Sierra Leone Spring 2011
(photos at the bottom of page)
March 2nd. Day -2.
I've finally got this years website live!
The blog will be coming soon, not long now so hold on....Day 0
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March 4th 2011. 5.20am. Day 0
Hi from Newcastle airport!
As I type on my iPad I'm looking at the screen that tells me I've got 31 mins to wait in the lounge before I'm allowed top go to the gate to get on board.
To my left is a party of hens in dayglo pink t-shirts and to my right is a family feeding their 6 year old chicken nuggets and e-numbers for breakfast. There's the usual selection of suits, couples and singles all with their own stories. I'm busy avoiding the giant bottles of perfume in duty free and I suspect other people are thinking I'm a bit of a nerd to show off by typing on my iPad in the coffee shop.
But what do I hope for this trip?
What do I want to get out of it?
Over the last couple of trips I think mostly I wanted to know I've been useful, but this one might be different. I think I want to get something from this trip. I do want to be helpful, but also want to have fun, have a break, make new friends, have an adventure, and perhaps most of all be able to spend a couple of weeks not thinking about work all the time. I love my work, and I am passionate about the people who work for me, with me, and the patients I treat, but I know I have a tendency to think about it too much.
Teresa, Zoe and Robyn have all had a hard time in the first month or two of this year, and I hope to come back giving them more of my time. More of the best of me. That's what I hope for on this trip. It sounds a bit selfish when I write it down, and I am quite willing to do my bit for the people of Sierra Leone, but I do hope I come back a better person than I am now.
Hey ho, time to go round the duty free one more time before I get on board my flight. See you from Freetown!
4.00pm
An extra day in Brussels.
Well, I thought that my Liberian trip had left me with enough of a view of Brussels airport, but it appears that the world believes not! For those of you who remember I spent 12hrs here on the way back from Monrovia in 2008. I arrived at 2am and the next few hours until the city woke up gave me enough time to look round the duty free.
Little did I realise that was just the prelude to this years Brussels stop over.
OMG! I've just been run over by twenty air stewardesses!
Let me explain.
The flight to Brussels from Newcastle was fine, save for a noisy party of 60th birthday celebrating ladies. The hanging around in Brussels arrivals hall was fine, save for the forgotten documents that had to me emailed to me by Teresa. The transit from one terminal to the next was fine, save for the automatic doors that closed in my face. The meeting up with lots of other Mercy Shippers was fine, save for the trying to remember names of people who I met three years ago who greeted me with a great big "hello Ali!". The getting on the plane was fine, the finding it wasn't very full so I had two seats was fine, the free newspaper was fine, the blow up pillow Mum bought me from Hexham was fine. It only got not fine when we were told to get off the plane again.
The flight has been cancelled for "operational reasons" whatever that means. So as I type I'm now sitting in the Holiday Inn with my new American room mate "Seth". We're waiting for tea time, when we'll meet up with the other 30 or so Mercy Ships people who are in this hotel tonight, hoping to get another flight out to Sierras Leone tomorrow.
I should explain the stewardesses. In the midst of the chaos of getting our hotels for tonight and tickets for tomorrow sorted, I thought I'd found a nice quiet spot to sit down and let you know what was going on. Unfortunately what I found was a space just under what turned out to be the cabin crew security desk. Needles to say the lovely ladies and gentlemen who work for Brussels airways don't like to get to work any sooner than they have to, so they all arrive together, at high speed, and head straight to their security desk... which I was typing under. 20 pairs of heels, 20 pairs of stockinged legs, 1 "Ow!", 1 "Oi!", 2 red faces later I was evicted. Sorry ladies!
Ah well, I did say I wanted adventure.
I'm off to see if anyone from the ships wants to go for a drink before dinner. Poor Seth my roommate has been travelling for 36 hours now so wants to go to bed.
See you all soon, hopefully from Freetown.
Ali
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March 5th – Day 1
Airlines are funny things aren’t they?
Get a delay because a wing falls off and the most they’ll give you is a voucher for a cup of tea and a long bus ride. Get a delay for “operational” reasons and they give you a night in a nice hotel, dinner, breakfast and 600 euros compensation!
So 25hrs later than planned we set off from Brussels to Freetown. 7 ½ hrs on the plane, followed by 2hrs in arrivals hall and I set my feet on African soil again. It feels like I’m home. Is that weird?
Immigration was a doddle. This time there’s neither scary man with a big gun, nor pedantic official with a stamp. Just a pair of smiley Mercy Ships people with orange baseball hats and everything in hand. No passport check, no visa waiver check, no yellow fever card check – though thanks to Mrs B for emailing it to me in Brussles airport anyway – no nothing. A few smiles, a few waves and all 25 of us that arrived on this flight are in with only one lost bag between all of us.
The ship lies south across the bay from the airport so we took a rather Heath Robinson water taxi for half an hour or so before we got here. It took another hour or two to complete the usual paperwork for the ship but I am now the proud owner of another Mercy Ships ID card, a room key and a full belly.
Off to bed it is.
Night night.
Ali
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March 6th - Day 2
2.00 am
Just arrived. I'm here. I'm alive. I'm going to bed.
Ali
12 noon
Just a quick update so far today.
I’ve done my orientation tour, met up with Dag, the Norwegian lead dentist, found out I am going to be doing the big screening tomorrow, and chilled on the deck for a while.
I’ll post this and then head back to bed for a while. All that sitting around on planes, trains and automobiles seems to have taken it’s toll on my wakefulness.
