A clinic day during the COVID19 pandemic…

It’s 6:45 am on a Monday. As I head out the door, I put on a cloth mask and make my way to the paediatric outpatient clinic at the Aberdeen Women's Centre. Unlike many places in the developed world where outpatient services have switched to telemedicine, here in Sierra Leone due to limited connectivity we are still doing in-person consultations. It is the only way to keep essential health services going, which is vital in a country with some of the highest maternal, child and infant mortality rates in the world. 

It goes without saying, safety is our priority: personal safety, colleagues’ safety and that of the patients and caregivers. This is not an easy task and takes considerable planning and resources. Hand hygiene, screening, personal protective equipment (PPE) and social distancing occupy my mind throughout the day. Psychologically it is challenging. Everyone I come into contact with potentially has COVID19. 

On arrival I wash my hands and go through the screening process. Once screened, I enter the hospital compound and make my way to the children’s clinic. I wash my hands. After changing into my scrubs, I wash my hands again before I don personal protective equipment (PPE): head cover, mask, apron, face shield, gloves. Now I am safe, as long as I don’t touch my mask or my face and I wash my hands frequently.   

I walk out of the clinic’s side gate and meet the line of patients waiting to be seen. Our first priority is triage and screening. Triage to ensure that the sickest children are seen first, and screening to identify any potential COVID19 cases to isolate them for testing. During this process we have to ensure that patients are socially distanced and masked up. Although it is made somewhat easier due to painted markings on the sidewalk and chairs placed at least a meter apart, it can be chaotic, requiring a lot of patience. 

Screening takes time but eventually the patients enter the clinic; all wearing face masks. Next, one of the nurses does a health talk, using the time to educate the caregivers about corona virus and how to prevent it. Meanwhile I attend to very sick children in our observation room or, if there aren’t any emergency cases, I prepare my consultation room; disinfecting the table and chairs and making sure I have gloves and hand sanitizer. Finally, I start the general consultations. 

Consultations are carried out as usual except that I consider every person to be a suspect case. Although we screen at the gate, we will miss cases, in particular asymptomatic caregivers. So, I make sure the caregiver and child are sitting at least a meter away from me and I keep my mask and face shield on, using gloves for every patient contact followed by hand hygiene. This process repeats itself until every patient has been seen, either by my colleagues or myself. 

After all of the patients leave, I remove my face shield for disinfection and reuse, wash my hands and attend to administrative tasks, trainings and meetings. My mask is kept on, because even those I work with are suspects. Anyone could be an asymptomatic carrier. 

It’s time to clock out. I doff any remaining PPE, wash my hands, change my clothes, put on a cloth mask and make my way home. On entering my compound, I wash my hands before heading indoors. The workday is done and I can only hope that I kept myself safe today. 

All across Sierra Leone, healthcare workers continue to provide essential health services, as well as COVID19 care. Please pray for courage, safety and perseverance. 

#TogetherWeCan #EndCorona #ProvidingEssentialHealthcare #ChildrenMatter

An unexpected Easter in COVID-19 times...

I am writing to you from mandatory quarantine; all is well. I am currently healthy. Spending time in isolation has given me the opportunity to reflect and although this Easter has not gone as planned, it is probably one of the more meaningful Easter’s I’ve had. 

Over the past few weeks, the following words have become all too real to people all over the world. Isolation. Chaos. Confusion. Fear. Death. Suffering. Loneliness. Pain. Hurt. Loss. Doubt. Distress. Uncertainty. Despair. We are confronted with the reality of separation, disease and death. Our world feels like it has been turned upside down. Maybe it’s not so crazy that this pandemic happens to coincide with Easter.

The moments leading up to Jesus’ death were full of turmoil. Jesus was distressed and troubled in the garden of Gethsemane. One of his very own, Judas, betrays him. Peter disowns him. Soldiers mock him. Those who pass by the cross hurl insults at him. And at noon, complete darkness fills the land. Jesus cries out “My God, my God, why have you forsaken me?” How many of us have asked where God is in the midst of this COVID-19 pandemic? The earth shook. The temple curtain split in two. Unprecedented. A day like no other.

