It's time to start blogging again...

It’s been 535 days since I blogged. Surprisingly the longer the gap, the harder it is to start, so I will begin by telling you about two major life events have taken place since I last wrote.

The first is the end of the Ebola outbreak, which was declared in November 2015. What a relief and great celebration that was! The Ebola outbreak greatly affected Sierra Leone – every sector and every person in the country was affected in one way or another. For me personally, as I wrote two years ago, Ebola became a part of daily life and it was a matter of persevering to the end.

“It seems as if an hour doesn't go by without Ebola being a part of it. Whether it is during a conversation, work at the hospital, a radio programme, an advertisement, a bucket of chlorinated bleach outside a restaurant, an ambulance with driver in a protective suit that drives by, the constant thought of not touching one's face, no personal contact, a billboard etc. Ebola has become entwined with daily life. Strangely though, when driving through Freetown things still feel fairly normal. It's a bizarre situation.” 

The battle was eventually won but sadly many lives were lost and we continue to remember those who succumbed to the disease as we rebuild what was destroyed and build it back better.

The second event is my resignation in June and my final day of work as Country Director for Welbodi Partnership mid-August 2016. After spending 6 years with this great organization it was time to step down from this particular role. I loved the technical/health programming/clinical improvements side of my work but felt that more and more of my time was being taken up by the operational/organizational/management aspects such as financing, human resources, procurement and line managing. It was too hard (and impossible) to do all of that well (and in reality, two different roles anyway), and so I decided that in order to continue with what I am most passionate about I would need to resign. This is one of the biggest decisions I have ever made but possibly the best. So, I am currently unemployed – which is both great and strange at the same time – and in transition mode - I just don’t know what I am transitioning into yet! Ideally, I find another job in Sierra Leone where I can use my skills to improve maternal and child health. It may or may not include some clinical work, but I would hope it would include things like quality improvement, health programming, capacity building of healthcare workers, guideline development, supporting Ministry of Health plans, etc. (i.e. a technical focus on child health as opposed to an operational/organizational focus, if that makes sense). I am waiting for the right opportunity to present itself and in the meantime I am enjoying this transition period after a pretty intense work pattern.

This is a quick catch up for now and I will be back very soon with stories, thoughts, photos and more.

10 years since opening the outpatient clinic in Aberdeen...

On May 10, 2005 a pediatric clinic opened in Aberdeen, Freetown, Sierra Leone. A doctor from the Netherlands came to set up the clinic and after two months of preparations the doors were opened to patients. Soon this became known as one of the best pediatric clinics in Freetown and parents and children lined up to receive good quality care.

It is hard to believe that it has been 10 years since I opened the outpatient pediatric clinic in Aberdeen. At the time it was called the ACFC - Aberdeen Clinic and Fistula Centre - operated by Mercy Ships. It is now known as the Aberdeen Women's Centre and no longer run by MS. Although the pediatric clinic is currently closed due to Ebola, I am confident they will reopen in the next few months.

I remember the two months leading up to the opening of the clinic - it was a bit of a bumpy ride trying to get the community to agree to the scope of services that would be provided. I was keen to open a pediatric clinic since the child mortality rate in Sierra Leone was the highest in the world and there was no pediatric care nearby. Fortunately the stakeholders agreed that this was a good idea. 

Day 1 of the clinic went well and I soon went from seeing 3 patients, to 18 patients, to 27 patients, to 50 patients, to anywhere between 60 and 80 patients per day. There were many mornings that I had to turn patients away at the gate which was very difficult. There were some occasions in which children died in the clinic because they came in such a bad state and there was so little we could do for them. Those were difficult moments in which we were faced with the reality of the high child mortality rate in the country. Fortunately there were many children, thousands, that my team and I could help and for that I am grateful. It's fun reading through some of my blog posts from 2005-2009 to see some of the adventures I had working in Aberdeen. There were good times and bad times but overall it was such a great experience. It was a really busy time, running the clinic, seeing patients everyday, overseeing the lab and dispensary, ensuring supplies were available, etc. It was worth it though. It was a very rewarding time. A few of my nurses still work there and it is great to be in touch with them. Sometimes I run into some of 'my former patients' or their parents in town or at the Children's Hospital and it is always a blessing to know that I was able to make a difference in their lives. 

Supporting World Hand Hygiene Day with my colleagues - #safeHANDS...

Katie, myself, Bob, Yembeh, Dolphine, Aminata,
Alimamy, Alusine & Aqueelah - #safeHANDS

Today, May 5th 2015, marks ten years of the WHO Clean Care is Safer Care Program and National Celebration of World Hand Hygiene Day. Approximately 800 hospitals in the African region have signed up to promoting hand hygiene and this includes the three hospitals that Welbodi Partnership is supporting: the Ola During Children’s Hospital, Princess Christian Maternity Hospital and Rokupa Government Hospital. As an organisation we want to promote hand hygiene and reinforce handwashing in the hospitals we support. Our Infection Control teams will go to the various wards in each of the hospitals to demonstrate appropriate hand hygiene using special GloGerm to show how important thorough handwashing with soap and water is in keeping themselves and their patients safe.