Ali
5.45pm
I’m in! I’ve got my place in the screening team!....And now I’m afraid!
My job, along with the two other dentists will be to examine, take a history and present the head and neck patients to Dr Gary, the chief medical officer.
It doesn’t half feel like the boot is on the other foot now. Over the last few years countless dental and nursing students have had to do that for me. They get to spend a few mins with the patient, find out what’s wrong, guess what questions I’m going to ask, and come up with a treatment plan, all before I swan in and tell them they’re wrong!
Well, now it’s time for me to be the quaking student again. On stuff I just don’t know much about. Rare and unusual head & neck swellings, tumors, goiters, clefts & who knows what else. But this is no teaching exercise, this is for real. I’m looking forward to spending time with the dental team, and especially Dr Gary. I’m not looking forward to the 5.30am start, or the feeling of being hopelessly out of my depth.
Special thanks today go to Marie Borthwick and Nick Lemmon, who between them have provided the portable surgical lighting I’ll be using tomorrow and to Laura Candlish. She's the latest in the long line a poor student dental nurses to get a grilling from me. Her openness and resilience on, what for her was a really bad day, has given me strength and courage.
Think of me tomorrow morning, as you brush your teeth and say a prayer if you can. Ask God to give me wisdom, strenght, no mosquitos, not too much sun, lots of cold water and patience, patience and yet more patience to go with the patients, patients and yet more patients.
Cheers
Ali
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March 7th - Day 3
All the crew are back safe and sound on board after a long and rather difficult day.
Just an official message today.
See you tomorrow
Ali
Mercy Ships is deeply saddened by the tragic events that occurred today during medical screening at the Freetown National Stadium when a crowd stormed the gate resulting in several injuries and one life lost.
Mercy Ships personnel working at the site attended the injured and accompanied them to local hospitals.
"Our hearts and prayers are with the individuals and families of those affected by today's events. The occurrence of this incident in the course of activities intended to restore lives is tragic. We move forward with tremendous sadness, but great determination, to assist as many people as possible in the next ten months," stated Mercy Ships Founder, Don Stephens.
Mercy Ships exists to serve the forgotten poor and has served Sierra Leone five times over the past two decades, also helping establish two land based health care facilities. For the next ten months, Mercy Ships will be providing surgeries for qualified patients while working alongside the Sierra Leonean Government to support its five-year healthcare plan and strengthen the functions of the national health system.
Update:
As you probably gathered from yesterday’s official statement our screening day did not go to plan.
For no obvious reason the crowd outside the Sierra Leone National Stadium, where we were doing our screening, became very restless and stampeded, causing minor and severe injuries and one fatality to several Sierra Leoneans.
Inside, though other Mercy Ships crew were near by, I was well away from the trouble, so did my best to keep screening as many of the head and neck patients as I could. Unfortunately instead of the several hundred patients I had hoped to see, the trouble stopped us working, before most people had made it through registration and pre-screening. I only managed to see 6 patients.
I did get to see some very interesting pathology. 2 inoperable malignancies, a couple of salivary gland tumors, a fibrous dysplasia and an encephalocele in a one month old baby.
Interestingly the way the team responded to the difficulty was marvelous. There was no panic, no blaming, no “I told you so”. Just some disappointment, lots of love and respect towards the leaders who had to make difficult decisions, and a renewed determination to find a way to help.
I wonder is the team here is so strong because the workers are inherently very committed, or because the leadership is particularly good? More honestly, I wonder ifI can help make the teams I work in, and often lead, so strong? From time to time in the teams I am a part of, the practice, D of E, church, I see workers go way above and beyond what could reasonably be asked of them, and from time to time I feel let down by team mates who seem to be more out for their own gain than that of the team.
More honestly still, I want to know what lessons I can learn from yesterday’s events, to become a more effective team leader. Our captain took time to speak to us in small groups and the leadership was quick to apologise (even though I don’t think they needed to). The team members were patient, even when information was scarce or contradictory, and were quick to overlook or forgive the failings in others.
We do all have one simple overriding goal, to help the people of Sierra Leone, and so all the rest is less important, but even so I would give my right arm to have a practice, d of e, or church team as committed to each other as we were both yesterday in the middle of the crisis and again today on the morning after the night before.
I’ve mentioned before in previous blogs that I seem to end up as the leader of teams and I’m not sure I ever really chose that role. I suspect it’s what comes of being a noisy person, who always believes there’s a better way. I know I’m not as gentle as I should be as a leader, but I can honestly say that I do try my best, and have the welfare of those I lead at heart.
My prayer today is that the one who is the Leader of Leaders will lead me in the right way. Show me the sweet spot between pandering and forcing, goal and journey, feelings and outcomes. Father, give me gentleness and patience, for all those I lead, and a double portion for those who, at that moment, are not happy with me. Above all else, above quality, dentistry or profit, above expedition, volunteering, physical or skill, above 12 core values, above ALL else, help me love the members of my teams with the same love as you love me.
Ali
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March 8th - Day 4
Finally made it to the dental clinic today!
It's a great building about 10 mins walk away from the ship. As of this morning we have light, power, air, water, space, instruments, nurses, dentists, translators, receptionists, engineers, a lab for upper partial dentures (13-23 only... But even so!), a technician and even air con. How long it will all work for remains t be seen but I'm happy for now.
