I'm leaving on a jet plane

All my bags are packed... I'm ready to go!!!

Yes, Sunday was my last full day on the ship. I had a busy morning cleaning my cabin and doing laundry. In the afternoon I went on one last trek through the city with my friend Joe. It seemed a bit quieter as many of the shops are closed on Sundays, but the road traffic was just as heavy. I almost got hit by a car on my last day, but luckily I was able to jump over a gutter just in time. We enjoyed Coca Cola on the street one last time and then headed back to the ship. I started to dis-assemble what was my little home for the last 6 weeks and pack it into my bags.

In the evening we went for dinner with a large group of people to a restaurant called Mamba point. It was very good food and a great way to end my time in Sierra Leone.

This morning, I had my last community meeting, where they say goodbye to all the people leaving. It was sad, but it has been a great adventure! Now I have to finish packing, have my room inspected, and then start the trek to the airport. We leave the ship at 1pm but do not fly out until 7pm so it will be a long day ending off with an overnight flight to Brussels. Once I arrive in Brussels, I will be heading to the Netherlands for 6 days, and then stopping in London, England for 2 days before heading home on July the 7th.

Thanks to everyone who tracked my blog! It has been so fun to write about my experiences and I hope that you enjoyed reading them! I have so many more stories and many more pictures to share with you all when I return home! This has truly been an amazing once in a lifetime experience, and I am so grateful to everyone who supported me financially and through thoughts and prayer. I really appreciate having such a great support network!



Signing off from Freetown Sierra Leone,

Karin :)

Hope you all have a great Canada Day!

June 24/25

Friday June 24

Today was my last shift at work. We had a good busy day in Maxillo facial. We had to do an enucleation (removal of an eye) and removal of a tumor.

After work I went out for dinner with my cabin mates. We tried to go to a place called Mamba Point but the taxi driver and about 20 people who had gathered on the street around the cab to help us, did not know where it was. We ended up going back to Aberdeen beach which was really nice. The adventure getting there was quite interesting. Because we had 6 people in our group, the taxi driver agreed that we could have 2 in the front and squish 4 in the back seat. As we took off down the road, it was strange to not hear the driver honking at people. I asked him if he should use his horn as we were getting very close to hitting people and he laughed at me and told me that the horn was broken. Most of us agreed that even though we find the constant honking annoying, it is much better than no honking at all. The driver kept almost running into pedestrians and almost taking out dogs. He then decided to take a "short cut" to avoid traffic. We ended up going into a very poor area of town that was basically in a big valley where all of the rainwater runs, it was fine but we still got stuck in traffic. On the way out of the valley we had to go up a huge hill that was quite slippery as it had just rained. Of course the traffic forced the driver to stop midway up the hill. All of the vehicles here are standard and you can imagine how quickly we started to roll down the hill as soon as the driver took his foot off the brake! We ended up almost hitting the taxi behind us, and all of us offered to get out of the car and walk up to the top of the hill where the driver picked us up again.

As we neared the restaurant, it started to get dark. The driver put his lights on, but they must have been on their last legs because we just got a slight hue of light (with his brights on!). The beach street on Aberdeen has many speed bumps so we all had to look out for them and yell when we saw them because the driver didn't seem to notice and tried to take them at top speed! We were very excited to arrive alive at the restaurant and did not ask the driver to wait for us. We had a lovely dinner and then started the trek back home.

Saturday June 25

On Saturday two of my friends and I took a taxi to John Obey beach for the day. It was a beautiful beach to spend my last Saturday. I got lots of pictures of the scenery. We did have some rain during the day, but not enough to stop us from enjoying ourselves! We had a nice lobster lunch (which I did not eat, but I enjoyed watching the men cook it) as well as grilled pineapple. The beach area that we went to is run by a company called tribe wanted  (http://www.tribewanted.com/). The company works to create a sustainable working co-op within an existing community, that is eco friendly.
We enjoyed another crazy cab drive to and from the beach. However this taxi driver did have a working horn and he really knew how to use it!

