Mission Possible: The Journey to Sierra Leone

Janine Karoly of Tinton Falls is blogging from Sierra Leone where she has accompanied her husband, an ob-gyn, as part of a medical mission to the West African country where the life expectancy is about 40 and women have a one-in-eight chance of not surviving a pregnancy. Pictures, Janine told Patch in an e-mail, aren't possible right now as her camera, along with medical supplies, were stolen somewhere between Newark and Freetown.

(This is the first in the series of five blog posts from Africa.)

The players

Nina Siegelstein - OB-GYN, fourth mission to Africa, third to Sierra Leone, one-woman-show responsible for fund raising to build a facility for women's health in Makeni, SL, fearless leader, thinks the 10 Things to Do in Africa (see below) are super duper. Lives in Little Silver.

Inger Nielsen -  Danish Midwife. Came to know Nina through a fund raiser held at Wellesley College, interested in working with the Makeni Midwifery School encouraging education and connection to Nina's goals for women's health.

Danielle Woos - Surgical Technologist. Hand picked by Nina to come on this mission.  Keeping a journal about her experience in Sierra Leone, highly organized, she connects all dots in anticipating  patient's and surgeon's needs.  She explains that "bat-shit crazy" should not  be confused with "eight shades of crazy," which is much worse.

Michael Karoly - OB-GYN, fourth medical mission, first to Africa, hand picked by Nina to come on this mission because of his skills, calm demeanor, jokes and sense of adventure.  

Janine Karoly - Observer/wannabee writer, Mike's wife, here to scratch his back, wants to be a voice for Nina's endeavor. 

Thursday and Friday, Jan. 5-6

We flew out of Newark on Jan. 5 to London, hit a crazy ass delay before the next leg of our journey from London to Freetown, Sierra Leone.  After waiting forever for our luggage at the airport, there's a one-hour car ferry to Freetown, followed by a drive north to Makeni, where extreme fogginess turns a two-hour drive into four hours and makes it feel like you're inside a video game with Hotel California the destination. We arrive in the total dark (no electricity between 10 p.m. and 8 a.m.) at 6:30 am.  

I am totally too old for this but then so is our 26-year old surgical tech, Danielle. She points out to us that it took 24 hours from London to our mattress pallet in Makeni. Our accommodations are located on the hospital compound.

We're greeted by Gianpiero, an Italian working for an Non-Governmental Organization, Don Carlo Gnocchi Foundation. Find our way to our rooms, basically crawl under our malaria nets and sleep.  

Saturday, Jan. 7

Gianpiero is our house helper even though I don't think we're really his responsibility, he helps us get some breakfast before heading off (a short walk across a field) to organize supplies and get to know Holy Spirit Hospital, meet staff and evaluate the first 10 patients. Nina and Michael fully expected to begin operating on Sunday and are disappointed to learn that working on Sunday is not in the plans for the hospital staff (our mantra quickly becomes "TIA" for "This is Africa").  Usman, our cook, makes us dinner of spicy chicken, vegetable couscous, fried "whole" fish, potatoes and plantains.

Sunday, Jan. 8

An unexpected day off, we arrange an excursion to see "the falls" (as in sorta like Niagara, but not really) a couple of hours away from our home base. This journey proves to be the stuff of National Geographic and defines for our group the magnitude of our environment beyond Makeni (like THAT wasn't enough!).

The roads for the most part are good but often it feels like you're in an unbalanced washing machine. Our driver, Amadu, is patient with our '20 million' questions. We pass villages that are sustainable, a word we use so knowledgeably (or so we think we do ... hahaha)!.  Thumbs up from the children is a welcome greeting to us as well as shouts of "Apoto, Apoto," or "white, white."  Michael has decided that everyone knows his name and has taken on Apoto like his "Norm!" on Cheers.

Arriving at our destination, Amadu gives the local priest a courtesy visit to announce our presence. Holy Spirit Hospital is involved in building a clinic in this area and Father Paul shares information with us. Funding has been provided by the new mining company in town. Mining iron ore is new for Sierra Leone and what appears to be a plus for the country.  We all know what that may imply, but right now, a facility to provide medical care is one step forward for the locals.  Facility ... meaning a structure not staffing, supplies, etc.  

Danielle taking photos, respectfully asking if it's ok, before she snaps (people will say "No snaps"), shows a village girl her photo and doesn't recognize herself as she has never seen herself.  Later, I understand what Patrick (Dr. Turay) means when he says the villages are fragile communities.

On to our destination and a short walk to the falls that provides hydro-electric power. Along the way we meet a group of mining employees, cooking curry chicken in a traditional South African pot (I want one!).  What an interesting bunch -- Australian, South African, and a few local women.  The Australian is the Health and Safety Officer for the mining company and he is happy to answer questions for our inquisitive group.  One man, the one doing the cooking, Danielle has dubbed "bat-shit crazy."  Not that we're nervous, but clearly not a person to tangle with. Was it sweet when he asked the female sitting next to him to scratch his back? eye-yi-yi!  There are two other charming men TOTALLY and instantly in love with Danielle. 

We journey back to Makeni and the hospital compound.  Michael and Nina walk over to the hospital to make sure everyone is ready for Monday's surgeries. TIA ... so, back they come only with hope that tomorrow will go smoothly, as opposed to, their patient orders completed.

There is one western-style hotel in Makeni and we plan to have dinner with Dr. Patrick Turay at the restaurant there, Wusum.  On our way with Amadu, we encounter a huge group of women parading through town.  Amadu stops the car, out of respect, and explains to us what is happening.  

Some town women (a secret society) are escorting a number of 18-year old women into the bush for circumcision.  By law, a women must be 18 AND consent to this procedure.  They are hidden within the mass group and we see some women costumed like men as part of this ritual.  Amadu explains that much education has occurred to inform women that this is wrong and/or unnecessary. His own wife was circumcised but she now does not believe (along with Amadu) that this is good and will not allow their own girls to have this done.  

In the town, girls not circumcised will be ostracized from the community at large. Amadu says this is slowly changing.  I asked him how he came to not wanting this for his girls and he simply said, 'education.'  I got nothin' left ... I feel drained.
Dinner, home, and surprised to see electricity on Sunday! Gianpiero explains the electricity is on to power up the operating theaters for Monday.  Thank you Nina and Mike!

10 things (or so) to do (or not to do) in Africa

• Do not open your mouth in the shower
• Only eat a fruit or vegetable that you can peel
• Drink only boiled water or sealed bottled water
• Sleep with a malaria net, take your malarone
• Bring Michael to make silly jokes
• Have an Italian guy in the kitchen to make espresso
• Have a guard at night
• Prepare for dribbling, cold water showers
• No electricity on Sunday and 8 a.m. to 10 p.m. weekdays
• Do not eat house rats, just bush rats
• Don't take being called 'apoto' the wrong way
• Invoke TIA (This is Africa) regularly

By the way, I did say Nina was fearless -- scratch that -- she's "eight shades of crazy" when it comes to spiders.

This is the first in a series of blog posts documenting the medical mission to Sierra Leone and the effort to bring a maternity ward to its northern region that is home to 1.7 million people and no ob-gyns. To make a donation to help One World Women's Health build a maternity ward in Sierra Leone, click here