Three Miles to the Clinic; Walking with Moses

As we huffed and puffed to climb the ups and down of the gravelly and rocky paths, Moses easily glided ahead of us with his crisp white shirt and sturdy hiking shoes. Walking through Allentown and Calaba Town, I was most struck by the variety of homes that were haphazardly arranged up the mountain. While the vast majority were of concrete foundation with corrugated metal for walls, there was the occasional large compound with high concrete walls armed with barbed wire and broken beer bottles cemented to the top. These contained huge, lavish homes that starkly contrasted with the modest, community-built homes. As we walked, it didn’t matter if it was a corrugated metal and concrete house, a large and lavish home or a tarp and wood shack, Moses led us straight through all of them, jumping over deep irrigation channels, ducking through the trees that spotted our path or walking past groups of people chatting out in front of their houses. Our intention for this walk was to experience the three mile hike that it would take any sick person (or pregnant woman for that matter) to get to the nearest clinic for treatment. The further we walked though, the harder it was to imagine to get to the clinic if you were going into labor. To get to the clinic, we walked about two miles of path that cut through houses, and then about a mile through a loud, crowded market. This market was incredible, it was absolute sensory overload! Every five feet was a new stall with brightly colored small peppers, smoke dried fish and eel, fresh fish, chicken feet, cassava and groundnut leaves, rice, bulgur, beans, medicinal herbs, foam soap, cloth, and other little trinkets. Essentially, every stall was selling the same things, but there was new vibrancy with each stall and each vendor was just as excited as the next to show off his or her goods. None of the roads in Allentown or Calaba Town is paved, but it was especially evident in the market because it was situated on flat land, as opposed to the incline of the rest of the roads we walked along. Because of the lack of opportunity for drainage, most of the road was covered with puddles of mud that the passenger vans and motor bikes splashed right through.

Home in Allentown.

Home in Allentown.

Entering the Calaba Town market.

Smoked dried fish.

Okra, persimmon and eggplant.

Typical stall in the market.

Rice and bean stall in market.

          Once we got to what seemed like the end of the market, we reached the clinic. At the entrance was a group of three men sitting on the porch area and they welcomed us graciously, and once we entered we were escorted straight to the doctor’s consultation office. The whole clinic that serves three large communities consists of a waiting room that could fit around 40 people with two adjoining rooms, both for consultation.  A walkway crossed outside to two enclosed maternity rooms for delivery. We talked for a half hour with Zaynab, the clinic doctor, before she excused us out so that she could tend to her patients. She discussed the need for prevention education because of the number of people that come into the clinic with problems that could have been lessened or avoided with preventative care. The three most prevalent ailments that she talked about were: malaria, diarrhea, and acute respiratory infections some of which are caused by overzealous hand-feeding of children by mothers - all of which are preventable. Zaynab also discussed the free, government-funded services that the clinic provides to children under five, pregnant and lactating women, as well as free delivery and malaria medication. Our most triumphant moment during the interview was her suggestion to teach about hygiene and oral rehydration therapy, which is exactly what we had come to teach! We talked for just a few more minutes before she had to back to working with her patients, so we left and continued on our walk.

Moses walking into the Calaba Town Market Clinic.

Health posters outside the clinic.

Dr. Zaynab and Moses in the consultation room of the clinic.

          After making our way through a bit more of the market and going up one of the winding dirt roads, we ending up at a Baptist secondary school where we were able to meet and talk with the principal. During our conversation, there was one number that still creeps back into my mind at least once a day, he told us that it costs le 50,000 (which is around $11) per year for a child to attend.  Most of the students from Abigail D. Butscher School (ADB) could not afford that and therefore were not able to attend secondary school at all. Walking through the classrooms, there seemed to be two grades per room, but were definitely larger than the rooms of ADB, it was also enclosed like a compound with a solid metal gate and a small door that stayed open during the day. We chatted about what the children learned and other such topics before we left to walk up the road again. The next stop we made was at a Catholic primary and secondary school where we were able to talk with the principal of the primary school. He escorted us through the beautiful, large hallways and we were able to peek into the classrooms which had metal and wood desks, pictures and decorations on the walls and glass windows. We talked in a small room adjacent to his office about Italian priests founding the school and the increasing cost of attendance. Our talks with the two principals confirmed what we learned about government-funded schools and what we learned from working with ADB: the Sierra Leonians have a robust appetite for education. It was apparent that the growing response to the demand for more schooling just was not able to keep up with the overwhelming demand.  While there is still a lot to be done, there is definitely a lot of very good forward movement.

