Tuesday, November 24, 2009

Recruiting: Voluntary Medical Coordinator 2010-2011

Voluntary Position Available – Medical Coordinator
Location: Freetown, Sierra Leone
Assignment Length: One year
Application Deadline: 31st January 2010
Starting – July 2010 (start date may be somewhat flexible)

Job Description

The Medical Coordinator (MC) will provide technical leadership and contribute to the development and implementation of ongoing and new project activities aimed at improving the quality of paediatric health care in Sierra Leone, starting at the country’s only specialist paediatric facility, Ola During Children’s Hospital (ODCH).


The Medical Coordinator (MC) is responsible for the design and implementation of all medical project work. This includes:

1. Needs assessment and planning: Work with partners in the Ministry of Health and Sanitation (MoHS) and Ola During Children’s Hospital (ODCH), to identify barriers to the delivery of timely and effective healthcare for children and develop ongoing plans to address these barriers.

2. Implementation: Take joint responsibility with ODCH management and staff for implementing medical project work. This may include coordinating and delivering in-service training for healthcare workers, promoting improved clinical standards and supporting the introduction of new technologies and techniques.

3. Monitoring and evaluation: Together the Welbodi Directors and local partners, design and implement systems to monitor the process, effectiveness, and impact of activities on desired outcome measures.

4. Relationships: Work closely with doctors, nurses and other staff in the hospital to ensure good communication between ODCH and the Welbodi Partnership on all issues. Periodically meet with donors, international and local NGOs, and MoHS to update them. Where appropriate, you may develop collaborations and partnerships within broader efforts to reduce child mortality in Sierra Leone.

5. Fundraising: Help the Welbodi Partnership fundraisers to identify funding needs and provide appropriate technical information as necessary in the development of fundraising materials and proposals.

6. Clinical Work. Engage in direct patient care in order to maintain clinical skills and gain first-hand knowledge of the realities of patient care within this environment.

1. Medical or nursing degree is essential with at least two years experience working in health care. Additional postgraduate qualification in international development, public health or public policy is highly desirable.
2. Professional experience of healthcare in Africa.
3. In-depth, substantive knowledge of healthcare policy in developing countries.
4. Excellent people skills and a demonstrated ability to work collaboratively with people from diverse backgrounds in a dynamic and constantly-shifting environment.
5. Excellent written and oral English communication skills.
6. Flexibility, focus, and the presence of mind to work in sometimes difficult and chaotic circumstances.
7. Commitment to the goals and principles of the Welbodi Partnership.


The Welbodi Partnership (WP) is a UK-registered charity established to support the provision of paediatric health care in Sierra Leone and in particular to support the Sierra Leone Institute for Child Health (SLICH). SLICH is a joint project between the Sierra Leone Ministry of Health and Sanitation, the Ola During Children’s Hospital, and the Welbodi Partnership to create a centre of excellence in paediatric care. It forms part of the Government of Sierra Leone’s Strategic Plan for Reproductive and Child Health.

Ola During is Sierra Leone’s only specialist children’s hospital, located on Fourah Bay Road in the poor and densely-populated eastern part of Freetown. More than 15,000 patients are treated at the hospital each year, spread across two inpatient wards, an outpatient department, emergency room, ICU and a therapeutic feeding centre. The hospital is extremely under-resourced, however, and providing adequate care is still a challenge.

To learn more about us, please visit our website at www.welbodipartnership.org.

We are seeking an individual to fill the role of Medical Coordinator described above, who will work alongside the two Welbodi Partnership Directors in Freetown and in the UK, our Fundraisers and a network of local and international partners.

Interested candidates should please send a CV and cover letter by 31st January 2010 for the attention of: Matthew Clark


Further Important information for applicants

The Welbodi Partnership is a small organisation with limited financial resources. To keep our overheads low, this position has been filled on a voluntary basis over the past 2 years.

We are willing to contribute towards cost of travel, visas, and medical insurance, but you would need to cover your own living expenses.

In order for you to decide whether or not you can do so, we want you to know what to expect in terms of the cost of living. Although Sierra Leone is a very poor country, it is surprisingly expensive to live an expatriate lifestyle. You can get a relatively simple self-contained local-style flat for around $3,000 per year, but it may not have running water (instead you'd find someone to bring you buckets of water each day), frequent electricity (you could buy and fuel a private generator), or modern appliances.