We met our locally hired assistants, known slightly confusingly as "day volunteers". They are about 180 Sierra Leonians that the ship employs to help out in all the departments, and we have about 8 or 9 of them. In the dental team they are used as translators, oral health educators and runners. We did their training today, and will offer them treatment tomorrow. That should be a relatively easy introduction to the clinic for us all. The day volunteers will be able to watch each other get treatment so they get an idea what it's all about, dentists and nurses get to know each other and how they work, the sterilising team get to run slower than normal and we can all get ready for the first full speed day on Thursday.
This afternoon I've been tinkering with my head lamps, chin wagging over a dinner of hamburger and chips and going through the inevitable round of orientation lectures. Health and safety, community life, health and safety, how to avoid the SL squits, health and safety, emotional adaption tips, health and safety, internet protocols, health and safety...etc.
As I type I'm watching Arsenal v Barcelona on the telly above Starbucks. As most of you will know, unless it's an England international, I'm not that into football, but it's important to get to know people here; and it's a good way to avoid the "Starbucks circuit". A rather embarrassing walk into the main socialising are of the ship, where you enter, stop for a moment to look for a friend, can't see one, walk round the room and back out the other exit, hoping not too many people spotted that you were Billy No Mates! The Dining Room Sweep is similar but the doors are further apart so the risk of being caught is lower.
Talking of being caught, I got caught doing a penguin dance along the hospital corridor mid afternoon today, which was somewhat embarrassing, though being found later trying to explain the Ethel Williams Hall Corridor Clip-Clop, might have been just a little worse.
As I write this I realise I have quite a number of silly walks, all of which seem to have their own names. Maybe I should call the ministry, or maybe the nice men with the special hugging jacket should call me!
One of the things I notice here is the rapid turn around for the very serious to the very frivolous. I think that's one of the things I love about my family so much, the way that Teresa, Zoe, Robyn and I can erupt into silliness and singing without any obvious trigger or warning. Maybe that means I'm noticing the family nature of the crew here. It would be nice to have more of that in my life.
Oh....1 min to full time and Arsenal are about to lose, I'll go bag a computer now and post this before the crush.
See you tomorrow.
Ali
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March 9th - Day 5
I've done it, it pulled my first tooth in Sierra Leone! And my second, third, forth and fifth. That was the first patient done, and on to the next one.
Actually it wasn't as manic as it has been in the past as we were only treating our day volunteers today. We got through them by the end of the morning, and then did some dental nurse training for them. How to set up and take down an extraction set, how to take deal with sharps, and some cross infection control.
Teaching here is all about compromise. Actually, all dentistry here is about compromise. My nurses sitting their exams, or preparing for one of our practice quality inspections would have a fit if they saw the compromises we make. Cold sterilising of hand pieces and syringes, reuse of aspirator tips, minimal bagging of commonly used kit etc. but that's just the way it goes here. Of course what we really need are some dental nurse and therapist tutors. Anybody know any?
I did get my loupes and head lights working, which is much better than last year, but didn't manage to get a seat to work to I'll need to find some small woman to walk up and down on my back to straighten it out.
No gory pics yet, but I hope to get some tomorrow.
Keep those "talk to Ali" comments coming, they're all read and re-read, and all help keep me going.
update:
New 2011 photogalary now in the "pics" section
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March 10th – Day 6
Between The Rock and a hard heart
On Christ the solid rock I stand,
All other ground is sinking sand.
These are the words of an old time hymn I used to sing as a child and sung again tonight in Africa.
Oh, how I wish those words were true.
It’s not that I dispute that all other ground is not sinking sand, I’m sure it is, but I wish that I really stood on Christ. I wish that my reliance on Him was total. I wish that I trusted Him, and nothing else. I wish that my heart would follow what my head knows to be true – that ALL other ground is sinking sand.
It appears to me, and I should know, that I am a man with a hard heart. I know what is true, I long to act like it, but I still end up doing things I don’t want to do, and not doing things which I wish did do. I know I’m in good company in that respect, but it’s still a frustrating flaw.
Many of you will know that my most ever prized possession, “Bruce” my beautiful black TVR Tuscan, had to go back to the garage this autumn. It hurt, but it did my soul good. Bruce had come to symbolise all that was successful in my life. I bought him with the profits from my practice, I controlled him with the skill of my own hands, it made me feel good when I sat in him and he shouted out loud to me and to the world “Ali is King.”
What a liar he was!
The truth is that all other ground is sinking sand. My practice, my hands, my money, my health, my “good works”, even my family. Only Jesus remains.
My practice could be taken from me in a moment by the whim of a faceless PCT official, or by any one of a hundred unsubstantiated rumours spread by a local newspaper, staff, or the playground jungle drums. My hands, and their dental skill, are at the mercy of countless hazards. During the civil war in Sierra Leone the rebel’s trade mark was the amputation of civilian’s limbs. Tens of thousands of people here are missing hands, feet, arm and legs, chosen for no reason, purely at random. But it could just as easily be a lift door closing, or a rally car accident during off season, or a garden fork, a rock on the Simonside Hills or a wallpaper scraper in Zoe’s room. Lives changed forever in an instant.
My money, as people in Ireland, Greece, and Iceland found out, and are still finding out, is just a number in a computer. Change the way the world thinks about that number and millionaires are made or life savings are lost. No thought, no value, just numbers. Health is fragile. Losing it here it is one insect bite away, at home it’s the width of a white line down the middle of the road. As for “good works”, what gain is that? Could all the good works in the world make up for my failures? Can two weeks in Africa make me worthy? What about three then? Or four? Or a lifetime? No. There is no Karma. That too is a lie. There is no, “Hope the good outweighs the bad”, it never can. My heart is proud and sinful, my thoughts are black and selfish. I do not love as I have been loved. I do not forgive without reservation. I do not give without counting the cost.
