Wind Blows Deeply

Wow! It’s been a busy few weeks but that is not excuse for my lack of posting. What could be an excuse would be very slow internet connections (remember the early days of dial-up?) and, recently, power outages every evening.

My first month in The Gambia has gone so quickly. Let me sum up some of the highlights.

Soon after I had settled in, two professors (Drs. Reed and Taylor) from Wycliffe College in Toronto and a grad student came to lead a theological conference. They were also successful in meeting with many Christian leaders and contacts at the Gambian university to plan the start of a seminary in the country. There is still much planning to be done.

A short while later, more Canadian volunteers joined us. One is a millwright from B.C. Since his arrival, he assessed two major repair projects at the Royal Victoria Teaching Hospital: repair of the generator at the main outpatient clinic area and repair of the second autoclave for sterilizing medical equipment. Both are estimated to be have been out-of-repair for several years. He has also worked with another Canadian volunteer to set up an irrigation system in a community garden.

The neonatal nurse has also been busy. Just after arriving, we learned of a nursing conference relating to the partogram – an assessment tool used in fetal assessment. So, in addition to teaching midwives about neonatal resuscitation, she was able to teach general nurses and nursing students. Based on test scores and her one-on-one experiences in working with them, she hopes to identify some key people who could be involved in a “train-the-trainer” workshop in May.

We have spent most of this past week in a village working on two focus areas. The first is the water project. The village of about 1300 only has a few working wells. CVM hopes to be the link between a local engineering firm and the village to implement a new well, solar-powered pump, tank and pipe system. At present, it is the dry season in The Gambia. Most everything is in various shades of brown and tan unless an outside water source is present. A stark example was seen on one day. A man living close to a well had taken the initiative to plant a small garden with fruit trees. It truly was an oasis in the middle of an otherwise barren landscape. (We were even given a large bunch of bananas which is just beginning to ripen now. Also, after much study, I think I have figured out how bananas grow. I am told it takes a regular and consistent water supply for the banana flower stamen to produce fruit.)

Our other recent activity in the village was a two-day children’s camp. We told a series of Bible stories, starting with creation to provide common-ground for the mainly Muslim population, played games (“Samba” says, duck-duck-goose, water relays, and –the biggest hit of all– water balloons), made crafts (mainly involved demonstrating what a crayon was and how to use it) and provided lunch with a special treat (banana boats with marshmallow and chocolate). I constantly had children hanging on each of my fingers, crawling on my lap, tugging at my shirt, stroking my skin or playing with my hair. The children were absolutely incredible and it was so special to be able to show them love and attention.

Together, the nurse and I have been able to lend some medical advice. One of the villagers appeared to have a very serious skin infection in one hand stemming from a cut on his finger. His hand was extremely swollen and painful and this was extending up into his arm. We took him into the closest major centre, found a pharmacy and, based on the available antibiotics, came up with a combination we felt might work even though it wasn’t necessarily ideal. Fortunately, his hand was remarkably improved when we returned a bit over a week later.

A neighbour also was having significant upper stomach pain. We had a very difficult time getting any type of history or explanation from her and her family. We provided her with some basic over-the-counter type medications initially and again the next day we she returned to our doorstep. Unable to do a proper assessment, we were a bit concerned that it might be something more serious. However, the second day of medications seemed to do trick.

Personally, I have also had a satisfying few weeks. I spent most of one day speaking with the principal pharmacist at the hospital. This was an extremely useful meeting as I was able to finally gain a sense of how the pharmacy system works in the country. Of note, The Gambia is the only remaining English-speaking West African country without a pharmacy or pharmacy-technician school. The only pharmacy related training in the country is that for pharmacy dispensing assistants which occurs at the hospital. (These assistants then go on to work in retail pharmacies, health centres or remain at the hospital.) A pharmacy technician program may even start as early as fall 2009!

Next week I will be teaching a series of lectures for the pharmacy assistants. It is a bit difficult to gauge the knowledge depth and scope they are to attain, so I hope what I provide will be sufficient. (In three days, I will be covering antibiotics, self-limiting skin disease and endocrine disorders [diabetes already covered].) I’ve also been asked to teach cardiology anatomy and physiology the following week, as the assigned lecturer for that area has not shown up to teach for several months now. This weekend will be busy putting some last minute touches on those presentations.

