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Sierra Leone: Living through epidemics and expanding in challenging times

12 Jul 21

“When COVID-19 came I was very nervous. I thought it would be another Ebola, which was a death sentence,” says 45-year-old Ira Jonson. Ira was heavily involved in the logistics of the response to the 2014-2016 Ebola outbreak in Sierra Leone.

Monitoring the spread of different diseases

During that time, he met a pregnant woman who was sick with Ebola at the Ebola centre where he was working.

She was always in his thoughts because they spoke the same Mende language and she was in a serious condition.

“When COVID-19 came I was very nervous. I thought it would be another type of Ebola, which was a death sentence,” says Ira Jonson from his office in Freetown during an interview to speak about his experiences during the 2014-2016 Ebola outbreak.

He managed to convince her to seek medical care at the centre.

However, it was too late and, sadly, she died a few days later.

“After we buried her, her husband thanked all of us, marked his wife’s grave with a cross and left,” says Ira.

“I felt I had let her down.”

An MSF-supported health facility in Kenema district, eastern Sierra Leone.

Sierra Leone was still recovering from Ebola and a decade-long civil war that ended in 2002 and when the COVID-19 pandemic began, it is currently struggling to overcome a third wave of the virus.

Médecins Sans Frontières/Doctors Without Borders (MSF) has been providing medical care in Sierra Leone since 1986 and continues to adapt and expand its projects to meet the growing needs in the country.

MSF’s first medical project in Sierra Leone was in response to a cholera outbreak.

Now, our teams monitor the spread of different diseases, including COVID-19, and MSF is part of the case management and surveillance group at the Sierra Leone Emergency Operations Centre.

The MSF outreach team in Kenema district, eastern Sierra Leone, after crossing Sewa river on their way to reach their patients.

MSF currently runs medical projects in three districts, Kenema, Tonkolili and Bombali, helping the Ministry of Health and Sanitation to provide general and specialist healthcare.

In Kenema, in eastern Sierra Leone, MSF’s activities are focused on children under five, pregnant women and lactating mothers.

Part of the daily life in Kenema district. A young girl carries food as she walks through one of the villages in Gorama Mende chiefdom in eastern Kenema district.

Curable and preventable, but still deadly

The outbreaks and years of civil war have severely weakened Sierra Leone’s health system. Children are affected by malaria, malnutrition, diarrhoea and skin diseases.

"Across all age groups, malaria is the country’s single biggest killer, accounting for 38 per cent of hospital admissions in Sierra Leone"

These diseases that are no longer a medical issue in countries with developed health systems.

The MSF medical team conduct afternoon rounds in the intensive care unit at Hangha hospital, in Kenema district, Sierra Leone.

Rehabilitating this sector is a high priority for MSF to reduce deaths among child and new or expecting mothers.

The medical needs of children are vastly greater than the available resources in this region.

The numbers of children who die in their early years has remained high for the last 10 years.

Children in Simbaru chiefdom, in Kenema district, eastern Sierra Leone.

Across all age groups, malaria is the country’s single biggest killer, accounting for 38 per cent of hospital admissions in Sierra Leone.

The disease itself is curable if diagnosed early it and can be treated by a trained community health worker. However, for many, reaching medical care remains a significant challenge.

MSF nurse Rebeca Sia Lahai works with the MSF Academy for Healthcare in Sierra Leone, mentoring other MSF nurses and discussing patients’ vital signs. The professional development of local health workers is one of the top priorities.

Parents bear the burden of not being able to afford the medical care and infected children suffer the consequences.

“Child and maternal mortality rates are exceptionally high in Sierra Leone, but we are working to lower them through our support of the Ministry of health and Sanitation,” says Whitney Ward, MSF head of mission in Sierra Leone.

26-year-old Ka Musa holds her child, who has been diagnosed with malaria, during a consultation with Ministry of health staff at the MSF-supported Hangha community health centre in Kenema, Sierra Leone.

Uninterrupted medical care

Hangha hospital provides medical care to children under five through an emergency room, an intensive care unit and two general paediatric wards.

There is also a therapeutic feeding centre where malnourished children are cared for.

All these services are complemented by a central laboratory, X-ray and a blood bank.

MSF supply manager Gerardo Rivera and logistics supervisor Mohammed Korma check the solar panels that partially power Hangha hospital in Kenema district. The MSF plans to run the hospital fully with clean energy in the future.

Between March 2019 and the end of end of 2020, the hospital treated over 24,361 patients affected by various conditions, including malaria, pneumonia, malnutrition and severe diarrhoea.

The hospital continues to grow the services it provides to patients.

The MSF hospital in Hangha town, Kenema district, eastern Sierra Leone, opened in March 2019. Construction began in October 2020 on a maternity ward, with an operating theatre for caesarean deliveries and a neonatal unit.

Currently, a team of more than 90 workers and architects is building a new maternity ward, with two operating theatres for complicated deliveries and a neonatal unit.