The Ministry of Health and Sanitation is also ready to celebrate World Hand Hygiene day in collaboration with its partner organisations and a special event will be held at Connaught Hospital, where the Minister of Health and Sanitation will sign a statement pledging support to address health care associated infections in Sierra Leone. This is a milestone in Infection Prevention & Control in Sierra Leone and a necessary step in the fight against Ebola, as we strive to prevent any further health care worker infections of Ebola. We aim for safer health care facilities for staff and patients alike as we move forward in this new era of infection prevention and control in Sierra Leone.

Save Lives, Clean Your Hands!

#safeHANDS

A quieter Easter Monday...

Easter Monday in Sierra Leone is a public holiday and generally one of the busiest, craziest days of the year. I think it's equal only to Boxing day (December 26th) as far as massive treks to the beach and possibly New Year's Eve and the Sierra Leone Independence Day (April 27th) celebrations. 

Usually the day is marked with devil parades in the streets of Freetown. It is generally not a nice atmosphere since the devils can be somewhat daunting and slightly aggressive in their approach. It's a combination of people singing, running, and dancing down the street, often combined with a lot of alcohol, and slight aggressiveness. The devil and his helpers force people to give money or make their followers bow down at certain points of time. The whole scene is a bit upsetting to watch to be honest with you. About 10 years ago I was once caught in the middle of a so called devil parade in the Eastern part of Freetown and it was a scary experience with drunk men climbing on our cars and not letting us proceed. We finally managed to get away from them and had to take a long detour to go home. All this to say, I do not like devil parades and am thankful that this year they did not take place. That is one of the few positive side effects of Ebola. No mass gatherings means no devil parades. I am not complaining about that.

The other most notable difference is that people are not allowed to gather at the beach. Today is usually the busiest day on the beach, Lumley beach in particular is usually packed, and today was probably one of the quietist days at the beach ever. I went to Lumley beach last year on Easter Monday and it was the busiest I had ever seen the beach. I guess today people found other ways to spend time with their family and friends. 

Anyway, for me it was just another day at work and thankfully a more peaceful day than it could have been. I was thankful that there was no traffic going home, no disruptive devil parades, and no noisy neighborhoods. I can't complain. 

Back after 18 days...

I'm back in Freetown, after being away for 18 days. It doesn't seem like I was away for that long, but that's probably because a lot of my time away was spent working. I had Welbodi Partnership Board meetings in London, some time at the UK office, a WHO meeting in Geneva and then a week with my family in the Netherlands, with occasional emails here and there. Despite the need to get work done, at least I was in a different environment for a bit and had some time to catch up on much needed sleep. 

On my arrival in Sierra Leone yesterday, I was welcomed by a pleasant warm breeze as I headed to the immigration line. First stop: the hand washing station, then immigrations and then the next stop: the temperature check. 36.2 Celsius. After that it was business as usual: trying to inch my way towards the conveyor belt in the overcrowded baggage hall to try to retrieve my luggage. I think I saw my suitcases circle the belt 3 times before I finally managed to get someone to pass them to me. After being waved through customs I managed to buy a ticket for the water taxi and before I knew it, I was in the bus on my way to the water taxi terminal. Within an hour landing I was on the boat, crossing over to Freetown - talk about record time - and my luggage was in the same boat. It was great to be picked up by a friend and head home to settle in. 

I spent most of the day today at work. The hospital was quieter than usual since it's officially a public holiday, so I used the time to catch up with some people. I caught up with some of my colleagues and was introduced to the more recent challenges, and some of the pre-existing ones that are on-going. There is an increase in the number of suspected measles cases yet still a difficulty in getting the surveillance forms filled out and the lab samples taken. There are more children being admitted to the holding unit to rule out Ebola but most of them have non Ebola illnesses such as severe malaria and anaemia and end up dying in the isolation unit because they do not have access to things like oxygen there. Waste management still has issues, with various organizations getting involved, but no right solution as of yet. The generator seems to have a problem but I couldn't find the right person to ask about it. Some hospitals have formed their infection control committees while others have not yet met. One of the hospitals we are supporting has not yet scaled down their holding unit and plans are still unclear. Welcome back, Sandra. I definitely have my work cut out for me over the next few weeks/months with finding solutions to these challenges and carrying out the many other tasks that need to be accomplished. Where there's a will, there's a way.

Honestly, although there is a lot going on and I know I will be very busy, I am very excited about the work ahead. Today I had good conversations with my Welbodi Partnership colleagues, with our new matron at ODCH (children's hospital), with the medical superintendent of PCMH (maternity hospital), with the head of environmental health at PCMH, with colleagues from other NGOs at ODCH and PCMH, and more people. It is encouraging to hear that people are keen to move things forward and improve the hospitals as a whole. With team work, motivated spirits, and a couple of deep breaths, this should be possible. 