Even the security of my family will fail. I love them dearly, but one day we will be parted. Even their love will give out in the end, and all that remains is Jesus.
When the day of reckoning comes what will I stand on? Not anything of my own doing. Not anything of the world’s choosing. All other ground is sinking sand. When all is counted up, the only thing I can stand on is Jesus. And even then, not my own belief in Him. That is small and faltering. No I have no choice but to trust in Him, in His righteousness, in His stability, His forgiveness, His strength. It’s not that I hold on to Him, but that He holds on to me.
And therein lies the rub. I can do nothing to affect His love for me. He either loves me or He does not. He either holds me or He does not. Not a word I can say, or an action I can take will make a scrap of difference to the objective truth.
So I struggle. A proud man who’d like to trust in Jesus, but who’s flawed character keeps trying to trust in it’s own achievements.
There have only been two times in my life I thought I was going to die. Once when falling down a cliff in Scotland on a solo hike, and once in Monrovia airport on my first visit to Liberia, when I was pulled, by my lapels, out of the immigration line by a man with a gun. In those moments, nothing about me made any difference. My life, whether I lived or died, was out of my hands. And not in the hands of a caring and compassionate friend, but the cold hard laws of physics and the mood of a battle scarred twentysomthing with machismo to prove.
If only I would realise that my life is always that fragile. Then maybe I would stand not on my own two feet, six foot tall, but not worth and inch. Instead I would keep my feet on the rock of my Lord. A tiny player on the shoulders of a giant.
In those moments when I trust in Him, it all makes sense. My place in life, my role, my priorities. I can see clearly the things that will last, and the worthless rubbish the world tells me is good. I know what I should do, and all is well, even when the s*&t hits the fan and flies in my face. But within a few days of forgetting that I am back trying to stand on the things that fail. Why is the quest for wealth, success, fame or adulation so unending? Because, like trying to climb out of sinking sand, the harder I fight the lower I sink.
So what can I do now I’m stuck? Stuck between The Rock and a hard heart? All that I have left is hope.
I hope that, on this one, I’m right. I hope it’s true that Jesus is who He says He is. I hope it’s true that He died, and rose again. I hope it’s true that He’s unchanging, stable, reliable. I hope it’s true that He is good. Not just OK, or not bad, but through and through good – to the core. I hope it’s true that He’s coming back, I hope it’s true that He knows me, I hope it’s true that he forgives me. I hope it’s true that He loves me, a whole lot more that I love Him.
My God, I hope it’s true.
Ali
March 11th - Day 7
What a view!
I've just stood on the top deck at stern of the ship looking out to the Atlantic watching the sun go down over the Freetown skyline. A perfectly graduated sky from black in the east thru dark blues, light blues and almost white in the west. A huge deep red sun, silhouetting The Cotton Tree.
The Cotton Tree is said to be the biggest and oldest tree in the area. It is the place the first returning slaves settled and still a site of national importance today. Think Trafalgar Square. We drove past there on Monday on our escape from the stadium and it really is a highly revered place. On Monday at least, it was the only clean area in the whole city. Though I may have to change my mind tomorrow. Tomorrow is "National Clean the Streets Day". The government has decided that Freetown needs cleaning up, so they have decreed that it will be illegal to open any shops, or go anywhere except just outside your house from 7.00am to 10.00am. During that time everyone is supposed to clean up their little bit of Freetown. Please excuse my scepticism but I'm not expecting to see much difference, when I head out at 10.05. If I'm wrong, I promise to let you know.
As we stood propping ourselves up on the rail, drinking iced juice, enjoying the breeze in flip flops and shorts I almost felt a little sorry for you all in northern Britain with your sleet and snow forecast. Almost, but don't worry, I got over it pretty quickly!
We had our second day of full on dentistry today. Another batch of 50 or so patients, averaging 4 or 5 teeth out each. My maximum in one patient was 10 teeth, spread though all four corners of the mouth. Mostly root tips, but a good few (about 1/3rd of the teeth) surgicals. That means a scalpel to cut the gum, a instrument a bit like the handle of a tea spoon to push it back, a burr to drill away the bone in a collar around the tooth, then shove a screwdriver blade in and lever the little fella out. A quick stitch and swap chairs to the next patient.
Because we've been the only clinic running at full speed we've had lots of visitors, and lots of people to teach. We've had two german actresses, who, from what I can ascertain, work on a daytime hospital based soap opera. They were doing minor celeb stuff on a Telethon a few months back and somehow ended up here for three weeks. Partly working in the canteen, and partly doing publicity. They were keen to help out so it was gloves on and dive into the very next surgical. That meant there was me, two german "martine mccutcheon's" their photographer and videographer all getting bloody together. Not the most useful of nurses but, with the obvious exception of anyone who works for I like my smile dental group, some of the prettiest! I used to wonder if having a video camera stuffed in my face or a flash bulb going off into my magnifying loops while working would be off putting, but today I was given a unique learning opportunity. I now know the answer to those questions. I'll leave you the pleasure of finding it out for yourself one day. Poor Rashel, my very competent Canadian dental assistant, as she prefers to be known, was somewhat sidelined. The lot of dental nurses everywhere. :-(
The afternoon changed flavour. More surgicals, but this now it was two Sierra Leonians to train up as nurses. Rashel, got to take her first tooth out and Sarah, a Brit dental student had to suffer Ali in full enthusiastic flow! What's this, why's that, what do you think is wrong with this. The poor girl's exhausted.