Arriving at the beach

getting the lobster ready to grill

watching the storm come in

Hanging out in the sun

Two little village boys who hung out with us

soaking in the last rays of sunshine

It started raining, so the driver passed me his handle to roll up my window

June 22 and 23

June 22

Yesterday I was on late shift at work  (10-7). I ended up helping out in the general surgery rooms. We had a great day and finished our lists in time to get some dinner! The ship gets most of its food shipped from the United States or The Netherlands (except for fruits and fresh veggies grown here...ie cucumbers and tomatoes...and sometimes lettuce), and you can tell that we are desperately waiting for the arrival of the next shipping container. Dinner for the last 4 days has consisted of rice, rice and more rice. Hopefully the container will come before I leave. Now that I am feeling better, I hope that I can try something other than rice!

I have been on call for the last 2 days. Last night was my last night at the bible study that I have been attending, so after work I went and baked some brownies as a treat for everyone! As I walked into the cabin of the family that hosts the group, my pager went off, so I turned around and headed down to the OR. We ended up having to bring a patient back to the OR who had a large blood clot. We removed the clot, washed out the wound and then cauterized anything that looked like it might be bleeding and sewed him back up. By the time I left the OR and got back to my bible study, they were just finishing. I still had time to chat with people and have brownies of course!

June 23

Today I was back in maxillo facial surgery. We had an interesting day. I started off scrubbing for a case where a woman had a neurofibroma covering the right side of her upper face. In the past, she had had a surgery to debulk this tumor, but with neurofibroma tumors, if you can't remove them completely they will grow back. The location that this tumor prevented us from being able to remove all of it. It is sad to know that even though we did a good thing by removing the tumor, it will continue to grow back. We did another similar case after that and then had a quick bite to eat.

After lunch we did a maxillary tumor. When I went to check in this lady she looked quite normal. Her right cheek was a little bit larger than her left but other than that you wouldn't be able to see her tumor, until she opened her mouth. The tumor had grown into her palate. It was a very interesting operation. The surgeons had to remove her palate along with some of her maxilla and half of her upper teeth. He then used a piece of the temporalis muscle (see pic below) from her head to create a new palate. It was an amazing surgery to be a part of.

Here is a picture where you can see the tumor bulging from the roof of the lady's mouth. you can also tell that her right cheek is larger than the left

We used a piece of the temporalis muscle to create a new palate

Here is a picture for all of my anesthesia friends back at Sick Kids. During the surgery that I described above, we noticed a gurgling noise coming from the airway. Wondering if the cuff had deflated, Gary (pictured) went under the drapes to check. He couldn't find the cuff! After searching around under the drapes, he managed to find it, completely separated from the endotrachial tube (as you can see him holding the balloon above. The anesthetic machine wasn't reading a change in the leak at all and the patient was ventilating fine. We had placed a throat pack at the beginning of the case, so we just plugged onward... ha ha we couldn't decide whether to to blame sabotage from the surgical end or the endotracheal tube for being reused to many times!

Working hard and having fun!



June 19/20/21

I have been out of commission since Sunday afternoon with the African Gastro. This morning I was finally able to leave my cabin and go back to work. There is a saying on the ship that you haven't really been to Africa unless you have gotten sick... I had thought that I was going to sneak away without getting sick. I was wrong! I am still not feeling 100%, but on the Africa Mercy, if you can stand up you can work!

June 19
In the afternoon four of us took a taxi to Aberdeen beach to get some food and walk along the beach. It was busy with soccer games. There must have been 8 separate games being played along the beach all at the same time.

You can see all of the people standing way down the beach. they are all playing separate games of soccer

Another view of the games

The scenery in Sierra Leone is so beautiful with all of the

rolling mountains edging onto the sandy beaches

We stopped at the Craft Market on the beach (Aberdeen and Lumley beach are the same place). It was a really neat experience because the people working there asked us right away if we were from Mercy Ships (I wonder what gave us away haha). When we told them that we were, they brought a little girl up to us. When she was little her arm got burned and he had a contracture. She had been on the ship 3 weeks ago and had surgery to release the contracture. One of the nurses who had come with us that day had actually been the little girl's nurse on the ward. It was really nice to see patients back in their homes after having successful surgery. The people from the craft market also brought us another child who had finger and toe syndactly (for non medical people it is like webbed fingers or toes but all the way up to the top of the finger, so the fingers look like they are fused together).