EVD: conversations during my travels...

It's inevitable that some slightly awkward conversations will come up related to Ebola during one's travels having come from the Ebola region. I have to say that as terrible as EVD is, knowing the mode of transmission and the extremely small risk of it reaching the Europe, I find the conversations and people's reactions somewhat amusing.

Conversation with the immigration officer at Heathrow:
Officer: Good morning
Me: Good morning, how are you? [handing over my passport]
Officer: [scans passport and looks puzzled] Where did you just travel from?
Me: Brussels and prior to that Sierra Leone
Officer: Um, that's what I thought
[pause in the conversation]
Officer: I am sorry but I will have to call someone
Me: That's fine, that is what I expected.
Officer: I am going to have to have someone from public health England meet with you
Me: No problem
Officer: You haven't been around any dead bodies recently have you?
Me: No, don't worry, I haven't and I am well 
Officer: Okay, sorry, this is the first time I have encountered this
Me: You don't have to worry, there's no risk to you
Officer: Okay, please have a seat and wait

Conversation with the man sealing suitcases at  Luton (yes, my suitcase if falling apart):
Me: Good afternoon, I would like to seal my suitcase
Man: Okay, I can help you [takes the suitcase and puts it on the machine]
Man: Where are you traveling to?
Me: Amsterdam and then Geneva
Man: Oh, that sounds interesting, what are you doing in Geneva?
Me: I am going to a WHO meeting
Man: Oh, wow, what is that about?
Me: Ebola
[silence]
Man: Are you sure it's safe for me to touch your suitcase?
Me: Yes, it's not a problem at all, you are safe, I am well, there's no risk 
Man: If my 11 year old daughter finds out about this she is going to be terrified
Me: Really, there's no risk
Man: My daughter is worried that I will get Ebola since I work at an airport. I better not tell her about this.
Me: I think you are pretty safe here in Luton, I wouldn't worry about it. Thanks for sealing my suitcase.
[and off I went with my sealed suitcase]

And there you have it. Some people just don't know what to do when they hear the word Ebola. I guess that is understandable. I have to say, I have wondered how people in the plane would react if they knew I had just come from Sierra Leone. I bet some people would feel pretty uncomfortable for no reason. Thankfully, so far, friends I have met up with in London have not treated me any differently and it's been great (although a bit weird) to shake hands and hug people again. And today for the first time in a long time I held a healthy baby on my lap - that's been a while. It made me realize how little physical contact I have with people now in Freetown. 

EVD: One year since Ebola was confirmed in Guinea...

A year ago today the Ministry of Health of Guinea notified WHO of a rapidly evolving outbreak of Ebola virus disease (EVD) in forested areas of south-eastern Guinea. As of 22 March 2014, a total of 49 cases including 29 deaths had been reported. Now, a year later, the numbers are  higher than anyone could have ever dreamed of.

In Sierra Leone alone we have had over 8,000 confirmed cases of which more than 3000 people have died. In the region, over 10,000 people have died due to Ebola and that is only counting the Ebola deaths. So many more people have died of other illnesses, in part due to the unavailability of health care services and fear of patients to go to health facilities for medical care. There is a real need for all facilities to resume regular services safely.

On Friday we had 0 new cases in Sierra Leone. Today we had 2. The numbers are definitely much lower than they were in November and December when we were averaging anything from 50-70 cases per day. However, although we have now reached the tail end, this phase of the outbreak may yet drag on for some time. The fewer cases recorded, the more chance that people become complacent and revert back to their traditional practices, such as following the traditional burial rites. 

Last week Liberia recorded its first case in more than two weeks of not recording any. In Guinea and Sierra Leone there are still pockets of high transmission. Even worse, in some incidences, is cases that arise without any known contacts. This is a cause of concern, as it means there are more cases out there that no one is aware of. 

Of the 13 districts in Sierra Leone, 4 of them are well past the 42 days without any new cases and 3 districts have gone 21 days without any new cases. However, the remaining 6 districts have all had cases within the last 0-8 days. There is still a lot of work to be done in the area of contact tracing and early case identification. For as long as there is one case in the sub-region, there is a chance that the the epidemic can ignite.

In the Children's Hospital our last positive case of Ebola was 12 days ago. However, staff must remain vigilant. They need to keep screening patients and isolating any children who meet the case definition. One Ebola case that ends up on the general wards in the hospital by mistake could have disastrous effects. We need to keep the safety of staff in mind and be on the alert for any suspect cases. Our plan is to do more training soon on effective screening and safe provision of care during an outbreak. 

Hoping to see zero cases for more than 42 days consecutively throughout the region someday this year...

EVD: difficult decision making...

Although the situation in Sierra Leone with respect to Ebola Virus Disease (EVD) has improved considerably since November, there are still cases in Freetown every day. With Ebola still present, it is important to stay vigilant and have a high index of suspicion. Every single person that enters the hospital compound needs to be screened according to the case definition, and anyone meeting the case definition needs to be isolated and tested. One positive case can infect many people, and that needs to be avoided. 