Between the three dentists here (two Norwegians and me) we've pumped out 300 UDA's (worth about £6000) in the last two days, all without a single penny being charged to the government or people of Sierra Leone. Worryingly there were quite a few people outside our clinic today, hoping to get screened for other, non-dental complaints. If word gets around that Mercy Ships are running a clinic, the people were not seen at the big screening day may try to get into our building. We had no choice but to have security to turn them away. That was pretty hard. The people I saw, as I reluctantly and literally, crossed over and walked quickly by on the other side of the street, had obvious head and neck tumours, damaged legs and abscesses eyes. All things the ship can help with, all real people, with real stories. How tough it is for our security people. They have to maintain public order, but that inevitably means that people with great need go unhelped.
But Africa, or at least The Africa Mercy, is a place of contrast. Back on the ship we played The Card Game, with 38 people, followed by The Great Del Mutti with pink motorcycle helmets, and Ali, as ever, got into trouble for being in charge of too rowdy a crowd!
I'm tapping away on my iPad in the Starbucks cafe, waiting for my friend Bob to arrive. Tomorrow we plan to wander into town (don't forget it'll be clean by then!) and them jump in a taxi off to one of the three 5 star hotels perched on top of the hills around Freetown. For Sunday we've booked a Podo Podo, a 15 seated minibus, to take about 25 of us to the beach. They tell me it's clean sand, clean water, good food and palm trees, all for about 100,000 Leones. That's not far off £15 to you and me.
I'm looking forward to a great weekend off then back to work on Monday, and if I know Bob, the clinic output will go through the roof.
One quick question to you all. I have been asked to tell a story for the 15 strong dental team on Thursday. Any suggestions, any or requests?
Ali
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March 12th – Day 8
Apology offered.
Yesterday I was very sceptical about National Clean the Streets Day. Today I am very impressed by National Clean the Streets Day.
To my amazement when I went to walk from the ship to The Cotton Tree (8°29'13.55"N 13°14'8.05"W) this morning, as I promised I would, at 10.05 everyone was indeed cleaning the streets! The roads here are pretty grim, with what should be covered drains running down each side, but the covers are often missing. The litter ends up in the drains, blocking them, so men, women and children were all down in their little bit of drain, pulling the muck out. They dumped it, initially onto the street, which made for rather hazardous walking in flip flops, but it was then picked up by the government bin wagons – just like the ones back home. Never before have I seen a bin lorry with 10 guys hanging off the back dancing, driving through the streets, with people cheering, and clapping.
One particularly chatty Sierra Leoneian man I spoke to told me (if I understood him right) that a before the war every Saturday was cleaning day. He said that the people all cleaned the streets together and the council took the rubbish away. During the war this had stopped, and that today was the first time since then. I guess the carnival atmosphere, then, is more jubilance at nearly 10 years of peace rather than just cleaning up the junk. I asked him how he felt about being obliged, by law, to clean the streets. He said that everyone was happy and he hoped the next time would be next week. Of course, 10 years of rubbish cannot be dealt with in one morning, however many people get involved, but it’s a start.
I wonder how well this idea would go down in London, Newcastle, New York or anywhere in Europe. I guess we are now obliged to sort our rubbish, and it doesn’t seem to have gone down well.
The rest of my day was indeed spent lounging by the pool at Bitnumami ( 8°29'50.51"N 13°17'19.91"W), one of the local “5*” hotels. It certainly wasn’t five star, but it was great. Nice big clean swimming pool, bar, restaurant, see view, palm trees, banana trees, attentive waiters, all for about £10.00. The journey home was a little odd; in a taxi in the middle of Africa listening to the English lower league football results on BBC world service. Not our choice but that of our driver. He tells me he likes the British, “they’re very disciplined” he says. I simply agree, but wonder what exactly he means. I take it he’s never been in an English school, or pub at closing time. “When they say they going to work, they come, and start work straight away” he continues. “I like working for the UK’s, you know you are going to get paid.”
It’s nice to know that somewhere in the world at least one other country likes us!
BTW I’ve not taken many pics of interesting dental (8°29'29.91"N 13°12'58.58"W) things yet, but there’s a teaser in the photo gallery. There’ll be great adulation from all who read the messages for the first person to correctly identify what you are looking at in close up. Post your guesses & I’ll tell you the answer in the next day or two.
I've also posted "Salamatu's Story". The story of a typical Mercy Ships patient. I didn't write it and it's not an easy read, but it's worth taking a few minutes to find out why we're all here.
Ali
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March 13th - Day 8
Stories!
Today I have been telling stories!
"The Good Shepherd, The Would Shepherd and The Should Shepherd" and "7 Ducks in a Muddy River".
There's at least one more booked for the dental team Thursday morning and it looks like we'll be doing a workshop on Wednesday night and maybe a whole ship event Thursday night.
We even managed to tell a story over 5000km of ocean this morning. Thanks, I believe, are due to Tim F and Mark E.
The rest of the day has been spent chilling (or should that be baking?) on the beach. Our Podu Podu ride was indeed very busy, very long and very uncomfortable. Apologies to American Melinda, who I sat on for most of the ride, there and back. Though she did leave both her sweat and peeling skin on me on the way home, so maybe we're even.
