Dave’s turning point in VVF surgery

Two weeks spent in Liberia on the new ‘Africa Mercy’ Mercy ship with a renowned teacher (and urologist), Steve Arrowsmith has been a surgical turning point for me. My previous trainers have shown me the problems and challenges of VVF surgery, but haven’t given me the confidence to dissect and repair the terrible pelvic injuries that face me. But the 25 cases I have done here with Steve at my shoulder he has given me that confidence. Challenges include:

• Thick rubbery scar tissue that faces you like a wall, hiding those delicate tissues within that have to be gently displayed so the repair can be performed.
• Fear that your finger or scissors will plunge in error through a delicate layer enclosing one body fluid or another.
• Fear you can’t reach the dark tight corner with scissors or small curved needle
• Fear that you cannot find the tiny opening of the ureter which must receive your 1 mm diameter catheter before the operation can proceed
• Fatigue in neck and shoulders & arms, knowing that there are another two cases to do
• Knowledge that the last suture you placed was your best effort, but it wasn’t really tight and secure
• A trickle of blue liquid through your repair at the end of the procedure when you perform the dye test, indicating that it is not water-tight and must be repeated.
• Failure of the repair days later, meaning disappointment for the surgeon and anguishing distress for the patient.

I am thankful for the help I have received for these challenges.

ELECTIONS

We were wakened at 5 am yesterday by the queue forming at the poling booth 50 yards from our front door. The booth opened at 9 am, two hours late. The rumbling sound of generally peaceful voices continued for about six hours. Election results will come out in 12 days.

Nutshell political history of Sierra Leone
With the arrival of a few hundred freed slaves the British colonialists created a divided country: Freetown a wealthy colony, and Sierra Leone a less developed ‘Protectorate’.
1961 independence and 'SLPP' leadership for 6 years of poor government, followed by messy elections and 2 years of military rule.
20 years of mismanagement by 'APC', creating a population ready for violent solutions to their problems.
1991-2001 civil war
Since then a shaky peace under SLPP
'APC' looks to be ahead, but a 2nd round ballot may be required if neither has sufficient majority.
Pray for good government for this poor country

Telephone Ladies: seeing a dream on its way

Before we left UK we were challenged by Mercy Ships to think what more could be done to help rehabilitate our ladies. Several God-chance conversations started the idea of some of the women becoming the village phone operators. This would give them: 1. An income. 2. Status in the village, where before they were ostracised. 3. A means for us to stay in contact with them for medical reasons. 4. A means for them to inform us of other women with fistula in their area.

On enquiry we found that Celtel, the local mobile network provider already has the perfect package set up, tried and tested, which to an average operator in the rural area they found gives £10 profit per month (half a monthly wage). The payphone has a hand-charged battery, and Celtel provides training for the women and technical support that visits remote areas. The cost is £20 per phone, which we can pay for out of your funds, and this is recoverable if the operator makes sufficient profit.

We have the go ahead to start a pilot project in September!