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.

“Peacemaker”

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.”

“Nothingness”

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”