Sunday, September 25, 2011

Sierra Leone - Part II of V

Downtown Freetown, Sierra Leone. The stormy clouds pack a punch - on average, Freetown gets over 26-inches of rain in the month of September alone!

Part II of V

Thurs Sept 8:
Today I went with the civil engineering team over to the far site, Connaught Hospital. Connaught is considered the top medical facility in the country. There is so much I could write today from our 4 hour visit to the site – the wastewater conditions were some of the worst I’ve seen on a trip: Raw sewage flowing out of the septic tanks right where the workers walk to hang laundry. The small amount of sewage that makes it into the designed system simply drains out into the ocean at the bottom of the site.

Believe it or not, this is the road we took each day to get to the far hospital. At times we had to stop for several minutes while people cleared their stuff out of the way so we could pass through. Remarkably, it's a two-way street!

But instead of telling all the stories related to that stuff, I want to share something else that happened since it had a bigger impact on me. At around 8:50am, an hour and a half after we arrived on site, as we walked through the center courtyard of the hospital I heard a young woman begin to wail in one of the hospital wards. It slowly got louder, as she was running/crying out of the building, through the courtyard and out the front of the hospital. The half-hearted cry and running struck me – it seemed that she was so emotionally devastated and physically spent that she couldn’t even muster the energy to do either full-hearted. Of course, I immediately wondered how I might feel if someone close to me died. But I was haunted by her cries, and I wondered, beyond the normal grief of a loss, what this death might mean for her? Will this be the day that her life changes forever? Undoubtedly. But with life being so difficult here, will she ever be able to recover?
Was this the loss of her husband, and now she has no means of supporting herself and her children? Will some of them be neglected and left to fend for themselves on the street, or sold into sex or slave trade? Or maybe she’ll have to sell herself for the sake of her family?
Or, was this the loss a child, and now she has to go on without her beautiful little toddler? Maybe this child was the one bright spot in her otherwise very dark and difficult existence.
Was it her sister who died, perhaps the one person who has been her rock in life since they were young girls? Had they clung to one another to survive the death of their parents at a young age? Or maybe she was the one lifeline this woman had out of her abusive marriage? These are all such common stories for the people who live in this tough place.
I don’t know the exact pain this woman was feeling, but something in me felt that it was a loss that cut to the very core of her existence. The depth of her half-strength sobbing created a momentary quiet in the otherwise bustling courtyard; I think everyone could sense that this was a monumental loss.
I’ll likely never see her again, but I’ll pray for her every time I think of those brief, haunting moments where I saw her at her rock bottom point. I’ll also pray that the work we’re doing will somehow, someway make a difference in this place. Maybe our clean water and sanitation design will prevent someone else from getting sick, and thereby save their loved ones from the agony this poor young woman faces now. It would be so easy to see the situation here and conclude that it was hopeless and therefore not worthy of any rehabilitation effort. But seeing people like this woman reinforces my belief that when faced with situations like this, if you have the ability to help you can’t just sit idly by.

The walkway at the far side of this picture is where I saw the woman, exiting the building on the left and heading right out of the campus. I snapped this picture later in the day - earlier the hallway was about 3X as full with people.

Later in the day, we were at the other site and I spoke to the Western missionary doctor who works there in a consultant’s role. She mentioned that it had been a tough week, as they had lost several kids there. The reasons for some of their deaths were frustrating to say the least – some had died because they hadn’t been given an I/V to be fed even though the hospital has those tools readily available. Why weren’t they fed? Essentially, it comes down to people not believing that they can make a difference by doing their jobs responsibly. Tragedy is a way of life here, and it almost becomes expected.
So what does this all mean? Is the situation really hopeless? As one of the Mercy Ships guys said at the beginning of the week: “The deficits here are massive. So we have a choice: We can do nothing, or we can at least make an attempt to do something. We’re choosing to try to at least do something, anything, to help.” We agree, and we’re honored to be partnering with them this week, equipping them with the technical knowledge needed to do the work they’re setting out to do.

