Monday, 3 March 2014

Giving Children a Chance: Reducing Child Mortality in Sierra Leone

In the second in a series of blogs focusing on THET funded health partnerships in Sierra Leone, THET's Communications Officer, Timur Bekir, visits Ola During Children's Hospital in Freetown to document the work of the Global Links project. 

It’s a stifling November day (the locals will later laugh and tell me that November is a cool month) and at Ola During Children’s Hospital in Sierra Leone patients crowd the corridors waiting patiently by the Emergency Room. In the Special Care Unit babies struggle to adjust to their new world. And in the ICU a mother tenderly reassures her child. In each of these vital wards is a volunteer from the UK working with local staff to help improve healthcare for Sierra Leone’s youngest residents. 

The volunteers: Paul Gibson, Liza Waldegrave & Gareth Lewis are part of the THET funded Global Links project, a health partnership between the Royal College of Paediatrics & Child Health and the West African College of Physicians. The THET funded Global Links project places long-term volunteers in five African countries: Sierra Leone, Ghana, Kenya, Nigeria & Uganda. The partnership is working with staff and institutions in each of these countries to establish a consortium of UK and East & West African central and district hospitals that will work to reduce child mortality and help meet Millennium Development Goal 4.

The 8 Millennium Development Goals.
Global Links seeks to address MDG4.
The volunteers work closely with the staff at Ola During, the main referral hospital for the whole of Sierra Leone, to provide clinical support, develop protocols and train staff. And, by all accounts, the relationship between the volunteers and their Sierra Leone colleagues is strong. Gareth Lewis, a Paediatric Registrar and Senior Resident at Ola During, highlights the relationship between volunteers and local staff:

‘All the doctors have been great. I’ve been working with one doctor in particular in the Child Protection Unit and she has been really helpful in teaching me bits of Krio here and there. They’ll help with translation. In general they have been very supportive and you never feel excluded as an outsider here.’

Walking around the wards I can see this inclusivity first-hand. The local staff and volunteers have a professional, but easy manner with each other, undoubtedly vital in ensuring a positive and productive working relationship.


Gareth Lewis in the SPU. Photo: Timur Bekir

Gareth Lewis with House Officer. Photo: Timur Bekir

There’s a huge need for support at Ola During, as Dr. Baion, Medical Superintendent, highlights starkly:

‘We have nine wards which means, at the least, we need nine doctors, but we have only two doctors in this hospital. So even having just one person from Global Links helps a lot. They are covering so many areas that we cannot do on our own.’

Paul Gibson, a Consultant Paediatrician in Lancaster, is midway through his twelve month placement. He kindly spends the day showing me around the hospital and introducing me to staff and patients, his energy and enthusiasm doesn't flag for a second. Dr. Gibson is well aware of the need he’s here to address:

‘When last measured, the mortality in Sierra Leone was approximately 170 per 1000 so about 17% of children died before their fifth birthday. What that means at Ola During Hospital is that approximately 10-14% of our admissions die, which is tough on the staff and the whole operation.’

Dr. Paul Gibson. Photo: Timur Bekir

Dr. Gibson and local team. Photo: Timur Bekir

Typical cases at Ola During include malnutrition, malaria and respiratory tract infections. And it’s a constant numbers game – not enough skilled health workers to deal with the cases that come in on a daily basis. As Dr. Gibson notes:

‘One of the features of health and healthcare in Sierra Leone is simply a shortage of numbers of health workers. Then there’s also the quality of skills those health workers have. If you start with the nurses, often they feel poorly paid and unrecognised. And training isn't just about giving people new knowledge and new skills, it’s about giving people a reward. So one of the things that external people like Global Links, funded by THET, can do is bring that in and send a message to nurses or nurse aides that what you do is valuable,  and it’s important to invest in you and your training.’

Emergency Room. Photo: Timur Bekir

Local nursing staff. Photo: Timur Bekir

Nurse attending to a patient in the ER. Photo: Timur Bekir

Patient in the ER. Photo: Timur Bekir

During my two days at Ola During it’s encouraging to see the emphasis placed on evaluating and measuring impact. Away from the wards and in the classroom I sit in on the weekly Mortality & Morbidity session. These meetings are not only a chance for the team to analyse and improve mortality rates in the hospital, but are also the start in rebuilding a much needed medical postgraduate life for the institution.  

The addition of ‘speed learning’ at the end of each day on ICU is helping to supporting and nurture leadership, team working, and improvements to clinical governance, team development and clinical leadership too. Led by the local Staff Nurse, these fifteen minute sessions are a chance for staff to get answers to questions that come up on ward rounds. The sessions foster a culture of sharing and learning as each member of staff contributes by imparting the knowledge they have to answer daily queries.

In addition to these sessions, the volunteers are helping to deliver more training, including twenty hours of undergraduate lectures and a regular, weekly, Continuing Professional Development programme for paediatric staff, including sessions on HIV testing, clinical assessment, and treatment of shock and dehydration.

Liza Waldegrave with nurse in the ICU. Photo: Timur Bekir

Dr. Gibson with patient in the ER. Photo: Timur Bekir

A mother feeds her child in the ER. Photo: Timur Bekir

Dr. Gibson tends to a patient. Photo: Timur Bekir

As my time at Ola During draws to a close, I reflect on spending the day with a really motivated team who clearly care passionately about their role. The challenges are numerous and can sometimes seem overwhelming. But the local staff, with support from UK volunteers, are making gains in a large number of areas. The RCPCH Global Links project is forging a relationship with Ola During and other hospitals around Africa in order to work together to train health workers and improve healthcare for children far into the future. As Dr. Gibson states:

‘Success for colleagues in Sierra Leone would be that in five years there would be an internal self-sustaining confidence that nurses, doctors and midwives actual felt that they were the leaders, that they could control things and come up with ideas. And that the workforce is self-sustaining.’

It’s that emphasis on long-term, sustainable healthcare that is fundamental to the health partnership approach, and why training and developing the skills of local health workers, not just delivering services, is key to realising that approach for real in hospitals in Sierra Leone and around the world.


Dr. Gibson with nurse and mother in the ER. Photo: Timur Bekir

Record keeping in the ER. Photo: Timur Bekir

Patients rest in the ER. Photo: Timur Bekir

House Officer in the SCU. Photo: Timur Bekir

A mother with her child waits to be seen in the ER. Photo: Timur Bekir

To find out more about health partnerships in Sierra Leone and around the world, visit www.thet.org 

To find out more about Global Links and how you can volunteer, visit the RCPCH website.