leoneans was heartwarming. Unfortunately we only had a few balls to give out. Yet, with a pump in hand we were able to fill a ball being used by a group of children in Kabala. The excitement and happiness they expressed in having a soccer ball with air in it left us speechless. How valuable this simple gesture was to these children can never be measured in dollars and cents, but only in hugs, handshakes, and thank you's.

Yes, Change can Happen! It doesn't take a lot. The people of Sierra Leone are happy with simple changes, with little changes. I sensed that they feel the big things will take care of themselves. Each little thing we can do; each little gesture of love and compassion; each time we opened an ear to listen to their needs; each soccer ball, tee shirt, or hat given away; each child's hand held; each minute of each and every day Change Happened. And the biggest change was in me! I received from these wonderful people more than I could ever give. I am blessed because of them! I am happier at choosing to live more simply so that others can simply live.

One more word of thanks - to Sister Helen and Miss Nash for teaching my freshmen classes while I was gone. You will never know how much I appreciate what you did. I owe you big time! And to Mr. Garret for allowing me the time away from school. Thanks to all of you!


Sunday, March 8, 2009

Thoughts from George - Part II

Note to Reader: Please read George's Blog from 3/7/09 prior to reading this blog passage. This is a continuation of George's blog of 3/7.

“The Dogs of Kabula

On Friday morning we completed the training in Bo. The closing ceremony and awarding of certificates was supposed to end at 11:00 a.m. but, consistent with African time, we finished at 1:00 p.m. Ray and Jim and others had sorted out 27 “rescue kits” for hospitals and health care institutions. They were thrilled to have them. We had a small riot as individual community medical officers wanted their own kit even though they were not affiliated with a health care institution. We also only gave out 11 soft cup reusable vacuum extractors as we wanted them used in places with more experienced physicians or midwives. Betty Sam quelled the commotion by insuring every person received at least a few bulb syringes! People left smiling and happy, shaking hands and assuring us what they have learned and received will be put to good use.

Twenty minutes later we were in a van traveling to Kabula in northern Sierra Leone. Traveling with us were three young women who had had fistulas repaired and were returning to their villages near the border with Guinea. I tried to get everyone to sing the “Wheels on the Bus,” but the language barrier prevented a sustained sing-along.

Five hours later we arrived at dark in Kaluba. The only electricity is from diesel powered generators. We found a guest house and crashed for the night. Let’s just say it wasn’t the Hilton: holes in the mosquito nets, a four-inch spider on Jim's wall, a toilet that wouldn’t flush, and the shower consisted of a water filled bucket. Starting at about 2 a.m., nearly every dog in West Africa converged on the guest house and began howling. Ray, Bob, and Jim hardly slept. . . Ray went outside and tried howling back, but the language barrier prevented meaningful discourse; the dogs kept barking.


We met many remarkable people on our trip, people who were truly saints and heroes in this troubled land. One of those people is “Peacemaker,” a community medical officer who went through the training and then came with us to Kaluba where he works at the Nesarah Clinic (named after his mother.) Peacemaker must be about 65, but he is as spry as a 20 year old. While he didn’t tell us where his name came from, you could tell from the respect he was given that he had played a role in healing the wounds of the civil war. He told us stories from the war – suturing a man’s abdomen together after he was eviscerated with a knife and putting him on a motorcycle, escaping out the back door as the rebels entered the hospital. He had to move from Freetown to Bo to Kaluba, trying to stay one step ahead of where the rebels would be next, all the while trying to offer what medical care he could.

Peacemaker says the war is behind them; it is time for reconstruction. The Nesarah Clinic is expanding and they have outreach to surrounding villages. During the day we toured the clinic, met with local paramount chief, and climbed a mountain behind the town. In the afternoon Bob and I sat through a staff clinic meeting while Ray and Jim (and Coleman - a staff member from the West Africa Fistula Foundation) visited the local Catholic primary and secondary schools.