It's a skill however to find a balance between isolating the right cases in an attempt to keep Ebola out of the main hospital and stop further transmission, versus not unnecessarily isolating cases in the unit since by doing so you may expose the patient to the virus in the unit. It's not an easy judgment call and I applaud the clinical staff making these decisions multiple times a day. Unfortunately EVD presents like a number of other illnesses, some of which are very common in children, like malaria, and so it really is hard to decide which children to isolate. Work is being done in country to try to refine the case definition for children in order to improve identification of possible EVD cases.

At times it's not only the children who are unwell, but also the caregivers, who are then also isolated and tested. Sometimes we have a group of siblings who are all unwell and so they are all isolated and tested. If the results are negative, it's pretty easy, the patient/siblings/caregiver can either be discharged home or be transferred to the hospital for regular (non-Ebola) care. When the results are positive, it is also pretty easy, although sad, and the patient(s) is transferred to an EVD treatment centre. The difficulty arises when you have a negative patients who is still highly suspect or when the results for a group of patients that are related to each other are different.

What do you do when a mother tests positive and her child tests negative? 
What do you do when two siblings test positive and one tests negative? 
What do you do when a highly suspect child, with a contact history, tests negative and is very sick needing non-Ebola care, but possibly incubating the virus? Can she go to the general ward? Do you keep her in the unit with sub-optimal care and risk of more exposure?

This is when some difficult clinical decisions need to be made and fortunately we make them as a team during our morning briefing after I have shared the laboratory results. At that particular moment you do not know if the negative case is truly virus free, or if they are incubating the virus and may develop symptoms and start shedding the virus at any moment. It's not until 21 days later that you really know and during that time they interact with many people. Experience during this outbreak has shown that children especially, can go from being well to being very sick in a matter of hours, testing positive for EVD and posing a high risk to those around them. 

I remember a mother who tested positive and her daughter tested negative. The mother died before she could be transferred to a treatment centre leaving the toddler, who was improving, behind in the unit. We knew the child had been highly exposed so we kept her in the unit in order to re-test her. However, by keeping her in the unit for two more days she was potentially exposed even more. It was a dilemma. The child tested negative the second time and was referred to an observational interim care centre (OICC), where they monitor asymptomatic exposed children for 21 days. If they become symptomatic, they are referred back to the unit for testing, if they remain healthy, they are discharged home or referred to an orphanage if the family cannot be located or if no suitable relative caregiver can be found. Fortunately we could discharge her to the OICC where she continued to improve on her antimalarial treatment and did not develop any other symptoms.  

Sadly these situations do not only pose clinical challenges but they also carry with them some severe psychological and emotional trauma. Siblings who have been admitted to the unit have watched their fellow siblings pass away. Some have watched on while their fellow sibling has been taken away to a treatment centre, not knowing what their brother or sisters fate would be, and whether or not they themselves were yet to test positive, and whether or not they would be re-united. Mothers and fathers have watched their children die, either due to Ebola or non-Ebola diseases. And occassionally, children have witnessed their parent dying in the unit, being left alone. Recently I went to the unit and saw a mother with her child. I knew the child was positive. Sadly the sibling, also positive, had died only hours earlier. It was only a matter of minutes before a nurse would come to tell the mom that this child too was positive and would need to be taken away to a treatment centre. Sadly these are just some of the many stories.

We are all waiting for Ebola to end, but until that day, or actually until 42 days of consecutively having 0 cases in the country, we need to remain vigilant. All patients and visitors must be screened, patents on the wards must be monitored continuously and staff must use the appropriate protective equipment and exercise good clinical judgement.

Welbodi is recruiting a WASH engineer for an exciting Infection Control Project...

Welbodi Partnership is looking to recruit a WASH Engineer for an exciting project in Freetown, Sierra Leone. We are supporting the Ministry of Health and Sanitation with the rollout of a national Infection Prevention and Control Program in three hospitals in Freetown. Through this project we hope to make a significant impact in infection control measures in the hospitals and ensure the safety of both patients and staff. Good infection control is only possible with a sufficient water supply, good access at the point of need (i.e. running water on the wards), an appropriate waste management system, etc. To implement the necessary WASH improvements we would love to have a WASH engineer join our team in Sierra Leone. Please forward this to anyone you feel may be interested:

Position: WASH / Civil Engineer

Location: Freetown, Sierra Leone

Start Date: March 1st 2015

Duration: 6-12 months

BACKGROUND: Welbodi Partnership (WP) is a UK-registered charitable organisation based at the Ola During Children’s Hospital (ODCH) in Freetown, Sierra Leone. For the past six years, Welbodi has worked towards improved paediatric care in the Western Area of Sierra Leone through hospital system development, infrastructural changes, staff training, provision of equipment and community engagement in partnership with ODCH staff, the Ministry of Health and Sanitation (MOHS) and the Sierra Leone Institute of Child Health (SLICH). 

