The Long Drive

Thursday, March 12, 2009

The rhythm of music echoes in my memories of the day we almost turned back. I was skeptical of the long drive into the Sierra Leone bush outside of Makeni to the village of Karina and opined that with the time short and the village still an unknown distance away that it wasn’t worth continuing. Short on fuel, everyone hot and dusty, it just didn’t seem wise to keep going. “How many patients can the medical team see in just the afternoon anyway,” I reasoned.

Just a few miles after my complaints we heard the drums. As we topped a slight rise the windshield filled with children’s faces—dancing, singing, everyone drumming on wooden logs or hollow bamboo, others on any spare tin can or plastic jug. The whole community of Karina was waiting for us and a festive mood pulsed through the crowd as they saw the white faces of our medical team.

Several uncontrollable factors led to our late start and long drive, but all my concerns melted away when we saw the village neatly set up for our arrival and our makeshift clinic arranged wonderfully. They even nixed the ceremony they had prepared so the doctors could see as many patients as possible in the limited time.

Dr. Fernando Espinosa roped off an area in the shade of nearby trees and began seeing the first of around 200 young children, referring the sickest into the main clinic and effectively keeping the overall volume in check.

The other doctors and the team jumped right in with the practiced efficiency of two previous weeks of mobile clinics.

During a spare minute I went outside to look around. The village elders, with the Deputy Minister of Energy and Power (Dr. Conteh’s contact at this village) acting as a translator, sat me down for a chat. I found out the local school had about 650 students—serving the whole section including 7 villages. The population of the sector was about 3500-4000 people. There was no clinic nearby and the elders stressed that there was a lot of “deep sickness.” During the war the rebels had burned the local church and it had not been rebuilt yet. It was a Muslim area but I’m not sure of the status of a mosque.

The elders made it clear that they have about 2 or 3 acres of land set aside with the hope of starting up a medical facility. And they asked for our help. It is always tough to separate your heart and the image of those pleading eyes from the reality that an organization like HCJB Global has limited resources and has to prioritize. Yet you never want to be guilty of shutting the door where God wants to work. There was no doubt about the need for health care here. But my job was to leave the possibility open without promising anything.

A farewell song, two goats presented as gifts from the community and the smiles of more than 130 adult patients that were treated were testimony that the long drive was worth it.

The Last to Leave

Wednesday, March 11, 2009

First and only day in the village of Mobanta outside of Makeni

The team loaded up and started driving before light on our way toward Makeni, about 2 and a half hours outside of Freetown. The road was a surprisingly modern highway and our drivers sped merrily along, causing some definite white-knuckle moments. Once we reached Makeni, we met up with some of our helpers from Freetown who had travelled the same route via taxi. The group then loaded up and drove a short distance outside of Makeni to a village called Mobanta. It was already a late start and then the community had an appreciation ceremony for the team. Wonderful drumming—I know there must be African rhythms in heaven.

The only problem was that we were supposed to set up the clinic in the same building as the ceremony. So when we started setting up, the whole community was already crowded in around the examination area and the pharmacy tables. The volume was so loud and the people so aggressive that at one point early on Sheila Leech made the call and the team retreated outside until things got more organized and peaceful. We learned that some of the helpers that had traveled from Freetown were nearly worthless in the local languages and their accents from the city were actually looked down on by the folks here.

Thankfully, one of the helpers must have been from nearby and had the right accent. She was able to get things settled down and organized—herding in small groups of 10 patients at a time as the team was ready. It only took about the amount of time it took for us to sip a cold drink before we were up and running again. But the tension in the air had been palpable.

It didn’t seem like long before more than 200 patients came through and things were winding down. That is all things except Dorothy, who had a huge circle of children outside the clinic playing duck, duck, goose. The laughs echoed off the nearby clay houses as Dorothy sped around the circle trying to catch the kids.

The heat remained oppressive in the metal-roofed clinic building with the temperature topping 100 degrees Fahrenheit during the hottest part of the day. We were all dripping.

The group was staying at a guest house in Makeni that night, but because Dr. Conteh had to return to Freetown, the two remaining vehicles had to make two trips to get everyone there. I was in the second group and got the pleasure of candidly watching as nurses Sheila Leech and Jessica McMillan, despite the long, hot day, sang songs to the children while perched on the steps of the clinic as the African sun turned the signature red and dropped below the trees.

