Oxygen concentrator installed!

A huge thank you to Friends of Nixon, Diamedica and everyone who has supported bringing the reliable provision of oxygen therapy to Nixon.

The machine and all the associated masks/tubing/accessories arrived safely and speedily by DHL courier and together with the hospital team we set about unpacking and installing it.

The hospital carpenter Pa Swarray and apprentices Peter and Foday built a custom made wooden box to securely hold the 3-way flow splitter on the wall and tacked the 3 output’s tubing along the wall to each bed. The machine itself is positioned in an elevated, ventilated position with a reinforced safety tray around the bottom to ensure it does not fall. This setup also keeps the power cable off the floor as cables sometimes get nibbled by the occasional rodent. I printed some signs and operation/maintenance instructions for reference and we have laminated them and set them on the wall.

After training the senior clinical staff in the use and maintenance of the machine we have all contributed to training the other staff and students in small groups so everyone is confident in using and looking after the machine correctly. We are also going to start a small maintenance book to document cleaning the air intake filter every fortnight.

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Nurses-in-charge Aunty Betty (far right) and Aunty Francess with me and 2 CHO students Mustapha (far left) and Ben

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Oxygen bed 1, Oxygen bed 2, Oxygen bed 3…Three children all simultaneously receiving oxygen therapy for breathing difficulties – photo taken and published here with permission from all families in the photo

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The first patient (Amniata) who received oxygen from the new machine – preparing for discharge with her happy parents and student nurse (photo published with permission from all in the photo)

The staff, patients and families are all so pleased and grateful for the new provision of oxygen and subsequent improvement in healthcare that the hospital can offer the community. I have had so many messages of thanks that different people have asked me to pass on… so thank you all once again for contributing to make this happen!

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Referee

I was asked to be part of the match officials team for the local youth football tournament. I had a list of fixtures – some referee, some linesman – and there was a game most evenings during June with group games/knockout until the final. The interesting added extra about being linesman here is it is also your job to keep any stray goats off the pitch as well as officiate the game!

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View of Segbwema town football field from the hospital

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Trying to keep up with play as referee!

Wedding

I was delighted to be invited to a traditional local wedding by a friend in the village. After dressing up we traveled by motorbike (Nurse Aunty Betty and student Amaru were also invited) to the bride’s local village in Pendembu. It was an enormous celebration with dancing, food and speeches. The ceremony itself was traditional and very interesting – luckily I had Aunty Betty commentating and explaining everything. The family elders were sat in a circle with the groom in the centre. One by one different veiled girls from the bride’s family were brought in and with lots of pantomime style joviality the groom had to graciously decline each girl saying that although she was very beautiful she was not the correct girl for him… until the correct bride was unveiled and everyone cheered. Such drama!

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Gladrags and 4 x 5gallon containers of palm oil as a wedding gift – don’t worry mum I was wearing a helmet it is on the floor for the photo while we are refueling!

Belong go be li pela?

I have tried learning a bit of Mende (local language) but it is very limited. One running joke however is on the ward rounds I ask ‘belong go be li pela?’ which means ‘do you want to go home/be discharged?’. When the patient is clearly too ill they or the family say ‘no!’ then when they are better and ready to go after a few days they reply to the same question ‘yes!’. This repeated exchange with each patient almost every day causes a lot of amusement – likely to do with my terrible pronunciation!

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Hawa with her daughter Princess – bag packed ready for ‘pela’ (home) after recovering from cerebral malaria. Permission to upload photo from Hawa.

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Pineapple selfie…A thank you present from Hawa! (sorry to Phil Chard as I have broken his rule of ‘you shouldn’t eat anything bigger than your head’)

Hospital update

The day to day clinical work of ward rounds/clinic/out-of-hours emergencies continue with the hospital almost full. Of course there are a lot of sad and frustrating moments working with limited resources and with very late presentations of patients but also happy moments too! We found a plastic/velcro ‘moon boot’ for the patient with a severe lower leg fracture (who I mentioned a few months ago) so after 2 months in bed with a weak cardboard splint he is enjoying moving around the hospital compound with a wheelchair knowing that his fractured leg is being held more secure so should heal better.

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no longer bedbound – photo uploaded with permission from patient

We have also enjoyed laminating the various newly developed clinical protocols…

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Aunty Betty – Nurse in-charge laminating new charts

Another machine dusted off after finding it in a cupboard… a mini foot massage/jacuzzi… A bizarre donation from a long time ago I imagine but it works and is now in the nurses office so they can rest their sore overworked feet!

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Foot bath selfie – not something I had envisaged

Teaching

As part of our emergency paediatric protocol development on the ward I was pleased to be asked to contribute at the Nursing School attached to the hospital as a ‘guest speaker’. I planned a short course (6 classes) to cover the basics of practical emergency paediatric care (Triage, Convulsion, Fast breathing, Dehydration, Malaria and Anaemia/Malnutrition) and delivered it over 2 weeks in June with sessions slotted in around their timetable and my hospital work. The students are enjoying putting some of their new practical clinical tricks into practice on their ward placements!

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Projector powerpoint in action

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Practicing with the newly dusted-off nebuliser machine

Euro 2016

I have enjoyed watching many of the games in a great atmosphere at the local ‘cinema’ where for a small entrance fee we all sit around the telly and shout at the football. The business is run by Mr Ibrahim and the games are all advertised on the board outside and streamed live by South African Satellite TV. He shows films during the day which is popular with many children!