Entrance to Holy Family School.

 

 

Classroom in Holy Family School

 

Entrance to Junior Secondary School.

       We finished our walk by going another half mile up to the next town, Wellington, where Moses lives and visiting a miniature version of Rio’s Christ the Redeemer at the top of the mountain. Standing up there and looking out on the villages and ocean below us was breathtaking and magnificent, not to mention the adorable goats that kept wanting to eat our fingers! To get back to the ADB school, we walked down a valley, cutting through more yards, hopping over a stream and climbing back up a steep hill to the school. Being able to walk through these towns was an experience that I believe gave us the proper frame of mind and textural understanding of the living conditions of the people were there to serve and it was an opportunity I feel so grateful to have experienced. Walking through all of these homes and markets, it was so apparent how privileged I have been to grow up the way that I have. To imagine my family, friends and neighbors having to walk three miles to the nearest medical facility that did not even have the full range of care, was almost impossible. At the simplest level, being able to use a stove within our kitchen as compared to building a coal fire outside to cook painted a new reality to me.  Yet, every single person we met was happy and joyful and beyond welcoming. Perspective is a wonderful thing, and I had the distinct privilege of gaining at least a little bit through this walk.

Christ the Redeemer in Sierra Leone.

 

 

 

Krishna, Syed, Rianna and Hannah in front of Christ the Redeemer.

Rebecca’s Interview

       At around 9am on our second Sunday, Dr. Maring and I set out to interview Rebecca, we saw where her house was at the top of a steep hill, but we had no idea how to get there. Surprisingly, it only took 20 minutes to get to her house, which seemed so far away at first. We got there early, so we explored a little bit of the area around her house which had a well that was seemingly just for a few houses to use. It was covered with a pump and had an open barrel with water next to the pump, there were also a few stray buckets scattered around the well. While it was nice to see that the people that lived in that remote area did not have to walk all the way down the hill to the stream to access the spring box, it was another reminder that there is no access to fully clean water. 

       We had asked a man if Rebecca was home and a short while later, she poked her head out of her porch and invited us in to her home. Walking in, it was very nice, she had small appliances, including a small television and stereo system and three couches. As we sat down, four children ran into the room, Rebecca introduced three of them as her own and one as the daughter of a woman that lived in her compound. She explained that she and her husband built up the compound as a place for people coming in from the provinces to stay if they did not have a place to sleep. This was our first time hearing something like this and it made us so happy to hear about such a wonderful initiative. As we talked more about the area and her life, we found out that she lived right next to the Chief of her area. 

        Rebecca walked us over to his house and I was most surprised with the manner in which they spoke, I had a very different construct of the social hierarchy in my mind that was much different from reality. While I had expected a rigid chain of command, there was a candid and light nature to the interaction between Rebecca and Mohammad (the Chief). She joked and poked fun while translating our questions for him and they both laughed throughout the interview! We learned a great deal about how a Chief is picked and how fluid the structure of hierarchy is. Once we finished our interview with him, we walked back to Rebecca’s house and she showed us the makeshift toilets that some of the residents of the compound used and the much more sturdy toilets she used. Seeing the difference between these two toilets and hearing how Rebecca understood that a proper toilet was critical for good health those who were not.  But because they live within close proximity, it seemed as though there would be an easier flow of information between people which was reassuring. Before we left, Rebecca had made a plate of fruit for us and lovingly insisted we take it with us, we took a fruit native to Sierra Leone that looked similar to an avocado. On our way down the mountain we were escorted by Rebecca’s children and a few of their friends as they expertly scaled the rocks and hills, while Dr. Maring and I carefully eased our way down. Being able to spend such a long time with Rebecca and to understand what a typical lifestyle is within Allentown was a treat and so eye-opening for us. Hearing from an involved and educated woman about her hopes, concerns and successes was so helpful in our understanding of her society and the background for a public health intervention.  Many of the insights she shared with us will inform our continued PHWB work.