As the light faded, the uproar of the exciting day also faded into the day-to-day life in the village. Two women pounded the cassava root to make fufu—a delicious West African dish. A mom soaped down her young baby before bedtime. Men strolled or rode bicycles home following a day at work. And the incessant sound of the well pump “squeak-splash, squeak-splash” as people gathered water for the evening.

Sometimes it pays to be the last to leave.

Desperation and . . . Fresh Hearts

Tuesday, March 10, 2009

Before the medical team started the second day of clinic at Abundant Life Faith Center in Freetown, Carol Carpenter, wife of Chiropractor Dr. Bob Carpenter, jumped into the fray to help our local partners with the registration process. Her valiant efforts did not go unrewarded as around 175 patients rolled through much smoother with fewer conflicts and a lot more efficiency.

Dr. Paola Velez noted after the first two days in Sierra Leone that there seemed to be more serious illnesses than in Ghana and thought that may have been why some of the people were so aggressive. Dr. Steve Nelson also noticed the overwhelming desperation of some of the patients. He stated, “I’ve never been in a country where there is NO [healthcare] system for the poorest of the poor.” He shared a story about a 31 year old woman who was totally blind in her left eye and losing sight in the other who simply cried out because she had no other option.

Another notable patient was a severely malnourished 9 month old baby sipping on a bottle of water. The team discovered that baby formula purchased locally, when it can be found, costs around $10 US dollars for about 5 days worth of milk. For most of the folks we saw this means that feeding a baby would cost much more than their entire month’s income if breast milk is unavailable.

Dorothy Nelson noted that the kids seemed to not have many material goods so they were really excited by the pencils and pens she brought and were eager to help set up and carry her crafts and games. She said that many of the children seemed hungry for touch and loved to laugh. She found herself doing lots of silly things with them to evoke laughter.

The most popular project seemed to be when she had the kids draw out the creation story and the things God created each day. The kids who lived near the church were impressive in their knowledge of Jesus and one budding artist even drew a great picture of the 12 disciples and showed it to Dorothy.

It seemed at the end of the day that the weight of the situation in Sierra Leone rested heavily on the shoulders of each of the team members. Sure we were tired, dusty and hot, but on top of that I think we had stepped into the desperation with the patients and felt the burdens they bore. Back at our place of lodging, it seemed everyone sought out a quiet nook to read Bibles, journal or talk quietly and process the day.

I Thessalonians 2:16-17 (The Message): “May Jesus himself and God our Father, who reached out in love and surprised you with gifts of unending help and confidence, put a fresh heart in you, invigorate your work, enliven your speech.”

Hiccups and Language Lessons

Monday, March 9, 2009
First day of Clinic at Abundant Life Faith Center, Freetown, Sierra Leone

As the medical team arrived for the first day of seeing patients at Abundant Life Faith Center in Freetown, Sierra Leone, a slight breeze was blowing, making the clinic in the still-under-construction top floor of the church a very pleasant temperature to begin the day. The concrete posts were in place, but no ceiling had been poured and the church members had used the framework to hang tarps to shade the clinic area, which was several feet above the main level on what will eventually become the stage at the front of the sanctuary. As we got underway, the spectacular view across Freetown formed the backdrop to the patient waiting area. And things were heating up quickly in more ways than one.

Despite our partner’s best efforts to pre-register patients and allow the sickest patients to be seen, there were several heated discussions going on amongst those waiting. There were several hiccups in the organizational process, including the fact that, unbeknownst to us, all the kids who were supposed to be seen by the docs had been shuttled off under a shade tree and were happily listening to Dorothy Nelson’s songs and stories.

It wasn’t until much later that upset mothers clued us in that all those kids needed to be cycled through to be examined. I thought there was something missing—the kids! But judging by all their smiles, “Dr. Dorothy” wasn’t doing them any harm.

Things definitely smoothed out and improved in the afternoon. About 233 patients were seen and there were 175 already registered for the next day.

I spent my spare time at the pill-counting station getting helpers Mathew and Ruthy to give me lessons in the Krio language spoken in the area. It is a linguistic amalgamation of several languages, English being one of them. For instance, the equivalent of asking “How are you?” in Krio would be “How da body?” with the answer being, “Body fine.” Sheila Leech periodically entertained us with her exclamations claiming, “Listen to this! I can already speak Krio.” We all just laughed at her rookie efforts, but even the Sierra Leoneans had to admit she was a good mimic. We could catch a few things, but when several native speakers got into a conversation it was easy to see that we all had a lot of learning to do. Thank God for our translator helpers.