The good news is, resurrection Sunday came. The angel said to the women, “Do not be afraid, for I know that you are looking for Jesus, who was crucified. He is not here; He is risen, just as he said.” (Matthew 28:5-6)  Death did not hold Jesus. The darkest moment in history transformed into the greatest love story the world has ever known. Amazing grace. Through His death and resurrection, we are brought out of the darkness and into the light.  He does not promise us an easy life but He promises us a life with Him. In the middle of our current unexpected storm, He is our anchor. He is our light and our strength in these dark times. He is our peace. Hope is not lost. 

Christ is risen! Let’s rejoice today as we celebrate our Lord and Saviour – our hope and our strength! May you have a deeper awareness of His love and peace today. 

Good Friday: in the midst of chaos and uncertainty

On Good Friday, I am reminded that in the midst of the chaos and uncertainty in the world, and despite Easter weekend looking very different this year than we may have imagined or hoped due to the COVID-19 pandemic, Jesus is the same yesterday, today and forever. 

Our circumstances change, but He doesn’t. We feel like we’ve lost control, but He hasn’t. We may feel alone, but He is with us. He is the same yesterday, today and forever. 

Today I reflect on the amazing sacrifice He made, the outrageous love He displayed and the grace He extends to me over and over again. May we rejoice in the hope that we have in Him. And may we remember that He is the same yesterday, today and forever. 

Whirlwind Weeks: COVID19 confirmed in Sierra Leone

The last few weeks have been quite something; it's hard to even put it in words. The whole world is consumed by COVID19 with daily increases of cases, deaths, lockdowns, overwhelmed health facilities, shortages of personal protective equipment and pretty much every headline focussed on the disease. Meanwhile, Sierra Leone was amongst a small group of countries in the world yet to confirm a case. However, as the President of Sierra Leone stated on the 24th March 2020, when he declared a State of Public Emergency, it was not a matter of 'if' the coronavirus would come to Sierra Leone, but 'when'. 

Sadly, today is that day. The first COVID19 case was confirmed in Sierra Leone. The index case is a national who traveled from Europe back to Sierra Leone. Symptoms were experienced during quarantine and the index case went to an appropriate health facility for isolation and testing without first going home. Confirmatory tests were positive. Thankfully, the person is in stable condition and measures have been put in place for contact tracing in a systematic manner. We all hope and pray this disease will be contained. 

The government has made good efforts during the preparedness phase to try to prevent/contain COVID19 from coming to/spreading in Sierra Leone. The big shift came on the 19th of March when the government announced that flights would be suspended for a period of 90 days. Within hours and days a myriad of measures were put into place including no large gatherings, closing of mosques and churches, schools stopping by the 31st March, stopping the LUMA markets upcountry, restrictions of passengers in public transport, closing the land borders and declaring a State of Public Emergency. Now that we have a case in country, additional measures will follow.

While the government plays its part, and the various pillars at the Emergency Operations Centre work hard to contain COVID19, it's important that we as individuals take ownership and make sure we prevent spread of this disease.

Wash your hands with soap and water frequently for at least 20 seconds.

Cough and sneeze into your elbow.

Do not touch your face. 

Avoid contact with sick people.

Keep physical distance from each other. 

Call 117 if you are sick.

Follow local health advice.

Let's pray for Sierra Leone and for the world.

Wake up world: stop tolerating harmful medical practice...

As you likely know, I am a qualified and registered medical doctor working alongside national staff in a facility that is run by a UK foundation and supported and registered by the Ministry of Health and Sanitation, providing outpatient medical care to sick children below 16 years of age. The severity of illness we deal with ranges from a child with a runny nose to a child who is unconscious due to severe malaria. Regardless of the situation, our team acts based on our training and experience. Yes, we are forever learning, but through years of training, we have been equipped to handle such situations. I cannot even begin to imagine managing critically ill children with no medical training.

