Tuesday, December 28, 2010

Want to Join our Team? (Update)

Head of Fundraising and Communications

The Welbodi Partnership is seeking to recruit a head of fundraising team to join their growing team. Welbodi was established to support the provision of paediatric care in Sierra Leone. This is an exciting opportunity to be at the heart of a young and dynamic organisation and to gain valuable experience in fundraising and development. The Head of Fundraising will initially be based for one month in Freetown, the capital of Sierra Leone, to gain an in-depth understanding of our work. After that, she/he will relocate to help establish our London office. The Head of Fundraising will work closely with the Welbodi Directors to design and deliver the organization’s fundraising strategy. The Head of Fundraising will also be supported by a team of 2-4 Fundraising Volunteers.

Job Title: Head of Fundraising and Communications

Salary: The Welbodi Partnership is a small voluntary organization, and as such is not able to offer a salary at this stage. However, the Directors hope that successful fundraising will enable the organization to create a paid fundraising position moving forward. Welbodi will be able to cover some expenses, including travel and living expenses in Freetown, and will provide office space in London.

Location: Freetown, Sierra Leone for one month, then central London

Full-Time / Part-Time: The job must be full-time for the first month in Sierra Leone, but could be part-time thereafter for the right candidate.


• Develop and implement both long-term and short-term fundraising strategies.
• Supervise a team of 2-4 Fundraising Volunteers.
• Network with high net worth individuals, such as private business people, philanthropists, and celebrities.
• Build relationships with institutional donors.
• Supervise applications to charity trusts.
• Supervise publicity and social media strategy and presence.
• Gather information from the team at the hospital on recent developments, accomplishments, and other figures.
• Respond to basic requests for information as needed.
• Manage the Welbodi Partnership office in Central London.

Person Specification:

Welbodi is committed to find the right person to join its dynamic and growing team at a leadership level. The Directors are open to people with different types of background and expertise. A successful candidate must:

• Have excellent written and verbal communication skills.
• Have excellent attention to detail.
• Be self motivated and enthusiastic; able to manage own time and work to deadlines.
• Have an interest in development and the cause that Welbodi represents.
• Have excellent relationship management skills, and be able to communicate with people at all levels of an organisation.
• Have excellent organisational skills.
• Have an ability to condense large amounts of information into concise formats, identifying key information needed.

The candidate may or may not have:
• Experience in marketing, public relations, or communications.
• Experience in fundraising or development.
• Experience in the non-profit sector.

The Welbodi Partnership expects that applicants may include communications professionals with an interest in transitioning to the international development or non-profit field; international development or non-profit professionals with an interest in building their fundraising expertise; and others with skills and enthusiasm who want to help Welbodi build a fundraising and communications strategy from the ground up.

Application Process and Deadlines:

CV and covering email to matthew@welbodipartnership.org .

Submit applications as soon as possible but no later than 22nd January 2011. Applications will be processed as they are received, so the position may be filled before that date.

For more information visit our website: www.welbodipartnership.org

Friday, December 17, 2010

A unique Christmas gift...

Do you want to give something unique this Christmas?

How about giving Oxygen?

Please help raise money for oxygen concentrators for the Children's Hospital in Sierra Leone.

Watch the video and then go to: http://www.justgiving.com/sandralako

MERRY CHRISTMAS on behalf of the Welbodi team.

Wednesday, December 15, 2010

"Sweet Salone" gives free healthcare to sick kids

Sierra Leone is known as “Sweet Salone” for her beautiful beaches, lush tropical climate and rich culture. But this small West African country and her people also suffer serious problems, not least poverty and ill-health, made worse by the decade-long rebel war which ended in 2002.

However, there is a spirit of optimism in the country these days that you cannot ignore. In April 2010, the President celebrated Independence Day by making healthcare free for all children up to 5 years old and all pregnant and breastfeeding women. As well as abolishing hospital and health centre fees, the Government provided drugs and supplies and increased doctors and nurses salaries , so that they no longer need to charge their patients.

In a country where so many live in poverty, even small fees prevent people from taking their sick children to the doctor. All too often, children are brought to the hospital so late in their illness that it is difficult to save them. The first few weeks of the free healthcare policy were pretty crazy at the Children’s Hospital, with enormous crowds queuing outside – including many mothers who had perhaps never brought their children to see a doctor before. Things have calmed down somewhat but overall the hospital is certainly much more busy than it was before the fees were abolished!

It was a great privilege for the Welbodi Partnership to support the Government and the Children’s Hospital through these momentous changes and we are impressed by the way that everyone has risen to the challenge. Our focus has been to continue to improve the Triage and Emergency facilities, so that the sickest kids are identified quickly and treated appropriately. Our partners at Abertawe Bro Morgannwyg Trust in Wales have been sending out a training team twice a year to support this work.

Training Children's Doctors

As you know, one of the biggest challenges for child health care in Sierra Leone is a lack of specialist children’s doctors. There is only one Paediatrician in government service in a country of 6.5 million people, where more than 1 child in 7 dies before their 5th birthday. Meanwhile, there is a new generation of keen young Sierra Leonean doctors who have had no opportunity to formally train to be Paediatricians.

On this front, 2010 has been a very exciting year. Firstly, in January 2010, we brought in Professor Tamra Abiodun, an inspirational children’s doctor from Nigeria. She soon had regular tutorials and clinical teaching in place, and our trainee doctors were finding out that training to be a specialist isn’t easy! Secondly, we are working closely with respected colleagues at the Ministry of Health to help implement both Diploma and Masters programmes in Paediatrics for young doctors.

By October 2010, two of our young doctors were ready to take their first exams under the West African College of Physicians. These exams are rightly feared amongst young doctors in the region, but both of our candidates passed on their first try. Congratulations to Dr Ishmael Turay and Dr Freddie Coker! And good luck to the rest of the group who are taking the same exams in April, under the Lady Vanneck Fellowship.

Training under the West African College of Physicians offers us the opportunity to produce international-standard children’s doctors over the next few years, with Prof Tamra leading the way and other sub-specialists coming in for several months at a time. But there is still much to be done for us to realize this dream.

First, we need to have the hospital officially “accredited” by the West African College of Physicians, which requires further upgrading of various departments and processes. This is our biggest, most exciting challenge for the New Year, with the prospect of several new Paediatricians trained in Sierra Leone by the end of 2012. This project has been generously supported by the Theresa Sackler Foundation and many others, but we do need additional funds to make this dream happen. Please give generously!

