I feel as if I have been in some kind of altered state since I arrived in Freetown ten weeks ago.  After an extended high, where I was bursting with ideas and determination, one day this week I suddenly ran out of steam and ground to a halt.

Everyone warned me about this moment; when Freetown suddenly gets to you and you find that actually it’s all too much.  The dirt, the traffic, the open drains, the strangeness, the constant attention from strangers, the light and water going off, the desperate poverty, the malnourished, the needlessly sick and dying.

I have had the odd moment before, of course; the day when, after being stuck in traffic for three sweaty maddening hours on the way back from sweaty maddening work, I got out of the car and brushed against a bush that happened to be covered in ants in full battle mode.  Of course, angry biting ants in your bra could be upsetting at any time, but there is a particular moment that fate chooses to deliver them.  And the questions that rush into your mind are “Why? Why me?” and “What have I done to deserve this?”.

This week, I think that my exhaustion is mainly triggered by finding that so many of my efforts to improve things don’t just fail but also bounce back at me, laden heavily with unintended consequences.

My cheerful newsletter, posted on walls around the Hospital, jeopardised our relationship with someone who felt inadequately credited.  The way that I invited a retired professor to do some teaching was felt to be insulting; I must now try to mend bridges.  Anything that we offer the doctors is taken by some to represent intentional neglect of the nurses.

The truth is that I don’t understand how most things are done.

Putting the contribution of charitable partners aside, the Hospital has existed and functioned at some level for many years, despite being hamstrung by a lack of basic resources.  It’s easy to say from the outside that “this Hospital isn’t working” and that anything is better than the old ways.  But, on the contrary, there is always some specific way that things are done.  And there is always a reason behind that, even if it is a historical reason or one that is not entirely clear to those involved.

When you come in and push, with the best will in the world, things will fall over.  Or people will push you right back.  Your “obvious solution” may not fit for a myriad of reasons and, if you force it, it may make things worse.  And for the do-gooding, know-it-all in me, that really hurts.

So, I’m going to try and go slower.  To listen more, to try to understand more.  For self-preservation as much as anything else.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.