When we finally got to Lakka beach ( 8°23'51.35"N 13°16'6.10"W), it was great. Long golden sand, palm trees, strange people selling stranger things, and barbecued barracuda for lunch. Yum.
Back on board we listened to Dr Keith tell us about his "starfish". A story which captures much of the reason I'm here in Africa, and much of the reason it doesn't do my head in on my return. Listen.
Once upon a time there was a little girl walking along the road by the side of a beach. It was a hot day and the sun shone brightly in the sky. Then without warning, out of the blue a big wave came in over the road. As the waters swept back to the sea she saw that thousands upon thousands of small starfish had been left behind. In an instant seagulls flew down and started picking up the starfish and carrying them off. A truck drove past killings hundreds under it's tyres, and any starfish that weren't carried of by the birds or run over began to dehydrate and die in the hot sun.
Immediately the little girl picked up a single starfish in the folds of her skirt and ran to the sea to drop it back in the life giving water. As soon as she had dropped it off she turned round and ran back up to the road to pick up another. A third and fourth time she did the same thing, before a man who had seen everything stopped her.
"Why are you wasting your time? There are thousands of starfish. Every time you carry one single starfish down to the sea the birds carry ten more off, the trucks run over hundreds and the sun is killing them all anyway. You can never make a difference to all those starfish."
" I know", she replied as she carefully scooped up the next starfish in gentle hand "but I can make a difference to this one".
Which starfish are we called to make a difference to? Who are the people we are called to serve?
When we're faced with disasters on the scale of West Africa or the Japanese Tsunami, it can be so difficult to decide that we often get overwhelmed and help nobody.
For me, for two weeks this year, starting again at 8.00am tomorrow, my job is to care for the starfish with toothache in Sierra Leone.
Where are yours?
Ali
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March 14th – Day 9
Back to work
Back to work with a bang today. Here are the stats:
92 patients (“how de body?” “De body fine”)
400ish extractions (Ow!)
250 UDAs (if we were back in the UK)
1 new dentist (my good friend Bob)
3 other dentists (Ali, Dag & Mona)
1 new hygienist (Dusti from America)
15 vision trip members (donors who come out to see where their money goes)
1 engineer (thanks Carmen for mending my suction...again)
1 broken suction unit (see above)
1 broken dental nurse (Rashel, hope you feel better tomorrow)
5 security (Grrr)
2 receptionists (tap tap)
2 oral health educators (brush brush)
4 dirty nurses (scrub scrub)
4 translators telling patients to bite on a cotton pack (“lock de teet”)
10 midwifery conference delegates (er...not sure why there came to us!)
100 litres of cool box containing lunch (yum yum)
1 jar of peanut butter (for the Americans)
3 headlamps (thanks Nick)
2 sets of AAA batteries (thanks Marie)
3 Brits (Me, Bob and Sarah)
2 tablets of immodium (so far today that’s been enough)
1 manager (“lunch time over”)
and
1 six year old girl who was so grateful after I had taken her 84,85 out that she sand me a song in Krio.
Good mornin Jesus, good mornin Lord.
I know you come from Heaven above.
De Holy Spirit sit on de throne
Good mornin Jesus, good mornin Lord.
In my 19 years as a dentist, although I’ve had a few cards, a few hugs and a few bottles of wine no one has ever sang me a song to say thanks before.
Aw, bless.
No, really, Bless.
Ali
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March 15th – Day 10
“Whatever your hand finds to do, do it with all your might, for in the realm of the dead, where you are going, there is neither working, nor planning, nor knowledge nor wisdom.” Ecclesiastes 9v10
I am struck by a paradox today.
Today I took many teeth out. Many teeth that were difficult. Many patients who were tricky to manage. Young people, old people. Men with thick African mandibles and even thicker maxillas. Children with no idea what was going on. Mums, bothers, sisters and Grandfathers who were having treatment in the chairs next to mine so couldn’t comfort or support each other.
Yet, of all the hundred or so teeth extracted today, not one of them broke. Not a single one. All the surgicals were planned ones, the bits of restorative work went well (even the 13-22m&d composites on a lady I was also removing 18-14,23-28). The locals went well, and barely a whimper from either of my two chairs all day.
Although it sounds a little odd, and indeed feels strange to say it out loud, my hands felt blessed by God today!
Can that be true?
Is God so real and interactive that he can affect the way I do dentistry?
I am a believer, mostly in “man made miracles”. I believe that God acts through people. That He prompts someone to give money, and that money helps the person who prayed for help. Or that He helps the homeless in Newcastle through people like Michel S and the People’s kitchen team or Aquilla Way or others. I believe that he helps me when I need support and encouragement through my friends, family and church. I believe he tells me what he wants me to do by writing it down in the Bible, and I just work it out. I believe much of the time there is no single “right way”, just being kind to the people you meet along the way.
And yet the Bible talks of much more. It talks of genuine miracles. It talks of God interacting directly. It speaks of an interested and active God.
Could it be that I felt him in my hands, my luxator, my forceps today?
And there’s the paradox. What if my students said to me “Dr Bartlett, we don’t need to practice, God will bless our hands!” or “We don’t need to revise, God will teach us!” or “We don’t need to wash our hands, God will keep our patients free from cross infection!”?
I would throw them out of my clinic!
And what of my stories, my games, or this blog? Can something as simple as “The Spaghetti Game (thanks Clark)” or playing “Roller Coasters” really be God at work? Can doing what God wants be as easy as doing what you’re good at?
