A Year In Review, 2021
In 2021, across four districts, PIH Sierra Leone’s 500-person staff worked alongside the Ministry of Health & Sanitation to strengthen Sierra Leone’s public health systems, with the needs of the poor prioritized above all else.
Our work includes supporting the country’s only dedicated tuberculosis and mental health hospitals and transforming the health system in rural Kono District—making health care more advanced, accessible, and dignified, from community-based care, to primary care clinics, to the district’s only hospital.
We dedicate our Annual Report, and all of the work it represents, to our late colleague and friend, Hassan Bunduka.
Hassan tragically passed away in the November 5 fire explosion in Freetown. He leaves behind an incredible legacy: As a driver during the Ebola outbreak and as our fleet manager in Freetown, Hassan was the glue holding together our operations and our work to make health care a human right. No one was a bigger believer in this mission than Hassan. We hold him in our hearts and will always look to his words to guide us:
“Every human is important, and we should see ourselves as one and equal.”
Letter from the Executive Director
Dear friends,
As a Sierra Leonean physician who long envisioned PIH working in my home country, it is a dream come true to be writing you as the executive director of PIH Sierra Leone. I assumed this position in May, and every day since, it has been my great honor to lead and work alongside our staff in Sierra Leone, our colleagues across 11 other countries, and our global PIH family, including all of you, whose vision and generosity makes our work possible.
It is also my honor to introduce our 2021 Annual Report, which outlines our growing organization’s seventh year of lifesaving impact. As you will see below, together we’ve had another progress-filled year, with accomplishments including breaking ground on the Maternal Center of Excellence, helping introduce mental health care for children, and steadily decreasing the spread of tuberculosis by treating a record number of patients.
This report is just a sampling of the personal and systemic changes we made together this year, on the path to building stronger health systems in Sierra Leone—and around the world—founded on quality and equity. While 2021 has been a year of hope, it has also been one of unjust challenges, such as ongoing COVID-19 vaccine inequality and a tragic fire in Freetown that claimed more than 150 lives, including a member of our staff. We mourn the loss of our beloved Hassan Bunduka, and will continue to remember and honor his life.
With every achievement—from an individual life saved, to a clinic revitalized, to a medical education system revamped—more need reveals itself. But for me, no matter the moment—joyous or sorrowful, promising or daunting—one thing remains constant: pride. I am so proud of our team here in Sierra Leone, who each day rises to the occasion to deliver the best possible care to their poorest neighbors. I am proud of our organization, which always, no matter what, prioritizes human rights and dignity, in health and beyond. And I am proud of our collective belief that a healthier, more just world is within our grasp, and is worth fighting for.
Thank you for your belief, commitment, and radical optimism. Together, we can achieve more!
With gratitude,
Dr. Mohamed Bailor Barrie
Executive Director, PIH Sierra Leone
Quality Care, Closer to Home
A Rural Health Center, Renewed
The entrance of Sewafe Community Health Center, August 2018
The entrance of Sewafe Community Health Center, March 2021
As PIH’s investments in Koidu Government Hospital, Kono District’s only hospital, and Wellbody Clinic, our model primary care facility, continue to take root, the quality of health care in the district is on the rise. Yet availability does not equal access. For Kono’s thousands of people who live hours away from district capital Koidu, taking time away from work and paying for a motorbike trip to visit the doctor is catastrophically expensive.
That makes community health centers often the most convenient path to health care. But stepping inside these clinics is like stepping into the past. Electricity is unreliable. Plumbing is nonexistent. Pharmacies and laboratories are nearly empty. And clinicians are undertrained.
As a result, most families in Kono skip visiting their local clinic altogether, knowing the facilities are unequipped to deliver adequate care. And that means living without health care at all.
That’s why PIH deepened its commitment to strengthening Kono’s health system top-to-bottom, and has been supporting remote community health centers with tried-and-true investments in staff, stuff, space, systems, and social support.
Sewafe Community Health Center, located a 45-minute drive from Koidu, is the first of six local health centers to have received comprehensive investments from PIH, through partnership with local health leaders.
Patient beds inside Sewafe Community Health Center, August 2018
Sewafe Community Health Center’s pharmacy area, August 2018
Patient beds inside Sewafe Community Health Center, March 2021
Sewafe Community Health Center’s pharmacy, March 2021
Our investments in infrastructure have fostered a more dignified, dependable health center. Once empty pharmacy shelves and laboratory counters are now fully stocked, thanks to a strengthened supply chain. And a new, ongoing clinical mentorship program means clinicians are prepared to use these resources effectively.
As care has risen in quality, so too has patient attendance. In 2021—Sewafe’s first full year as a renovated, resourced clinic—the number of people opting to seek health care has skyrocketed.
