Baked Bean Curry & Tomato Plants

Even quite a drastic change in environment can soon become normal and life in Segbwema has settled into something almost consisting of a daily routine, even if that routine is one of regular interruptions that mean we are yet to complete our new favourite meal of a baked bean curry in one sitting. This newly discovered feat of gastronomy is made possible courtesy of an overpriced Lebanese shop in Kenema selling imported tins (including baked beans) but it appears that the novel aroma must be a lure for patients as the noise of placing our bowls on the table thus far has been universally swiftly followed by the sound of a student nurse knocking at the door with a new patient’s chart in their hand waiting to be reviewed.



One routine that has proved rewarding is our daily trips with a basket of food to Evelyn on the TB ward. Evelyn is a young woman who arrived at the main hospital several weeks ago. Half blind, emaciated and coughing up blood; she was not a well woman. I am not a fan of descriptions of malnutrition that often try to be colourfully emotive but I can’t imagine this fully grown adult weighed more than 30 kilograms and her arms were not much thicker than broom handles. She was stabilised on the ward and after the diagnosis of Tuberculosis was confirmed she was moved to the TB ward, a separate building situated at the bottom of the hospital compound. Although the separation is designed to limit the spread of the disease, the patients are somewhat isolated and it arguably contributes to any residual stigma.



The TB ward

 Many of the patients appear to improve significantly when their treatment is commenced so I was sadden to see Evelyn looking increasingly weak and frail some days after she had started her medication. Despite my Krio and Mende (the locally spoken languages) only extending to a few words, with the assistance of some signing, she was able to tell me that she had no food and had not been eating. When we returned later that evening with some rice, water and ground nuts she was laying on her bed under a mosquito net supported by wooden sticks and was half asleep. With no particular expectations, Janna returned the next day to pick up the bowl and found a huge smile on Evelyn’s face and possibly the beginnings of a new woman. Like her TB, her malnourishment certainly won’t be cured overnight, and we acknowledge we are by no means a long term solution to her nutrition problems, but at the most basic level having a hot meal inside her certainly helped.  It is reassuring to see that her strength has improved so that now when we go down each day she has carefully washed the bowls and cups and has them stacked ready in the basket.

Life sways between adrenaline filled moments and the benign daily grind. Last night I was traipsing out through the darkness and sheets of rain with my head torch and stethoscope to a pregnant woman with twins who had eclampsia (seizures). However, the previous weekend had been mainly filled up with hours spent washing clothes in buckets, drafting funding applications and labelling new folders for each hospital bed.  So much for the “African dream”; the reality of administrative tasks and household chores appear to be constant throughout the world. Hopefully the new folders will help make the hospital run a little more smoothly, as previously patient notes and drug charts on A4 sheets seemed to be scattered throughout the wards making it difficult on occasions to discern which patient was being treated for what.  It can be challenging to know where to begin with initiatives to improve clinical activities at the hospital, particularly when, at times, even some of the most fundamental ingredients are missing. When I arrived to assess the pregnant lady who had been fitting, there was no catheter available and only two vials of magnesium sulphate, the vital drug which needed to be given every 4 hours to stop any further seizures. (Even these two vials had been personally bought by the midwife.) Perhaps the unexciting hours spent completing funding applications will bear their fruits of a more consistent drug supply and make night time visits to the ward a little less daunting.

 On the first week we arrived I planted some tomato seeds. This was not for any particular symbolic reason, just in the hope that by the time December comes we may have a crop of fresh tomatoes to supplement our diet of baked bean curries. However, as they steadily grow, sitting in their individual coke cans, baked bean tins and empty sachets used for drinking water, they do serve to reflect that in the same way ripe, juicy tomatoes will not appear overnight on the kitchen table, changes and progress at the hospital, however small, will take their time.