Seeing the conditions of the wastewater system on site at Connaught Hospital was disheartening, especially given my experience earlier with the young woman crying.

Friday Sept 9:
I think I need to introduce the team before the trip is over! It is an extremely talented and experienced team and I feel very blessed to have them here as this is a very high profile and challenging project.
Dan Mason – a civil engineer from Indiana with over 30 years of experience. Dan travels multiple times a year to Africa to do development and mission work and is very familiar with working in this context. Dan runs his own design and construction business and has incredible knowledge and practical advice to offer to the local maintenance workers here.
Marlin Keel – another civil engineer with over 40 years experience. Marlin is a quiet and humble man, but has great wisdom and experience, including his participation on the EMI trips that did hospital evaluation work in Liberia in 2007 and 2008. Marlin has been the city engineer for Nashville, TN in the past and current holds that position for the city of Mt. Juliet, TN.
Austin Hewitt – a civil engineer from North Carolina with around 10 years experience. Austin has written hundreds of assessment reports for all types of facilities, so his experience with the formal report writing side of things will be a huge asset for us.
Bruce Brubaker – From Pennsylvania, Bruce is actually a Mercy Ships volunteer for this trip, but in every way he is functioning as another member of the EMI team. Bruce’s practical knowledge in civil engineering has been a big help to us.
Wes Turner – an electrical engineer with nearly 40 years of experience and multiple EMI trips under his belt, Wes’s knowledge and confidence to work in the developing world has been a great asset and brings a lot of legitimacy to our team.
Geoff Watson – Geoff has nearly 15 years of experience as an electrical engineer from North Carolina. Geoff’s knowledge well exceeds his 37 years, and his fun personality has been great for the team. He has a great laugh!
Joe LaBrie – my brother-in-law, a structural engineer from the Los Angeles area. I’ve known Joe since I was 5, but the team has quickly learned how impressive of a person he is. His energy and enthusiasm for being here has been a welcome addition to the team, and his well-spoken and passionate demeanor has clearly resonated with the ministry. Joe’s ability to communicate in a way that makes you hang on his every word has definitely won over both the team and the Mercy Ships guys.
Mike Corsetto – intern Mike has been a great help to the team, and he has proven to be a very capable engineer and person. No task is too small for him, and no task is too big for him. He’s a very talented and intelligent young man and has impressed us all in a short time. Also, he's a UC Davis grad - so with me and Joe there are three UCD grads on this team!
This really is an impressive team and I feel honored to be working with them. They also are a lot of fun to be around, and team bonding has been effortless.

The team, from left to right: Joe LaBrie, Dan Mason, Geoff Watson, Bruce Brubaker, Wes Turner, Austin Hewitt, Marlin Keel, me, Intern Mike Corsetto

One note from the day – while we were walking around the children’s hospital today, we heard another person wailing – this time a mother who had just lost a young child. It again was haunting to hear the depth of despair, but this time the people around the hospital seemed to show little reaction. In talking with the local on-site missionary, she said on average that 4 young children or babies die at the hospital every day. Oftentimes, they are dying from very simple things that could easily be prevented, such as hypoglycemia and not being given an I/V or the medication they need (even though it’s available). Or as it relates to our work, a lack of basic sanitation is causing people to become sick, or the lack of water supply is limiting the quality of care that can be given, or the lack of consistent power to the hospital prevents the necessary equipment from running. The hospitals have the equipment and basic infrastructural pieces in place, but in large part they have just not been maintained or operated properly. We could easily come in and fix a number of things that are causing the problems, but without the buy in of the hospital personnel the systems would just break down again.
It’s so frustrating to see these people suffering and dying on a daily basis for reasons that often could be easily addressed. But it does underscore the need for us to lay out the technical solutions needed so that when the human resource and mentoring issues are addressed, the infrastructural systems can be restored as well. The structure and content of our report is beginning to take shape in our minds as we are identifying where the short-comings are with the water, wastewater and electrical systems at these hospitals.