Please make a donation on our website! Your support can be a huge help to sick kids in Sierra Leone.

New Developments in 2010.....

Two exciting new developments underway at the Hospital should dramatically increase doctors’ ability to diagnose children’s problems accurately.

The first is a major revamp of the laboratory, which has been led by Angela Allen of Swansea University and funded by THET, the British Council and the Oxted Trust. As well as new equipment and supplies, laboratory staff have gone to Swansea to receive training in use and maintenance of the new equipment, all of which will be followed up and reinforced over the coming year. This will have knock-on benefits for the national Maternity hospital next door, which shares use of the laboratory.

The second big improvement is the arrival of an Xray machine. Before now, patients requiring an Xray had to travel miles across town to the main government hospital, which was unsafe for the sickest or those requiring oxygen. We are now working to ensure that appropriately trained staff, procedures and supplies are in place.

The Hospital has benefited enormously this year from a back-up generator, generously paid for by RTC Ltd. Power cuts are common and essential equipment, such as oxygen machines, rely on continuous electricity.

Life-saving equipment was also provided for the Baby Unit, where all children under 28 days old are admitted – often directly from the Maternity Hospital next door. The Oxted Trust and others paid for oxygen concentrators and a suction machine, whilst volunteers including Dr Chris Bird, Tina Koso-Thomas and Dr Fiona Ringholz carried out training for the staff.

Tuesday, December 14, 2010

First Journal Club at the Children's Hospital...

Today was the launch of the journal club at the Ola During Children’s Hospital. Two professors, seven national doctors and three expatriate doctors sat together in an office for the first meeting of its kind.

The journal club was launched as a part of the postgraduate training program in pediatrics that will hopefully kick off in early 2011 (more on this soon). Similar meetings held in the hospital or soon to be held include the morbidity and mortality review, the tutorial topics, lectures, grand rounds and the perinatal meeting. The momentum for an academic atmosphere is exciting.

The journal article chosen for today’s event was published a mere three weeks ago in the Lancet and depicts a trial comparing intravenous artesunate versus the gold standard of intravenous quinine for the treatment of severe malaria in children. This is a very relevant topic in a country where malaria is endemic. Malaria leads to a high number of hospital admissions and contributes greatly to the death rate in children younger than 5 years. To give you an idea, in October 466 out of 981 new admissions were diagnosed with severe malaria (not all laboratory confirmed) and 45% of the total hospital deaths were attributed to severe malaria.

One of the national doctors gave an excellent summary of the article including the methods, results and discussion points. His summary formed the basis for a discussion by the professor on the importance of criticizing such studies – pointing out both the positive and negative aspects of the trial. As this was the first time to evaluate such trials, she further discussed the research process and involvement of various players in research.

We then moved on to the application of the discussion points to clinical practice in the hospital. This to me is one of the most important parts of these meetings. Yes, it is good to discuss trials and outcomes and point out whether or not the trial was performed well but in the end one needs to analyze whether or not clinical practice is evidence based and whether or not it needs to be adapted.

The outcome of this trial is that intravenous artesunate is superior to intravenous quinine in the treatment of severe malaria with artesunate substantially reducing the mortality rate in children. Artesunate is said to be simple, safe and effective.

This sounds good and it seems like the best thing to do would be to switch to using intravenous artesunate in the hospital, however, in a place where artesunate is not affordable and scarcely available this is not a sustainable treatment option. So, we have to look at what we can do, which is make sure our use of quinine to treat severe malaria is optimal. You see, when reading the article I was reminded that the preferred way of administering quinine is intravenous rather than intramuscular and 8 hourly instead of 12 hourly. So I brought this up. This of course led to an interesting discussion and critical look at our treatment choice.

Yes, the doctors know intravenous is better than intramuscular, however, for various reasons (poor monitoring of a child’s blood sugar, poor monitoring of infusion rates, lack of fluids and other resources, lack of nursing staff) they choose to prescribe it intramuscularly arguing that it is safer in most cases and generally as effective. Of course, they give this 12 hourly to decrease the chance of an injection abscess. We discussed the issue and went back and forth, deciding to consult the guidelines. Seeing as the World Health Organization recently published the 2010 Treatment Guidelines for Malaria it seemed like a good place to look. So, based on the information and the high cost of intravenous artesunate (although a good cost analysis should be done of iv quinine versus iv artesunate), the patients will continue to receive quinine, but 8 hourly. When possible they will receive it as an infusion rather than as an intramuscular injection but in reality we will have to see how that works.

All in all I would say that the journal club was a success leading to a critical look at malaria treatment at the Children’s Hospital, which will hopefully lead to better outcomes for children coming in with severe malaria. This was a good start to the journal club.

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.

As posted on the BMJ site: http://blogs.bmj.com/bmj/2010/12/13/sandra-lako-journal-club/

Friday, December 3, 2010

Want to be part of our team?

Head of Fundraising

The Welbodi Partnership is seeking to recruit head of fundraising team to join their growing team. The Welbodi Partnership was established to support the provision of paediatric care in Sierra Leone. This is an exciting opportunity to be at the heart of a young and dynamic organisation and to gain valuable experience in fundraising and development. You will initially be based in Freetown to gain an in depth understanding of our work. After the initial month you will relocate to help establish our London office. As head of fundraising you will work closely with our directors to design and deliver our fundraising strategy. You will also be supported by a team of interns.

Job Title: Head of fundraising

Salary: Voluntary, with expenses.

Location: Freetown for one month, then central London


· Develop long term fundraising strategy.

· Network with high net worth individuals.

· Build relationships with institutional donors.

· Supervise applications to charity trusts.

· Gather information from the team at the hospital on recent developments and relevant figures for donor reports.

· Supervise publicity material and social media strategy.

· Responding to basic requests for information.

· Manage our London office including a team of interns.

Person Specification

  • Good written and verbal communication skills.
  • Analytical with excellent attention to detail.
  • Self motivated and enthusiastic, able to manage own time and work to deadlines.
  • An interest in development and the cause that Welbodi represents.
  • Excellent relationship management skills, able to communicate with people at all levels of an organisation.
  • Excellent organisational skills.
  • Ability to condense large amounts of information into concise format, identifying key information needed.

Application Process

For more information visit our website : www.welbodipartnership.org

CV and covering email to matthew@welbodipartnership.org

Tuesday, November 23, 2010

we've come a long, long way together!

It’s amazing to be back.