Patient Volume at Sewafe Health Center
“We suffered. There was only one building. There were no laboratory tests. There was no medication. They would write you a prescription and you would have to go buy it. This was very difficult for those of us without money. It’s very different now. Many people are coming because there is free treatment for you and your children. They’ll give you your diagnosis and treat you. That wasn’t happening before. They care for us well, and kindly.”
— Elizabeth Momoh, Sewafe native
Fighting TB, Village by Village
A PIH community health worker screens a household in Kono District for tuberculosis.
Tuberculosis (TB) has been all but eliminated in most wealthy parts of the world. But in Sierra Leone, it continues to spread. Poverty, geography, and a weak health system have meant that an estimated one-third of Sierra Leoneans infected with TB never receive treatment—leading to countless deaths from a curable illness.
In response to this injustice, PIH partnered with Sierra Leone’s National TB Program and the Civil Society Movement Against Tuberculosis to design MIND-TB: a community-based screening and referral program.
Running from June 2020 to June 2021, with funding from The Stop TB Partnership/TB REACH, the project aimed to widen access to TB testing and treatment and to demonstrate the effectiveness of active community-based TB services. In Kono District, we trained “informal” health care providers—such as traditional healers and drug store owners, who are the primary point of care for most families—to screen people for TB and connect them with our community health workers (CHWs). We then trained CHWs to safely collect samples right in patients’ homes and to send them to PIH-supported health facilities for testing.
As the TB REACH project completed its work this year, we began to study its impact—leading to a research study that has shown the power of bringing care directly to communities. By engaging the caregivers patients are most accustomed to accessing, and by eliminating the ancillary costs associated with screening and sample collection, more people in Kono than ever before were tested for TB and, if positive, started on free treatment and connected with support from a CHW. The results: more TB survivors, less disease transmission, and a better understanding of how to fight one of the world’s deadliest infectious diseases.
164,202
people screened for TB directly in their community
89%
of patients successfully completed treatment
33%
increase in people diagnosed with TB and begun on treatment from previous year
Compassion Through COVID-19
PIH psychosocial counselor David Mafinda (left) and PIH mental health community health worker Daniel Korgbendeh provide a counseling session to Kadiatu Karku, whose livelihood and wellbeing has declined since she had COVID-19. “If it weren’t for David and Daniel’s intervention,” she said, “I would have given up.”
In a country with few social safety nets, and still recovering from its historic Ebola outbreak, COVID-19 has taken an immeasurable toll on livelihoods and mental health.
1,531
people in Kono affected by COVID-19 have received psychological first aid from April 2020 to date
Last year, soon after the virus was confirmed in Sierra Leone, our community-based mental health team in Kono formed a hotline that people could call for free counseling. And we made it a practice for mental health staff to provide psychological first aid to COVID-19 patients and suspected cases in Koidu Government Hospital’s isolation ward and in quarantine locations throughout Kono. As the pandemic took a toll on patients’ mental health, our dedicated staff provided a listening ear and equipped patients with techniques to cope with difficult emotions: from fear for their health and anxiety being away from their families, to stress losing their daily wages away from work and alienation upon returning home and facing stigma from their communities.
This year, the program has continued, with our mental health staff visiting the hospital and homes and answering the hotline to support patients recovering from COVID-19’s emotional, social, and economic ramifications. As the pandemic’s second and third waves hit Sierra Leone in early-to-mid 2021, this support proved critical to hundreds of patients.
Fatmata Conteh, 38, is a nurse at Koidu Government Hospital who contracted COVID-19 from someone in her unit. Admitted to the hospital’s isolation ward, Fatmata received psychological first aid from PIH mental health workers. She says they helped normalize her feelings while in the hospital. Fatmata recovered but, upon returning home, she and her family faced stigma—a painful obstacle emotionally as well as financially, as Fatmata’s mother’s customers refused to patronize her business. As time passes, Fatmata says, stigma is becoming less; but to this day she regularly calls the COVID mental health hotline to talk about her emotions and challenges.
“The mental health team gave us hope.”
A Commitment to Capacity Building at Koidu Government Hospital
A Teaching Hospital Emerges
Dr. Leila Amini (center), an emergency physician and global health fellow from the United States, demonstrates how to control life-threatening bleeding to a group of Koidu Government Hospital clinicians during a month-long training in emergency care.
Dr. Remy Nkwiro Bitwayiki (right), a PIH internal medicine doctor from Rwanda, supervises a group of Koidu Government Hospital clinicians as they practice using IVs and medication pumps during a month-long training in emergency care.
Highly trained health workers are essential to delivering quality health care. But deep, longstanding poverty has made quality clinical education rare and hard to access in Sierra Leone. That’s why PIH is investing in new education, training, and mentorship programs for current and future health professionals in Sierra Leone.
For staff at Koidu Government Hospital (KGH), we’ve expanded our continuing medical education programs, offering daily, on-the-job mentorship and new training programs across pediatrics, maternal health, emergency care, and more. These programs are provided in partnership with visiting international clinicians and institutions, including the University of Washington and Boston Children’s Hospital.