The staff meeting lasted for more than 2 hours: what a challenge to run a health care institution on a shoestring budget and lack of adequate infrastructure. A shipping container with medications and equipment was held up in Freetown for three weeks. The electrician working on the clinic has wired the outlets incorrectly. They can’t afford the transport for an agriculture worker trying to help families with farming. Yet, the work goes on, one patient at a time, fueled by a great faith and a quiet determination that blazes in Peacemaker’s eyes.

After the meeting, we head to a small housing area for amputee victims. Men and women captured by the rebels were either killed or, sometimes, had their arms amputated. The practice came from the Belgians when they ruled the Congo. The best way to disable an African man, short of killing him, was to cut off his arms – he could not farm and he could not work. The amputees, along with their children, greeted us, and we exchanged short words of welcome. The only word I could think of was “courage.” Courage, raw courage, to keep going after such atrocities.

“Radio Kaluba

Peacemaker wasn’t done yet. We drove next to the Kaluba School for the Blind. Peacemaker and his group provide the rice for the children. They are in a makeshift building after the original school, like so many other buildings, was burnt to the ground during the war. Most of the children had contracted river blindness; they range in age from 6 to 17. The headmaster Emmanuel was a former pupil and he is passionate in his resolve to see these children be educated and have some kind of hope for employment. He is desperately hoping to get modern learning technologies for the blind – such as “talking computers.” The scale of need is indeed huge, from simply food to eat to the possibilities presented by modern technology.

It is now 8:30 at night. Peacemaker, Bob and I are walking up a steep, rock studded road in the dark to the radio tower. Peacemaker wanted to talk on community radio about Maternal Life's Family Health Alive "Safe Passages" training program to prevent maternal and newborn deaths. We knock on the metal doors of the building and a security guard lets us in. In the radio booth is a young West African “Wolfman Jack” who crowds us in, flips some switches and suddenly we are on. Peacemaker begins by immediately announcing that no longer will mothers and babies die in childbirth in Kaluba. He then lets everyone know that he and others, who went through the Safe Passages training, will in turn train others. The calls come in, “Wolfman” fields them by holding the microphone next to his cell phone speaker. People are excited but confused. They say, “How can you say no women and babies will die when many times you cannot find the district medical officer at the hospital?” Peacemaker assures them that things will change.

Meanwhile Bob and I are waiting nervously for our moment on the air.

Wolfman” turns to us and asks, “What is different about this training?” Bob answers by outlining how the program is based in evidence and experience, which have dramatically lowered maternal and infant death rates in the US and many parts of the world. And, he adds, the training is appropriate to the level of resources available. You don’t need open heart surgery or ICU’s to save mothers and babies; you need skilled birth attendants who are well-trained, compassionate, equipped and motivated.

I notice on desk in front of me several tapes with radio jingles. One is from “Maria Stoppes Clinic,” an organization that sets up abortion clinics in Africa and the developing world. They are well funded and organized. The last thing Kaluba needs is an abortion clinic. What is different about our training? I speak into the microphone, “Our training is based upon respect for the life and dignity of all persons, born and unborn.” It is only by recognizing the infinite value of the human person that authentic development can take place. . . Peacemaker nods in agreement.

“Go Slo-slo

By 8:30 the next morning we are headed home. Forget the crocodiles and civil wars, the greatest source of danger in Africa are the two “M’s” – mosquitoes and motor vehicles. During our last training in Nigeria a year ago, we had the greatest driver in the world, a gentleman named Ojo, who never went above 100 kilometers per hour. Bob tells our driver how much he liked Ojo’s style and carefully pointed out the 100 kilometer mark on the speedometer. “Go slo-slo, like Ojo.”

