Saturday, September 15, 2012

Screening day - Up Close and Personal

And then they meet me...

Here is a slide show of all the amazing photos our photographers (Deb and Michelle) took during the day. Grab a coffee, sit back and enjoy the pictures. Then go on and read some personal stories. N-Joy!



Our photo stand is the last stop before they leave the building. By then they are are extremely tired, both physically and emotionally. Most of them had been standing in line for a good 5+ hours and even though we were giving out water and sandwiches we couldn't protect them from the sun. They are exhausted emotionally as well; many of them are so used to hearing NO that they cannot afford to allow hope sneak into their hearts. As they get closer to the gate...inside the gate...meet the pre-screener...GET PAST the screening station... escorted to the first station, then the second... all the time expecting to hear the dreadful word and yet a tiny hope is rising deep within as they get closer to the last station, our photo booth. It's hard to see their genuine smiles through the veil of wariness!

Outside there was some breeze that helped easy the discomfort of everybody, patients and crew alike. Inside, where we worked, it was hot, humid, stuffy, stinky… you name it. We tried to open the windows, but the generators were placed right outside the walls. We couldn’t hear each other’s words! I opened one slightly. Fresh(er) breeze entered our booth and we could all take a deep breath. Deb was standing 3 meters away from me and I saw her lips moving… darn, we must close that window NOW! :(

We have about an hour before the first patient makes it to our station so I go outside. Screeners stand in front of the patients' line, each with a translator. Their job is to decide if the patient has something we can treat thus sending them towards the building or turning them down. I stood behind Ans, who is a Chaplain on board now, but a nurse by profession. She raises her hand (saying she is ready for the next patient) and a young men steps forward. To my untrained eyes he looks fine. Of course I am neither a doctor nor a nurse, but I did learn a lot since I joined this unique hospital. Ans greets him and asks the standard question : what’s the problem. I can’t see the nurse or the translator as they have their backs to me, but I have a clear view of this man’s face. He is touching his head as he explains his reason for standing in line for so long. The translator conveys his words to the nurse. She nods, asks a few more questions in return. The man’s eyes grow narrow as he listen to the translator, clearly not liking the direction of the conversation. His behaviour changes: he puts his hands on his stomach, then on his back, his speaking becomes  fast, his gestures desperate. The nurse listens patiently, but I guess they both know the answer will be no. He desperately tries to convince the nurse, his eyes are begging, but the answer is still NO. We do not treat back or stomach pain and we do not give out free medicine. We are a surgical hospital!

It’s a tough call! Clearly it’s not the answer this young men was hoping for. His whole body looks broken all of a sudden. It’s a horrible feeling for everybody: for the nurse, for the translator, for the man, even for me, who is only observing the scene from afar. The nurse looks apologetic as she calls for an escort. The man sadly accepts the answer and starts to follow to escort towards the exit gate, which is opposite to the building. On his way out they stop at the prayer station where we offer prayer for those who got ’no’ and would like us to lift them up in prayer. As he walks out he keeps looking back towards the building; the building of hope… 

I go inside and embrace myself for a long and busy day. As the first patient arrives we jump into action. The 2 translators who were promised to us didn't show up so we have to do without a common language. I smile at the lady and force myself not to look at the massive goiter on her neck. I offer my little French to her (Good morning, how are you, my name is Reka, I don't speak French). When she keeps starring at me I realize that she doesn't speak French either. Oh well...

I take her papers and copy her name, patient number and surgery type onto a small white board. This will serve as patient ID and also as the "before picture". I motion to her to follow me. I take her precious yellow card and she looks at me worried. I desperately try to tell her I am not taking her card away, I just need to take a picture of it. I don't think I will ever be able to fully comprehend the significance of this small yellow piece of plastic. For them, it's their life line!