Every time we go out, once people know we are from Mercy Ships, they bring us people who are in need of surgery. It really shows how great the need is here. Mercy Ships being here for 1 year is not even going to make a dent in the amount of surgeries needed. It is really hard to go out into the community as a medical professional and not be able to help people. We had to tell the family to listen to the radio for when the next screening is. After the craft market we were ready to head home (especially me as I was starting to feel sick). We took a taxi home and found out that the driver had also been helped by Mercy Ships. He had been to the dental clinic and had had some much needed dental work done!

One the way home we stopped at the cotton tree again for another photo op!

June 20

You don't want to know about this day... sick in bed... enough said!

I was glad to hear that I didn't miss anything in the OR though, as there was a problem with the oxygen concentrator and all surgeries were cancelled. We will try to do a few extra each day so that no one gets cancelled.

June 21

 Today I was feeling better so I went back to work. This week I am in Maxillo facial and we did 3 cases. First we removed a neurofribroma from a man's neck. For the non-medical people this was non-cancerous tumor (although rarely they can become cancerous). This man had neurofibromas all over his body. from what I have read, they tend to only grow to a certain size and they do not tend to spread. Surgery is the only way to remove them in Africa (although they can be removed with a laser back home). The reason we only removed the neurofibroma on his neck was because if it grew any larger, it could obstruct his breathing. Our second case we removed what we thought was going to be a neck cyst but ended up being a neck lipoma (a big hunk of fat). We ended the day with a young man who spoke english very well. He told me he was in university taking developmental studies. His upper lip hemangioma was quite large and was ostracized for it. We did a debulking of his lip.

As you can see from the pictures below... we had a bit of a leak in the OR today. The air conditioner condenser was leaking. We had to tape blue pads to the ceiling and hope for the best!

bowls on the floor

blue pads on the ceiling (there are 2 more behind me as well and a few more you can't see)

June 17 and 18th

Friday evening

After another full day in the operating room, we decided to treat ourselves and go out for dinner. One of my friends Lourens is a long term crew member so he is allowed to drive the Mercy Ships land rovers. Going out for dinner is fun, but almost as fun is the adventure getting there. Because the restaurant we went to was on the other side of one of the mountains, we had a choice, go through the city and sit in evening traffic or go over the mountain on the "back roads".  We decided it would be more fun to go off roading in the back roads and test out the land rovers capabilities. I don't have a great picture to show you the exact incline... but if you look at the picture below, you can see the path that 3 people are walking up, that is one of the "less steep" roads we took!

As we were driving up the mountain Lourens offered to drive us up to one of the highest points of the mountain to see the sunset. It was an amazing view, you can see for miles the city of Freetown.  

Lourens, proud of his parking job... about a foot away from a straight drop down the mountain

We had a great dinner at the Country Lodge and then took the regular streets to get back home.

Saturday - Bunce Island

On Saturday I went out with a group of 2 land rovers (18 people) to Bunce Island. As I said above, part of the adventure in Sierra Leone is getting to various locations. So we started the morning with a 4 hour offroading experience over the mountains and down random dirt roads. I got to ride in the front of the land rover with Chris a fellow Canadian driving. He made my day when he pulled out a tin of Tim Horton`s coffee (quick side note... the coffee is quite bad here... for all of you who know my coffee addiction, you will be impressed that I have cut down substantially) Chris had a french press and we managed quite well with the coffee mug and press while in the city. Once we started climbing the mountain... it was a different story. Somehow I ended up with coffee all over my pants as you can see from the picture below. But it was okay because I had my first great cup of Tim Horton's since leaving Canada so I couldn't complain!

The coffee that ended up all over me

pit stop enjoying the view from on top of the land rover

A picture after successfully completing the hill

The beautiful back country

After 2 hours we finally hit pavement... it was a very strange feeling to all of the sudden be driving on smooth road. It didn't last for long though. Bunce Island is listed as only being accessible by boat to tourists from Freetown. Tourists pay about $100 American to take a motor boat to the Island. Lourens and some friends enlisted the help of google earth to look at satellite pictures of the back country. they found that there was in fact a dirt road that led to the water right in front of Bunce Island. I believe that this was Lourens` 3rd time to the Island so we trusted his navigation skills! It was a fun experience driving on the dirt path for over an hour to get to the sea. we passed through many small villages that did not see vehicles very often. All of the children came running out to greet us and wave by the road.

