Sierra Leone Remembered

I was amazed to see the work that the doctor did.  From early morning people started coming to the hospital.  By eight o’clock there was a crowd waiting.  Before the doctor began work the hospital “chaplain” (usually one of the African staff) lead a service and talked to the people.  Then the “dresser” gave “shooks” (injections) previously ordered by the doctor, took care of many other things, and then began to call the people in four or                Dr. Silver   and Ernest Kroma at work

five at a time, to the office.  Of necessity the doctor

gave very little time to each patient, but twenty years of experience had enabled her often to tell at   a glance what was wrong with  the patient.  There were as many as two hundred  to four hundred patients at the clinic every day. 

My part of the work was in the laboratory, of course.   I did examinations for intestinal parasites, urine analyses, some blood counts, smears for gonorrhea and T.B.  Later, as we were able to expand the lab and I began to train a young man to help me, we were able to expand our work.  Every time I looked in the microscope I was thankful for the four months I had in England studying parasitology.  Parasitology was quite rewarding–instead of being rare to find anything, as is usual in the States, it was rare not to find anything there.  Almost everyone had hookworm or roundworm, or both.  In addition, some had tapeworm and other intestinal parasites.  We had occasional patients from other parts of Sierra Leone with bilharzia ( schistosomiasis), filariasis (elephantiasis) and sleeping sickness.  There was lots of tuberculosis.  I always had a sinking feeling when I found the organism, for it was almost certainly a sentence of death in those first years.  (Later, some new medications were discovered, which did help a  number of people.)  When our leprosy clinic was opened, I also did skin snips for leprosy, and later still, for onchocerciasis, which causes so much blindness.

Then there were the accidents–in the first months of our arrival in Rotifunk a man was brought in who had been attacked by a leopard.  His companion, also a hunter, was killed.  When this man heard his cries, he went to the rescue, but was mauled in several places and had a broken arm and a thumb that was almost cut off by a knife of one of his rescuers.  We had no surgeon at that time, but Dr. Silver managed to take care of him and he recovered.

A more pitiful case was a man who fell from a tree and broke his back.  This meant that he was completely paralyzed from his waist down.  There was nothing that could be done for such cases at that time.  To make matters worse, his friends had used “country” medicine on him before he was brought to our hospital four days after the accident.  Their treatment was to dig a deep pit and build a fire in it.  Then the fire was scraped out and the victim put in it and buried in the pit up to his neck.  Because the man had no feeling from his waist down, he was terribly burned.  The doctor kept him in the hospital for almost two weeks, but saw the signs of death setting in.  Evidently his family did, too, for they asked to take him away.  They always wanted to die at home; so the doctor let him go.  We heard that he died the next day, and at the native “inquest” they  found his trouble had been caused by witches!  I asked Ernest Kroma, our dresser, why they should think that when they knew he had broken his back.  Ernest answered, “But, you see, they think it is the witch that cause