Next week, I have also arranged for a meeting with the Minister of Health. Now that I have a basic understanding of the pharmacy system, I hope to move forward with better understanding (and perhaps addressing) some of the limiting factors I have experienced. Also on the agenda will be discussing other medical initiatives CVM would like to move forward with.

Since I am now over the thousand word mark, I’ll call that enough for the time being. I am thoroughly enjoying my time, the food, the culture, the people and the opportunity to make a difference. There have also been some challenges in leading a team with very diverse volunteer or ministry areas while focusing also on my own.

I’m sure no one in Canada will feel sorry for me but most days have been rather cool. I’m wearing sweaters some mornings/evenings and many nights am cuddling under a blanket. (And no, there is no air conditioning.) Let’s just say morning bucket showers are still quite hard to handle.

Thanks to those who have sent emails – I’m sorry if I haven’t responded. I also have a snail mail address if you want to try that method. Send me a note and I can get it to you.

Hope you are all keeping well. Will write more soon.

Things to count:
-one suitcase
-two days of work
-one week with family
-two weeks until departure
-three days of travel
-four incredible months

With my past trips being only a few weeks long, it was relatively easy to plan, prepare and pack. Four months is all about the details. All said, I am continually amazed at how God is bringing everything together.

I have been very encouraged by your financial generosity! I am currently at 80% of my target and the goal is within easy reach now.

Your notes (and letters!) have also been very encouraging. While I may not have an opportunity to respond in a timely fashion, please keep the emails and blog comments coming. The updates will flow both ways.

There are many projects starting soon after I arrive in The Gambia.
Nurses Training
-A returning Canadian Neonatal nurse will spend three weeks leading a “Train the Trainer” workshop
-Once trained, Gambian nurses will teach other nurses across the country about neonatal resuscitation (helping babies breathe)

Working with Children
-Work with a local group caring for ill and malnourished children
-Host a week-long day camp for either children in our neighbourhood or in a village

Village Water Project
-A community-identified need, we will partner with the village to establish a water source (central tank, solar array, pump, borehole)
-Preparations will continue in February with construction planned for May

Founding a Gambian Seminary
-Two faculty from Wycliffe College will participate in a theological conference
-This may develop into long term partnerships

RVTH Pharmacy
-With the change in store-keeper, additional training and support may be needed
-Study impact of 2008’s building project (shelves)
-Better understand the Gambian healthcare system

Isn’t that how it often works? Someone walks into the room, gets your attention and says ‘I need to make an announcement.’ Then, depending on the person, there is a pause of varying lengths. Sometimes only a second while they take a breath. A few moments while they look down, shuffling their feet back and forth. A few more while they look out at the group, trying to find a friendly face or someone with whom to make eye contact. Then they swallow or clear their throat. Another deep breath. And then it comes; good or bad, joyous or painful, hurtful or healing. Whatever it is, the news comes. Eventually.

Some of you already know this and have known for some time now. There are two things really.

The first is that I got a new, but only temporary, role at work. I am now a Project Coordinator. It’s more like a project facilitator — keeping track of the regional pharmacy department initiatives and keeping them on track, periodically pulling in staff to work on them, ensuring priorities are adhered to and maybe even sitting on committees. I’ll still be taking care of the transplant patients I call my own. While it would be hard to give that up, I think this new position will help me become somewhat less attached … which will be a good thing.

The second thing, perhaps somewhat more exciting, is that I will be returning to The Gambia in February. Unlike previous trips to Africa, this time I will be spending about four months in the country. Part of my role will be to continue working at the hospital; probably doing some teaching and continuing to improve the inventory system. The other part will be to help CVM coordinate the short term teams they will be sending in February and May. As such, I will be the chief hospital liaison — setting up opportunities for the volunteers. I will also be more involved with their projects and help with follow-up.

I will also need to raise approximately $2,500 per month ($10,000 total). If you are interested in partnering with me financially, please let me know and I can give you the specific details.

Of course, I certainly encourage you to pray for me too.

So there it is, after a long pause over the weekend, two, somewhat large, announcements.

