Sierra Leone: When children laugh again

28 March 2017

Doctor Regina Giera decided as a student that she wanted to work with a humanitarian aid organisation. After working with Médecins Sans Frontières/Doctors Without Borders (MSF) in Congo and South Sudan, she is now spending her third assignment in Sierra Leone, a country that continues to suffer from a massive lack of professional medical care after the Ebola epidemic.

I've been in Kabala, Sierra Leone, for almost a month now, and I've finally found time to write to you about my assignment.
MSF supports a large hospital in the north of the country. We work in cooperation with the Ministry of Health and support the emergency room, paediatrics and obstetrics, as well as the laboratory and the pharmacy.
We are a large team of international staff: The medical team currently consists of nine people, including two gynaecologists, one midwife, one surgeon, three emergency nurses for infection control and paediatrics, and a laboratory technician.
I am responsible for the emergency room and the paediatrics department.

After Ebola

A normal workday begins at 7:30 am when we go to the hospital together, which is about 5-10 minutes drive away from our house.
Then the morning round begins first in the emergency room and then in paediatrics.
In the team I have seven local Clinical Health Officers (CHOs) who do medical work. A major challenge for the health system in Sierra Leone is the lack of qualified staff - there is a single doctor from the Ministry of Health here, who is also the medical director at the hospital.

During the ebola epidemic, many healthcare workers  died or fled the country, which has made the healthcare situation here even worse.

During the ebola epidemic, many healthcare workers  died or fled the country, which has made the healthcare situation here even worse.
Sierra Leone has one of the highest mother-child mortality rates in the world, 50 per cent higher than in the West African neighbour countries of Guinea or Liberia.
This was also one of the reasons why MSF decided to stay in the country after the end of the ebola epidemic, and above all provide support for obstetrics and paediatrics.

The children's station

Most of the time, I have a lot of daily work at the children’s station.
Many of our young patients have severe malaria, diarrheal diseases with dehydration, respiratory infections or malnutrition.
During the visits, I support our clinical health officers and do a lot of practical training at the bedside. One of the main focuses of MSF's efforts is the development of local staff's know-how and medical care capacity, which means training and support for local employees.

Regina poses for a photo with an eight-year-old patient

Regina poses for a photo with an eight-year-old patient. Photo: Regina Giera/MSF.

At 1 pm, the international team will get together for lunch, and at 2 pm the hospital team will return - mostly to see more patients being treated in the in-patient department, examine laboratory findings, carry out training and discussion, and transfer critical patients to more specialised facilities.
We usually work until 6 pm - 7 pm, often longer.
We have our own ambulance car so that we can go to the hospital quickly, especially when there are emergencies in the night.
The work is usually never-ending and exhausting.
One can be rewarded, however, by the laughter of children who come to the hospital, half dead, and after stationary treatment they can get back home healthy - as well as the gratitude of mothers and fathers.

My Children

Here is a short story about "my" children:
Last week, I was called to the emergency room. There was a five-year-old boy with acute dyspnea and edema, which is when water is retained in the body.
An ultrasound showed a lot of free fluid in his abdomen. For his relief and to help with diagnostics, we made a puncture.
Our preemptive diagnosis was that he had tuberculosis coupled with malnutrition.
The boy lived alone with his sick grandmother in a remote region north of Kabala. The mother left home for three months to make money.
On her return she found her boy in this critical state of health and brought him to the hospital.

Our boy ate away the required amount of peanut paste in record time and then asked with big eyes for more.

After we stabilised him in the emergency room, we took the boy to the paediatric clinic.
For the treatment of malnutrition, we use a special milk, which we first had to administer through his nose, since the patient was too weak to drink it himself.
Under this therapy and the corresponding antibiotics, the condition of our small patient improved day by day.
I was also linked by telemedicine with specialists in Europe who provided diagnostic and therapeutic advice - made possible through an MSF Internet platform for consultation with specialists.
After two days we were able to remove the stomach tube and feed the boy with a cup and a spoon.
The therapeutic milk is first administered eight times daily every three hours. After a few days the patient is given another type of milk, which contains more calories, more proteins and also lactose.
The health of our young patient improved visibly - the edema lessened and his appetite finally returned.
Prior to discharge from inpatient care, malnourished children must have an appetite test. They must eat a ration of therapeutic food (peanut paste or special biscuits).
Our boy ate away the required amount of peanut paste in record time and then asked with big eyes for more.
Finally, we were able to get him home with appropriate therapy and follow-up care in the outpatient nutrition program (here supported by UNICEF).
Together with our team for health education we were able to bring the grandmother to the hospital for diagnosis and treatment. She is now also covered by the National Tuberculosis Program.
Here is another photo of the young boy's discharge from our care:

Regina with her young patient

Regina with her young patient. Photo: Regina Giera/MSF.

The photos were taken with the mother's consent - she was asked by one of our nurses in the national language, Krio.
I am trying very hard to learn Krio - a mixture of English and Portuguese. My hospital vocabulary (diarrhea, vomiting, stomach pain, fever ...) is already considerable ;-)
I hope I will soon find time for another blog post, but in the meantime, many small patients with great challenges are still waiting for me.
Greetings from Sierra Leone,