A City on the Bay

Freetown, Sierra Leone

On Sunday, March 8, our medical team boarded a Kenya Airlines flight from Accra, Ghana to Freetown, Sierra Leone. We were met at the airport by the advance team members Jeremy Maller, Steve Iwan and Joseph Kebbie as well as HCJB Global radio partner Dr. Momadou Conteh. Conteh, on top of being a pastor at Abundant Life Faith Center, also heads up New Life Ventures radio. The team stayed at his house, most of the guys spreading out camping mats on the floor.

When you arrive at the airport in Freetown, you actually arrive across the bay from the main part of the city and must cross in a ferry (or in the expensive, scary, aging helicopter shuttle). As we left our luggage secured in the vehicles, the team climbed the steep stairs to the passenger deck to enjoy the ferry ride. As the colorful masses filed in and we got underway, the Muslim preacher with the megaphone was our first clue that we were travelling to a country where Christians are the minority.

The more aggressive vibe and the sense that people were on edge or somewhat fearful was our first hint that many invisible wounds were still raw from the civil war that raged from 1991 to 2002. Tens of thousands of deaths occurred during that time. Nearly one third of the nation’s population (around 2 million people) was displaced during the fighting.

The country is still rebuilding and much of the infrastructure remains non-functional. It is amazing to me that Freetown, an entire city of nearly 2 million people perched beautifully above the bay, has no widespread electrical power grid and no centralized water system. Hauling water appears to be a never-ending task for everyone and noisy, smelly generators rattling long into the nights seem to be the status quo for those who are lucky enough to be able to afford them. The team got intimately acquainted with this phenomenon on the very first night. “Honda’s Ode to Diesel Fumes” serenaded our dreams.

The Team Takes A Fall

The last day of Ghana ministry for our medical team.

The day began with a bit of a rush as Lee and Michelle Sonius' alarm clock failed to wake them up. Sharon Kealy knocked on their door about 10 minutes after 5 a.m., wondering if something was amiss. Besides the faulty alarm, Lee was still feeling under the weather. He decided to stay home to recover and Michelle volunteered to drive the shuttle for the team.

At about 5:30 am as the team prepared to leave, Dr. Bob Carpenter made a quick trip to the waiting van to retrieve something. In his haste and with the shadowy light from the street, Bob didn't see the open gutter -- two feet deep. Stepping in full force, he fell hard as the team in the van gasped, fearing the worst.

Skinning his shin and wrenching his back, Bob was clearly in pain but refused the strong suggestion he stay home. He gamely climbed in another vehicle and joined the team for the day. He hobbled around, but continued giving chiropractic care all day, taking only occasional breaks to elevate his injured leg.


Once the team arrived in the small village of Kortorbu (which, I'm told, means "crab hole"), the day improved. Setting up in the shade of a large tree and in a small shelter, the team saw around 250 patients in a very short time. Dorothy Nelson moved to the nearby soccer field to sing and play games. A real highlight for me personally was the chance to help her teach the kids how to play "red light, green light." I couldn't help but smile at the frozen poses and huge smiles when I shouted "red light!" and stopped them in their tracks.

As the day wrapped up and the team took turns in the latrine before the long drive back to Accra, Dorothy found her own quiet and inventive way of giving Michelle the "red light." After using the latrine and allowing Michelle to enter, she absentmindedly shut the latch from the outside, locking Michelle inside.

Ever the Africa veteran, Michelle simply waited for rescue . . . knowing she had the keys to the van.

It Seemed . . . That A Life Had Been Saved

Day Two at Fante Mayera was another busy day of seeing patients with the total nearing 260 yet again.

Entering the village in the early morning, we couldn't avoid noticing the long lines of women and children walking back from a nearby spring with containers of water deftly balanced on their heads. Upon arrival, we took a short walk to the water source and Sheila Leech saw in it great possibilities for a spring capture improvement. This, to prevent the contamination that occurs when people wade into the water source to fill containers.