Welbodi Partnership continues to support healthcare in Sierra Leone during the outbreak of Ebola Virus Disease (EVD) by providing coordination support to the holding unit at the Children’s Hospital while at the same time strengthening the safe provision of ‘routine’ health services (non-Ebola care) to children in the hospital. WP is working with the MOHS and other partners to roll out a national programme to strengthen Infection Prevention and Control (IPC) in government hospitals and to ensure that hospitals have the water and sanitation infrastructure necessary to adhere to IPC. Welbodi will implement this programme in three hospitals in Freetown: the national referral Ola During Children’s Hospital, the national referral Princess Christian Maternity Hospital and Rokupa Government Hospital, a community hospital. 

SCOPE OF WORK: Welbodi Partnership is looking to recruit a WASH / Civil Engineer to join the team in Freetown to work in collaboration with the existing hospital maintenance teams and local contractors to improve the water and sanitation infrastructures in the hospitals that are essential for the implementation of IPC practices to reduce the health risks for staff and patients. The WASH Engineer will collaborate with the MOHS established Patient Safety Committees (PSC) as well as the national IPC focal persons and Welbodi Partnership IPC Mentors.

Due to the urgency, applications will be reviewed as they are received and suitable candidates contacted on an on-going basis. This position is for 6-12 months. At this time, WP can only accept applications from citizens or permanent residents of North America, Europe and Sierra Leone due to limitations in the complex evacuation process in case of emergency.

RESPONSIBILITIES:

• To develop a plan for improving the WASH infrastructure at the hospitals based on assessments carried out by partner NGOs in January 2015 and to prioritize the WASH activities according to urgency
• To prepare technical drawings, BOQs and specifications for water and sanitation infrastructure as well as develop, negotiate and manage contracts with service providers, which will include preparing tender documentation and evaluating capacity and quality of contractors
• To provide effective and efficient management of the project implementation in line with the project proposal
• To provide ongoing supervision and mentorship to hospital maintenance staff, technical assistants, contractors and direct labour work teams during the implementation and evaluation of projects
• To offer technical solutions to problems arising during construction and ensure appropriate safety and construction practices are adhered to at all times on site
• To collaborate with the maintenance team and local contractors to implement WASH activities and ensure a functioning management, monitoring and planning body for the ongoing sustainability of the WASH infrastructure
• To carry out further assessments of the hospitals and set up maintenance systems, train staff and arrange repairs of tanks, pumps, generators, pipe networks, drainage systems, etc. as required
• To support the PSC, IPC focal person and IPC Mentor with the implementation, including delivery of training, of the SOP for “Safe Provision of Hospital Services during an Ebola/Viral Haemorrhagic (Fever)” and the Ministry of Health and Sanitation’s “National Patient Safety Guidelines” – this would include specific WASH related training such as disinfection and waste management and monitoring adherence to disinfection and waste management protocols
• To take a leading role during the regular hospital PSC meetings on WASH related matters
• To take a leading role in interagency WASH coordination meetings and develop networks with relevant WASH actors to ensure coordination and works suitability
• Ongoing monitoring and regular reporting of WASH activities for WP and partners
• To support the Project Manager / Country Director in evaluating the impact of the programme
• To perform any other duties deemed necessary to meet the needs of this project

 REQUIREMENTS:

Essential:

• University Degree in Engineering or other relevant WASH field(s)
• At least 3 years of practical, hands-on experience in WASH interventions
• Experience of programme implementation including financial accountability
• Experience of staff management and capacity development
• Excellent people skills and the ability to work collaboratively with people from diverse backgrounds
• Ability to self-motivate and work autonomously within the scope of the role
• Excellent computer skills particularly in Microsoft Word, Power Point and Excel
• A good command of the English language (verbal and written) is required
• Flexibility in roles and responsibility is essential

Highly desirable:

• WASH experience in a development, emergency or post-conflict setting with a good understanding of water (especially water networks), sanitation and/ or solid waste management in the African context
• Experience in a hospital setting
• Experience in WASH/environmental health related training/mentorship/programme development
• Krio or other local language ability

SALARY/BENEFITS: Based on qualifications and experience, to be discussed with shortlisted candidates.

APPLICATION PROCESS: Interested candidates should email a copy of their CV, cover letter, and a list of three relevant references to jobs@welbodipartnership.org as soon as possible. The job title should be included in the subject line. Your cover letter should include: your country of residence and nationality, your date of birth, dates you are able to commence and duration of availability. Only those applicants shortlisted for an interview will be notified. 

Equality and Diversity Statement

The Welbodi Partnership confirms its commitment to a comprehensive policy of Equal Opportunities in volunteering and employment in which individuals are selected and treated on the basis of their relevant merits and abilities and are given Equal Opportunities within the organisation. It is the Welbodi Partnership’s policy as an employer to treat all people equally irrespective of race, ethnic origin, nationality, sex, marital or parental status, sexual orientation, creed, disability, age or political belief. Applicants for this position should be aware that if successful, they will be requested to complete a Disclosure and Barring (DBS) check, or equivalent in countries other than the UK. The Welbodi Partnership complies fully with the DBS Code of Practice. The entirety of the Welbodi Equality and Diversity statement is available upon request.