When I was little I was raised on a diet of “missionary talks”. Of stories, usually by ladies of a certain age, of African children and a funny hat. They were people who had trials. They had hardship. They were people who suffered. Is it really true that I am that missionary now?
But my stories are of silly games, of laughing, of fun at Lakka beach. Sure they’re about sweaty dental clinics and diarrhoea too, but being here is fun.
There have been just a few times in my life where people have prayed for or about my work. There are many prayers said in the churches I have attended for sick people, but not many for those with toothache. It’s just not that glamorous a disease! Many times have I heard people say “God, bless the doctors and nurses who look after Mr or Mrs Bloggs, guide their hands and show them the best way to treat him.”
Only once can I remember hearing someone say the same prayer for me, and though it sounds ungrateful I was offended.
Yes, offended.
The prayer was offered for one specific patient, who was in the room at the time, who I was due to see the following day for a 38 XLA. The patient was anxious, and it was good to pray for them but it was almost as though the prayer was saying I could only help that patient if God took over and moved my hands for me.
What about my hours of practice? My study of anatomy, physiology and pharmacology? Couldn’t they have anything to do with it?
And what about story telling?
Is my story telling God working?
If it is should it all be by “magic download”? What about rehearsal, writing and re-writing, practice and preparation?
I guess the answer is that it is not either God or Ali, but both God and Ali, together.
It’s late as I type this because I’ve been prepping for a story telling workshop tomorrow evening. I hope to both entertain the volunteers on the ship, but also to empower a few to tell the stories of their adventures when they get home. Maybe someone else will then be inspired to come. But is that really God at work, or me just having fun?
There are many mysteries in my life. Things I cannot explain. My scientific self says “there is an answer. If only you knew every variable you could predict the outcome”. But that is an outdated theory, even for science, and a woefully inadequate one for a spiritual life.
I do not understand Heaven and Hell, I do not understand why some root fillings fail and others, that are not as well done, don’t. I do not understand destiny and free will, why good things happen to bad people or bad things happen to good people. I do not understand Tsunami’s, lottery wins or why I was born in England in 1969AD not in Sierra Leone in 2500BC.
I don’t even understand if looking for understanding is wisdom or futility. Is accepting a mystery laziness or faith?
So of the paradox; what made those teeth come out so well today?
Was it Ali or was it God?
You decide.
Ali
PS just noticed it’s 1 min past midnight – Happy Birthday Dunc!
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March 16th – Day 11
Been working hard all day and all evening.
Night night. Zzzzzzzzzzzzzz
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March 17th – Day 12
Reflections
Tonight is my last night in Sierra Leone, so it’s time to take stock of the trip and see how it matched up.
For those of you who get excited by big pathology (me included) there has been much less this year, though I had a couple of big cases today.
The first was a young lady of 20 or so who had had caries in 16 exposing the pulp, this had lead to osteomyletis and necrosis of the maxilla. She presented with pain & mobility of 14,15,16,17.
16,17 popped out easily enough but when we started on 15 the alveolar bone from 14-17 came along too. Good view of the floor of the antrum on the end of my forceps and the roof of antrum / floor of orbit in the mouth. Maxillary nerve amazingly intact! Yum Yum.
The second was a man in his 50s with caries 17-27. Yup, that’s all 14 of his upper teeth, mostly buried roots. We raised buccal and palatal flaps all the way round and took them all out. 6 sutures to hold put it all back and Bob’s your Uncle, as they say. Took about 30mins all told. About the same time as I would have at home for a single tooth extraction. He’s got a few teeth to go on the bottom (48,47,46,36,37,38), but I thought he’d had enough for today, so that’s next week.
Whilst the dentistry has been less exotic than on other trips I have had more students this time. Today we had another “vision trip”, who had, at best, a mixed reaction to the detail of bloody surgery. No fainters, but some very pale and shaky looking Texans. Hmmm, would you like to have little sit down over here, and then talk to some of our sterilising team instead? He he he!
If I’m truthful, whilst the exotic stuff makes for good stories, the run of the mill multiple extractions probably helps more people. It might be good that we are seeing less of the wired and wonderful, if it means that there are less people with that sort of pathology out there. Though I am worried, along with the rest of the team, that, because of the screening day trouble, we simply haven’t found it yet.
Local beliefs are held very strongly in west Africa, and facial deformity is usually associated with evil spirits, at a least bad luck. Consequently people with deformities often hide behind closed doors. Our queue this morning was about 500 people, of whom we could offer appointments to 160 over the next two days. Most of the people who were seen today had waited since 2 o’clock this morning to be in the front of the line, so the people with deformities are going to find it tough to get seen.
Back on the ship it’s been a time for goodbyes. All three of my African trips have brought me into contact with some fascinating people. The two German “Martine McCuteons” have actually turned out to be very interesting, and have been doing lots of great publicity for the ship in Germany. Claire, Melinda, Xenia, Dianne have made up the greater part of my partners in crime and Irishmen Billy and Mick have been fine flatmates. Happy St Patricks day. Many of the people I met here in the previous trips have, to my amazement, remembered me. Many thanks especially to Anne and Roseanne.
Bob, and even if her absence Georgie, have been my rocks. In the ever changing world of Mercy Ships they are a stable place. Oh how I have needed that from time to time.
Back on Day 0, I deliberately recorded my thoughts about what I wanted to get out of this trip whilst I was still in Newcastle airport so that I could see if it delivered.
