Sierra Leone was still recovering from the largest and deadliest Ebola outbreak in history and a decade-long civil war that ended in 2002 when the COVID-19 pandemic began, and today the West African nation is struggling to overcome a third wave of coronavirus infections. Doctors Without Borders/Médecins Sans Frontières (MSF) is adapting and expanding its projects to meet the country’s growing medical humanitarian needs and helping to strengthen the health system, which is still reeling from years of emergency.
Curable and preventable, but still deadly
Disease outbreaks and conflict have severely weakened Sierra Leone’s health system, leaving children susceptible to malaria, malnutrition, diarrhea, and skin diseases. Rehabilitating this sector is a high priority for MSF to reduce deaths, among both children and people who are pregnant or have recently given birth.
The medical needs of children in particular are vastly greater than the available resources in Sierra Leone. The numbers of children who die in their first few years of life has remained high for the last 10 years. Across all age groups, malaria is the country’s single deadliest disease, accounting for 38 percent of hospital admissions nationwide. The parasitic disease is curable if diagnosed early, and it can be treated by trained community health workers. But for many people reaching medical care remains a significant challenge.
“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,” said Whitney Ward, MSF head of mission.
Uninterrupted medical care
Hangha hospital provides medical care to children under five through an emergency room, an intensive care unit, and two general pediatric wards. There is also a therapeutic feeding center where malnourished children receive care. All these services are complemented by a central laboratory, X-ray, and blood bank.
From March 2019 to the end of 2020, the hospital treated more than 24,361 patients for various conditions, including malaria, pneumonia, malnutrition, and severe diarrhea.
The hospital continues to expand the services it provides. Currently, a team of more than 90 workers and architects is building a new maternity ward, with two operating theaters for complicated deliveries and a neonatal unit. This expansion will bring the total hospital capacity up to 160 beds.
As Kenema district is still not 100 percent 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 transition the hospital to 100 percent clean energy.
Linking remote villages to Hangha hospital
In Sierra Leone, 60 to 65 percent of people live in rural areas. Some are in remote, hard-to-reach villages. MSF outreach teams deliver medical care directly to people where they live to address medical issues such as malaria, diarrhea, and pneumonia. These teams provide community-based medical care in 25 villages in Kenema district’s Wandor, Nongwa, and Simbaru chiefdoms 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,” said Olga Em, MSF medical coordinator. “Some villages are too far away from health centers and people can't access adequate health care.”
MSF ensures consistent supplies of essential drugs to medical consultations, child vaccinations, and health facility rehabilitations. And our health promotion teams provide education sessions in remote villages on malaria prevention and treatment.
The MSF Academy for Health Care
MSF’s work in Sierra Leone goes beyond providing mother and child care and reaching patients in remote regions. Hundreds of health care workers died in the Ebola outbreak between 2014 and 2015, and today staffing for health care facilities remains a critical challenge in delivering quality medical care to people. Sierra Leone urgently needs more skilled, qualified health workers to help improve the services provided in general and specialist health facilities and deliver effective responses during outbreaks and natural disasters.
To help rebuild this capacity, the MSF Academy for Health Care initiative focuses on strengthening the skills and competencies of medical professionals providing pediatric care in MSF’s Hangha hospital.
“Investing in health care workers has a direct impact in the quality of care provided to Sierra Leonians,” said Chloe Widdowson, the MSF Academy’s learning manager. So far, 110 nurses and 58 clinical health officers have been enrolled in the Academy’s training programs in Kenema. In addition, Ministry of Health staff working in different community health centers have been enrolled in an outpatient program that will help them to provide quality health care in the long term.
The MSF Academy for Health Care is also reinforcing capacity by setting up a collaboration with the Sierra Leonian Nurses and Midwives Board. The Academy will welcome groups of nursing teachers for training in mentoring and facilitating skills. These medical professionals will have access to all of the Academy’s electronic learning resources, including handouts, learning games, session plans, simulation scenarios, films, and learning journals.
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,” said Victor Siroky, MSF Academy representative.