Things have changed so much that it’s hard to even know where to begin. The last time I walked through Ola During Children’s Hospital, a year and a half ago, all I could see were broken systems, missing equipment, disenfranchised healthcare workers, and dying children. I left Sierra Leone feeling frustrated and somewhat defeated after a year of battling what felt like insurmountable challenges.

Now, the seeds we planted have finally taken root, sprouted, and begun to blossom. All of the pieces are coming together. Government, donors, hospital staff, other NGOs – everyone seems to be working with a level of energy that I’ve never seen before. It’s truly breathtaking.

You enter the newly paved hospital compound, and first are struck by the construction activity which surrounds the entire campus. The feeding center for severely malnourished children has been de-roofed and will soon acquire a second story. VIP latrines are being built around the back of the hospital. Bricks are being laid for the new staff canteen. The main hospital facade gleams with a fresh coat of white paint.

Inside, the changes are even more dramatic. Women and children fill the benches in the registration and triage area. Gone are the days when mothers carrying sick babies would enter a deserted hospital, desperately find their way up to the wards and be forced to beg and bribe for medical attention. Back then, untold numbers of children died without being seen by a doctor, without so much as an IV in place. No record existed of them ever having entered the hospital, having suffered, died. Today, every single child who enters the hospital is registered with a unique patient number, is measured, weighed and has vital signs taken by specially-trained nursing staff.


The sickest kids go directly to the emergency room, where children lie two to a bed receiving timely care of a quality that is rarely found elsewhere in Sierra Leone. We now have oxygen concentrators, enough for many (although by no means all) who require it; a back-up generator so that power outages don’t cost lives; doctors on call in the hospital 24-7 (with comfortable sleeping quarters and recent government salary increases that allow them to devote their time to government service); a free supply of most essential drugs (for which we have the Ministry of Health and the German Emergency NGO, Cap Anamur, to thank); and a more motivated staff to provide much-needed care. Since the removal of user fees for children under the age of 5 in April, hospital numbers have skyrocketed. The place hums with the energy that is being devoted to the business of saving lives.

The Emergency Room in Action

And we do, indeed, save lives.

I remember the days when the hospital mortality rate was upwards of 20%. We will soon publish data which shows that mortality has almost halved, which represents hundreds of lives saved over the past year alone. It’s a compelling argument in favour of free healthcare, targeted interventions to improve the quality of clinical care, collaboration between government and NGOs, and, crucially, the slowly-slowly locally owned approach that we have tried to demonstrate.

Much to celebrate! And, as always, lots more to be done.

Dr. Toyin Ajayi is a Director of the Welbodi Partnership and spent a year in 2008-2009 working as the Medical Coordinator in Freetown. She will spend the next few weeks at Ola During Children’s Hospital and in the surrounding communities, and will be blogging frequently about her experiences.

Friday, November 19, 2010

Prospects and Challenges of a new x ray unit...

The Ola During Children’s Hospital is close to having the x ray unit up and running. This is very exciting especially since it has been 6 years since the last x ray was taken at Ola During Children’s Hospital. Can you imagine a hospital without x ray services?

Presently children need to travel across town to Connaught Hospital for x rays. This is often a three-day process. The child receives an x ray request form on day 1, goes to Connaught very early in the morning on day 2, and goes back to Connaught on day 3to pick up the x ray and report. This is an obvious delay in the diagnostic process. Also, for very sick children, having to travel across town is simply not possible because there is no way to transport them safely, especially if they are in need of oxygen. Clearly, there is a need for a functioning x ray unit.

The new x ray unit will complement the ultrasound services in forming the radiology department shared between Ola During Children’s Hospital and Princess Christian Maternity Center.

In June the Ministry of Health and Sanitation promised to deliver an x ray unit to the hospitals. Honestly, I was a bit skeptical. However, they kept their word and mid-July an x ray machine was delivered to the radiology department. Step one was complete. The next step: assembling/installing the unit. This took longer than expected, but was a success. The next hurdle was to connect the new processor to the water supply. Unfortunately this proved too difficult, in part due to lack of high quality plumbing but also due to the poor water supply at the hospital. It was decided that for now the old processor would be used until the water situation has improved.

Now that the x ray unit is ready for use, the department is faced with the biggest challenge yet, namely, the lack of x ray films and developer and fixer solutions. The government supplied central medical store is in short supply and it is uncertain when or where the next stock will come from. To further compound the problem, Connaught hospital can now only give 10 children access to free x rays per day due to their limited supplies. Of course, one can still pay for an x ray but the majority of the families do not have the Le 30,000 – Le 40,000 ($8-10) needed for one x ray. Yesterday there were three children in the feeding center needing chest x rays who have already made the early 5 am trip to Connaught two days in a row and been turned back because the 10 slots for free x-rays for the day were already used up. This is a bit of a dilemma.

So, now I sit here wondering where the supplies will come from and how this department will be sustainable? Will the Ministry step in and be able to help with a constant supply? Will the hospital need to find funds to buy films and solutions from Guinea or possibly even the UK or USA? Will the hospital be able to provide free x ray services for inpatients or will it be on a cost-recovery basis in order to generate income to purchase more supplies? And what is the role of the non-governmental organizations (NGOs) in this? If the NGOs help with the initial supply, how long must they continue supplying and who will sustain this? It is a dilemma and I am afraid I do not have a solution.

So, if anyone does have a solution, feel free to comment. And if anyone out there has a never ending supply of x ray films and solutions that they could deliver to the door of the hospital free of charge, you would be more than welcome to do so.

Let’s hope that the x ray department starts functioning soon. It will improve clinical care for the children and it will also bring the hospital one step closer to accreditation as a teaching hospital. Ola During will move forward one step at a time…

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.

First published on BMJ Group Blogs

Sunday, November 14, 2010

Night check at the Children's Hospital.

It’s 1:00 am. My colleague and I have just returned from a surprise visit to the hospital. Three times a month we do spot checks on the wards; periodically we check during the early or late shifts and occasionally during the night and weekend shifts. The reason for these checks is that the Welbodi Partnership set up a performance-based incentive scheme a couple of months ago to monitor nursing care at the hospital with the aim of improving staff performance and ultimately reducing child mortality.

Unfortunately nursing care at Ola During Children’s Hospital has been suboptimal for a few years. This is due to various reasons, one of which is that for years salaries were low, and nurses were forced to work elsewhere, abandoning their posts at the Children’s Hospital. This caused a dramatic fall in nursing standards. Also, high medical fees meant that patient wards were half-full and patients often could not afford proper treatment and mortality rates were high. This was demoralizing and led to even more nurses not showing up to work. Lack of equipment and supplies worsened the matter.

