“I usually had to send an MSF driver twice a day to fetch large containers of water from wells about half a mile away, in order to ensure the hospital had an adequate supply. The hospital was built on the same site as the previous government facility, which had been destroyed during the war, and although it only opened in June last year it has many problems, including the water supply. After only a couple of months, the hospital looked rundown and dirty. It was vital for the staff and carers to be able to wash their hands properly and have adequate drinking water available, since diarrhoeal diseases were one of the main medical problems - there was a cholera outbreak in the town whilst I was there.
I arrived in Kambia last July on my first mission with MSF. It’s a small and quiet town in the West of Sierra Leone, normally about five hours drive from Freetown, the capital, but up to seven hours in the rainy season owing to bad road conditions. There are a few shops, mostly selling food, and a couple of bars. It’s definitely not the place for a wild night out but we made the most of it! We were a team of six international volunteers, living in a compound. We, the medics, slept in our individual ‘tukuls’ – huts - which contained a table and a bed and were very comfortable. We ate meals and did our work reports in a communal house where the logistician and project co-ordinator slept. In the centre of the compound there was a large tukul where we could all relax in the evenings - if some of us weren’t called out!
The only really difficult thing to cope with was finding your way to the toilet (which was at the other end of the compound) in the middle of the night in the pitch dark or with the aid of a dim torchlight. There was a pit latrine built especially for us in ‘western style’, with a seat over it which the cockroaches liked to share! Despite a team decision to remove the seat, it still remains, although the cockroaches have diminished since our project co-ordinator had a crazy notion one night and used our entire stock of insect killer in the latrine. Going to the toilet that night I wondered what the crunching under my feet was - it was dark and I couldn’t see. In the daylight we saw the massacre of the roaches. Not a pleasant sight!
I went to Sierra Leone as a nurse but soon found I was given a lot more responsibility than I had ever had in the UK. As well as the daily ward rounds, I had to manage the paediatric ward, maternity ward and operating theatre. I was also the pharmacist, sometimes occasional scrub assistant in the operating theatre, and in the last two months, I took over the anaesthetic duties for C-sections and other operations since the anaesthetist left!
The work was constant: ordering drugs and equipment, doing stock counts in the pharmacy, distributing medicines, attending to inpatients and treating outpatients, being on call every third night and eventually 24/7 to cover the anaesthetics. It was difficult seeing ill patients during the nights when I was on call, as the only light available was a few kerosene lamps shared between the wards. Extra work included helping to set up and manage the staff and supplies for a cholera centre, which we had to open away from the hospital in order to decrease the risk of infection.
I was also constantly trying to motivate the local staff, and it was a major challenge to encourage them to turn up for their shifts. Giving them regular teaching sessions helped to motivate them as they enjoyed learning new skills. It was tiring and hard work but I enjoyed it and my learning curve was enormous.
The paediatric ward had 28 beds, but often there were 50 children in there with two or three in each bed. Many were suffering from malaria and unfortunately they were brought to the hospital very late, sometimes because the parents had to carry them from the surrounding villages and it could take a day to reach the hospital. Although there are health clinics, not all of them have the right drugs available and, if they do, many people are too poor to afford them. Some children arrived in a really bad state, already unconscious. Sadly, for some of them it was too late and they were already taking their last breath when they reached the hospital. Others, however, made a miraculous recovery with treatment. Unlike in the UK, I was expected to diagnose and treat, so it was very rewarding for me to watch children under my care, who had been on the verge of dying, walk out of the hospital gates fully recovered. Other children were severely malnourished or had suspected tuberculosis. Many others probably have HIV and AIDS, but are not tested since there is no treatment available for them yet. MSF started a programme last year for the prevention of mother-to-child transmission of the virus. A first step in addressing HIV/ AIDS in the region.
In the hospital we saw the effects of the native herbs which parents gave to their children and very young babies (some only a few days old). I watched several of these babies and children, and also one pregnant woman, die as a result of taking these native herbs. In effect they were poisoned. The parents would often deny using the herbs but then the truth would come out when they knew their child was dying. Sadly, there was often nothing we could do as the poison was destroying their fragile bodies. Unfortunately the use of native herbs is a central part of the culture and the people believe strongly in its power. I only hope these parents will not use them on their next child, but it’s a hard lesson to bear.
My lasting impression will be the positive outlook of the Sierra Leonean people, who have been through such horrific atrocities but somehow remain optimistic and whose smiles I will remember forever. You realise that one of the most important things you can do is to find ways to offer encouragement and support as they rebuild their lives and communities.”