Public Health Moves Stones

       Each and every day, the engineers never failed to surprise me with their complete dedication to the project to work as hard as they could for so long each day. They had recruited some local men to help with their work and it was so wonderful to watch them work together so seamlessly.  Before our eyes we saw a mutually-respectful and supportive cross-cultural community grow. We, the public health team, would offer our help every day when we had a lull in our work during the day, and the engineers would always have little tasks for us to do! We helped carry gravel to mix into the cement, help hold rebar straight, carry materials into the classrooms for storage during the night, but our most important job was unwavering moral support. The commitment to the project and to each other built a team of engineers and local men which we were proud to be an occasional member of.  More than the help we gave them in moving materials, they helped us to more deeply appreciate the context of our Public Health Without Borders mission: people helping people to overcome challenges with a shared understanding of humanity.

Syed helping pour concrete.

Hannah helping align rebar.

Krishna helping carry gravel.

Rianna helping move rebar.

Ready, set, stickers!

     I have never seen such excitement for something so simple as a smiley face sticker as when Krishna and I began handing them out after our first hand washing workshop! After their Saturday Seventh Day Adventist service, we decided to host impromptu hand washing and oral rehydration therapy workshops because of the unexpected number of people that attended the service. Krishna and I took the lead on the hand washing, while Rianna and Syed took the oral rehydration therapy. 

Our first audience for a hand washing workshop.

        When we started the workshop, we had a mere 20-30 children, and by the end we had a packed classroom of around 60 children. We started by having some volunteers come up to demonstrate their current hand washing habits, using GloGerm to show their resulting cleanliness. The GloGerm works by highlighting the remaining germs after the children wash their hands.  We had them rub the gel into their hands, wash their hands and examine the remaining “germs” with a UV light. The kids were fascinated by the fancy technology and enthralled with examining remaining germs on their classmates’ hands.  Most importantly, they witnessed a common pattern, with the children missing between their fingers and their wrists. Completely winging it at this point, Krishna and I decided to demonstrate the way that we wanted the children to wash their hands, using a cup of clean water poured over our hands before and after scrubbing our hands with soap, making sure to clean palms, wrists, fingernails, between the fingers and the backs of hands. After our demonstration, we sang some songs that changed words from “Row, Row, Row Your Boat” and “Twinkle, Twinkle Little Star” to enforce some of the ideas about hand washing. It was these songs that really captured the attention of the children, they truly seemed to love learning and singing along with us! Once we finished, Krishna and I had the bright idea to have all the children come up to us to get a sticker to thank them for sitting through our presentation, but it resulted in total anarchy. We had gigantic crowds of hands extending toward us, shoving the smaller children out of the way and some coming back for two and three stickers! While it was complete chaos, it was still so much fun to watch the children interact and get to engage with so many at one time, this was our first experience in Sierra Leone with this many children! 

(From left to right) Syed, Hannah, Krishna and Rianna teaching proper hand washing technique.

We learned a lot about how to structure our workshops from this experience and we ended up teaching the rest of the hand washing workshops the same way and a few days later we were able to spend around a half hour in each of the classrooms in the school to teach! Going through the rooms, the children welcomed us so warmly. Throughout our whole time in Sierra Leone, we would hear them singing our songs and some of the younger ones, whom we had a harder time communicating with, would show us how to wash our hands out in the play yard. Working with the children was an experience I will not soon forget.  I hope the children remember how to wash their hands and teach their friends how to wash theirs with as much warmth as we felt during our workshops!