“I do want to be helpful, but also want to have fun, have a break, make new friends, have an adventure, and perhaps most of all be able to spend a couple of weeks not thinking about work all the time”
I believe I have been helpful, I have certainly taken a lot of teeth out, I should hit the 500 mark tomorrow morning if all goes to plan. I have also had fun (the card game, rollercoasters, spaghetti game, story telling, Yiddish dancing whilst extracting), had a break (Bintumani hotel, Lakka beach), made new friends (see above), had an adventure (Brussels, Water Taxi, Screening day chaos) and managed most days to not think about work too much.
For all of these things I am thankful. Having missed 2010, this trip has been a long time coming. I had so looked forward to it that it could have easily been a let down, and yet it’s not been. It didn’t pan out quite as expected, but it did pan out well.
I am grateful to the people who made it possible. To Teresa Zoe and Robyn, for knuckling down and getting on the day to day of normal life without my help, to Mum and Dad who have helped pay for it, to Nick and Marie, who have made the dentistry eaiser and to Amanda, and the rest of the practice who have taken on extra duties, including my on-calls while I’ve been away.
I am grateful to the people who have read this blog, and especially to those who have emailed me or posted a message. In doing that you are directly affecting the dental health of the people of Sierra Leone. Thank you.
I am, of course grateful to the One who made all this possible. The One who came with me, was here waiting for me, and will be home before me. He has surprised me with his gentleness and his persistence. He treats me like a little boy trying to learn to ride a bike. He let’s me go, runs along side, cheering and then picks me up and puts me back on when I fall off.
When I return to work on Monday I hope that I return a better man. I hope I am less grumpy, more patient, fairer. I have a fight brewing with our PCT over funding, the outcome of which will make a big difference to the way we work. I hope that I will be able to find that fine line between push over and belligerent. I hope I will remember that the people I speak to are not faceless goons but real people, with real lives trying their best to do a difficult job. I hope I win the fight, and get the UDAs I want, but perhaps I hope more that I win perspective.
No job, however rewarding will count for anything in the long run. In the long run there isn’t much that counts for anything. But love does.
I want to love Teresa, Zoe and Robyn like never before. I want to love my staff, even when they don’t love me. I want to love my church family despite their many and various faults. I want to love my patients, my friends, and the annoying kids who kick footballs of my windows. I want to love the people I believe are ungrateful and spoilt. I want to love the people who show no mercy, no pity, no compassion. John Elizabeth Sally & Martin, I want to love you, and make sure you know that I appreciate all you’ve done for me over the last 42 (and 26) years.
How will you know if I have succeeded? Here’s the measure, judge me against this.
Count my ability to charm you, flatter you, make you laugh, give a powerpoint, or tell a story as nothing.
Count my knowledge, my wisdom, my insight as nothing.
Do not consider my faith, my works, my charity, as anything other than packaging. Discount it, throw it out, it is of no value.
Am I patient? Am I kind? Count that as worthwhile.
If I am the sort of person who doesn’t envy, or boast and isn’t proud, count that. That’s worth something.
Do I treat you with dignity? Do I look out for your prosperity before my own? Do I hold my temper and overlook your weaknesses? Do I prefer truth to gossip? Do I stand up for you, trust you, hope you’ll come good and keep on supporting you?
Then I am worth something. Then I have achieved. Then I have succeeded.
Everything else turns out to be transient. Knowledge, wisdom, words...all gone within a single lifetime, but love goes on.
What I know now, what I think is wise now, all my best thoughts, arguments and presentations will soon be outdated and discarded.
Like the ideas I had when I was little. When I was a little boy I thought I knew everything. I knew the best way to get off a swing in mid flight, where the good kerbs were to ride my bike down to get an extra speed boost, how to build a great lego car, and that’s all I thought there was to know. When I was a teenager, I thought I understood everything. If people would do things my way the world would be fine. The rules were clear, black and white. But now I realise there are more questions than I have answers to, and that with every answer come ten new questions. The quest for understanding is like running down an infinite corridor, like trying to read writing that gets ever smaller, like looking at yourself in a dirty and wonky mirror. There may be glimpses of the truth, but nothing more. Not for now at least.
So my task now is to remain faithful. Faithful to the commandments of a God I don’t understand. Obeying when I may not know why, trusting when I don’t see the purpose.
And to keep on hoping. Hoping He’ll come though in the end. Hoping He will forgive my shortcomings, as long as I keep forgiving yours. Hoping He knows what He is doing.
And above all else, I need to be someone who keeps on loving. Loving with passion, with strength, with determination. Loving as only Ali can. Loving with all my personality, all my creativity. Loving, by getting my hands dirty, loving by allowing myself to be disappointed.
That is the measure by which you may judge me. Nothing more, nothing less.
And when I fail... forgive me.
Ali
March 18th - day 13
Signing off
Well that's it. My bags are packed, my cabin is cleaned and hoovered and I've closed my ships bank account for another year.
At the end of the last two trips, although I knew I wanted to return, I wasn't sure I would. This time I am pretty confident I'll be back next year, hopefully with Zoe in tow.
I've had a great time, faced some difficult challenges and done some fun dentistry. As I return to "normal life" I fear the challenges will be much greater. Living up to the standards of this place in the day to day grind can be pretty challenging.
What lesson will I take home more than any other?
That circumstances are fleeting. They come and go, but love goes on.
So how will that play out on monday morning?
How long until someone winds me up and I behave as though I'd never been here?
And when will it be your turn come to the Mercy Ship?
I'm afraid I can't tell you that, because that is another story.
THE END.