I am shocked but not too surprised to read the story of Bach, who according to this article, went to Uganda as a 20 year old highschool graduate with no medical training, and ended up running a centre for children with severe acute malnutrition for five years, performing medical procedures herself. If these facts are true, this is wrong on so many levels. And sadly, stories like this are a reality in many developing countries. 

This would not be the first time a possibly well-meaning, but naïve or ignorant, individual sets out to help others but puts lives at more risk. Some might call it the White Saviour Complex. Whatever you call it, it is appalling and needs to stop. Whether it is foreigners coming in to “help” or nationals "helping" their own people, if they are working outside of their realm of expertise or doing more harm than good; STOP THEM. If the facts are accurate, it is also infuriating that Bach's friends, family and Board did not intervene but applauded from the side lines.

I don’t have more details than what is included in the article linked above, but I know this is a global issue and I believe we can and must do better. We owe it to ourselves and we owe it to those we care for. The world needs to wake up. So, here are some reminders...

Common sense: 

• Don’t do what you’re not qualified to do.
• Always make sure that what you are doing is legal.

Responsible humanitarian aid: 

• Don’t think YOU can save faulty systems or the world for that matter.  You may be able to help, but you are by no means THE solution. 
• Work alongside local authorities and nationals on a long-term sustainable and coordinated response. 
• Do not do your own thing.

Appropriate support and sponsoring:

• Know who and what you are supporting.
• Make sure the charities you support are law abiding.
• If you know that someone is working in a capacity overseas that would not be acceptable in your own country, strongly advise them to stop.
• Advise people you support overseas to work alongside nationals who know far more about their setting and context than a foreigner ever will.

Wake up call for local authorities in developing countries: 

• Supervise and monitor all of the so-called health facilities and professionals. Put clinical governance systems in place. I know that in Sierra Leone, there are “clinics”, pharmacies and healthcare workers working outside of their legal boundaries, providing potentially harmful care. Some do more harm than good and should be shut down. Why tolerate it at someone else's expense? 

Building a good health system does not only mean improving standards and ensuring high quality care but it also entails regulation, which means shutting down illegal and/or unsafe health facilities and revoking licenses of those who do more harm than good.

#wecandobetter #sierraleone #healthcare #clinicalgovernance #healthsystems #partnership #collaboration  #regulation #moreregulationneeded #ethics #healthramblings #commonsense #dogoodnotharm #supervisionandmonitoring

Another year...

Today marks the first day of another year at Aberdeen Women's Centre! Yesterday, I completed my first year working as a doctor in the outpatient paediatric clinic. There was a lot of transition at the start, including a move to a new home, resuming clinical work and starting my online Masters in Public Health and at times I wondered if I would make it to the end of the contract. Thankfully, I did and I’ve decided to stay put for another year.  

Although there are parts of my work that are frustrating and challenging, like any job I suppose, the work I do in Aberdeen is also very rewarding. I have the unique opportunity to help children get better and advise and encourage the caregivers to provide healthier environments for their children, whether it’s through nutritional advice, encouraging them to bring their children for immunisations or teaching them how to prevent illness. It’s a privilege to work alongside a Sierra Leonean team and provide healthcare that makes a difference in the lives of children and families in Freetown.

Now that the rains have started, the clinic is even busier than usual and in the past three days alone we’ve treated over 400 patients. We are seeing more diarrheal disease, respiratory disease, as well as cases of severe malaria, in children of all ages. At times it’s scary to see just how sick these children can get but on the flip side, it is amazing to see how so many of them recover. I’m hoping for ongoing wisdom and energy for our team as we strive to help as many children as we can despite the craziness and long days. Here’s to another year at AWC.  