Tuesday, September 20, 2011

Mercy Ships project trip - Sierra Leone

Part I of V

Travel days Sept 4-5:
Leaving for trips is never fun for me. My past fears of leaving home come crashing down on me as the hours tick down to departure. I know the term ‘depression’ is a very real condition that plagues people so I don’t want to minimize that by using the word flippantly, but the dread I feel of having to leave Alisha and the boys sets me into a depression-like state. I know it’s irrational and not what God would have me feel, but it’s very real and a real area of growth for me to pursue. It’s far worse than the actual leaving itself, which is quite ridiculous when I think about it after the fact.
Overall, the travel was fine. All the flights were fairly smooth and uneventful – exactly how I like them! We had 5 flights in all, so it was a very grueling trip. Denver to Chicago to DC to Brussels to Banjul (Capital city in The Gambia) to Freetown. Including our team, there were 31 Mercy Ships people arriving on the flight – all but one of us got our bags (a young Mercy Ships gal didn’t get one of hers). Stepping off the plane it felt like Haiti – quite warm with oppressive humidity. It was also raining off and on, which made maneuvering our bags from spot to spot a little tricky.
We gathered in the parking lot, which was quite chaotic, and somehow piled all the bags and people into cars driven by local guys and drove 30 minutes on very dark, half-dirt roads to the ferry dock. We arrived at the dock about 2 minutes after the “nice” ferry left. So, we had to take the “other” ferry, which seemed a little sketchy (I later learned onboard that this company had lost a ferry here a couple of years ago after overloading it. A few hundred people drowned in the rough sea water.) So, after an hour and a half wait in the hot, humid and very still air, we took the 45 minute ferry ride across the four-mile wide river mouth. The Ferry was packed with Sierra Leonians, with loud music blaring on one level and a documentary about the civil war there blaring out a tv on another level! After the ferry docked and we waited for the swarm of people to get off, we carried our bags out into the light rain and divided into 8 landcruisers owned by Mercy Ships and drove the final 15 minutes to the ship. So all told, from my front door to the ship was exactly 35 hours.

Welcome to Sierra Leone, Joe! (My brother-in-law Joe joined me on this trip. Joe is a structural engineer who has specialized in hospital projects for nearly 30 years. It was so fun to have him along, though I'm pretty sure the first few hours after arrival were a bit of a shock for him, this being his first time in Africa.)

Waiting at the airport after arriving. The fact that there were 31 people total from Mercy Ships arriving made things way more complicated and hectic than it otherwise would have been.

It was quite the chaotic scene in the airport parking lot. People were coming up to us and trying to take our bags from us so they could carry them for us (and be paid for doing so!). Then trying to get our bags onto one of the several vehicles scattered amongst the crowd - I was sure we were going to mistakenly put it in the wrong car and never see it again!

This picture in no way describes the discomfort of this shot on the ferry, waiting for it to depart. The air in the room was so warm, humid and still, not to mentioned crowded with people and blaring music. Shortly after this the team scattered throughout the ferry to search for cooler or at least moving air!

The top floor on the ferry - it was so warm and crowded in the room. It was quite a heavy dose of culture shoved in our face right from the start! Good fun.

The locals crowding their way off the ferry arriving in Freetown.
But walking on the ship, the immediate contrast of the cold and dry, air conditioned air was an amazing relief from the warm, heavy and sticky outside air. I don’t think angels were actually singing, but it sure felt like it to me! The ship hospitality people took charge right away with paperwork and process orientation. It is impressive how well organized they were and how thorough the systems they have in place are.
So after a very long journey, Joe and I were shown to our room – which was like a small little hotel room with our own bathroom. We were exhausted, but neither of us could hold back the giddiness of relief we felt after walking on the ship and seeing where we’ll be staying. We finally hit the hay just after midnight.