From Kaluba, we arrived in Freetown and then took the ferry across to Lungli. One of the technology students Ray had been training (JU) met us in Freetown and graciously helped us negotiate the ferry ride and the trip from the ferry to the airport. While our plane didn’t leave until midnight, the last ferry on Sunday was at 2 p.m. As always, I wanted to buy some local crafts to thank our supporters. Yet, there were none to be found. Civil war doesn’t help with tourism and so the absence of any African artwork. Someone said that between 65 and 80 percent of the country’s economic base is from “donor assistance.”

In the airport we met the man with his father who had had the stroke. The hospital had agreed to release the father as long as there was a doctor on board the airplane. (I’m not sure what Bob and I would have done if something went wrong over the Sahara Desert). The wheelchair ramp on the plane consisted of four of us carrying the patient up the stairs to the plane. The airline was kind enough to give him and his son a first class seat. We arrived in Heathrow to find our connection to New York-JFK was cancelled because of a snowstorm. In Chicago, the man and son caught a tight connection to Springfield, Missouri where he would be admitted directly to the hospital there.

I caught the flight to Salt Lake City. No more did I want “slo-slo.”


Does it make any difference? The question haunts us all. Is all the effort worth it and in the end, does anything change? In this journey we are all on, I hope that in and through the grace of God we leave something behind – our own ego. The ego needs validation, the grace of God needs nothing.

I believe the work will go on. In Nigeria, where we have conducted Family Health Alive training since 2003, the idea of a “Safe Passage” is becoming part of the consciousness. Be it in a phrase, or on a poster in an isolated maternal health center, the image of a mother and her unborn child held in a pair of hands is taking hold.

In Sierra Leone, good things will continue. There are people who will take what has been started and build upon it: Betty Sam, Peacemaker, Samuel Pieh, Dr. Darius Maggi, Dr. Koroma, Helen Weld, and on and on – people who are committed to health care development in Sierra Leone. Darius is determined to fix all the fistulas that remain; at the same time all of us together must work to stop any further deaths and fistulas.

Our job is just beginning. Ray and I and Cort will reshape our grant proposals for distance learning and try and get funding for ongoing training in maternal and infant health. We will keep working with the Christian Health Association of Sierra Leone and the West African Fistula Foundation to identify other training and resource assistance possibilities. We will keep the dialogue going with key people in Sierra Leone and share with you the success stories – a mother’s life who was saved by medications for post-partum hemorrhage, a baby who has been resuscitated who would have otherwise died, the trainings that have been taken from Bo to Kaluba and on to other places in Sierra Leone.

I’ll end with a note of thanksgiving and resolve. Thanks be to God for all the beautiful people we were privileged to work with in Sierra Leone. Thanks be to God for all of our supporters who have believed in our mission and have allowed us to continue to reach out to countries like Sierra Leone. I am convinced more than ever the world needs our voice, our passion and our commitment to health care development based upon respect for the life and dignity of the human person.

Let us never tire in our efforts, and if I may steal a few lines from Mary Oliver, let us keep believing:

“Belief isn’t always easy
But this much I have learned-
If not enough else-
To live with my eyes open.

I know what everyone wants
Is a miracle.
This wasn’t a miracle,
Unless, of course, kindness –
As now and again
Some rare person has suggested –
Is a miracle.
As surely it is.”

Mary Oliver
“Into the Storm”

Saturday, March 7, 2009

Thoughts on Sierra Leone from George

As I begin, I feel I should be banished to blogger’s hell for my failure to post anything while in Sierra Leone. Thanks to Ray and Jim for posting what they did. For myself and Bob, we were saddled with a training schedule that went from dawn to beyond dusk, and by then the Bo Internet Cafe was closed -- which had the only point of Internet connectivity.