Later, I chatted briefly with Mark Adu-Danso of HCJB Global´s partner, Theovision for a bit of the background that laid a foundation for the HCJB Global team's medical ministry. In Ghana, a national insurance policy is available for about eight dollars per year. However, in most of the village areas no one can afford that much. The area we have been visiting is the second poorest in Ghana.

The listening club in Fante Mayera is well attended by around 30 people, resulting in the planting of the Christian Life Mission Church. Mark said that our medical team is bringing "the act that backs up the gospel." He believes it will be a big help to Theovision's ongoing ministry.

A stellar example of this was how the medical team rallied around an extremely sick baby boy having seizures because of a high fever. Nurses Sheila Leech and Jessica McMillan teamed up and within moments cool water was sprinkled on the young child while he lay nearly lifeless and grey in his mother's arms. After medicines were administered, the mother moved was instructed to come back in an hour.

A bit later they returned and the change in the child was dramatic. His skin color was normal; his eyes followed movements and sounds, and he was sitting up and moving around. It seemed to my untrained eye that a life had been saved that day.

The team at the pharmacy tables were joined by Derrick Jeffers, Executive Director of Finance at HCJB Global. With bounding enthusiasm, Derrick jumped in and began counting pills. Our jesting about the finance chief or "bean counter" was quickly "countered" by Derrick's own humor. Holding out a handful of iron pills, he told us, "It's the iron fist of the mission finance department."

Dr. Fernando Espinosa shared another humorous tale from his second day in Fante Mayera. As he was treating a local woman, Espinosa happened to comment to someone, "I'm sorry." His patient immediately stood up. He looked at her in surprise and got her to sit down once again. Thinking she might have been upset, Espinosa once again apologized and the patient quickly stood up again.

It was then his translator noted that the English words for "I'm sorry" sound similar to the command to "stand up" in the patient's mother tongue.

photos: Steve Nelson

Each Day More Organized, Each Day Like a Dream

A wonderful schoolyard with a tree-shaded area served as the setting for Day 3 of medical ministry on our first look at the village of Fante Mayera.

About the same distance from HCJB Global offices in Accra, Fante Mayera has about double the population of Hateka. Our patient numbers reflected this difference as the team saw 260 patients and Dorothy Nelson spent the day surrrounded by children.

"It seems like each day we get a little more organized," said Jeremy Maller. Things progressed so smoothly that he took some time in the late afternoon to play with the local kids. He set up relay races on the soccer field, having the kids hop and run. "They really started competing when I set the teams as boys against girls," he said.


Dr. Susana Alvear said Fante Mayera residents seemed better nourished, and possibly more literate, than in the other community where we worked. A ot more pregnant women who were doing fine. Her one surprise was noticing quite a few heart murmers in the young men, possibly due to anemia.

Dr. Paola Velez also saw differences in this community, commenting that people seemed more familiar with the city. Alvear chimed in that she saw her first female patient who was wearing pants, a huge exception to the normal village attire for women.

Velez said today that each day "is like a dream with lots of nice people who are smiling and so happy to see you."




Dr. Bob Carpenter, the team's chiropractor has been steadily treating patients all week for various aches and pains. He said it was interesting that the Ghanian people he has been adjusting call their malady "waist pain" instead of back pain.

He also noted that many seem to have thoracic pain on the upper back. He believes the origin is that many people are sleeping on their stomachs on hard bed surfaces, placing a common twist at that point of the spine.

Several local soccer players watched him work from across the road until he began to encourage them to come. After adjusting a couple of their backs he saw them telling their friends about what was almost certainly their first chiropractic treatment. Soon all the players showed up for adjustments.





The day ended with a birthday celebration for HCJB Global missionary nurse Jessica McMillan who turned 30. Michelle Sonius, Lee's wife, pulled out all the stops, cooking heaping plates of lasagna and providing Jessica with a birthday cake complete with candles and ice cream.

Jessica's most memorable birthday gift was the chance to gnaw on a chicken foot as part of a local dish known as “fufu”. It is common in most of West Africa and is made by pounding cooked cassava root into a rubbery mash and dipping globs of it into a spicy sauce. Jessica commented with a smile that she received gifts originating in Ghana, Cote d´Ivoire, Ecuador, the UK and the USA--a true international party.

photos: Steve Nelson

Soccer and a Snapshot of Jesus´ Voice and Hands in Ghana

The morning mist still hung low across the fields after yesterday´s rain as the medical team drove into Hateka, Ghana. Our team was joined by two Ghanaian doctors and six nurses who volunteered for the outreach as friends of Theovision, the local partner of HCJB Global.