First 24 hours...

I arrived in Freetown last night after being away for a month. I had a great time on my three country trip but it was really good to come home! 

Besides the fact that the electricity cut out at around 3am meaning my fan switched off and it got pretty warm, I slept quite well. Thankfully the power came back and my fan cooled the room down again. Breakfast today consisted of tea with a Basha donut, courtesy of my housemate who was very considerate to buy some 'welcome back donuts' yesterday. 

Within 10 hours of arriving home I walked out of the front door and out of the gate to find a taxi to take me to work. On arrival I was warmly welcomed by staff at AWC, which is always encouraging and fun, except for the comments about how I’ve gained weight because I was fed so well while on leave. This is one of those cultural things I will never quite appreciate. Is it really okay to tell someone they are fat?! I'm sure the donut this morning didn't help. ;)

There were about 45 patients waiting in the clinic when I arrived and they had probably been waiting since 5 or 6 am already. That’s the way it works here - no appointments and people come early to make sure they are seen that day. Thankfully clinic didn’t get too busy and we were able to take our time during the consultations. I even had time for lunch, which was rice with potato leaves - my favorite AWC meal.

My first patient was an infant who needed to be referred due to severe pneumonia. I also saw a child with epilepsy, a 5 year old weighing 11 kilograms and a child who had been mismanaged at a pharmacy who I diagnosed with malaria and started on treatment. I saw others with acute respiratory tract infections, skin conditions like scabies and diarrhoeal disease. It’s definitely never dull! I even had a little time left over at the end of the afternoon to update one of our protocols. 

After work I found a taxi to take me to Aberdeen road junction, walked to a supermarket to pick up a few essential items and then walked home from there, ignoring quite a few “white girl” comments on the way. Another one of those things I have never gotten used to!

I had a relaxing evening at home, which is a nice change since I usually come home and have to start studying right away. Thankfully module 3 of my MPH doesn’t start for another week. 

Alright, that’s it for a little glimpse of my first 24 hours back in Sierra Leone. More another day. It’s bed time now.

#lifeinsierraleone #sierraleone #alwaysanadventure #outpatientclinic #AWC 

Breaking news in Sierra Leone - Presidential Elections…

As of tonight, Sierra Leone will have a new President, with the swearing in taking place any time now. Congratulations Julius Maada Bio. It was a 4 week process, but we finally have an outcome. 

The first round of elections between 16 Presidential candidates was held on the 7th of March, 2018. The results were announced on the 13th of March. SLPP was in the lead with 43.3% of the votes, with APC closely behind with 42.7%. Since neither party had more than 55% or more, a run-off election was announced for the 27th March 2018. NGC had 6.9% of the votes and C4C 3.5%. The remaining 12 parties all had 1.1% or less. There was an 84% voter turnout. 

However, on the 26th March we awaited a decision by the High Court due to an interim injunction halting the runoff presidential election. Fortunately it was halted and the run-off election was allowed to go ahead, however, due to logistics that needed to be put in place, the run-off was postponed to Saturday 31 March, 2018. 

On Saturday 31 March, 2018, the run-off Presidential election was held. 2,578,271 people voted in 11,122 polling stations across the country, representing 81/11% of all registered voters.

On Monday 2 April, 2018 the tallying was halted due to a disagreement between the parties on the process used.  Later that day ballot counting and tallying continued with both parties having come to an agreement with the National Electoral Commission resolving the earlier dispute about which system to use. 

On 4 April, 2018, just after 10 pm, the National Electoral Commission announced that Bio Julius Made, having polled 51.81% of the valid votes cast on the 31st March 2018 Presidential election run-off, has been duly elected President of the Republic of Sierra Leone. 

There has been a lot of cheering, singing, whistle blowing, banging of pot covers tonight as many Sierra Leoneans are out in the streets celebrating. Let's hope for continued peace and for good conduct amongst people from various political parties. Hopefully everyone will graciously accept the election results. The people have spoken.