The new ward will bring the total hospital capacity up to 160 beds.

The MSF hospital in Hangha town, Kenema district, eastern Sierra Leone, opened in March 2019. Construction began in October 2020 on a maternity ward, with an operating theatre for caesarean deliveries and a neonatal unit.

As Kenema district is still not 100 per cent covered by the national electricity grid, MSF runs the hospital using a hybrid electric system of solar energy and diesel generators.

In the future, we plan to fully run the hospital with clean energy.

MSF logistics supervisor Mohammed Korma stands amid the solar panels that MSF has installed in Kenema district. MSF is aiming to run the Hangha hospital fully with clean energy in the future.

Linking remote villages to Hangha hospital

“Today I will be crossing Sewa river by the ferry to reach my patients’ in the Wandor and Simbaru chiefdoms. The ferry is bit slow, but eventually I will reach them,” says MSF outreach nurse Saffiatu Timbo.

A ferry worker transports an MSF vehicle across the Sewa river in Kenema district, eastern Sierra Leone. People, cars and goods are transported across this ferry, using a wooden stick that pulls an iron rope.

In Sierra Leone, 60 to 65 per cent of people live in rural areas. Some are in remote, hard to reach villages.

"People face serious obstacles to access medical care; sometimes it’s the high cost of transportation or medications"

Olga EM, MSF Medical Coordinator

MSF outreach teams are delivering medical care directly to people in their villages to address medical issues such as malaria, diarrhoea and pneumonia.

Ferry worker transports MSF vehicle across Sewa river in Kenema district eastern Sierra Leone. People, cars and goods are transported across this ferry and the worker uses a wooden stick that pulls an iron rope.

The outreach teams provide community-based medical care in 25 villages in the Wandor, Nongwa and Simbaru chiefdoms, in Kenema district, through 10 local health units set up in these areas.

“People face serious obstacles to access medical care; sometimes it’s the high cost of transportation or medications,” says Olga EM, MSF Medical Coordinator.

The MSF outreach team in Kenema district, eastern Sierra Leone, waits to cross Sewa river via the ferry to reach their patients at the health facilities on the other side.

“Some villages are too far away from health centres and people can't access adequate healthcare.”

From ensuring consistent supplies of essential drugs, to medical consultations, child vaccinations and health facility rehabilitations, our health promotion teams are providing education sessions in remote villages on malaria prevention and treatment.

A motorcycle transports a generator to a village in Kenema. Parts of Kenema are still not covered by the electricity grid, so people have to transport generators. These roads are not suitable for cars, the only way is to walk or use a motorcycle.

The MSF Academy for Healthcare

MSF’s role in Sierra Leone goes beyond providing mother and child care.

Sierra Leone needs more skilled, qualified health workers to help improve the services provided in general and specialist health facilities, and to deliver effective responses during emergencies like outbreaks and natural disasters.

As part of her training with the MSF Academy for Healthcare, nurse Mariama Seesay and clinical mentor Musa Mansary discuss areas of improvement and how to fill out Mariama’s learning journal.

Between 2014 and 2015, during the Ebola outbreak, hundreds of healthcare workers died.

Staffing for healthcare facilities remains a critical challenge in delivering quality medical care to people.

In Sierra Leone, the MSF Academy for Healthcare initiative focuses on strengthening the skills and competencies of medical professionals providing paediatric care in MSF’s Hangha hospital.

"Investing in healthcare workers has a direct impact in the quality of care provided to Sierra Leonians"

Chloe Widdowson, MSF Academy learning manager in Sierra Leone

The MSF Academy for Healthcare in Kenema district, Sierra Leone, uses the simulation lab to create lifelike scenarios where clinical health officers can practice clinical skills and assessments on a mannequin.

“Investing in healthcare workers has a direct impact in the quality of care provided to Sierra Leonians,” says Chloe Widdowson, MSF Academy learning manager in Sierra Leone.

So far, 110 nurses and 58 clinical health officers have been enrolled in the Academy’s training programmes in Kenema.

MSF doctor Maria Martin runs a training session on how to respond to convulsions for participants of the MSF Academy for Healthcare in Kenema district, Sierra Leone.

In addition, Ministry of Health staff working in different community health centres have been enrolled in an outpatient programme that will help them to provide quality healthcare in the long term.

The MSF Academy for Healthcare is reinforcing the local capacity by setting up a collaboration with the Nurses and Midwives Board. The Academy will welcome groups of nursing teachers for training in mentoring and facilitating skills.

They will have access to all of the Academy’s electronic learning resources, including handouts, learning games, session plans, simulation scenarios, films and learning journals.

Musa Mansaray changes the dressing of an injured child while being mentored by MSF Academy for Healthcare staff at Hangha hospital in Kenema district, Sierra Leone.

We are currently pursing accreditation status with the Sierra Leone Nurses and Midwives Board.

“The official accreditation will enhance academic status of participants studying in our academy and will encourage them and boost their motivations,” says Victor Siroky, MSF Academy representative.

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