Our physicians saw several severe ailments in need of further care, such as a young man with a case of chronic osteomyletis (bone infection). This was cleaned up, and the patient directed to a local hospital. A man with a large hernia was also directed to somewhere capable of the surgical repair he needed.

One of the more tragic cases revealed small uniform scars on the belly of a young girl cut crudely with a knife in the belief that it would allow the evil spirits to escape from her. Two blind men also came to the makeshift clinic in hopes the reading glasses the team had might give them sight.

"It speaks of the hope that people put in us and the desperation they face when we can't help them," said HCJB Global Hands International Coordinator Sheila Leech. It’s a difficult shared by the physicians, just not to the same degree.

With a longer day and a few logistical adjustments, the team saw around 275 patients and distributed medicines to nearly everyone needing them. On top of that, the day hit a lot of high notes as well.

Lee Sonius, who directs HCJB Global´s Sub Sarhara Africa (SSA) region office, donated a soccer ball to the community and helped the young men put it into immediate use. Awhile later, he returned to the clinic drenched in sweat and loudly voiced the excuse that he is a goalkeeper and not accustomed to running the field.


Dorothy Nelson's outreach to the children didn't slow down at all either and she had the help of a translator today, allowing her to share some stories in the kids’ mother tongue, Twi, spoken in this area of Ghana.

Several men in the community spent the day diligently working on the community's new latrine. By the time the team had packed up all the equipment and medicines, they were able to hang the “tippy tap” handwashing station outside the latrine and use the facility before the long car ride back into Accra.




The crowning moment of the day brought Hateka community leaders to the clinic to present the team with a goat to show their appreciation for the medical care. Joseph Kebbie, our training director at HCJB Global SSA, also attended, carrying a high quality digital recorder.

Kebbie recorded the ceremony as the leaders and the team shared their thoughts.

The recording is to be broadcast later – a firsthand snapshot of healthcare and media as the Voice and Hands of Jesus in Sub-Saharan Africa.

Soaked While Offering Mobile Medical Care in Ghana

A heavy rainstorm cut short our medical team´s day of prescribing medicines, vitamins and doing chiropractic treatments for about 170 patients at Hateka outside of Accra, Ghana. By three o´clock in the afternoon, we were back at HCJB Global's Sub-Saharan Africa Regional offices after our first mobile medical clinic.

Dripping wet after hurriedly gathering medicines stuffing them in bins and boxes to shuttle to our vehicles, we considered the day. The palm shelter had not shed rain pouring down on our makeshift clinic.

Earlier in the day, International Healthcare Coordinator Sheila Leech and Lee Sonius, Sub-Saharan Africa Regional Director, joined Reverend Theo Asare, president of local partner, Theovision, for prayer. They prayed for the new well the two groups worked together to fund.

People of the community expressed their gratitude for the health and life that clean water brings. They are currently in the process of building a sanitary latrine in the village as well.



Dorothy Nelson, wife of long-time missionary doctor Steve Nelson, was engulfed with groups of singing and dancing children long before the medical team was unloaded and seeing patients. Although she was often out of sight, the echoes of laughing children and Dorothy's strong voice created a joyous background soundtrack to the cacophony of the patients in the waiting area. The pharmacy workers could see the occasional stray frisbee zinging past the waiting patients -- further evidence that Dorothy was still spreading her joy to anyone willing.



Fernando Espinosa, a family medicine resident at Hospital Vozandes in Quito, said the poverty in the Hateka is not so different from some areas of his home country, Ecuador. However, he found the enlarged spleens that indicate severe, chronic malaria was much more widespread and serious in Ghana. Espinosa found dialoging with his patients very difficult when the information was travelling through interpreters from local languages into English, which is not Espinosa's mother tongue either.

With a plastic jug, some string and soap, HCJB Global’s David Kealy, Jeremy Maller and Nate Dell crafted a water-saving handwashing station called a "tippy tap." Then the medical team readily used the simple, appropriate technology while washing hands before sorting medicines or seeing patients.



With a pick-me-up coffee in hand, the doctors and nurses took over the offices to dry and re-sort medicines and equipment to re-outfit and head back to Hateka early tomorrow morning.