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       Recently, Dr. Roland traveled with Let Them LOL and Global Outreach Mission to the Mokanji region of Sierra Leone, Africa, on a humanitarian mission providing medical care and clean water wells.   Here are some of his experiences.

    First day, visited a couple of villages that have had wells dug in the last year, then went to an orphanage where the next well is going in.   We planned on just doing some general medical check-ups on the kids there, but almost half of them had some sort of significant bacterial infection (most pneumonia, some skin infection and an abscess).   Due to the civil war that lasted 11 years, a large part of the infrastructure of the country was destroyed, most notably there is almost no access to healthcare.   They don't seek medical care, because there is none to seek.   Nearest "clinic" is 15-20 miles away (walking) and there is no guarantee that they have any medications when they get there.   Mokanji has a once weekly clinic for pregnant mothers, but that is it.   Nearest facility capable of emergent care or surgery is 2 hour drive, and none can afford it.

    Second day, plan was to run clinic at the abandoned Mokanji hospital (previously prominent hospital, destroyed in the war - now empty building donated to mission organization).   We arrived at 8:30 am and there was a line-up of probably 100-150 people, and growing.   The morning went smoothly, but more and more people kept arriving.   We had seen 90 patients in the morning, but by the end of lunch we realized we would never be able to see all of the people waiting outside (numbered over 250 still to be seen by that point).   We ended up seeing another 140 patients and told the rest to come back the next day.  

    When we arrived on the third day, there were between 600-700 people in the courtyard.   Tension levels were high.   We couldn't possibly see that many, but also couldn't send them away without anything.   After some discussion with the chiefs of the area, we decided to give numbers to 200 patients, and then provide anti-parasite medication to all of the rest.   The chiefs got them all to line up and we went down the line and gave the med to each one to take.   With some "urgent cases" added to our 200, we ended up seeing about 250 that day, and the ones that were sent away did get their intestinal parasites treated.  

    The most common problem is diarrhea, due to the contaminated water supply (see picture at left).   Often they are getting the water from local streams, the same water that the village upstream washes in.   They will sometimes have shallow wells (30 feet), but they dig their latrines to the same level, so they are contaminated.   30% of children die before the age of 5 yrs. and the number one cause of death is diarrhea, followed by pneumonia.

    Each day, other team members were going out to villages to assess them and see where future clean water wells can go in.   On each of the first two days, they came back with a critically ill child.   The first clinic day, they brought back two children with kwashiorkor.   This is a syndrome of severe malnutrition.   Essentially, they were starving to death.   It is characterized by being severely underweight, lethargic, with muscle wasting, skin breakdown and slowly progressive organ damage.   Holding them was like holding a dead baby.   One was aged 21 months, weight 5 kg ( 11 lbs.) and the other was 11 months and 4 kg (8 lbs.).    We were able to provide a medical nutritional supplement called Plumpy Nut (peanut butter based in packaged in small sealed containers for the parents to take home), and the local missionary will follow up with them in two weeks.   The next day, they brought in a 2 yo child with pneumonia and severe dehydration that was critically ill.   We gave him injections of antibiotics, then placed a nasogastric tube to rehydrate him.   Within a couple of hours, he had perked up quite a bit and we felt comfortable sending him home with his parents.   Sending him to the hospital was not an option.   We heard through the grapevine that he was doing much better the next day (see picture at right).   Very difficult days - emotional and lots of crying throughout the days over what we saw.   Felt good to at least provide a little hope for people who basically have none.

    The next day, we went out with the village assessment teams and were able to get some more insight on how the people are living in the villages.   No electricity, no water.   There is a general shortage of food - most have a diet of rice and Casava ( a leafy vegetable that they make a cereal out of).   Occasionally they can grow pineapple, bananas and a few other things, but usually barely enough to eat and almost never enough to trade.   The poverty is not only severe - it is widespread.   Once you leave the capital city of Freetown, it is pretty much a continuous state of poverty for hundreds of miles.   Even compared to its African neighbors, this is extremely bad.   Trying to obtain any product that is not handmade and primitive is very costly.  

In passing this along, if anyone wants to learn more about the clean water initiative, you can always refer them to the web site http://ltlol.com/#/home/, and for information on the hospital, here http://www.missiongo.org/Mokanji.html.