In April 2010 the free health care initiative was launched for patients under-5 years. This led to more patient admissions and a heavier workload for the nurses. For some, this made it difficult to stay motivated again.

Thankfully, a few months ago the government increased the salaries substantially, which led to an influx of nursing staff. For some nurses that was enough of a motivator to come to work when scheduled and perform well. Sadly for others, this was not enough of a motivation.

The set up of the scheme is to do spot checks using set criteria to monitor the level of care given. The criteria include checking if every bed has a mosquito net, if every patient has a sheet or “lappa” to lie on, and if soap and water are available. We also check if all scheduled staff are present and in uniform, and if equipment is clean and well maintained. Sharps must be disposed of properly. We look to see if patient’s vital signs have been checked, if medication has been given accurately, if the handover book is filled out and the ward is clean and the nurses’ station tidy. The criteria are modified as time goes on and are often linked to what the nurses have been taught in a workshop.

Although the scheme sounds simple, it is actually quite complicated. It looks at a ward’s performance, not an individual’s performance. So, if a colleague does not show up to work, the others on the ward are penalized. If a colleague has not documented medication properly, points are deducted for the ward and everyone is affected. It does not sound fair, but the idea behind it is that nursing care should be based on teamwork. When one person falls, everyone falls. Unfortunately we are not able to monitor each nurse’s individual performance because that would be a full time job. So, we look at the performance of the ward as a team. If one shift functions poorly, then the other two shifts will be affected.

Another issue is that the same scoring method is used on every ward, but every ward has a different workload. Obviously 3 nurses in the observation unit or measles ward will be able to handle their work load of 5 – 10 patients much better than 2 nurses in a general ward with 40 – 50 patients, or 4 nurses in an ICU with 40 patients. Fortunately Welbodi encourages local ownership and makes sure to engage matron’s office in every check. This allows Welbodi and the matron’s office to discuss issues such as the number of nurses posted to each ward and so on. It also empowers matron’s office to enforce rules and the nurse’s code of conduct.

The actual checks are a bit of an adventure, especially on the weekend or in the night. Sometimes I am a little nervous as I don’t know what I will come across. Fortunately tonight was okay. Some things were not so good and definitely need to be improved, but thankfully there were also areas that had improved. Most of the staff was present which was a welcome change from a few months ago. The main issue now is proper administration and documentation of medication but I am convinced that with more training, mentoring, and feedback this too can improve. As I said before, it’s not simple. Constant monitoring and evaluation of the program is crucial to make sure the scheme still works towards improving nursing care. It needs to be a scheme that continues to encourage the nurses and not discourage them. Their job is not easy but it is so desperately needed and we need to help them find a way to regain a passion for what they do- helping the children in Sierra Leone.

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.

From: http://blogs.bmj.com/bmj/2010/10/08/sandra-lako-on-a-night-check-at-the-hospital/

The Death of a Child...

Last week there was an ultrasound workshop for the medical officers and I thought it would be interesting to join, so I did. The ultrasound room is adjacent to the emergency room so while we were waiting for everyone to arrive the internist and I were reviewing a few patients. There were many really sick children. One infant had been brought in due to rat bites, although I think the child must have been sick prior to the bites because the child was really unwell. Another child was very pale and in urgent need of blood. Another child had a very high fever and was convulsing. It was hectic.

After thirty minutes, the internist decided to begin the workshop, so off we went to talk about the ultrasound machine, the use of ultrasound as a diagnostic tool, etc. Meanwhile, the emergency department was bustling. After the workshop, we left the ultrasound room by way of the emergency room and I noticed two doctors resuscitating a child. However, minutes later they stopped, realizing it was ineffective. As I stood there and watched I could not help but realize that everyone else in the room carried on with whatever it was they were doing. The other caregivers were not paying much attention, nursing staff was preoccupied with other patients and even the child’s mother could not be found in the emergency room. In silence, the child passed.

After the doctors covered the child with a cloth, they slowly moved away, disheartened by what had just taken place. Meanwhile the now lifeless child remained on the bed and to her left and her right, two other children were struggling to stay alive.

Chills ran through my body as I realized again how much death, has become a part of daily life in Sierra Leone. The death of a child, that would bring masses of people to action in both the hospital setting and the home setting in the developed world, goes by almost unnoticed here. Why is that? It is because unfortunately 1 in 5 children do not reach the age of 5 years. It is not that the death of a child has no affect on people, but they react differently than someone from the West might expect. I’m starting to believe their response has to be different, or they will not cope.

The mothers wail to the point of throwing themselves to the ground in uncontrollable sobbing but seem to move on with life more quickly. They are told to “bear,” which means, “to put up with” or “endure.” They are told not to cry. To me this seems inhumane, but there must be reasons for this. Maybe it’s simply because a wailing mother will cause other caregivers to worry more about their own children. Or maybe it is easier for everyone else involved to cope better. Or maybe it is because in a place with so many child deaths, a mother somehow needs to accept that this time it was her child. I am sure that any time a child dies in the Emergency Room, the other mothers present are worried that their child might be next. What an unsettling thought that likely one or two more children will die in the emergency room today.

Of course the doctors and nurses are affected too, but rather than appearing shocked, they sometimes don’t seem phased by it. I am not saying this to be judgmental and obviously do not know what goes on in their minds but I have noticed how demoralizing child deaths are for the staff. Of course it hits them hard, but they tend not to show their emotions. They are frustrated with the lack of diagnostic facilities or treatment options to save a child’s life. They are irritated that caregivers tend to delay so much before bringing their child to the hospital. They are saddened that the health care situation is changing ever so slowly. When a child dies, the doctors and nurses tend to step back in silence. How long can they continue to give their all when the outcome does not seem to change?

Where the average doctors and nurses in the developed world rarely experience pediatric deaths, these doctors and nurses are faced with children dying every single day. How does one deal with children dying on a daily basis? I think that the only way one can continue to work under such circumstances is to distance oneself from the patients and guard one’s emotions. Clearly in a profession devoted to caring for people it is difficult to find a good balance between building a relationship with the patient and maybe even becoming attached to distancing oneself from a patient and becoming indifferent. When faced with death everyday one has to find ways to cope.