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Half time outside the cinema

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Inside the cinema as Gareth Bale scores against England

The nursing students who are also football mad have also organised a sweepstake which has been very entertaining! 24 people staff/students signed up and paid a small amount into the pot…all the teams distributed by ballot with the winner taking the prize…I got Ukraine … played 3 lost 3…!

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Amaru conducting the sweepstake draw

 

Thank You

Thank you all so much for the incredible response to the oxygen concentrator appeal. I am overwhelmed by the messages of support and for all the generous donations. The Nixon staff and student nurses are so grateful and excited by the prospect of the new machine that will significantly improve the care the hospital is able to offer for many patients, and for many years to come.

I would particularly like to give a shout out and a huge thank you to my wonderful sister Elspeth and all her Sheffield friends for organising a fundraising party bonanza which raised over half the required amount! With the total almost reached, ‘Friends of Nixon’ are kindly giving an advance on the final bit so the machine will be here and set up by the time I leave. This will give me time to ensure it is installed correctly and the staff are fully trained in the use and good maintenance of it. Any further donations would still be gratefully received by ‘Friends of Nixon’ though as they do so much to support the hospital with many different projects.

In other good news, a record number of ‘Nixon School of Nursing’ final year students (attached to the hospital) recently passed their national state final exams, placing the school as the top ranked nursing school in the country. Congratulations all!

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A celebrating happy student mob!

Oxygen

Many friends and family have kindly asked me how they can help contribute to improve and develop healthcare here in Segbwema. Now I have an answer – identified together with the hardworking hospital staff here! We would be so grateful for any donations towards an oxygen concentrator for the children’s ward – a bit more information is below…

In UK hospitals we take oxygen for granted for any unwell patient with breathing difficulties. Oxygen is piped through the walls (like water) to every bed. Each patient has a new, clean, single-use disposable mask which is attached to the oxygen pipe, providing immediate oxygen whenever needed. It is such a basic medical intervention that all UK medical professionals and patients take it for granted.

Here is a little different. Like many less economically developed countries, oxygen provision in hospitals is poor. There is no piped oxygen in any hospital in Sierra Leone including the main referral hospital and only Intensive Care Unit in the country. One method of providing oxygen is pressurised oxygen cylinders but these are expensive, quickly run out and are difficult to refill as we are 400km away from the only refill plant. A better system is to use an oxygen concentrator. This needs a reliable source of electricity which we now have courtesy of the wonderful new EU funded post-Ebola development of a large solar panel farm and battery storage facility which provides 24 hour electricity for the wards.

The machine takes in atmospheric air (free unlimited supply!) with an oxygen concentration of 21% and uses electricity (free unlimited supply via the sun and panels) to produce an output of 8L/min of 95% oxygen which is delivered by tubing to the patient. We have found an excellent company who supply durable machines specifically for use in tropical climates, and are specialists in supplying clients from less economically developed countries by providing ongoing support by phone/email for the entire lifespan of the machine. Their website is http://www.diamedica.co.uk/english/product_details.cfm?id=263

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The greatest need for oxygen here is on the children’s ward. Sierra Leone has the 2nd worst child mortality rate in the world (from every 1000 live births, 161 die before aged 5 years). A large number of these deaths are due to acute respiratory infections, some of which would be prevented by oxygen therapy. From auditing our hospital admissions Jan-May 2016 4 out of 10 children admitted with severe breathing difficulties die. Of course there are many other factors contributing, but looking at published studies in similar settings to here – oxygen therapy reduces these deaths by one third.

Each child requires oxygen supplied at 2-3L/min and the machine we propose to get can supply 8L/min. The company supply a splitter device so that several children can be treated at the same time. Below is a sketch illustrating this plan.

Oxygen concentrator setup

Although the machine will last a long time and has a free and plentiful supply of electricity and atmospheric air, the initial cost is expensive. Together with the charity Friends of Nixon (FoN) we need to raise a total of £3000 to cover the cost of the machine, tubing/masks, and shipping/customs. We would all be so grateful for anything you can donate.

To donate online follow this link
https://mydonate.bt.com/events/oxygenfornixonhospital

Or post a cheque payable to ‘Friends of Nixon Memorial Hospital’ with the completed giftaid form  (FoN Donation Form) to the charity treasurer at

Mr Robert Dixon (FoN)
11a Denbigh Road
London
W11 2SJ

Thank you all so much for your support. This machine will provide much needed oxygen and save many lives in the years to come.

Sports Day

One Saturday afternoon I was invited to a local primary school sports day. Four ‘houses’ each with a colour and named after local landmarks. Blue house happened to be called ‘Nixon Hospital’ house so I had to support blue house really! There were many events like sack race, egg&spoon race, wheelbarrow race, hopping race, ‘find your colour’ race (collecting all the ribbons of your house’s colour then running to the finish line), and relay. There was a great atmosphere with music, a loudspeaker commentator and lots of flags. As some of the children were very young – the relay was particularly funny as batons were handed randomly to different team’s runners at each change over – a novel tactic! As you can see from the photo, the blue runner is in the process of handing to the yellow runner (while the actual yellow runner is a long way behind in 4th place. I think this tactic would make Olympic relays even more exciting…!

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