Ebola affects every person and every sector...

Today [8th January 2015] is the 228th day of the Ebola outbreak in Sierra Leone. A year ago I would not have believed anyone who told me that I would be in the middle of an Ebola outbreak in January 2015. A confirmed Ebola case in West Africa never crossed my mind. Even in May of last year, when the first positive case in Sierra Leone was announced, I could not imagine the extent to which this virus would spread throughout Sierra Leone. No one was ready for the battle we are up against.

To date there have been 7696 confirmed cases in the country, affecting people in every district. Still the virus is looming. It has been an incredibly challenging time for Sierra Leone. Life and work for many people has been consumed by this outbreak and sometimes it is hard to remember a time without Ebola.

Ebola is a terrible disease, causing suffering and death, but its effects go far beyond the illness alone.

Ebola has caused an already fragile healthcare system to collapse, with people afraid to access clinics and hospitals for fear of contracting the virus and healthcare workers anxious to provide care for similar reasons. Some health facilities are closed and others only provide outpatient services. This has led to an increase in morbidity and mortality from more common illnesses and gaps in essential health services. Fortunately people’s confidence in the healthcare system is slowly being restored and at the Ola During Children’s Hospital we are experiencing an increase in the number of non-Ebola cases being admitted to the regular wards. Healthcare workers are starting to feel more protected owing to increased access to personal protective equipment and additional training, however, the loss of over 300 healthcare workers in Sierra Leone due to Ebola still weighs heavily on health professionals with many of them often wondering “Who will be next?” In a country with long standing shortages of healthcare professionals these losses will be felt for years to come.

The impact of this outbreak extends much further than the healthcare sector alone. Many children have been orphaned due to this disease. Families have been wiped away. Some survivors are stigmatized and shunned by their communities. Businesses have closed and trade is limited. Primary and secondary schools have been shut for months with children accessing what little education they can by radio or personal tutors at home. It is unlikely that the College of Medicine and Allied Health Sciences will produce any graduates this year. Farming has come to a halt, leading to food shortages across the country. Every sector and every person is affected by this outbreak.

Thankfully in some parts of the country, the number of cases has significantly reduced. In Freetown, (Western Area) the numbers seem to be stabilizing, but it may still be too soon to tell. There are fewer patients in our holding unit, but that is likely due to the fact that patients are now spread out across more facilities. Even if the number of cases has not dropped, I do know that the number of holding beds for isolation and testing, and treatment beds for confirmed cases have increased considerably over the past few weeks, which is essential for the containment of this virus and breaking the chain of transmission. This gives me hope.

We are all working hard to make sure that this outbreak ends and despite the difficulties, it has been amazing to see the resilience of my Sierra Leonean and international colleagues and the sacrifices that everyone is willing to make in order to achieve a common goal: an Ebola free Sierra Leone.

Read more about Welbodi Partnership’s response to the Ebola outbreak.

Read more about the impact of Ebola on child health.

The first 30 days of thankfulness...

I started a Thankfulness project on Facebook 30 days ago. I'm writing down something I am thankful for everyday to take some time to reflect and by doing so, I hope it will give me a more positive outlook and maybe it can encourage other people as well. I thought it would be fun to compile the list and post it every month.

Day 1: I am grateful for my amazing family and time I have been able to spend with (some of) them over the past two months. Love you all to the moon and back - actually more - make it Pluto and back. (Yes, I know Pluto is a dwarf planet, but it's still further than Neptune.)

Day 2. Grateful for an extended (although unexpected) time in Holland, including wishing my niece a happy 5th birthday!

Day 3. Thankful for a safe and uneventful trip back to Freetown.

Day 4. Thankful for a fairly smooth first day with some chaotic moments and a heightened sense of caution but many welcoming colleagues.

Day 5. Thankful to know that "He is my Refuge and my Fortress".

Day 6. Thankful that one of my friends arrived in Sierra Leone this evening! It was fun to surprise her at the water taxi. Welcome back!

Day 7. Thankful for a lovely dinner at an Indian restaurant (Saffron) with the remaining Dutch contingent

Day 8. Thankful that I can sleep in a little bit tomorrow. Heading in to work at 9 am instead of 7:20.

Day 9. Thankful for a chocolate milkshake at Gina's. Definitely a perk when actually there for a work meeting.

Day 10. Concept note written for world bank funding - urgently need to make sure they or someone funds the Free Health Care Commodities (drugs etc) so that there is no stock out in January 2015! This is essential to ensure ongoing maternal, neonatal and child health care services in the entire country. Should get some feedback and then forward it on to the Ministry and they can take it from there.