I do hope that the staff continues to cope with the dire situation and of course, hopefully one step at a time, the situation at Ola During Children’s Hospital will improve and child mortality will start to decrease. Maybe someday deaths will not be a part of daily life in Sierra Leone. One day. I just hope that until that day comes the doctors, nurses and other staff will continue to endure under such trying circumstances.

Posted by Sandra Lako, Welbodi Medical Coordinator in Sierra Leone

From: http://sandralako.blogspot.com/2010/09/death-of-child.html

Intraosseous access saves lives.

One afternoon I passed through the emergency room and noticed two doctors hovering over a patient attempting to get intravenous access. As in many of the emergency cases, the patient’s circulation was poor. While one doctor was attempting jugular access, I suggested inserting an intraosseous needle.

Having experience, albeit a year ago when I was last in Sierra Leone in the outpatient setting, I was handed a standard 19-gauge needle and attempted to get access into the tibia of the left leg. Using some force and a screwing motion I felt the needle push through the bone and within a minute or two the needle was in place. I quickly withdrew some bone marrow content, confirming the needle was in the cavity. I then flushed the needle with normal saline to reconfirm the position. Thankfully, a few seconds later the patient received dextrose and a normal saline bolus through the needle in the tibia. What a relief. Now, I could only hope that the insertion of the needle had saved this patient’s life. Since the condition on arrival was very poor, only time would tell what the outcome would be.

I checked up on the patient every day to assess the general condition and was glad to see a little bit of improvement each time I checked. The patient was soon transferred to a general ward and finally, after about a week, discharged home in good condition.

Fortunately intraosseous access did save this patient’s life. And although many people are not as familiar with this procedure, I would definitely advocate that it should be done more often. Contrary to what many people may think, it is actually not a difficult procedure to perform and as long as a sterile environment is created, the doctor is fairly confident and a large bore needle is available, it can be done successfully within a few minutes. The chance of complications is very small if a sterile technique is used and as long as the needle is removed after a few hours. In my opinion, the benefits of this procedure far outweigh the risks and in an emergency setting it is an ideal way of ensuring a quick delivery of fluids, blood, and medication. I am definitely in favor of intraosseous access.

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.

Monday, July 26, 2010

Help kids in Sierra Leone without leaving your seat

Tracy Dockray image Vote online NOW for Rebecca Cridford and the Welbodi Partnership to help us win support from the Vodafone Foundation for our work in Sierra Leone.

Rebecca and Welbodi are in the finals (up against stiff competition) and it’s up to the public to choose the winners – so we need your votes NOW!  It takes just 60 seconds and could make a big difference to our work supporting pediatric healthcare in Sierra Leone.

The competition ends on Wednesday 28th July 2010, so just a few days left!

What can you do to help?

FIRST: Vote online for Rebecca Cridford through Facebook. Voting closes on Wednesday 28th July 2010.

THEN: Tell everyone you know to vote as well. Post a link in your status. Message all your friends on Facebook. Tweet or blog about us. Email your friends, family, colleagues. Forward to any listservs or groups you belong to. We have just until noon on Wednesday 28th July 2010 to get as many votes as possible.

WANT TO DO MORE?: Contact friends who have blogs or who tweet or facebook frequently and ask them to help spread the word. Ask your school or workplace if you can set up a virtual “voting booth” at lunchtime -- all you need is a connected computer. Call your local radio or write a letter to your local paper to encourage others to vote.

Just a few moments of your time can make all the difference.

Read more below about the Vodafone World of Difference contest, the Welbodi Partnership, and our work at the Ola During Children’s Hospital.

Who is Rebecca Cridford?

Becky Cridford is a UK trained nurse with 7 years of experience in the NHS and overseas. She plans to spend a year working with the Welbodi Partnership at the Ola During Children’s Hospital to support the nursing team to further develop the life-saving skills they need, and to put them into practice. Becky applied to the Vodafone World of Difference programme and was chosen out of over 2,500 applicants to go forward to a public vote on Facebook.

What is the Vodafone World of Difference International programme?

Each year, the Vodafone Foundation  supports a handful of inspiring people to work for a year with their “dream charity,” while also providing funds and publicity to those winning charities. More than 2,500 people applied this year for just 8 spots, and it’s now down to a public vote to decide which of 4 candidates will win one of 2 remaining spots! The competition closes

Vote now for Becky and the Welbodi Partnership

What happens if Rebecca wins?

The Vodafone Foundation will provide funding for Rebecca’s year volunteering in Sierra Leone. Vodafone will also make a sizeable donation to the Welbodi Partnership, and we will also benefit from significant free publicity in the UK and elsewhere.

Why do we need support for nursing in Sierra Leone?

Nurses are absolutely vital to save the lives of children in Sierra Leone. The Welbodi Partnership is working to support nurses at the Ola During Children’s Hospital in Freetown in various ways, including in-service training, support to nurse managers to improve supervision, and provision of essential equipment and supplies that help nurses to do their jobs better.

One in four children in Sierra Leone die before they are 5 years old (UNICEF, 2009). There is only one government children's hospital in Sierra Leone, which also serves as a training facility for doctors and nurses. The Free Health Care Initiative launched on the 27th of April this year, which made essential health services free to all pregnant women and children under five, was a wonderful step to improve access but has also resulted in a quadrupling of patient numbers. This puts an added burden on the hardworking nurses and doctors at Ola During.

What is the Welbodi Partnership doing to help?

The Welbodi Partnership’s volunteers work in the Ola During Children’s Hospital to provide on-the-ground training and support to the nurses, doctors, and non-medical staff of the hospital, to improve the quality of care and transform Ola During into a center of excellence for training the next generation of pediatric health workers. To learn more, visit www.welbodipartnership.org .

Vote now on Facebook to help Rebecca Cridford and the Welbodi Partnership win support from Vodafone.

Sunday, June 13, 2010

Meet Tamra Abiodun, our Director of Clinical Teaching!

Welbodi had an additional fundraising and communications volunteer in Freetown for the first half of 2010, Katy Willings. She spent two days at ODCH in April, interviewing some of our key team members so that our supporters could get a first hand insight into the amazing work happening on a daily basis at the hospital, and the progress which has been made possible by the ongoing generosity of our donors and volunteers. Freetown bandwidth made uploading the content whilst on the ground in Sierra Leone a pipedream, but now back in the UK, I am (hopefully!) able to share with you the inspiring stories and personalities I encountered.

Apologes for the background noise in the videos, the hospital was reassuringly noisy the afternoon before free healthcare was launched in Sierra Leone, and the Prof's little office was a relative oasis of calm.