In contrast, a room in a larger, higher-end house in one of the nicer areas of town will likely run you upwards of $400 per month, plus $200-300 more for electricity, water, a cleaner, internet, etc. Likewise, it is possible to by a local meal of rice and sauce for just a few dollars, but an individual pizza in one of the more upmarket Western-style restaurants costs $12. And taking local shared taxis back and forth to the hospital would cost about $1-2 / day, while chartering an individual taxi could run $10-15 per day and buying and fuelling a private vehicle is similar.

As the Medical Coordinator of the Welbodi Partnership, you would have a direct and significant impact on the quality of care provided to children both at ODCH and throughout the paediatric healthcare system. You would be part of building a relatively new organization from the ground up, of identifying and implementing high-impact interventions -- including quality training for Sierra Leone's young doctors and nurses -- and of building a foundation for lasting change. You would join a committed core team and would be responsible for leveraging the contributions of a wider network of volunteers and partners to bring significant and lasting change to ODCH.

Friday, November 20, 2009

The devil is in the detail

Our Medical Coordinator, Dr Emily Spry, is writing for the BMJ about her experiences at the hospital...


The devil is in the detail

It might seem odd that the most challenging folk to work with here are not the Sierra Leonean ones. Sometimes the toughest part is dealing with the endeavours of my fellow “whiteman”.

“Development” can be a painful business. It’s painful because of the contrast between what is promised and what is possible, what is dreamed versus what is ever implemented or achieved.

In a country as poor as Sierra Leone, it is so easy to “see” solutions, so easy to make big promises - so much could be fixed with so little, everywhere you turn. Or so it seems.

The truth is, of course, that if it were easy, someone would have done it long ago.

The devil is in the detail, every time. And the details are messy, dirty, tiresome and impossible to uncover from the sanctity of an air-conditioned office.

A classic example is the two giant generators sitting quietly in a building at the back of the Children’s Hospital. Installed during the “rehabilitation” of the Hospital in the early 1990s, just after the war, these were paid for by an African Development Bank loan.

Despite the fact that the regular power cuts leave the hospital operating by candlelight, they have never been used. Why?

Generators of that size use 16 gallons per hour of fuel such that running them would cost 240,000 Leones (around 40 pounds) per hour.

This fuel cost per hour is around the price of employing a full-time nurse for a month. Even if the Hospital received its meagre budget from the Ministry (which it has not so far in 2009), the generators are useless.

Who on earth would buy such a thing with money meant to get the hospital back on its feet? And why are they not held accountable?

In fact, these generators were paid for by Western tax payers. Even more painfully, they are paid for by the ordinary Sierra Leonean who should have got rather more development bang for their aid buck. Every dollar wasted is not just a dollar wasted. It’s a dollar that should have been spent on something better.

Being white here, and particularly British, bring great benefits to one’s self-esteem. Many Sierra Leoneans credit the British army with ending their decade-long war and we are often joyfully hailed as “IMATT” (the remaining British military representatives here) as we drive our old Landrover around town. Strangers regularly thank us for our work, without ever asking what we are actually doing in Freetown.

But when I look at how often the “whiteman” has stood so proud and magnanimous and then failed to deliver, I feel acutely ashamed.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.

Friday, November 13, 2009

Emergency Room Progress

Our Medical Coordinator, Dr Emily Spry, is writing for the BMJ about her experiences at the hospital...


Emily Spry on ER in the Pikin Hospital

Pikin HospitalI am happy and exhausted at the end of the first week of the new Triage system and Emergency Room at the Children’s Hospital. Around 80 children present to the hospital each day and Triage nurses now briefly assess them and rush those with Emergency signs to the new 3-bedded ER. There they are assessed and given emergency treatment by a team of specially-trained nurses and the Medical Officer on call.

After 4 days of training last week, the nurses are showing great enthusiasm. I have seen several cases where their prompt intervention bought the child crucial time, allowing a happy outcome instead of a tragic one. This is particularly the case with the hypoglycaemia associated with malaria and malnutrition. It is hard to describe the buzz you get when a grey, clammy, barely-breathing child wakes up after their dextrose infusion and starts screaming. The nurses had most of the skills and knowledge before, but the ER seems to allow everyone to focus their attention on the sickest children for the crucial first half hour or so after they arrive.

That’s not to say it’s all been plain sailing. It quickly emerged that, despite recent payments to the hospital electricians to renovate the room, none of the plugs in the ER work. Our brand new oxygen concentrator tubing now stretches across from another bay and is trampled on every few minutes. The concentrator also has a two-pin plug; the nurses do a hair-raising trick with a pair of scissors to jam it into the three-pin sockets.