Day 11. Thankful for King's Sierra Leone Partnership and the work they are doing at Connaught Hospital. I met some of the team yesterday and saw parts of their isolation set up/operations there. Great people doing a difficult job.

Day 12. Thankful to catch up with a small group of Dutch colleagues and meet one of the Dutch embassy people visiting from Accra headquarters.

Day 13. Thankful to meet up with friends and resume our 'International Bible Study Group' prayer time. Encouraging!

Day 14. Thankful for lab results - we finally got some results after days of not receiving any.

Day 15. Thankful for some time at Roy's restaurant on Lumley beach this evening.

Day 16. Thankful for a productive Saturday - lab packaging handed over to the lab staff at the hospital (to hopefully speed up delivery of specimens to the lab), meeting with one of the Welbodi Board members, talking about infection control in hospitals with a colleague and enjoying fast internet at Country Lodge.

Day 17. Thankful to spend the day at the beach with friends. Sun, Sea, Fish, Chips, Sand, Playing, Chatting. An all around good time with friends.

Day 18. Hmmm. Thankful for a yummy meal of pasta.

Day 19. Thankful for a good day although a very long one. Calling it a day now.

Day 20. Thankful I wasn't hurt (just a slightly bruised hip) when a vehicle backed into me from behind today on the hospital compound. And thankful for the nurse that pushed me to the side. Daily prayers for continued health and safety are welcome.

Day 21. Thankful for a friend who helped clean both Welbodi flats, which were a bit of a disaster after being empty for two months with this humidity. (I'm temporarily staying elsewhere anyway so I am not on my own)

Day 22. Thankful for a good Skype connection to communicate with our Director of Operations in the UK.

Day 23. Thankful for one of my friends and that I can celebrate her birthday with her today - heading to the beach later today.

Day 24. Thankful for an overnight trip to the beach. First time at Cockle Point.

Day 25. Thankful that the ODCH holding unit opened yesterday, starting with the transfer of suspected cases from the isolation area in the Emergency Room to the holding unit (support centre, donated by Cap Anamur, a German NGO, and they will also support the running of it), which is located on the compound next to the hospital with an access gate to the hospital compound. It has 3 wards for suspected cases (low, medium, high risk) I'm not directly involved, but may provide coordination support when needed. Two more patients were admitted today, of which one was a transfer from another facility. We have 4 patients with positive results awaiting transfer to a treatment centre (but the treatment beds are full). This is a positive step forward but there are still many challenges.

Day 26. I am so thankful for the email I received from a friend today saying that he is doing much better but still in Frankfurt recovering from Ebola. Thank God that he is beating this. Continuing to pray for his full recovery and release from the hospital (hopefully soon).

Day 27. Thankful it's bedtime. Feeling rather exhausted today. Praying for a good nights rest and a productive day tomorrow!

Day 28. Thankful that I was able to contribute to the International Child Health Group Winter meeting today. I joined the conference through Skype and provided the attendees with a brief overview of Welbodi Partnership and gave an update on the Ebola outbreak, recent developments and the many challenges. Afterwards there was time to answer questions from the audience. It was insightful and enjoyable!

Day 29. Thankful that people are finally seeing the importance of training hospital staff on infection prevention and control (IPC) so that they can safely provide regular care for non-Ebola cases. It's so important! Preliminary findings show that 60% of the health workers that have been infected with Ebola in Sierra Leone were infected in the non-Ebola areas of the hospitals, 20-25% in the primary care facilities, and the rest probably in either private practice, community settings, and Ebola units. I've been tasked to co-chair a committee with CDC focusing on training hospital staff in IPC.

Day 30. Thankful to have just made a teenager very happy by telling her she does/did not have Ebola. She was on her bed in the ward and I was standing in the visitor area within a 2 meter distance from the ward. She has been in the unit for 5 days and was eager to go home since she was no longer sick. I dropped off the discharge pack of clothes, slippers and transport money, so once she has showered she can head home. Mind you, for the next 21 days she will need to be monitored, in case there was any exposure in the unit. Praying she stays healthy!

Welbodi is recruiting: come and join me in Sierra Leone...

Welbodi Partnership is a UK-registered charitable organisation based at Ola During Children’s Hospital (ODCH) in Freetown, Sierra Leone. For the past five years, Welbodi has been working towards improved paediatric care and a reduced child mortality rate in the Western Area of Sierra Leone through hospital infrastructural development, staff training, and community engagement in partnership with ODCH staff, the Ministry of Health and Sanitation (MOHS) and the Sierra Leone Institute of Child Health (SLICH).

Welbodi Partnership will continue to support paediatric healthcare in Sierra Leone during the current outbreak of Ebola and is looking to recruit the following people to join the team in Freetown, Sierra Leone:

• (Paediatric) Nurse Educator
• Community Coordinator/Advisor
• Project Manager

Ebola has a big impact on the public health systems in the country and will lead to a higher morbidity and mortality from other illnesses. Many children will die during the outbreak due to preventable and treatable conditions such as malaria, pneumonia and diarrhoea. While measures to stop the transmission of Ebola are scaled up, there is a need to focus on supporting the hospital to safely provide routine paediatric services.