Congratulations Sierra Leone on conducting a peaceful, fair and transparent election. The people have decided and effected change. Let’s work together for the good of the country. Be positive. One country, one people. 🇸🇱💚

#SierraLeoneDecides #SierraLeoneElections #sierraleone #votesalone #salonevotes #keepthepeace #slppwins #onecountryonepeople

Sierra Leone election results...

Sierra Leone Election News. Freetown, Sierra Leone: The last 24 hours have been a little tense in Sierra Leone as we have been waiting for the results to be announced from the presidential election held on 7 March 2018. 

There was a lot of anticipation on the 12th of March 2018 with the hopes that the results would be announced by the National Electoral Commission (NEC). There were rumors that they would communicate at 14:00 hrs, then 16:00 hrs, then 19:00 hrs. However, the announcement did not take place and instead we were informed that ballot papers were going to be recounted at 72 polling stations in various districts. This was in addition to recounts in 82 polling stations, announced the previous day. These recounts were being conducted after deliberations with political parties. 

During the day on the 13th of March there were more rumours that the results would be announced. Finally at 16:30 hours, NEC announced that there would be a briefing held at a press conference at 19:00 hrs today. 

At 19:00 hrs today thousands of people in Sierra Leone were tuned in to their radios, waiting in suspense for NEC's announcement. Finally, at 19:46 hrs, NEC announced the election results for the presidential election with the opposition party, SLPP, leading with 43.3% of the votes and the ruling party, APC, closely behind with 42.7%. Since neither party has 55% or more of the votes, a run-off election will be held on 27 March 2018, two weeks from today.  NGC has 6.9% of the votes, C4C 3.5% and the remaining 12 parties all have 1.1% or less. 

NEC reports that the results from 221 polling stations were excluded, including stations where votes cast exceeded the number of registered voters at those stations.  Also, after deliberations with political parties, recounts were conducted in 154 polling stations, none of these results were nullified. 

There were 3,178,663 people registered to vote, of which 2,676,549 people voted (with 139,427 invalid votes), meaning there was a 84.2% voter turnout on 7 March 2018. 

Well done Sierra Leone for conducting a credible election. Let's continue to keep the peace in the lead up to the run-off and the transition of power to whoever is elected as the next President of Sierra Leone. 

National Electoral Commission results: 13 March 2018

#SierraLeoneDecides #SierraLeoneElections #sierraleone #keepthepeace #undivided #votesalone #presidentialelections #NEC #votesalone

Let girls be girls...

Today on International Women’s Day I want to be a voice for the many girls, who are yet to become women; those who have already experienced pregnancy. Sierra Leone has the 7th highest adolescent pregnancy rate in the world, with 38% of women aged 20-24 giving birth by the age of 18. This has significant consequences for their own health and that of their baby, as well as vast socioeconomic impact. Children bearing children. This is wrong. 

Sierra Leone has some of the highest maternal, infant and child mortality rates in the world and 40% of maternal deaths are as a result of adolescent pregnancy. Infants born to teenage mothers are at higher risk, with stillbirths and deaths in the first week of life being 50% higher, compared with babies born to 20-29 year olds. 46% of adolescents with no education become pregnant, compared to 22% with secondary education or higher. The third most common cause for school dropout among girls is pregnancy. Education is crucial. For every year a girl remains in primary school her income increases by 10-20% with an extra year of secondary school increasing earnings by 15-25%. These wages are likely to be reinvested into their families, creating better opportunities for their children. Every year of secondary school may reduce child marriage by 5% and for each additional year of girl education, child mortality decreased by 9.5%.

There are many health and gender inequalities that contribute to adolescent pregnancy: poverty, lack of education, gendered social norms, child marriage, traditional practices, and the list goes on. Girls in other countries face similar risks. What is being done about this? Can we do more?

