On the Ground in the Fifth World

April 22, 2010

by Andy Harris

Former Oregon PeaceWorks Board Chair Dr. Andy Harris is in Sierra Leone on a medical mission of mercy. Here is his fascinating report on the work he’s doing.

Greetings from Kamakwie

We haven’t had Internet access for the past several days, as we are 180 miles into the bush and everything is hit or miss.  The town has no electricity, no running water and no sewers.

It is remarkable to be back in this town after 44 years.  Time and the Civil War (1991-2002) have been hard on the people of Sierra Leone and on the hospital compound here.  The town has many burned out homes that sit as relics of the ferocious fighting.  During the war the hospital was occupied by rebel forces for four years.  Metal hospital beds were used to grill meat over open fires.  Buildings were stripped of electric wires, which were sold for cash.  Pumps and generators were destroyed.  Open cooking fires were built indoors in many buildings on the grounds, destroying the floors and ceilings and blackening the walls.  It is truly remarkable how much the locals have done to rehabilitate the buildings with very little funding.

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Once the Cold War ended in 1990, churches in America saw Eastern Europe as the new frontier for Christian evangelism.  They pulled people and resources out of Africa and directed them to countries like Ukraine, Romania and Moldova.  Church mission directors say that they want churches and hospitals to be self-sufficient.  That may work for churches, but no hospitals anywhere in the world are self-sustaining on the money that patients are able pay out-of-pocket.  Think of the expense of running in Oregon: medications & IVs, lab facilities, staff, etc.  The biggest expense here is diesel for the generator because most of Sierra Leone outside of Freetown has no electricity. The hospital is sadly dilapidated – no one is here to do maintenance anymore — and most equipment, e.g. the X-ray machine, is non-functional. The same surgical autoclave that was barely functional in the 1960s is still in use today.

Rare African nations, like Ghana, have had enough infrastructure and income from oil and diamonds that they have prospered, but the vast majority of African states has languished with stagnant economies, corrupt governments and minimal health care and education.  In Sierra Leone, the civil war drove all foreigners — except the mercenaries — out of the country and closed NGO offices.  The result is that, of all the world’s 192 countries, Sierra Leone is #1 in maternal and infant mortality.   This is not really the third world – it is more like the fifth world, neglected and forsaken by all but God.  While much of the world has moved forward in the past half century, Sierra Leone has sadly slid backwards.

Serving the People

It is a privilege to be able to serve the people of Sierra Leone.  They are a wonderfully warm-hearted, friendly people and far more patient than Americans.  I have been able to help many patients by diagnosing and treating their eye problems.  Fortunately, I brought crates of medications, and they are getting into the hands of those who can benefit.  The heartbreak is the patients who think I can perform miracles on eyes that have old injuries or scarring from previous infections.  One father cried his heart out when I was unable to help his 10 year-old son with an eye that had been severely traumatized.

We have no general anesthesia here at the hospital.  The only option for abdominal surgery is IV ketamine anesthesia, and this is what we used for a bowel obstruction in a 3-month-old that I scrubbed in on last evening.  I tried doing eye muscle surgery today under the same anesthetic, but the patient was not able to hold still, and I had to abort the case.  A real shame, as he is a good looking 20 year-old male with one eye that very noticeably turns out.  I assisted with a C-section this morning under a spinal block.  Tomorrow I’ll assist on the amputation of a severely injured and gangrenous arm.

I’m working with a husband/wife medical team, Tom & Karen Asher, and a fourth year medical student, Loren, as well as a number of competent Sierra Leonean community health officers [CHOs], who are like PAs, and nurses. My health is fine, and I even got in a little run this morning at daybreak.  Please keep us all and the patients in your prayers.  Φ

Dr. Andy Harris is a retired Salem, Oregon ophthalmologist. In addition to his Oregon PeaceWorks connection, he served a term as national president of Physicians for Social Responsibility. He is currently leading the effort to establish a “world medicine” department at Oregon Health Sciences University, where physicians will be trained to offer the kind of emergency medical assistance he is currently providing in Sierra Leone. Harris believes more and more of this expertise will be needed as climate change and resource wars lead to more human disasters.

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