Fieldset
Sierra Leone: My life as an MSF epidemiologist

Epidemiologists are key members of the MSF team, using their analytical skills to understand how diseases are spreading and where medical teams can make the most difference. Louis Bahina Essengue takes us behind the scenes...

Louis Bahina Essengue stands in front of the maternity unit in Kenema Hospital

For the past four years, I have been working as an epidemiologist with Médecins Sans Frontières / Doctors Without Borders (MSF). Despite the fact that I come from Yaoundé, Cameroon, I have not spent much time at home since I began my career with MSF, instead I’ve worked in Niger, Bangladesh and Guinea.

Surveillance of diseases is central to my work – analysing the data to spot changes or outbreaks...

It had barely been four weeks since I had greeted my family in Cameroon after returning from Guinea, and I was already preparing to say goodbyes when I was offered the position as mission epidemiologist in Sierra Leone.

I started thinking about the new challenges I would face, the new people I would meet and work alongside, and began to imagine what my new home would be like.

Kenema

In Sierra Leone, I am based in the Kenema project, where I have now been working for more than one year. Kenema is home to Hangha Hospital, a large Paediatric Hospital of around 100 beds, incorporating an in-patient therapeutic feeding centre (ITFC), intensive care unit (ICU), in-patient department (IPD), the emergency room and isolation unit.

There are two main components of activities in place: the hospital and the outreach programme.
Every day, the hospital staff care for patients in a critical condition, mainly related to malaria, pneumonia and severe malnutrition cases. The nurses and medical staff strive to provide each patient with a high standard of care and treatment, delivered according to MSF standards.

Meanwhile, the outreach team works with local communities, meeting them where they are to share important information about health and services.

But to make the right decisions – about things like where we need to concentrate our efforts, changes we need to make, or how we can prepare for new medical needs – the teams need reliable data.

My role

As the epidemiologist here, I support the entire hospital and outreach team with data management and analysis. I calculate health indicators like mortality rate, bed occupancy rate, length of stay of patients admitted in our hospital and more.

I analyse data from the different strands of our work, so we know if we are achieving our targets or not, helping management to spot any problems or to celebrate successes.

Whilst I often work “behind the scenes”, improving patient care and outcomes is at the heart of everything that I do...

I also do surveys and assessments, which help to identify areas of attention and contribute to decision-making at the project level. Surveillance of diseases is central to my work – analysing the data to spot changes or outbreaks. It’s also central to the team, allowing them to receive punctual alerts and to organize a timely response if required. That could mean anything from a vaccination campaign, a new treatment facility, or health promotion teams working with the community to reduce transmission of a disease.

Whilst I often work “behind the scenes”, improving patient care and outcomes is at the heart of everything that I do.

Sharing skills

One of MSF’s goals in Kenema is to build capacity among local healthcare staff, so part of my role involves transferring skills and knowledge. I provide training on how to properly complete registers and forms to ensure that patient information is recorded accurately.

I’m always looking for ways in which MSF can increase support to the community in order to improve the health of local people...

Data management can be a challenge; when caring for critically ill patients, the staff are not always able to properly complete patient registers, which are the primary source of data collection in the hospital.

Alongside my team, composed of a data supervisor and four data encoders, I closely monitor and support the hospital staff to ensure the quality of data recorded and to see that patient confidentiality is maintained.

Staff support

Being meticulous and vigilant is key to ensure data is analyzed accurately: even small errors have the potential to affect decisions made at the project-level. My skills on Excel, Word and computer sciences help me daily to improve the quality of reporting.

I create templates for reporting and data collection, and on a monthly and quarterly basis, I work with the hospital and outreach managers to review activity indicators.  Together we compare the target originally set with what has been achieved and agree recommendations for the next quarter.

Disease surveillance

Disease surveillance is an important part of what I do, including notifiable diseases such as measles and meningococcal meningitis. These diseases can spread quickly and are particularly dangerous for young, unvaccinated children, so spotting outbreaks early is key to saving lives.

Kenema is also an endemic area for Lassa Fever, a viral haemorrhagic disease spread by rats. I support the hospital team with reporting cases to the Ministry of Health and Sanitation (MoHS); tracing people that suspected Lassa fever patients have been in touch with so they can also be tested; and the shipment of test samples, which is not always a simple task.

It’s vital to maintain a positive collaboration with the authorities and to ensure they are well informed of our activities, particularly for priority diseases. This helps to improve the quality of the partnership between MSF and the MoHS.

I have a good relationship with the surveillance officer with whom I meet weekly for updates.
I am always using the data collected to monitor what’s happening in local communities. For example, I follow the number of diarrhoea and malaria cases in order to flag where environmental health activities need strengthening.

I’m always looking for ways in which MSF can increase support to the community in order to improve the health of local people.  

Working under pressure

Ensuring high data quality and reporting is the essence of what I do, working under pressure to meet strict deadlines. One of the really positive aspects of this is getting to reflect the hard work of the MSF team here.

Through our reporting we highlight the support we are providing to the MoHS and the difference we are making to the lives of those in Kenema district.

Simply feeling that you are doing a good job may be nice but having the data to prove it is much better.

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