Wednesday, May 26, 2010

29th April 2010: Emily Spry on the launch of the free health care initiative

Yesterday was Independence Day in Sierra Leone, marking the start of the country’s fiftieth year since independence. It was also the launch of the President’s free health care initiative for pregnant and breastfeeding women and children under 5.

I previously shared with you my frustrations and grumbles as we got ready for the launch, specifically about problems with the allocation of drugs.

In the bigger picture, this is a really bold and important step by the President and by Sierra Leone as a whole.

Making health services accessible to those patients who need them most is a key weapon in the fight to reduce maternal and child mortality.

There have been nothing less than heroic efforts by the Ministry of Health and its funders and partners, who have been busting a gut for months to make this dream a reality.

The launch itself was held at our twin hospital, the Princess Christian Maternity Hospital and afterwards the President made a short tour of the two hospitals, visiting the therapeutic feeding centre, where malnourished children are cared for.

A huge throng of mothers, babies on their backs, had been queuing outside the Children’s Hospital since very early in the morning. Crowd control has been a bit of a challenge, but everyone pitched in with staff and volunteers making sweeps through the crowd to pick out emergency cases.

On Independence Day itself, we saw around 350 patients, around eight times our usual number of patients. There were a similar number today (Wednesday). All the doctors were working flat out in the outpatient department, apart from one in the emergency room and one in the neonatal unit. The wards are full to bursting – three-in-a-bed is now quite widespread. The drug supply problem is being taken seriously and we are expecting a quick re-supply, as many useful outpatient drugs have now run out.

Fingers crossed that the outpatient numbers will calm down fairly soon, as is expected. I’ll let you know how it goes.

22nd April 2010, Emily Spry: The free health care initiative in Sierra Leone

It is now less than one week until the launch of the free health care initiative in Sierra Leone when, as regular readers will know, government health facilities, such as my own dear Children’s Hospital, will be required to provide free healthcare to children under five, pregnant and breast-feeding women.

The big day is Tuesday 27th April, Independence Day, when the nation will celebrate 49 years since the end of colonial rule by Britain.
Clearly, this is a hugely complex project and myriad things need to come together to make it possible. A good deal of money is being spent by the UK Department for International Development (DFID), UNICEF, and several international non-governmental organisations.

One key step has been to increase health-worker salaries to a living wage, so that it is plausible to demand that they stop charging user fees. This has been done, though negotiations did involve a full-blown strike.

My sources now tell me that the strike was only ended by a secret meeting in which the President agreed to increase salaries further. This apparently will ensure that first year doctors take home $600 after tax, rather than being taxed heavily on a gross salary of that amount.

Of course, the salaries haven’t actually been paid yet and many beleaguered health workers prefer to reserve judgement “until we feel the money in our pockets”.

The second key issue is for the government to supply free drugs and consumables to the hospitals and clinics for the first time in many years.

I’m sure that UNICEF and the others had a strategy for this at some level. Certainly, they have brought several million dollars’ worth of drugs into the country.

For many months now, I have tried to find out which drugs we can expect at the Children’s Hospital, and how much thereof.

Just three days ago, the Hospital Pharmacist finally got a list.

Unfortunately (and AGONISINGLY predictably), whoever wrote the list clearly has no idea what the Ola During Children’s Hospital is (the clue is in the name) and what that might mean in terms of our drug needs.

According to this list, we are to be given the same drugs at the same quantity as if we were a small primary health unit.

Thus, we have been allocated inappropriate drugs and consumables (clotrimazole vaginal suppositories, anyone? Or would you like to have our allocation of drugs used only in childbirth?)

I can’t see any injectible anti-malarials on there, though I’m still hoping that I’m missing something.

And we have been allocated tiny quantities. In a really staggering disappointment, we have been allocated 13 intravenous cannulas. For a hospital that admits around 800 patients a month.

We are trying to engage the relevant people to make changes but, with three working days to go before the launch (and nothing yet delivered to the Hospital), it may well be too late.

Another key to all this is communication. A truck turned up at the Children’s Hospital today, pumping out music and blaring messages about free care.

Who is going to tell an expectant public that it’s only basic healthcare that is free? (if your child needs a second-line antibiotic, you will need to go out and buy it or go without). Who is going to tell them that the 13 cannulas have run out?

I found out today that the President is going to launch free health care at the Children’s Hospital. I’m not sure if that will be a blessing or a curse.

8th April 2010, Emily Spry: Emily Spry is back in Freetown

If you blinked, you probably missed it, but I’m back in Freetown after a short Easter jaunt to the UK to see my family and a few friends. I was surprised but delighted to be snowed on in the mountains in Wales; at least I can say that I experienced the legendary winter of 2009-2010, no matter how briefly.
When I left, the Children’s Hospital was entirely empty of patients; the doctors and nurses were nearly two weeks into a strike over pay. Several of the administrative staff were beside themselves, as they milled around the empty corridors; they hated seeing the Hospital that way. The only silver lining was that the Environmental Health people got to spray the wards to their hearts’ content, hopefully banishing unwanted insects.

However, the day after I left, the president issued a statement that all those not back at work by the Monday morning would be fired. Frantic meetings followed and eventually the associations agreed; they would go back to work.

It seems that ultimately, the nurses will get around 150 USD per month, with more for very senior nurses, whilst the house officers (i.e. newly-graduated doctors) will get around 600 USD, pre tax. Paying the highest rate of tax plus national insurance, the house officers will take home around 300 USD per month.

The mood seems to be cautiously optimistic. “It’s not what we wanted, but it’s better than nothing,” several people have said to me.

The focus is now moving to the looming day (27 April) when user fees for pregnant and lactating women and children under 5 will be abolished. I would love to say that the Children’s Hospital is ready but it’s not. They are currently trying to create an appropriate store for the free drugs and a dispensary.

For me, triage is the scary part. We expect a huge influx of people coming to get whatever free stuff they can while it’s there, not yet believing that the programme is to continue. The danger is that the emergency cases will be hidden in the crowd.

The great thing about going back to work today was appreciating again the incredible warmth of the people that I work with here. I was only away for a week but everyone welcomed me with huge smiles and hugs and asked me about my holiday, my family, my journey and everything else. It’s so different from the working culture in the UK, where a brief nod would probably have done. After very mixed feelings leaving family and friends at home, today I felt really glad to be back.

26 March 2010, Emily Spry: The Strike Continues

After 11 days, the total strike of all government healthcare workers in Sierra Leone has finally been elevated to a BBC World Service African news headline.

