Wednesday, January 17, 2007


Mobility Impaired: Electrical Fires, MCL Tears and Blown Radiators

As I write, Aaron and I are stranded on the roadside somewhere between MaKeni and Kabala. It’s night… and thanks to the wonders of the ever increasing cell phone range in the north, we have been able to reach Joseph Sesay to let him know of our predicament (a busted radiator), so help will arrive in a couple of hours. Meanwhile, night sounds are emerging – and they are remarkably like night sounds on a summer Michigan night. Lots of crickets.

It seems that in a country known for it’s impediments to getting work done, Aaron and I have run into a particularly long stretch of frustrations and set-backs. My arrival was slightly complicated by both pieces of luggage being left behind in Heathrow Airport for a few days – joining the now 28,000 pieces of luggage that have been delayed or lost there in the past month. Aaron’s blue suitcase (containing research-related content) was lost on the flight that he took on December 10th and has not yet shown up. On arrival, I was greeted by Aaron at Lungi (a nice surprise) as he wanted to pre-empt the plan I had to take the helicopter (which recently suffered an electrical fire) from the airport to Freetown. Instead, we were treated to a much nicer boat crossing – thanks to Aaron’s friend Allen who owns an operates a small tour company and frequently takes NGO visitors on trips out to the Banana Islands.

As most of you are aware, Aaron had a motorcycle accident a week and a half ago which has resulted in a moderate tear to the MCL, damage to the Vastus Lateralis (hamstring) and ‘laxity’ in his ACL. This is going to change the nature of the work that he is able to do for at least the next few weeks, as the 20 mile hike in to the Loma Mountains, steep climb, and rough rocky terrain at the top are taxing even to one in peak physical condition.

Dealing with this injury has provided us with an interesting first-hand experience of the various medical resources available in the country. Basically, with the help of Mary Hodges, a British physician, a Sierra Leonean orthopedic specialist, and a physical therapist residing here with the ‘Mercy Ships’, we feel that we have been able to get a good diagnosis… though MRIs are not available. In the process, Aaron was turned away from clinics by power-wielding receptionists and doctors who appeared less sympathetic to a white patient than SL patients. He was also sent for x-rays (at a fee) to a friend of the doctor – even though soft tissue injuries can not be detected with x-ray. When he questioned the directive, he was told, “you are not the doctor.” Aaron’s case is border-line, and so we are in the limbo regarding the need for surgery for a short while. The MCL and the hamstring injuries should heal just fine within weeks, and then it will be much easier to tell the extent of the ACL injury – if there is one.

One blessing of the forced delay in Freetown (waiting five days for my luggage to arrive) was that we had an opportunity to spend a good deal of time with Mary and Zed, long- time friends of the Kortenhovens and residents of Sierra Leone. Mary is a pediatric doctor with a specialization in worms. She has been working with Njalla University to develop the curriculum for their CHO (Community Health Organizer) program. Before looking it over, I was under the mistaken impression that this was a fairly ‘light’ medical program, focused primarily on sanitation, basic medications and injuries. I must say, I am now in awe of anyone who tries to get through this program and who can practice effective ‘first responder’ medicine with the limited resources available in this country. There is only one CHO that we know of as far north in the country as Kabala – and often, there really is no back-up for this person, except in cases where they are responding to someone with monetary resources to get to a bigger city. The program requires an intensive three years of coursework and it is very carefully formulated. Unfortunately, it is currently only offered in Bo (in the south of the country) and few from the north are able or willing to relocate for that long of a period of time.

Mary believes that (from a medical perspective) the best investment this country can make is in the CHO and CHA programs: making distance learning possible, creating partial scholarships, doing appropriate follow-up, etc. One ‘advantage’ to training people for the CHO degree is that is not a transferable to other countries as a medical degree, so the expertise has a higher likelihood of remaining within Sierra Leone.

I am realizing more and more that expatriates trying to ‘help’ the situation here work with basically two different operatives:

1) Develop personal relationships and try to do the best thing possible for the individuals with whom you come in contact.

2) Develop ‘systems’ that incrementally elevate the living standards and opportunities for many people by one small notch.

It is really difficult to strive for the middle line between these… to develop personal relationships but try to invest time, energy and money in ways that actually serve a whole community well.

Well, the computer battery is just about to die, so it will be just Aaron, me, a broken down truck and the night road until Asmana comes to find us.

Love to all,


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