She sits down to my stool. I ask her to smile. She gives me the African smile. (very straight face, no showing of emotions). Suddenly the next patient shouts something at her in susu or pular at which point she offers a tiny smile. I go over there and ask in English if she understands me. "I de tak na sma-sma englis" I jump for joy! She speaks Krio, a language that I more or less understand!!! :)

This lady is from Sierra Leone. She came over the border just to be seen by our doctors. She, too, has a huge goiter on her neck, and to my amusement, her name is also Jane Kamara (well, it's not. I don't want to give out her real name, enough to say Kamara is a very common name in Salone and in Guinea as well. Imagine like Jane Smith x2) So, my first 2 patients had the same name and the same condition...

I happily accepted her help. She was translating my words to Susu as I later found out, one of the many tribal languages here in Guinea. When the first Jane Kamara left, she hopped onto my stool and gave me a wide grin. "Yu de make me pretty, yes?" Yes! :) I showed her the head shots I took of her and her neck from each angle; she approved.  She is scheduled for surgery in a few weeks! I am so looking forward to meeting her in the wards! She told me she had traveled for over a day to make it here. Last year when the ship was in Salone she couldn't make it to our screening and she was over the moon when she found out we are coming to the neighbouring country. Now she WILL RECEIVE a surgery! :)

The next 3 patients I photographed were also called Kamara - some spelled like Camara to show the French influence. Over the course of the day I think we photographed over 50 patients with goiters! Yay!!!
As we suspected, many came from Sierra Leone. Jess, our dietitian shared similar experiences. Last year she treated a little boy who was soooo malnourished due to a cleft lip and palate. He couldn't suck milk from her mum's breast and was too tiny for operation. Jess worked with him for months before he gained enough weight for a surgery. They fixed his cleft lip back then, but he was too young for the palate surgery. Jess told them last year to try to make it here for a second chance. She was looking out for them all day and finally she saw the mum! They didn't have any common language, but the joy in both their eyes spoke loud enough!

Later in the day this little fellow (now over 1 year old) ended up on my table. We had to photograph his palate. Now... THAT was a challenge, let me tell you! To begin with these babies have very tiny mouths! Even if you get them to open their mouths you still won't see the palate without tilting their heads back. Even if you tilt their heads back you can't keep them still long enough to take a picture. Even if they lie still with heads back and mouths open, the flash is not lighting the mouth up enough, because you have 3 extra people hovering over the baby: 1 to make them still, 1 to tilt the head back and 1 to hold the mouth open with a tung depressor. :)

If you stood a bit further away you wouldn't see the baby, just hear their cry and see 3 adults surround the table while I stand on a chair with a huge camera and flash in hand doing my best to get a sharp picture of the palate... Fun times! :) And to make matters worse in some cases the mothers didn't want our male helpers to touch their babies. I understand the whole Muslim thing and tribal beliefs, I really do, but what do you do when you have a long queue of patients to photograph and a reluctant baby with a difficult mother???

Another challenge presented itself in the forms of doctors' hand writing. (see my note on this matter here) Sometimes the condition is obvious, but sometimes the patient looks fine to me. Before I ask them directly, I try to look through their papers and decipher the doctor's scribble. NOT easy! :)

The other big challenge we faced was taking pictures of "Ponseti Kids". (Ponseti is a special technique to fix club feet of little children with a series of casts instead of an operation). The Ortho doctors requested a series of pictures (30+) in different positions and angles to test the abilities of the kids. Before the screening we asked one of the healthy kids on board to be our model so we could take test pictures of each angle and position, also bending and stretching each knee and ankle in every possible direction - it took over 25 minutes! And she understood English, she wasn't afraid of white people, we weren't foreigners to her and above all, her legs and feet were fine! Now, imagine this procedure with a kid who is the exact opposite in everything...

Maybe I shouldn't say it, but by the end of the day I "earned" the name "child torturer" :)))

All in all, it was a very rewarding day! Yes, it was long (we finished taking pictures after 9 pm), yes it was exhausting and yes, sometimes it made us cry, but it was all sooooo worth doing! :) I thank God I could be part of this day and see the Miracle in Action!

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