Help Sierra Leone Children

      The MSF hospital in Kenema is modern proof of this principle.      Sending international health care workers is good, but teaching local doctors and nurses is better.  The ratio of international to local health care workers in most MSF projects is about eight to one. This is because MSF is committed to leaving a legacy of better trained national health care workers.      There has never been many doctors in Sierra Leone. Not during the British colonial period. Not since. Never. No wonder health care has languished. No wonder this poor country has the highest maternal mortality in the world!       About ten percent of the few doctors in the country died in the 2014 Ebola epidemic. Imagine losing a tenth of the doctors in Canada!      MSF saw this happen and decided they would be part of the solution. MSF decided to build a hospital for mothers and children and to focus on educating the next generation of Sierra Leone doctors and nurses. They are doing that in Kenema and it

Achatina achatina, a large air breathing land snail, grows up to 7 inches long and 2.5 inches wide. These snails are on the path I take to reach the MSF truck that takes me to the hospital. 

There is a rhythm to malaria. I know there is but I don’t have enough experience to feel it. Knowing the rhythm is important. When you know the rhythm, you’re inside the disease and can feel the ebb and flow. Inside is a very intimate experience because you can see the future. When you are inside you are in control, not the disease. I do not feel anything yet. Rhythms are like puzzles that move and you need to know the precise fit of the various pieces to feel the rhythm. So far I’ve figured out the basic pieces but have no sense of how they might fit together. There’s always a temporal sequence of events. A medical history is fundamental to understanding the rhythm. The infection starts with an initial symptom. Then another symptom develops. Then another and another, all in a sequence that is often remarkably consistent. I cannot take a good history because I do not speak the language. Without a better history I will not understand the beginning. Beginnings are impor

Good news from home. My new collection of short stories is published and now available at the various online retail outlets. The collection of about fifty short stories and poems was written over the last three decades. Most stories are based on real life experience with names changed to depersonalize the situations. A few are legitimate fiction.  As a young man I decided I wanted to write short stories like Somerset Maugham. This book is my attempt to respect his tradition of clarity and insight. I wrote these stories because I felt a need to record the events and personalities I encountered. The events seemed startling and somehow important, at least to me. From the start I realized I was writing for my own enjoyment. I learned that writing helped me understand what I witnessed. 

The dangers of dehydration are well recognized. What about over-hydration? Too much fluid can kill as surely as too little. The FEAST ( F luid E xpansion A s S upportive T herapy) Study reported in the New England Journal of Medicine in 2011 changed the conventional thinking on how to hydrate a sick child. Over 3000 seriously ill African children with fever and poor blood circulation were treated with different intravenous fluid regimes on arrival at hospital. The 48-hour mortality was 3.3% higher in children treated with a larger fluid volume. This might not seem like much but 3.3% of the half of the 3000 children who received the extra fluids equals 50 children! The children died due to cardiac collapse 2 to 11 hours after treatment with the higher volume of intravenous fluids. The children admitted with malaria at the MSF hospital in Kenema already have a stressed heart when they arrive. The parasite breaks down red blood cells which clump up and narrow the corona

Beautiful girls and boys. I was surprised. Guess I naively thought the children would all look malnourished and generally unwell. Most of the children I see in the ER are well-nourished and loved infants and toddlers much like at home. They started their life in a good home with good parents and were fed good food and loved. They reached the normal developmental milestones. I have grandchildren the same age who look the same. Then the rainy season started and armies of mosquitoes invaded their homes. A female mosquito bites them during sleep. It takes a few weeks or a month for malaria to develop. They all develop malaria. Just depends on how severe and how often. Malaria is the fourth most common killer of children under five years of age in the world. Malaria in children is more aggressive and more likely to progress to severe malaria with seizures, low blood sugar, severe anemia, and sudden death. I’ve seen a lot of severe malaria in my first week. Fifty pe