![\"Pikin](\"http:\/\/www.bmj.com\/columns\/icons\/pikin_hospital.jpg\")
\u201cWe don\u2019t have thoughts of maintenance here in Sierra Leone.\u00a0 Few people have any idea of that.\u00a0 If you look at the cars driving around, you can see.\u00a0 I wonder how they are able to register them.\u00a0 Yes, you have to adjust your expectations in Sierra Leone, otherwise you can become depressed.\u201d<\/p>\n
These wise words are from Mr Bundu-Kamara, a retired pharmacist, who spent much of his career working in the UK, before coming home to establish a quality pharmacy in Freetown.<\/p>\n
I have battled to adjust my own expectations about maintenance at the Hospital.<\/p>\n
Let\u2019s take the example of the oxygen concentrators.\u00a0 These have been donated by Welbodi and other Hospital partners.\u00a0 These machines, which grab precious oxygen out of the air and deliver it to sick children, are Trojans of medical equipment and can withstand continuous use for years at a time.<\/p>\n
However, like any machine, they live longer with basic maintenance and can die prematurely if they suffer abuse.<\/p>\n
One chamber should contain regularly-changed water, to moisten the gas streaming past.\u00a0 A sponge filter should be cleaned once a week of the clogging red dust of Freetown.\u00a0 The nurses know about this.\u00a0 When I explain, they look impatient and say, \u201cYes, yes.\u201d<\/p>\n
But when I pop into the Emergency Room on an average morning, despair rises in my chest; the machines are caked in dirt and unknown liquids, their tubes trampled, their water run dry, their filters choked.\u00a0 Their two-pin plugs are jammed into three-pin sockets, the converters and extension cables missing or burnt out.<\/p>\n
When a child needs oxygen, the hunt for the \u201cY connector\u201d, which allows the oxygen to be split several ways, is missing.\u00a0 Nurses hunt half-heartedly through drawers.\u00a0 \u201cEeee bo\u201d, they say and shrug, the Krio expression of regret and resignation.<\/p>\n
Now, that isn\u2019t fair, the nurses would respond.\u00a0 The wonderful nurse-in-charge of the Emergency Room soon sorts the place out when she starts her shift.\u00a0 She does care about the ER equipment, but finds it difficult to influence what happens when she\u2019s not around.\u00a0 Matron, similarly, can cajole or shout or issue orders, but has no obvious carrots or sticks to use to improve performance.<\/p>\n
But what does all this mean for those who would donate vital and previous equipment to the Hospital?<\/p>\n
There are two extreme positions that one might take.\u00a0 On the one hand, imagine my granny, an upright lady of Colonial times, who would have said \u201cDon\u2019t give them a single thing until they have proven that they know how to look after it\u201d.\u00a0 On the other hand, I imagine a more contemporary hippy friend who might argue \u201cYou can\u2019t punish the kids just because the culture is different\u201d.<\/p>\n
Of course, there must be something in-between.\u00a0 An approach where we try to promote better care of the machines, whilst accepting that complete and lasting success is unlikely.\u00a0 It is important to avoid obsession with Western cultural and professional norms and falling into the trap of thinking that these are somehow innate to decent human beings.\u00a0 Being too fixated on having things done your way can jeopardise the relationships that are the key to attitudes and behaviours, if only in that individual.<\/p>\n
When I visit the ER, I will try to take time to gently remind and demonstrate, whilst resisting the urge to shriek in annoyance or start frantically cleaning the machines myself.<\/p>\n