Restoring Capacity as Ebola Wanes

Today, Andrew (Director of International Programs and Emergency Response) and I visited the Holy Spirit Catholic Hospital in Makeni, a beautiful 85-bed capacity hospital in the third largest city in Sierra Leone.  The facility was clean, spacious, and well-kept.

Infection control procedures prevented us from visiting patient care areas of the hospital without properly donning protective clothing, which we were not prepared to do.

Dr. Patrick Turi told us that the hospital was closed during the height of the Ebola crisis and is now running at about half capacity because of the sharp decrease in patients seeking care at medical facilities. He believed that the hospital would run at full capacity again as the surrounding communities regain trust in the health care system.

In the pharmacy, we took turns identifying items that we recognized as having been donated by Direct Relief through local partner Medical Research Centre.  Noticeably, several Teva drugs were being distributed to patients, such as the antibiotic azithromycin.  Dr. Turi was excited about the prospect of receiving more specialized drugs for cardiovascular disease, diabetes, and hypertension, which could help offset costs, such as rehiring of staff.

Support Continues for Successful Ebola Treatment Unit

Next, we visited the Ebola treatment unit dubbed Hastings II, which still boasts the highest survival rate in the country at about 70 percent.  The unit is operated by the Sierra Leonean military but the hygienic tasks and nursing duties are carried out mostly by volunteers. These individuals choose to work in a dangerous environment in hopes of getting priority for paid work.

When we arrived, there were no less than a dozen men and women in matching blue scrubs cooling in the shade outside the treatment ward.  In the compound that houses the Ebola treatment unit (a converted police training facility), there is an administrative building, a storage unit, and the Ebola ward itself, which is divided into several sections.  The Ebola ward is partially visible from the common area.

Recovering patients watched us as the doctor pointed to the notes stuck on the inside of the plexiglass and explained that this was a form of communication, as no items are physically transferred in and out of the ward.  Direct Relief, through Medical Research Centre (MRC), shipped significant amounts of pharmaceuticals and supplies to Hastings.

Supplies Stocked in Country

Down the street from the Hasting Treatment facility, MRC Director Abdul Jalloh showed us the warehouse rented by MRC to store donated drugs and supplies.  Direct Relief provided a grant to MRC to rent and operate this warehouse as well as purchase a truck to transport the supplies to more than 50 facilities in three districts.

The warehouse was beautifully clean and organized, and stocked entirely with supplies sent by Direct Relief: Ansell gloves, Baxter fluids, We Care Solar panels, and much, much more.  A small team was loading up the truck to take to Bo – the second largest city in Sierra Leone.  Andrew and I were very impressed.

Abdul recalled how Hastings II once ran out of ceftriaxone, which was essential to treat patients with certain types of bacterial infections, and MRC was able to provide the drug immediately because of the donation. He said the Central Stores would have taken two weeks.

Reinstating Maternal & Child Health Services

To end our day, we visited Aberdeen Women’s Centre in Freetown, a facility which we have supported through the Obstetric Fistula Repair Program.  Aberdeen is the only permanent facility providing obstetric fistula repair in Sierra Leone.

Through funding from the United Nations Population Fund (UNFPA) and others, and supplies from Direct Relief, Aberdeen strives to provide at least 200 fistula repair surgeries per year (an incredible number).

Because of reallocation of resources to fighting Ebola, they have not been able to provide fistula repair services since April, but they plan to restart soon and continue to provide birthing services. The facility delivered 1,228 babies in 2014, several by caesarian section.  Painted on the wall toward the entrance is “YU NOR DEY PAY NO MONEY” – all services are free of charge.

Looking Toward Life After Ebola

After only a few days, but endless discussions about Ebola with health authorities, politicians, local leaders, and medical practitioners, it is apparent that the complexity of the issue is staggering—the disease, the politics, the unintended consequences, the international response, the messaging, the historical implications, and on.  Sierra Leone’s history will forever be divided into “before Ebola” and “after Ebola” just as it is colloquially divided by the civil war.

The post From the Field: Health Facilities in Sierra Leone Work to Restore Services appeared first on Direct Relief.

The Aberdeen Women’s Centre (AWC) is the only facility in the country that is dedicated to providing comprehensive care for women living with obstetric fistula, one of the most devastating injuries that women can suffer during childbirth.