Apologies made, let me offer a few perspectives on our trip:

“Do little things with great kindness”

The days prior to a training trip are hectic. We had to finish the training manual, arrange for the final pickup of medications and equipment, and get everything packed into a 44 kg baggage allowance. So many people stepped forward with the little things that make this effort possible. Lisa McLean and the ob nurses at St. James Hospital in Butte arranged and paid for additional meds and donated retired nursing uniforms. Insty-Prints did a fine job printing the “Safe Passages” training manual. Assembling the rescue kits – bags and masks to resuscitate newborns, magnesium to prevent a newborn seizure, misprostol to stop a post-partum hemorrhage – I am struck that this work is not about big things, but little things. Little things done right save the lives of mothers and babies.

“On a jet plane”

We made the baggage allowance and started the journey – Butte to Salt Lake City, Salt Lake City to Chicago, Chicago to London, London to Freetown. What, no direct flights from Butte to Sierra Leone? On the last leg (London to Freetown) I met a young man traveling to be with his father, who had had a stroke in Sierra Leone six days earlier. The man hadn’t spoken to his father in two years. By chance I was sitting next to an Indian businessman who was well connected in Sierra Leone. When he saw the plight of the young man and his father, he went out of his way to help.

When you fly into Freetown, you actually land at Lungli International Airport. This presents a unique challenge. The airport is north of the Sierra Leone River where it flows into the Atlantic Ocean. Freetown, the capital of Sierra Leone and its largest city, is south of the river estuary on a peninsula. The Indian businessman arranged for us to take a helicopter from the airport over the water to Freetown, and then his driver took us to the hospital. Most travelers take a water taxi, ferry or hydroplane to get to Freetown, which has the third largest natural harbor in the world and is the starting point for most in-country travel. Our Family Health Alive-Safe Passages training to prevent maternal and newborn deaths was to take place in Bo, well inland. (See Blog map of Sierra Leone.)

We arrived at the hospital near midnight. The father was paralyzed on the right side and could barely speak. When he saw his son, tears streamed from his eyes. I examined the patient and called his local doctor. They had no CT scan and had been treating him with steroids and mannitol – but apart from that had done a good job. We made plans to take his father out with us the following week. Good people – the son in search of his father, the Indian businessman, the nurses trying to comfort a patient in a completely different world.

“To be DRY”

Imagine being a young woman with urine dribbling out of your vagina everyday. You smell, you are dirty and poor, and you are rejected by family and village. Somehow, you found your way to the West African Fistula Foundation and a surgeon named Darius Maggi. He and his team welcome you, comfort you, feed you and prepare you for surgery. A few weeks later your fistula is repaired. After the foley catheter is removed, you no longer leak urine. One word, one beautiful word – DRY. You are dry. To be dry is to be alive; to be dry is to become human again.

As we entered the fistula ward, the women burst into song at the sight of Dr. Maggi. This man and those working with him had given them a new life.

“Work begins”

Bob and I have done this many times. The opening day of the training workshop. How many people will come? What will be their skill set? Will we have electricity for the power point? Our mission is simple – provide training, inspiration and equipment to begin the process of change so that women don’t die in childbirth or develop complications like obstetrical fistula.
The lecture hall is full. Eighty people come from all over the country. There are physicians, midwives, nurses and community medical officers. They are eager to learn and participate. We are blessed to have dynamic leaders: Mrs. Betty Sam, the director of the Christian Health Association of Sierra Leone; Mr. Samuel Pieh, a native Sierra Leonan now working as a consultant for health and development in Liberia. They speak of a new day for women and babies in Sierra Leone.

Will the words become flesh? Will the protocols in the manual – the signs of preeclampsia, the dose of antibiotics, the order of resuscitation – move from word and print into practice? We shall see.

I begin with our core principles at Maternal Life International (MLI) – respect for the life and dignity of all persons, born and unborn. We exchange stories and questions. Bob takes them through the basics of antenatal care. He is the consummate professor, asking questions, drawing out information, helping explain not just the “how” but the “why.” They are 100 percent engaged – this is why they came.

The day passes quickly. At the end of each day, we always ask, “What were three things that were good about today?” and “What are three things that need to be improved?” They were superlatives for the training. What should be improved – they begged for a meal to be provided at lunch and they asked that we make time for prayer.