Unpacking our bags that first night, the smile of relief on Joe's face says it all. We could see right away that we would be living like kings on this trip. One of the first things Joe told me when we reached our room is that he had definitely chosen the right trip to come on!
Tuesday Sept 6:
Waking up in the morning after a full night’s sleep was a huge blessing. I still couldn’t get over how nice it was to be sleeping in an air conditioned room with a fan on – actually we had two fans on! The normal ‘gut check’ I have to do when I wake up on trips was not there – it is nice having Joe here with me, and coupled with staying in a nice, comfortable place it definitely softens the blow of being gone from home.
After breakfast (cinnamon rolls –are you kidding me?!), we had an opening meeting with the team and then programming meeting with the Mercy Ships guys. It didn’t last nearly as long as typical programming meetings simply because this is a different kind of trip – assessing and recommending water, wastewater, and power system improvements for the three hospitals.
We then met Dulce, our Honduran host who will be our main point of contact while we’re here. She’s a fun gal with a great outgoing personality.
Dulce gave us a tour of the ship and it was impressive – over 450 people housed on the 500-foot-long ship, a library, several lounges, a full cafeteria, a cafĂ© donated by Starbucks so Starbucks coffee is served free with very cheap specialty drinks, full laundry services, and a small swimming pool up on the top deck. All of this of course exists to sustain the families who live on the ship to work in the fully functioning hospital down on deck 3.

Meeting with some of the Mercy Ships folks to kick off the trip that first morning.

The Starbucks cafe on the right with the ship store in the background. This mid-ship area was the main lounging area on the ship and where we spent a lot of time on board.
The hospital on deck 3 has 6 surgical rooms where they do eye surgeries, orthopedic surgeries, and facial surgeries (mostly to remove tumors). They work in conjunction with the local hospitals, helping to fill in the gaps that exist as well as to work on catching up with the huge backlogs there. They also provide training for local doctors on the ship and employ a number of local people to work on the ship. They are typically docked for 10 months, during which time 3000 people receive their sight back with corrective surgery that fixes their blindness from cataracts. What an amazing ministry!

Leaving the ship and entering 'the real world' was also a very stark reminder that we weren't in America. The difference in the air on the ship and the "fresh air" outside couldn't have been more drastic - the ship had cool, dry air from the A/C, and outside was warm, extremely humid and heavy air, with plenty of airbourne dirt too.

Preparing to head out from the ship to the hospital sites. Mark Palmer, our Mercy Ships contact person, is in red. Ryan, a long-term Mercy Ships volunteer who works off-ship on various development projects, is squatting down. Mark is Canadian, and Ryan is South African.
In the afternoon, we took a tour of the three hospitals in town to get an idea of what our scope of work will be. The water, wastewater and power systems will be our primary focus, as well as a structural evaluation of the buildings to make sure they are worthwhile of system upgrades.
Traffic in Freetown is terrible, so it took an hour to get to the one hospital that is 3 km (2 miles) from the ship. The other two hospitals share a site that is about a 10 minute walk from the ship, so that will be convenient. We met the important hospital players and introduced ourselves as we took a brief tour of the facilities. Doing an assessment of one of these hospitals in the 10 days we’ll be here would be a huge task. Doing THREE assessments will be a major undertaking. Fortunately, we have a very experienced team here (3 engineers on our team have over 30+ years of experience) so I am really excited to see them work their magic! Tomorrow begins the real work.
One other nice perk about the ship is that it has a phone with a Florida number. People on board can purchase a $10 phone card to call home (using the phones in our rooms!) for about 3-cents per minute! So tonight, I got to talk to Alisha and catch up with her and the boys. Things are going well back home, though the boys are always a little ‘off’ while I’m gone, and Alisha’s job is 10x harder. I do miss those 4 special people!
Weds Sept 7:
Today we broke up into two teams to visit the sites. I went with all the civil engineers and one electrical engineer to the ODCH/PCMH site. The site has two hospitals on it, but shares water, sanitation and power systems so we are treating it as a single site. We spent the day with the local maintenance guys who showed us around the property.