There is no precise system for sharps collection or disposal. Although this part of Africa has a relatively low HIV prevalence, this is clearly still breath-takingly dangerous for all involved. As far as I have been able to ascertain, the standard method of waste disposal in Freetown is to chuck it over the nearest wall, which doesn’t give me great confidence about where our lovely mixed clinical waste is going.

But it’s one day at a time… this weekend I’m buying some plastic buckets so that water for hand-washing can be fetched when the taps go off. Maybe I’ll buy an extension cable and a plug adapter too. At some point in the next few months, I’ll spend a day following the cleaners and pondering how to make a sharps bin that has no resale value (else it will undoubtedly be emptied and recycled somewhere along the chain).

Staffing the new ER was in its first week was complicated somewhat by it coinciding with the Sierra Leone Medical and Dental Association annual conference, in which several of our Medical Officers played a role.

Amazingly for a country of 6 million people, there is only one fully-trained Paediatrician in Government Service in Sierra Leone, Dr David Baion, who is the Acting Medical Director of the Children’s Hospital. The Ministry also allocates 10 other doctors, including 5 newly-graduated doctors on three month placements. The five Medical Officers, two of whom work part-time elsewhere, are the more experienced and mostly hope to stay in Paediatrics, although there is as yet no formal Postgraduate Training available to doctors in Sierra Leone. The Medical Officers graduated between 1 and 5 years ago and some have special roles in treating TB and HIV.

One of the Medical Officers, Dr Freddie Coker, is on permanent night shifts. If you can imagine it, this means that Freddie works every night of the year, except when he can get a colleague to cover for him. What would the European Union have to say about that? With Freddie on nights, that leaves two full-time and two part-time doctors to cover the ER, Wards and Outpatients by day, with the help of the House Officers. When I collapse in a heap after a morning in the ER, I do wonder how they do it.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.

Emergency Room Opened

At the end of October, the Welbodi Partnership trained 20 nurses in Triage and Emergency Care, with help from colleagues from VSO, Abertawe Bro Morgannwg NHS Trust Link and Cap Anamur.

The programme was a great success and the staff are now working well in the new Triage and Emergency Room, which opened on the 1st of November.

This is the first time that the Hospital has had an Emergency Room and a robust Triage process for prioritising the treatment of the sickest kids who come to the hospital. The new facilities and equipment, combined with the new skils of the staff, should help give the Emergency cases a better chance of survival.

Emily Spry, our Medical Coordinator, is writing about her experiences at the Children's Hospital on the BMJ website and here are her reflections on the training and nursing at the Children's Hospital from the BMJ site.


Emily Spry on nursing in Sierra Leone

The nurse steps forward into the circle, putting her hands together. She prays aloud, “in Jesus’ name,” asking that our four day workshop at the Children’s Hospital be blessed, “so that we might put everything that we have learnt into practice.” After a rousing Christian song, we proceed directly to the Muslim prayer. Nearly every nurse who clapped, sang and loudly proclaimed “Amen” now turns her palms to the ceiling and intones in Arabic. Quietly atheist, I vaguely join in with the gestures; luckily no one expects me to know the words.

Such religious tolerance is the norm in Sierra Leone, though I do wonder if my faithlessness would be as well accepted, if I were more open about it. Either way, I’m sure that this society has much to teach, as well as to learn. Someone told me that life is so hard here that the wise hedge their bets; mosque on Friday and church on Sunday. A nurse whose birthday it was told me that she would spend her special day praying that she will see another one next year. With average life expectancy in the 40s, it is perhaps unsurprising that people in their 30s are nervous.

The last day of our Emergency Assessment and Treatment workshop for the nurses this week coincided with pay day. The junior nurses receive 120,000 Leones (around 20 GBP) per month from the government for working a six day week. It’s not enough even to buy rice for an average family for the month, though many nurses are the only breadwinner. At the Children’s hospital, a charity provides a monthly top-up of a further 50,000 Leones (around 8 GBP), still little more than the average monthly spend on getting public transport to work.

Nurses’ neglecting to come to work at all is a major problem at the Children’s Hospital, particularly at night. To make ends meet, staff often take part- or even full-time jobs in private healthcare facilities, on top of their government jobs. The Ministry of Health and Sanitation has central control of staffing, making it hard for the Children’s Hospital to replace those who do not attend.