Their first-ever Direct Relief donation included many of the items that Aberdeen Women’s Centre requires on a daily basis to provide high-quality surgical care, including sutures and catheters, syringes and needles, pain medication, antibiotics, infection control supplies, and incontinence products.

“The supplies and drugs from Direct Relief are of superior quality and came in at a time they were really needed,” said Samuel Munywoki, the Fistula Program Manager at AWC.

“Some of the drugs have been very difficult for us to get in the past but are important for fistula cases. These drugs and medical supplies have and will continue to contribute to the success of the project particularly the fistula ward and operating theatre. It is a big gift. Thank you for your kind donation to Sierra Leone and Aberdeen Women’s Centre.”

Since the facility was founded in 2005 by Mercy Ships, it has provided life-restoring fistula repair to over 2,000 women. The facility is now managed by the Gloag Foundation.  In 2012 alone, more than 220 women received life-restoring fistula repair surgery.

Beyond ensuring high quality surgical treatment, Aberdeen also runs a maternity clinic to care for women during pregnancy and childbirth in order to prevent fistula and reduce maternal mortality. Last year, 1,093 babies were safely delivered at the facility.

But Aberdeen Women’s Centre provides more than just medical care. It’s a place of hope and happiness for many women who suffer from fistula.

Samuel Munywoki explained, “The women come here and are very down and depressed, but when they come here they are appreciated, they are given clean clothes, and they meet a whole group of women with the same problem and they come to know that they were not the only one. They see those that are happy. They feel at home after suffering for some time.  After repair we give them a new dress and then we sing and dance, we have a “Glady Glady” so they feel honored. When they are dry they want to go home and tell their villages ‘now I’m dry, I’m different, and I have a new life.”

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In Freetown, I meet Dr. Alyona Lewis and her dedicated staff at Aberdeen Women’s Center. The Center provides treatment and support for women who have developed a debilitating obstetric fistula as a result of prolonged and obstructed labor. Obstetric fistula is almost entirely preventable with improved obstetric services. In places like Sierra Leone and other countries in sub-Saharan Africa where access to and quality of care is inadequate, obstetric fistula still occurs at alarming rates.

In 2010, Aberdeen Women’s Center provided fistula repair for 189 women who came from all parts of the country and even neighboring Guinea and Liberia. The center includes a maternity ward (which was completely full during my visit) and an outpatient clinic for children. All services are provided free of charge.

The joyful rhythm of African drumming and singing rose up over the compound during my visit, happily interrupting my conversation with the procurement manager as we were discussing how Direct Relief could provide surgical supplies and medical materials to the center. I witnessed the Glady-Glady ceremony, a weekly celebration when the whole center breaks into song and dance to bid farewell and good luck to the women who are leaving to return to their villages. After staying about two weeks to heal following their fistula surgical repair, the women don a new dress and get ready to return home to their families and their community as a whole new person. The hope and positive energy of these brief weekly celebrations underscore the significant value of a center like Aberdeen.

The Center focuses on holistically healing women with obstetric fistula—repairing the debilitating physical condition and treating the emotional and psychological distress attached to the stigma of fistula. A three-month follow-up visit is required for every woman, to ensure the integrity of the surgical repair as well as providing an opportunity to share information on family planning and reproductive health. Dr. Alyona told me that when a woman returns, she often wants to learn about how to plan her family and is curious about her ability to have another child. (Women with a repaired obstetric fistula can have children but are counseled on the importance of having a cesarean section.)

The good news: The long waiting lists for fistula surgery in Sierra Leone have all but disappeared. While there are likely to be women that are harder to reach, or are tentative to come for treatment–many women from remote areas have never been to the Capital and are afraid to leave their village for an unfamiliar place–it is also possible that the incidence of fistula has decreased due to recent interventions to improve access to and quality of obstetric services. Aberdeen is planning an expanded outreach program in the coming months to areas not yet reached to offer help to women who still need treatment. Meanwhile, continued attention remains on improving obstetric care to prevent fistula and maternal death.

Someday, the fistula ward at Aberdeen Women’s Center will become obsolete, like the Fistula Hospital in New York City that was torn down 150 years ago and later became the famous Waldorf Astoria Hotel. Until then, Aberdeen Women’s Center will continue to play a critical role in restoring the health of women living with obstetric fistula and Direct Relief will remain committed to bolstering such important efforts.

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