Walking up 'Bad Boy Lane', between the ship and the closer of the two hospital sites (about 1/2 mile). I suggested a name change for the road to help improve neighborhood pride!
The water, wastewater and power systems on the site are not functioning well, and we saw several instances where simple solutions would make a big difference. Some interesting observations from the day were:
* The main site electrical panel has no cover and sits about 20 feet from the front of the hospital. Our electrical engineer pointed this out to them as an immediate hazard and life safety issue. If anyone got to close, the power could ‘arc’ over to them and they would be dead.
* In one location, a septic tank on site had been overflowing each day. They discovered that a nearby break in a water line was filling the tank with water. To ‘fix’ the situation, the maintenance crew installed an overflow pipe that allowed the top of the tank to drain into an open-air, concrete drainage trench that runs through the site (in other words, allowing raw sewage to flow openly in the trench). Earlier in the day, one of our engineers had observed a woman who was washing clothes with the water in that ditch reach down and scoop a handful of the water into her mouth for a drink (probably assuming it was just rainwater).
* We saw several situations where the hospital had equipment (generators, oxygen systems, etc.) that was not working and had been out of operation for months or years. One generator had never been used before, just setting there next to the panel in one of the power rooms because they had run into difficulty in hooking it up.
* In one of the children’s wards we walked in, it was heart-wrenching to see all the young toddlers laying sick in their hospital beds with their mothers layed out on the ground or a small chair, sleeping beside them. I felt for these poor mothers, who love their children no less than I love mine but are unable in many instances to get their children the care they need. What a hopeless, terrible position to be in – I can imagine few things being worse.
* One little boy had a large tumor growing on the front of his face, beneath the skin at his cheekbone. The tumor disfigured his face in a manner that caused his left eye and cheek to bulge out significantly to the side of his face. I asked and the doctor said he had a form of cancer and would begin radiation soon. He was very smiley though, and I could tell his attitude on life was way happier than I know mine would be if I were in his predicament.
One positive thing about our visit is that there is a young Dutch doctor, Sandra, who is working there in partnership with the hospital. She actually grew up on a Mercy Ship as an MK (‘Missionary Kid’) and is now a doctor herself, having lived in Sierra Leone for nearly 6 years now. She works for an aid organization that has an office at the hospital, providing support and working on improving infrastructure with the local hospital doctors and administrators. She is doing great work there and is a perfect example of how missionaries can and should be partnering with locals to meet the needs of the people. She is very thankful that our EMI team is here to help sort through some of the technical issues that she has been working on while feeling deficient technically since it’s out of her area of training.

Sandra, the missionary doctor, shown here with the EMI water engineers figuring out the water delivery system on the site.

A pretty well designed water tower supporting two water tanks...both tanks sit empty due to broken pumps.

Very nice laundry facilities at one of the hospitals...except for the fact that they broke down over a year ago and haven't been used since. All hospital washing is now done by hand.

Some of the laundry is done in these trenches...the same trenches the septic tanks drain into.

Also, in the evening, we had a very productive meeting with the main Mercy Ships players. We were able to each share our expectations for the project and communicate that we’re all on the same page – what a crucial development for our team and the ministry to see that we’re all of a singular mindset on what our team is doing here. What a blessing it is to be working with design professionals who truly are at the top of their field.

The trash (including medical waste) dump site out back of one of the hospitals. The trash beach in the background is part of a housing development. The water is the Atlantic ocean, which in this case is serving as a major trash depositing spot for the city of Freetown. The pollution is staggering.

...trash from a different angle.

Figuring out the water storage system on top of the roof of a 3-story building where the main water tank is located.

A couple of the many open trenches on the site, designed for rainwater runoff, but being used for the sewer system as well. Obviously, that's not good.

Talking through things while we tour the site