A partner organization is running an Ebola holding unit at ODCH, which enables Welbodi Partnership to focus on the hospital itself. Our main activities are:

• To support ODCH in strengthening the delivery of essential ‘routine’ health services (non-Ebola care) to children during the Ebola outbreak in a safe manner, by providing training (plus supervision and ongoing assessment) to hospital staff (nurses, doctors, cleaners, porters, laboratory technicians, etc.), with a primary focus on infection prevention and control (IPC); and by ensuring that IPC supplies and equipment are available to ensure a safe working environment. Thorough screening of patients prior to entering the hospital should decrease the risk of exposure of health care workers, but a degree of risk remains, making the need for strict infection prevention and control (IPC) protocols essential. Other training modules will be taught once the IPC programme has been implemented effectively.
• To provide ODCH with an Ebola Response Fund to meet immediate needs for the hospital during the outbreak for projects that have a direct impact on the Ebola response. The projects can relate to infrastructure, equipment & supplies and capacity building
• To play an active role in the Case Management Committee for the Ebola Response, chaired by the MOHS Director of Hospital and Laboratories, which reports to the National Ebola Response Team. This role involves providing input to Standard Operating Procedures (Holding Centres, Non-Ebola Care Units, Infection Prevention and Control, Ambulance/Transport systems, and more) rolled out at national level.
• To provide direct coordination support to the ODCH Ebola Holding Unit, supported by MOHS and a partner NGO, to ensure that laboratory results are obtained quickly and patients are transferred appropriately.

Once the Ebola outbreak stabilizes we will resume our core activity, which is to provide long-term health system strengthening. We will do this in collaboration with ODCH staff, the Ministry of Health and Sanitation (MOHS) and the Sierra Leone Institute of Child Health (SLICH) to address the infrastructure, equipment and capacity building needs of ODCH and surrounding PHUs by using a participatory approach at community, PHU and hospital level. We will also help establish and support training programmes such as in-country postgraduate training for doctors in paediatrics, a diploma course in paediatric nursing management and leadership and continuing professional development for healthcare workers.

We are currently looking for people to fill the following positions as soon as possible. Due to the urgency, applications will be reviewed as they are received and suitable candidates contacted on an on-going basis. All of the positions are for a minimum of 6 weeks, desirable is 6 months with the possibility of extension. Familiarity with Sierra Leone is a great plus.

Job title:	(Paediatric) Nurse Educator
Role:	To support the national nurse educator in the ODCH nurse training office and help ensure the continuous implementation of high quality in-service training for nurses. Initial focus will be providing IPC training and supervision and monitoring on the wards to healthcare workers (nurses, doctors, cleaners, porters, etc.).
Requirements:	Minimum: A recognised professional nurse qualification with additional qualification in paediatric nursing or infection prevention & control or education, with at least 2 years of experience.
Desirable:	Experience of nursing and/or teaching nurses in West Africa.

Job title:	Community Coordinator/Advisor
Role:	To assess the current needs in the communities and Peripheral Health Units (PHUs) in the vicinity of ODCH in terms of social mobilization in the Ebola response as well as access to and availability of child health services. Long term: To support women and children by engaging community groups in participatory learning and action cycles to identify and prioritize challenges in accessing quality care and addressing these issues at community, PHU and hospital levels.
Requirements:	Minimum: Graduate level degree in relevant field or minimum 3 years health sector and project management experience.
Desirable:	Community or project management experience in a developing country.

Job title:	Project Manager
Role:	To manage projects at community, PHU and hospital level approved by the SLICH Board or a designated sub-committee that have a direct impact on the response to Ebola and neonatal and child health. This includes managing financial and material resources as well as ensuring that project objectives and outcomes are well designed, monitored, evaluated and met. To reconvene and facilitate quality improvement groups in facilities when this is feasible and appropriate.
Requirements:	Minimum: Graduate level degree in relevant field or minimum 3 years health sector and project management experience
Desirable:	Project management experience in a developing country

Benefits

We are looking for people to join the Welbodi Partnership team in Freetown as soon as possible. Benefits include a return flight to/from Sierra Leone, cost of visas and residence permits, cost of national professional registration, shared accommodation, emergency medical and travel insurance (including evacuation), transportation to and from work and a monthly stipend. A good command of the English language is required. Flexibility in roles and responsibility is essential. Appropriate training will be provided on arrival in Sierra Leone and personal protective equipment will be provided on site.

Application process

Interested candidates should email a copy of their CV, cover letter, and a list of three relevant references to jobs@welbodipartnership.org as soon as possible. The job title should be included in the subject line. We welcome applicants of any nationality, including Sierra Leoneans at home or in the diaspora. Only those applicants shortlisted for an interview will be notified.

Your cover letter should include:

• Your country of residence and nationality
• Your date of birth
• Dates you are able to commence
• Duration of availability