But, as I consider the small pile of tatty bank notes that the nurses are taking home for the month, I wonder about things the other way around. While some do not attend, most are there, many working longer than their hours rostered. Why do they come to work at all? The Children’s Hospital is trying hard but is chronically under-resourced and treating a poor and sick population; around 1 in 10 children who are admitted die.

As I see it, these nurses are no different to healthcare professionals elsewhere. Yes, they want to be paid; they need to eat and they have families to support. But that’s not the only reason they work here. They are here because of the respect that they get from their community for their skills, even if that means being woken in the night by a neighbour with a sick child. They are here because of the gratitude of parents when a child recovers. They are here because they enjoy the camaraderie with colleagues who have also seen life and death and everything in between.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.

New Medical Coordinator

Dr Emily Spry recently started at the Hospital, where she will be spending a year working as the Medical Coordinator.

She is writing about her experiences for the BMJ (British Medical Journal) and we will also post these pieces here.


Emily Spry’s first impressions of working in Sierra Leone

Pikin HospitalI’m excited to have started at the Ola During Children’s Hospital in Freetown, after hearing so much about it from the Welbodi Partnership, the charity I’ll be working for over the next year.

On first impressions, things at the hospital look good. There are freshly painted wards and uniformed nurses. There are notices on the wall: “Drugs for inpatients are now free” (thanks to a German charity). The outpatient benches are lined with parents and kids, waiting to be called into three consulting rooms. The observation ward is full of children, one loudly fighting off the advances of a nurse brandishing a cannula.

But look beneath the surface, and you start to see the problems. The Pikin Hospital (the name given to the Ola During Children’s Hospital in Krio, the lingua franca of Sierra Leone, meaning children’s hospital) has its outpatient department, three main wards and a newly-introduced intensive care unit.

The ICU would not be recognisable as such to those of you who are used to the hush of ventilators and the banks of machines that go “ping”. “Intensive care” is defined by its relatively high staff-to-patient ratio, but it’s 4 nurses and 4 untrained nursing aides to around 30 sick children, all lined up cross-ways in 10 adult sized beds. The only equipment is a lone oxygen concentrator, with tubing splitting the precious gas four ways, and an oxygen saturation probe to help doctors decide who gets to use some.

Around 10% of the children admitted each day die, usually within 24 hours of admission and usually due to severe malaria, anaemia, sepsis, dehydration, malnutrition or, more often, a combination of several of these.

After a while, you start to see what is lacking. Sitting with the busy medical officers in outpatients, you realise that they have to make decisions without access to even basic investigations. Those they can order, parents may not be able to afford.

As a parent, the odds are stacked against you. The hospital charges a flat fee of 15,000 Leones (around 2.50 GBP or 3 USD). This might sound trivial, but when more than half the population lives on less than a dollar a day, it’s a crippling cost for many. Inpatient drugs are currently free but outpatient drugs must be bought and counterfeit drugs are common.

If you have four kids and one of them is about to cost you the family food budget for the month, it’s not an easy decision to make. If your child has a chronic disease, such as sickle cell disease, and gets ill repeatedly, it’s not hard to see why you might feel unable to follow the doctor’s advice.

So, as soon as you start thinking about this your head starts spinning. Everywhere you look, there are little things that might make a huge difference, things that it might be in your power to influence. What if I went out right now and bought 30 thermometers? What if we could find a way to get people to donate blood? What if we could find a haematological hero in the UK who would come out and set up blood screening? What if I could persuade someone to donate an Xray machine? What if I could train the nurses to recognise the sickest kids and act on it? Where on earth to begin?

And then the doubts also bubble up to the surface. Who will ensure that equipment is used properly? And maintained? What if things are stolen? How would the government-employed laboratory technicians here react if someone tried to set up a parallel service to take away their only income? Will giving the nurses and doctors more work to do really help? Will my NHS-learnt ways of working actually be useful here? Or would they upset a delicate balance that stops everything falling apart? Can I realistically do anything here that will last after I’ve gone? How can we decide the best way to treat kids here when we don’t even have basic diagnostic tests? Could even the best hospital in the world help the children brought by their parents only when they are at death’s door?

Luckily for me, the Welbodi Partnership have spent some years building up their relationship with the hospital and refining an approach that combines their optimistic vision with the patience to grapple with the day to day limitations of the hospital. My project is to set up a Triage system and an Emergency Room, to try to focus staff and resources on the sickest kids each day. It’s going to be interesting…