When we finally arrived at the village, we got into canoes (which the villagers were quickly bailing out excess water from) to make the trek across the river. The boats were very tippy and there were multiple occasions during the crossing that I thought we were going to tip over. We made it safely across to Bunce Island and met an archaeologist from Syracuse who has been working at the site. He told us that he had been here in the late 1980`s surveying the site and was hoping to start a restoration project. When the civil war started, he had to delay, but has returned and has a large grant to start preserving the site. It was great running into this man because he gave us a quick overview of the buildings so that we would have some bearing as we explored.

bailing out the water from our canoes

inside the `Georgian manor` which was the slave traders home on Bunce Island

Kate and I inside the mansion

The slave quarters. The mansion overlooked this area.

The opening to the left went to the women and childrens area and the opening to the right was for the men

Where the men were kept

Where the women and children were kept

Inside the armoury cave

It was dark and full of beetles, but you could still smell gun powder.

Cannons were the main defence against ship attacks. If things did not go well the  slave traders would escape from the rear of the island and paddle to the mainland

This Island is very historical as it was home to one of 40 major European commercial forts on the coast of West Africa during the slave trade era. It was in operation from 1670 to 1807. This fort is of particular importance to the United States as large numbers of slaves were sent from this location to South Carolina and Georgia. Slaves from Sierra Leone were very valuable to the slave traders in the southern states because they were very skilled in rice planting. The Island itself was attacked twice by pirates and four times by the French. It was a very sobering experience to visit the Island.

June 15 and 16

This week one of the surgeons has left the ship and no one has replaced him yet, so we actually have enough nurses in the Operating Room!!! It is so exciting to not be short and running around like crazy!

Yesterday I still was able to get a little bit of excitement though... we had finished up in the general surgery room and I was cleaning up some supplies in the sink. One of the nurses from the Maxillo Facial room stuck her head out of their room and asked me if I was busy. I said no. She said "okay then scrub in and come here"! They had been waking up their patient who had had a huge neck tumor removed. As the patient woke up, her neck started getting bigger and bigger. Something was not right. We ended up putting her back to sleep and re-exploring the incision. In the time that had passed since the original surgery ended, enough blood clot had formed to fill an entire kidney dish! We removed all of the clot, found the bleeding vessel and tied it off, and then closed the wound again. It was kind of exciting... it made me miss scrubbing for big cases back home (especially liver transplants Lachica!!!).

In the evening, we attended the first of 3 trivia nights on the ship. I wasn't really looking forward to it, but it was actually really fun and a lot of people turned up to play. Unfortunately my team did not win... but there is always next week!

Today was another hernia day in general surgery. We ended up finishing our list early today and so we were sent to one of the wards to help them assemble paperwork for their charts. As you can see by the picture below, we did lots of work ...and had some time for fun as well!

Taking a break from sorting papers in C ward. It is the smallest ward on the ship and is closed right now. A, B, and D wards are all open and have double the amount of beds!

Even the Anesthetists were put to work counting pills for the pharmacist 

This is Arega, he is one of the 3 residents training here on Mercy Ships. The residents each spend 1 month in Maxillo facial, general surgery, and anesthesia.

Tomorrow will be my last day in hernia world and then next week I will hopefully be in Maxillo facial all week where they do lots of big tumor cases.

June 13 and 14

We have been working hard again this week. I am again in the world of general surgery (mainly consisting of hernias again haha). The staffing has been a bit better this week as we are down one surgeon and have more nurses to go around... although there has also been a bug going around and we have had 2 people sick both yesterday and today.

We did have to do a masectomy yesterday. It was a young woman and was very sad because the tumor was quite advanced (it was about the size of a golf ball). The prognosis does not look very good. This reminds me how blessed I am to live in a country where we have easy access to primary health care and early detection is much more the norm. Here in Africa the norm tends to be palliative due to the advanced stages of disease when they are diagnosed.

If you are wondering how we do our pathology here on the ship, the answer is... we don't. Some lucky person (ie. any crew member the lab can get a hold of as they leave the ship) gets asked to take the specimens with them in their suitcase to be dropped off in a lab (I believe they are usually taken to England). From there the specimens are taken to a lab and the results are forwarded back to the ship. This means that the results may take longer for a patient to receive depending on transporation!

Here is the room that I have been working in last week and this week

For all you SickKids people, here I am with the "casecarts" for the morning. For all non-SickKids people this is how we organize all of the sterile supplies for each case