Yesterday, the President called all the doctors and nurses to a meeting in a room at the Stadium.
I was also indirectly invited, but decided that it would be better to stay away.

As you know, I’m entirely sympathetic of the doctors and nurses, although I do very much regret the suffering the strike is inflicting on those poor people who rely on public healthcare. The Welbodi Partnership has always said that staff must be paid appropriately as an essential part of any attempt to improve healthcare here. It’s common sense that nurses cannot work for the Government in any meaningful way when they are not paid enough to cover their transport costs to and from work.

At the same time, we are only able to work in a Government Hospital because of the approval and cooperation of said Government. I was very keen to avoid being asked to come out for one side or the other in a public meeting!

The meeting took things back to square one. The President’s exhortations and promises did not impress the health workers; they did not even applaud him, which seems like quite a statement in a country where people respect their elders. They rejected his pleas to call off the strike and go back to work.

The strike has apparently also spread “upline” (a lovely phrase left over from the days of the railway, decades ago) to the towns and villages outside of Freetown.

The good news is that yesterday we managed to transfer the last three babies from our bizarre temporary ward at the private hospital. These children were those left behind in Children’s Hospital after the strike was called. They were too sick to go home, so a few volunteers ended up looking after them.

Yesterday, I once again prevailed upon the professionalism and humanity of the wonderful Lieutenant Colonel Foday Sahr, who runs the Military Hospital in Freetown. Although packed to the rafters with those who would normally be treated in the public hospitals, he and his staff agreed to take the three babies and one very anaemic mother.

The small Paediatric ward and Maternity unit at the Military Hospital left a strong impression. The nurses and doctors are present, proactive and communicative; the wards are clean, tidy and organised.

I’m sure that there are many factors contributing to this; the Hospital is resourced directly by the Ministry of Defence, the staff organised in the strictly hierarchical command structure of the military etc. But they also have a great leader – knowledgeable, kindly and determined to improve the services the Hospital provides.

I am going back to the UK tonight for a week. It seems a rather frivolous jaunt in some ways but after 8 months away, it is also very welcome. I’m going to meet my first godson (born in September – he has been patient, as have his parents!), read a decent newspaper, drink real milk and help my sister celebrate her 30th birthday. And I’m going to bring back a lot of parmesan.

“Wi go si back Freetong” (See you later Freetown).

March 23rd 2010, Emily Spry: Sierra Leone doctors still on strike

Despite my best efforts, I seem to have ended up with four sick babies and a mother with an infected Caesarian wound, all of us stranded in an unused wing of the fanciest hospital in Freetown.

It all started on Wednesday when the doctors and nurses went on strike across the capital. As I have noted before, doctors here are paid around $100 per month and nurses around $50 per month, not enough to live on in Freetown. After the strike was called, there was a flurry of phone calls and between myself, two German NGO nurses, the VSO doctor and an experienced neonatal nurse, who also volunteers almost full-time with me for the Welbodi Partnership.
The gut reaction was for us to step into the breach at the Hospital. At least to review those who were too sick to be discharged and field the Emergency cases. To be heroes.

But there were lots of questions. Safety for one; VSO ordered its volunteers to stay away from the Hospitals, as there could be risks in a situation with angry staff and patients. In fact, no trouble
materialised, but it wasn’t an outlandish concern.

Secondly, and more complicated, the question of whether we should interfere with the healthcare workers’ decision to shut the Hospital down. Who were we to go against their decision? The healthcare workers know the implications of what they are doing; patients will die. But they feel strongly enough that the upcoming abolition of user fees (the President’s Free Healthcare Initiative) cannot and will not work if their conditions of service are not improved to fill the
gap left by user fees. They feel that this is their only chance to force the Government to meet their demands.

This also leads on to what our role should be here. The Welbodi Partnership’s approach is to form a long-term relationship with the Hospital that will bring slow but, hopefully, sustainable improvement. Breaking a strike is a strategy that could seriously damage important relationships and raise questions about our role.

After long discussions and advice from my boss, all of this led to me staying away on Wednesday and I had a prior engagement speaking at a conference on Thursday. But by Friday, I felt that it was time to go and have a look at what was going on.

In retrospect, it seems that the best way to deal with an insoluble ethical dilemma is to stay as far away from it as possible. As soon as I got into the Hospital, I was sucked right back in.

When the strike was called on Tuesday evening, the staff had discharged most of the children, with only the sickest remaining. By Wednesday, there were less than 30 patients left, gathered in the ICU. Somehow, the German nurses and another volunteer ended up caring for these patients between them, with an occasional doctor review. The Military sent a nurse to relieve them on Thursday night. The Head of the Hospital forbade further admissions (not that the skeleton team
could have handled it) and all patients were turned away at the gate.

By the time I arrived on Friday morning, they were exhausted. Some senior nurses were also murmuring about why the Hospital was still open three days after the strike started. So, with the Prof’s help, we swung into action, reviewing, discharging and ringing around to try to find Hospitals that would take some of them.

The Military Hospital generously accepted some patients and we discharged several more. But we were left with four sick babies, all on IV drugs, two of whom were dependant on oxygen. The manager of a private hospital offered us a room with some beds, but had no extra staff; he had already taken around 15 surgical patients from the main Hospital in town. There was talk of a general strike at the Children’s Hospital, so the security and porters would be gone by Monday.

Late on Friday night, we ended up cramming four cots, an oxygen concentrator, boxes of drugs and equipment, four babies, mums, aunts and grandmas and all their stuff into two cars. A friendly local policeman agreed to lead our strange convoy through town on his police motorbike, haring down the middle of the traffic, flashing and beeping (we have no oxygen cylinder, so we needed a quick transfer for the babies dependent on oxygen). I have never crossed traffic-clogged Freetown at such a pace.

I also never quite imagined myself in this situation, especially in my non-clinical role with the Welbodi Partnership. I tentatively think that we have done the right thing. We made sure that the children already admitted to the Hospital were cared for appropriately, though we didn’t accept any new cases.

There is no doubt that sick children will die because of this strike. But I am not here to break the strike of the Sierra Leonean doctors and nurses whose duty it is to care for those children. I believe that I am here to try to help them build a system whereby all children have a better chance at life-saving healthcare. And paying doctors and nurses properly is a must for that to happen.

But it’s a bit of a minefield, to say the least. As I write this, I do wonder if it will sound insane or just plain wrong from another perspective. Do please let me know.

