Latest updates from Freetown

This is the latest edition of a Blog that Dr Emily Spry, our Medical Coordinator in Freetown, is writing for BMJ.com.

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Most of my job here in Freetown requires skills not covered at Medical school or my GP training thus far. For a start, most of my role here is about management, coordination, and training. But, trying to get things done on behalf of a small charity in a poor country, there are many unusual demands, which are hard to prepare for.

Many of these demands come about because the Welbodi Partnership, the charity for which I volunteer, supports the Children’s Hospital in a rather unusual way.

The Directors of the charity, mindful of others’ failed attempts, tried to find a more efficient and sustainable way to transform the Hospital. The first step was to build relationships within the Hospital and with the Ministry of Health and to spend a lot of time trying to understand in detail the problems and the barriers that keep things from changing for the better.

After some time, they formed a Board which brings together the Chief Medical and Nursing Officers from the Ministry, the Management of the Children’s Hospital and representatives of the Welbodi Partnership. This Board meets every three months to consider proposals put forward by the Hospital for how Welbodi funds should be spent. It also reviews progress on previously-approved proposals.

We had our quarterly meeting last Saturday and around 30,000 USD worth of funding was approved, for projects ranging from improving the water supply, to furniture in the Outpatient Department, to pulse oximeters and suction for the Special Care Baby Unit, to making more basic tests available in the Emergency Room.

It was all immensely cheering. Until I remembered that I now have to help the Hospital implement these projects.

I know from experience that this involves things well beyond my ken. How often in your UK practice have you designed an Emergency patient trolley from scratch and given your drawings to the welder? Only to find that caster wheels with brakes cannot be sourced in Freetown.

Luckily, I only had a single prototype made before committing more money. The nurses politely but firmly stuck the brake-less trolley in the corridor and reverted to the hip-height beds with no sides. Don’t worry, they said, the mothers make sure they don’t fall off.

Fortunately for me, I persuaded my partner to accompany me to Freetown this year. Alex has been volunteering as a small business advisor, helping Sierra Leonean entrepreneurs to get their businesses going. But, knowing his many practical skills and problem-solving nature, little by little, I have inveigled him into the Hospital and its problems. As a result, he spent the whole of this Saturday at the top of the 5-storey high water tower, working with the Hospital maintenance team to fix the water pump. I think it’s a key new skill for me, this inveigling.

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.