I would be remiss if I did not also mention that today we pause to remember those who strive to protect the freedoms held so dearly by our country. It matters not so much if one favours or disfavours war. The sacrifice can be appreciated. There are others, like my grandfathers, who did not fight. While their sacrifice was different, the concept of service was still present for those conscientious objectors.

…we will seek alternatives ways to serve humanity and our countries in the spirit of Christ.

While yesterday was our first official day at the hospital, it was mainly touring and meeting with the directors. Today was the first work day. We met again with the head pharmacist, Essa, got some ideas on what the processes were in place and worked out what we’d be working on for the next week and a half. Then we decided to organize the donated medications located in the main pharmacy. Everything was covered in a thick layer of dust, in random order and most certainly set up for errors to happen. Initially we were a little daunted with the task ahead of us, so we went for lunch. Beans on a bun and a coke cost us 18 dalasis … or about 75 cents.

After a lunch in the hot afternoon Gambian sun we sorted and cleaned and classified. (I do have to say that I find myself increasingly able to tolerate the heat and humidity … it may even be growing on me.) We only got about 3/4 of the way through the first large shelf but I think Mel, Tim and I all left with a good sense of satisfaction at the end of the day.

One of the new items on my list of “pharmacy-related things to be empassioned about” it that of foreign medication donations. Now that I have been able to see the variety of agents that are donated (without generic drug names, in foreign languages, opened containers, old prescriptions from patients, expired stock) I hope to “let the world know” how much of an issue this is. Simply the time that it takes to sort through all the individual boxes and sort it into some reasonable system would be overwhelming for a country or local clinic/hospital/pharmacy. The WHO recommendations are certainly something to bring to people’s consciousnesses.

Once these medications are sorted, we will likely spend time in the various satellite pharmacies to observe the processes in place and make recommendations for improvement. At the moment, there is only one full-time pharmacist and two part-time ones. Pharmacy assistants (not technicians) do all of the day to day work: recieving prescriptions, filling the medications, checking their own work, giving to patients and limited counselling. The pharmacist simply does not have time to be involved in any of these steps. Already we have observed many potential concerns. (One thing we heard was that medication errors account for about one third of all deaths in the hospital.) In addition to sorting and observing, we may spend some with the physicians (mostly Cuban) on the wards.

Hopefully we can also put together a plan for the hospital’s medication store room. The room is of average size with cartons stacked floor to ceiling and very little space to walk around between them. I’m sure they cannot have a good idea of what is actually inside the boxes. Once we have a better sense of how big the problem is, I hope that we can find pharmacists and pharmacy technicians that would be interested in coming in the future.

Friday and Saturday will be spend putting together a medication kit for a rural health worker and doing the training for this. I think we will be able to procure the medications from the community pharmacy where Essa (the hospital pharmacist) also works. Community pharmacies are a bit of an interesting thing here in The Gambia: no prescription needed — just walk in and request whatever it is you think you may need. Sleeping pills, antibiotics, pain relievers … pretty much anything you want.

That’s enough ramblings from me right now. I’ll be sure to get on my soap box again soon.

This November I will be heading to The Gambia, in Western Africa (map), for a missions trip with Christian Volunteer Movement.

There are many exciting things which I may be involved with. However, I am excited that I will be using my expertise as a pharmacist while I am there. Along with two other hospital pharmacists, I may be involved with developing medication kits for rural health workers, attending rounds in the hospital along with local physicians, organizing the hospital’s pharmacy dispensary and medication supplies, and/or teaching pharmacology courses at the local university.

Through a discussion with a work colleague, I was reminded that despite the fact that many of us live in neighbourhoods, a sense of community is often quite lacking. As I began thinking about this conversation, the upcoming trip to Africa and how God has blessed me with great abundance, I had an idea. I have a job that both pays well and offers flexibility in having time off. So I thought, if I have the time and financial resources to make the Africa trip possible what are ways that I could also benefit the local community? My solution …. you!

I have decided to use the resources God has entrusted to me to go to Africa. In turn, I want to extend the invitation to those who may have otherwise considered supporting me to instead support their local community with their own time and finances. Of course, your prayers for myself and other group members are highly valued.

If you decide to take me up on this opportunity, I’d love to hear how you got involved.

Read the rest of this entry »