“Beneath a tree”

We start at 9 a.m. sharp with an hour to get things set up. We move to normal labor and complications of pregnancy and delivery. By the afternoon we are beginning small groups. I am rotating participants through basic neonatal resuscitation. There are no rooms apart from the main lecture hall, so we are under a tree outside. Ten, twenty, fifty times, each participant goes through the basic steps – position airway, suck the mouth then the nose, assess if on the “no breathing road” or “yes breathing road,” begin bag and mask ventilations, insure a good seal, “1 breathe . . . 2 breathe . . . 3 breathe.” Very few of them have ever seen a bag and mask for newborn resuscitation. Some have tried mouth to face resuscitation. The studies tell us that 23 percent of newborn deaths are from asphyxia. It doesn’t have to be that way.

In the afternoon heat, I am reminded of “the tree of life,” of God who “breathed life into man.” Oh to simply breathe, to fill an infant’s lung sacs with air and push out the fluid . . . forget for a moment about medications or surgeries, in those moments after birth, work for sweet and steady breathing.

“Stabilize and Deliver”

Nobody does a better job in explaining preeclampsia that Professor Scanlon. He takes the participants through the basic pathophysiology and how vasospasm affects every organ system. You can see the lights go on (even as the power and fans go off.) If they diagnose severe preeclampsia, management becomes simple – stabilize and deliver. And, thanks to our donors we have the “goods” to stabilize: magnesium for prevention of seizures, hydralizine to lower severe high blood pressure.

This isn’t Bob’s first rodeo. He takes it to the realities of providing care in an understaffed, poorly resourced West African Hospital. What if you don’t have urine dipsticks to measure protein? (Many health care providers don’t). What if you have no idea about the woman’s due date? (Many patients arrive “unbooked” without any antenatal care). What if the woman’s cervix is unfavorable and you have no one able to do a Cesarean-section? (Many institutions don’t.)

Bob finishes and one of the participants says, “This is fantastic!” They have seen too many women die from complications of preeclampsia. All of a sudden, they are educated and empowered to manage for this condition in a clinically sound and practical way. I get the sense of the “word is becoming flesh.”


(To finish reading Dr. George Mulcaire-Jones reflections on Sierra Leone, please see blog posting 3/8/09)

Thursday, March 5, 2009

Thoughts on Sierra Leone - From Ray

Our good intentions to blog each day were met with the challenge of not having access to the internet for much of the time that we were in Sierra Leone. So now, afer the fact, we will each provide our own personal summary of the trip, what we accomplished, and where we go from here. I will leave it up to George and Bob to summarize the Safe Passages Training Workshop but will just add that it was very successful with close to 80 Sierra Leonean healthcare workers trained.

Sierra Leone is a beautiful country with wonderfully friendly and open people. We were warmly embraced everywhere we went. It was quickly apparent, however, that this is a country that is in need of much help. I will attempt over the next week to add some more blog entries about some of our experiences and will add some photos.

As for our technology demonstration project, it ended up being somewhat disappointing, but not a complete loss. The intent of the trip was one of discovery ... to determine the infrastructure, technical, and human resource challenges that we need to face if we are to successfully implement distance learning technologies in Sierra Leone. We discovered early in our trip that access to the internet is very limited, controlled primarily from ISPs located in Freetown, and the bandwidth is very poor. They are working now somewhere in the 56K to 128K bandwidth arena ... possibly as high as 256K at times. They hope that will double in the City of Bo during this next year. While we were able to access the internet, the bandwidth limitations prohibited us from doing much testing with the Tandberg Tactical Unit we lugged with us. We were even experiencing difficulties with Skype audio, while Skype video simply did not work. Going into this project, we knew that internet access existed but were not aware of what type of access we would have. While there, we were able to connect with the owner of the only internet cafe in town. He did not have local control of his firewall and network, so our ability to work through him were quite limited.