As we stand up for women today, let us also stand up for girls. Let’s educate them and empower them. Let’s provide the needed health and social services for them. Let’s enforce legislation that protects them. As the government in Sierra Leone states: “Let girls be girls, not mothers”. 

Let’s work together to make this happen. Whether you are a government official,  or a teacher, or a nurse, or a social worker, or a stay at home mother, or an aunty, or a grandmother, let’s all play our part. Change policies, provide better services, be a positive role model. Encourage. Empower. Educate. For the girls you have the privilege to interact with, invest in them and raise them up to be strong women.  

#internationalwomensday #letgirlsbegirls #empowergirls #educategirls #endchildmarriage #educationforall #genderequality #healthcareforall #raisestrongwomen #adolescentpregnancy #teenagepregnancy

Note: Data in this post is taken from my end of module project for my Masters in Public Health submitted 28 February 2018.

Sierra Leone Decides...

7 March 2018, Freetown, Sierra Leone 

Today was a big day in Sierra Leone as voters went to cast their votes at the polling stations. Across the country 11,000 polling stations were open for voting between 7 am and 5 pm and according to the National Electoral Commission, 3,178,663 people were registered to vote. At some polling stations, people starting lining up at 2 am, at others it was later, but by 7 am, most of the stations were open to voters. The voters were each given 4 ballots to vote for Presidential, Parliamentary, Local Council and Mayoral candidates. Once the ballots were marked, they were immediately deposited into the designated ballot boxes. After polling stations closed at 5pm, the manual counting of the votes began.

The day was peaceful and there was a great atmosphere in the air. I was able to visit two polling centres and it was great to sense the excitement. From what I could see, and from what I’ve read, NEC organised the election extremely well, and in most polling stations, it has been reported that voting was carried out well.

It wasn’t until after 5pm that there was some commotion reported in a few different areas in Freetown. Apparently the police searched the premises of the main opposition leader, where he and his team were monitoring the elections, on allegations that they were hacking results. This intrusion led to commotion. Thankfully the former Ghanaian President, also head of the Commonwealth election observer mission, diffused the situation. It is of note that counting of votes is all done manually.

A time of waiting and anticipation has begun and many people will be listening to their radios over the coming days while the counting continues. NEC will announce initial results once 25% of the votes have been counted and verified.

Let’s wait patiently and peacefully. Amazing patriotism was shown today. Please continue to make Sierra Leone proud. Stand United.

#SierraLeoneDecides #SierraLeoneElections #sierraleonevotes #presidentialelection #sierraleoneelection #electionsinsierraleone #sierraleone #undivided #keepthepeace

Election eve in Sierra Leone...

It’s the eve before the elections. 

What a gorgeous sunset. 

There’s so much excitement in the air today. 

Everyone is talking about the elections. 

People are so keen to vote tomorrow.

Some people are still traveling to whichever town or city they are registered to vote.

A lot of people are scurrying about running errands.

I went to the supermarket after work today.

I’ve never seen it busier.

Many people are stocking up, just in case. 

Hopefully it’s not even necessary.

But maybe it’s better to be safe. 

It’s hard to judge what the risk is anyway. 

Some organisations made staff stay indoors today.

I’ve been going to work and other places using public transport. 

There’s no right approach except to be alert, listen for legitimate updates (there’s a lot of fake news) and be flexible. 

Right now, there’s a good vibe in the air. 

So far so good. 

I hope and pray it stays that way.

Let’s pray that tomorrow’s elections are free and fair. 

And that everyone who registered to vote can get to their polling station despite vehicle bans. 

Soon we will know who the people of Sierra Leone voted for.

The next week will be a week full of anticipation. 

Let’s pray that tomorrow, and the days following the elections are full of peace and unity.

Vote wisely Sierra Leone. 

Make your vote count.

#sierraleonevotes #presidentialelection #sierraleoneelection #electionsinsierraleone #sierraleone #undivided #keepthepeace