March 18th 2010 Emily Spry: Doctors and Nurses on Strike

Here in Freetown, both the doctors’ and nurses’ associations have decided to go on strike with immediate effect.

The strike has been precipitated by the Free Healthcare Initiative, which is due to remove user fees for healthcare for pregnant and nursing women and children under 5 years old on the 27th April 2010, Sierra Leone’s Independence Day.
The issues behind it have, however, been brewing for a lot longer.

In the Children’s Hospital, user fees are low compared to many other Hospitals, although still prohibitive for most of the poor families who live in the slums around the Hospital.

Thanks to the contribution of Cap Anamur (German Emergency Doctors) and other partners, patients at the Children’s Hospital pay a one-off consultation free of 15,000 LE (3.8 USD). If they are admitted, drugs and other consumables (IV lines, dressings etc) are free, though many laboratory tests and blood transfusions are still charged for.

The Free Healthcare Initiative was announced by the President in November 2009 and is supported by donors and NGOs including DFID, Save the Children and various UN agencies. Since the announcement, a progressively more frenetic atmosphere has been building up at the Ministry of Health and Sanitation, the Ministry of Finance and in all health-related organisations across the capital. With six weeks to go to the launch, major decisions are still to be taken and many crucial issues are still to be resolved.

The plan is that all user fees for the three vulnerable groups are to be abolished. Huge consignments of drugs and consumables are being shipped in and will (inshallah) be distributed to the patients who need them. Salaries are to be raised for all staff, with incentives for hard-to-fill rural posts. Performance-based incentives are to follow next year.

So, what on earth are the doctors complaining about?

Firstly, doctors and nurses are extremely poorly paid, even by the standards of neighbouring countries, such as Liberia. Junior doctors, when they are fortunate enough to be “absorbed” onto the Government payroll after graduation, are paid around 100 USD per month.

I am paying 550 USD per month for a bedsit. Even taking into account the fact that I have the luxury of relatively constant light and water, and the inevitable “whiteman tax”, it is clear that living in Freetown is not cheap.

Moreover, the user fees actually contribute significantly to the doctors’ income at present. The consultation fees are put into a pool and shared out according to seniority. The Children’s Hospital medical officers get up to 200 USD per month from the user fees pool.

So, using this example, to avoid an income loss with the Free Healthcare Initiative, these doctors will need to be paid roughly three times as much as they are at present.

Moreover, it is the intention of this policy to substantially increase access to healthcare. In other words, there will be more patients and therefore more work. For a doctor who sees 40 or 50 patients a day in outpatients, this is not a very appealing prospect, especially if combined with a loss of income.

The whole initiative is brave and fascinating. There is consensus among those involved in the planning that it has already forced a lot of progress in the healthcare sector here that might never have happened otherwise. For example, cleaning the payroll of “ghost” workers and improving the process for absorbing new staff (previously many worked as “volunteers” for years, awaiting laborious process at various Ministries).

However, it is also a risky strategy and there is a lot of work still to be done, prior to 27th April and after the launch. The drugs may have started arriving in Sierra Leone, but if the doctors and nurses aren’t satisfied, I am not sure what will happen.

Monday, March 8, 2010

A new era at the Hospital?

Our Medical Coordinator in Freetown, Dr Emily Spry, is writing a blog about her experiences in the Children's Hospital with the Welbodi Partnership.

Read on for the latest installment, about exciting improvements over the past few months...

From: http://blogs.bmj.com/bmj/category/emily-spry/

Over the past month or so, things have been changing fast at the Children’s Hospital, thanks to my new hero, Professor Tamra Abiodun.

As you may remember from my previous posts, there is a desperate shortage of specialist children’s doctors in Sierra Leone. In a country of 6 million people, around 1 million of whom are children under 5 years old, there is only one trained Paediatrician in clinical Government Service. Dr David Baion is the Specialist-in-Charge of our Hospital and therefore has to grapple with enormous administrative, clinical and teaching responsibilities.

At present, there is no training programme in Sierra Leone to produce more Paediatric specialists. Some of the young doctors at the Children’s Hospital have been working there several years and have been on short courses organised by the World Health Organisation and the like. But they have not had access to any formal post-graduate training. Under the West African College of Physicians, it takes a minimum of 4 years to train a Fellow in Paediatrics i.e. someone who could then train others to become Specialists. As things stand, however, no specialist Children’s doctors are being trained to meet the country’s substantial need.

On this background, the Hospital and the Welbodi Partnership felt it would be helpful to bring in a Consultant Paediatrician from elsewhere, who could contribute to teaching for medical students and young doctors.

By happy coincidence, Prof Abiodun, a Paediatric Consultant and Associate Professor, was in town late last year for a short contract with WHO. She happened to meet one of our medical officers, who told her how desperate he and his colleagues were to get further training and one day become Paediatric Specialists themselves. She was moved by their story and a train of events was started that led to her arrival in Freetown in January 2010.

It hasn’t been easy. As you will know from my blogs, the Hospital is often deficient in basic supplies and systems and staff are not adequately trained. Not to mention the potential political minefield of an outsider coming into a Government system, but being paid an “international salary”, way above the pittance that the Sierra Leone Government currently pays doctors.

The great thing about Prof Abiodun is that she has been through all this before; she was a founding member of her department in Nigeria, which has gone on to become a fully-fledged training centre for Paediatrics, accredited by the West African College of Physicians to train specialists. Not only does she know how things can and should be done in West Africa, she has experience of the long road towards the lofty goal of becoming a high-quality Teaching Hospital.

Her personal qualities are as important as her professional experience. She has this bubbling enthusiasm and warmth, combined with a hard-nosed no-nonsense attitude when important issues are at stake, presumably sharpened by many years as a successful African female.

I have learnt a huge amount from her; as much about African values and perceptions as about how to develop high quality Paediatric training. Her faith that we are doing the right thing, gives me confidence and strength when the challenges seem overwhelming.

The changes so far are quite striking. The doctors are on a proper rota, rather than having one poor soul on constant nights. Units previously neglected have daily ward rounds by the doctor responsible. Tutorials and clinical meetings happen three times a week; the doctors prepare these exhaustively. There are twice weekly teaching rounds and a Specialist clinic. The drug formulary is being revised and prescribing practice improved. Most impressive of all though, is the excitement and can-do attitude amongst the doctors. Some have been in the Hospital for a number of years but, for the first time, they feel that they are learning, improving their practice and moving forwards. There is still a long way to go, but it’s fascinating to see what one very optimistic and determined leader can do.