In the end, we determined that we can not rely upon the existing internet infrastructure in Sierra Leone (like we did in Nigeria last year), and we will need to communicate directly to a satellite.

I can't thank the folks at Tandberg (Kjierstin and their team) enough for everything they did to support this project. They went the extra mile and I had hoped we could show off the great technology that Tandberg brings to the table. Now that we know significantly more about the infrastructure and operating environment, we can now make sound technology decisions for any future projects in Sierra Leone.

While we were not able to conduct our live video conferencing sessions as we had hoped, we did walk away with the knowledge of how to proceed in the future. After all, the intent of my visit was to conduct an assessment of needs and capabilities. From that perspective, the trip was a great success.


Wednesday, February 25, 2009

Wednesday in Sierra Leone

It is Ash Wednesday today. Several of the participants at the opening of the conference at 9AM proudly wore their ashes on their foreheads. George, Bob, Ray, and I will be going to Mass tonight at 6PM. We are all anxious to participate in an Ash Wednesday celebration. The conference has been going well. There are 75 participants and they possess an eagerness to learn that is incredible. My Theology of Hope sessions were well received. Mr. Garrett would be proud of me as I got several "amens" and "alleluias" from the class. Maybe there is a little "Baptist preacher" in my blood, as Dermot would say. Ray spent hours and hours yesterday trying to get a communication hookup onlyto find out that it just ain't gonna work. Sorry!!!

Sierra Leone is a beautiful country and it's people are so welcoming. I am amazed as I watched the continual activity outside the internet cafe where we must go to get any kind of internet connection. What amazes me so much is that no one carries anything in their hands. Everyone carries everything on their heads, hustling peanuts and leaves, and all sorts of food that I have never seen before. Yesterday I saw a boy carrying a tire rim on his head. Women with babies on thier backs is very common and many will stop when you want to take their pictures. All school children are in uniform and each color uniform represents a different school. Boys on motorbikes serve as taxis to the people moving them very swiftly around the area. Across the street from the internet cafe is a market place filled with clothing from the United States and other countries. In a way it is a good thing, but having the abundance of western clothes has also destroyed the garment industry in Africa. This afternoon Ray, JU, Aminada and I are going to a Catholic Grade school (St. Vincent's) I think to deliver some soccer balls and spend time with the students. I am looking forward to that. Tomorrow we will watch Dr. Maggi perform a fistula surgery. There is so much to tell and so little time. I will leave you today with a note that we are all doing well even in the heat and high humidity. A special note to Char, I love you!! And to the rest of my family - I look forward to seeing you and talking to you when I return. Jim

Tuesday, February 24, 2009

Greetings to LCHS and ST. James, Lititz, et. al

Greetings from Bo, Sierra Leone. If you read Ray's blog you will read of our journey here. Today we are working on getting conectivity with the satelite. Hopefully we will accomplish the task and see all of you. We are sitting at Mars Internet Cafe in Bo and the people have been most gracious in helping us get connected. The trip to this point has been eye-opening to say the least. The people of Sierra Leone are extremely friendly and want to go out of their way to talk to you and meet all of your needs. I look forward to giving my first presentation today to the over 70 attendees at the conference. Wish me luck! There was a wonderful welcoming banquet for us last night. We had all the traditional Western US bar-be-que fixings: chicken, ribs, mashed potatoes, cabbage, and a salad with some homegrown ingredients. It was all very good. However, I was bribed into trying a hot sauce for the cabbage. Needless to say in Africa "HOT" has a whole new meaning. My tongue is still on fire!!!! To my Christian Service students I want to way thank you for the going away party. And to the people of Saint James, know that your dollars will be well spent. Finally I send my love to my wife Char. I miss you!!! Until later today, I sign off. and yes, it is hot and humid, but it's better than the cold ANYDAY.

Love to all

Jim Rogers