We’ve also forged new partnerships with clinical schools across the country, establishing KGH as an academic medical campus and forming a pipeline of clinicians passionate about rural medicine. This year, nursing, midwifery, and surgical students from urban universities across Sierra Leone have completed rotations at KGH, receiving high-quality training and exposure to our vision of equitable health care. Soon, they’ll be joined by future anesthetists, as this November the hospital was accredited by the West African College of Surgeons as a rural training facility for specialist trainees in anesthesia.
And in an effort to make quality medical education available throughout Sierra Leone, we’ve partnered with the national College of Medicine and Health Sciences and the University of Makeni to develop a new Bachelor of Science in Internal Medicine program. Based at KGH, this two-year program is already equipping community health officers—mid-level providers trained to carry out a defined set of more complex clinical tasks that are otherwise done by physicians—with expertise in internal medicine and the confidence to better deliver care and strengthen Sierra Leone’s health system.
Ultimately, by investing in staff across the hospital, we’re investing in patients, helping enable even those with the most complex of illnesses to survive and regain their health.
50
clinical trainings conducted between January and September
76
student midwives, nurses, doctors, and other clinicians completed rotations at KGH
82
clinicians, on average, received formal clinical training each month
85
staff completed University of Washington courses in clinical HIV management and health leadership
13-year-old Emma arrived to Koidu Government Hospital unconscious after suffering a series of unexpected seizures. She remained unconscious for three months while clinicians worked on her case—eventually determining that she was suffering from tuberculosis in her brain. With the right treatment, Emma slowly but surely recovered, and today, at 15, is healthy. She and her twin sister dream of becoming nurses, inspired by the care they received from the hospital’s well-trained clinicians.
Empowering Clinicians to Empower Women
Phebian Sondufu-Sowa, nurse in charge of the adolescent and youth-friendly services clinic at Koidu Government Hospital, practices inserting an IUD during one of PIH’s two-week long family planning trainings. The adolescent and youth-friendly services clinic has seen a 155% growth in family planning visits since last year.
This year, with support from the Government of Canada, we trained more nurses and midwives than ever before in family planning, with 40 health workers completing two-week trainings on theory, skills, and clinical practice. As a result, Koidu Government Hospital’s (KGH) maternity ward staff, as well as clinicians at Wellbody Clinic and other primary health clinics, are now equipped to provide contraception, including long-acting methods, on demand. Women no longer need to wait for the right clinician to receive the family planning method of their choosing, which means wider access to family planning and fewer maternal deaths. These changes have especially impacted the dozens of young women who visit the hospital’s adolescent and youth-friendly services clinic seeking contraception—and control over their futures.
Family Planning Trained Clinicians
Family Planning Visits at KGH
Care Beyond Medicine
Health care isn’t just about medicine. It’s also about safety nets—something many Sierra Leoneans lack, particularly around sexual and gender-based violence (SGBV). To promote safety, justice, and healing for women who have experienced this violence, we formalized our partnership this year with the Rainbo Initiative, a local nonprofit that offers free clinical, legal, and psychosocial support to survivors at five centers across the country. With support from the Government of Canada, we’re investing in their center in Kono, based at Koidu Government Hospital, to bolster and expand our shared goal of combating SGBV and empowering survivors.
In 2021, our support in this area echoed our support across Koidu Government Hospital: training. Together with Rainbo staff, we invested in training and resources for all professionals responding to SGBV cases, equipping them with the tools and knowledge to best care for survivors. And we conducted a campaign to raise awareness and equip communities with the knowledge needed to recognize SGBV, know their rights, and access care.
20
local police trained on recognizing and managing cases of SGBV
1,696
Kono residents reached with SGBV education via 16 community meetings
13
paralegals, nurses, midwives, and psychosocial counselors trained in SGBV care
168
cases of SGBV seen at Rainbo between April and November
A Promising Future for Maternal Health
A Historic Groundbreaking
This spring, we marked a historic milestone in our mission to radically reduce maternal mortality in Kono District and across Sierra Leone: We broke ground on the Maternal Center of Excellence, a 166-bed, state-of-the-art teaching hospital that will not only provide a new level of health care to women and families, but also train new generations of equity-minded clinicians in Sierra Leone and set a higher standard for what’s possible for women and children’s health care around the world.
PIH staff, including Co-founder and Chief Strategist Dr. Paul Farmer, joined government officials, including Minister of Health Dr. Austin Demby, on April 23 to break ground on the facility and usher in the construction phase, after nearly four years of planning.
Together, we celebrated much more than a building: the MCOE represents long-overdue progress toward women’s health care in one of the global epicenters of maternal mortality. Since that day in April, we’ve continued to push this mission forward, on the land the MCOE will stand on and within the communities it will serve.
Two-year-old Esther lays an MCOE brick with PIH physician Dr. Aramide Oteju, her babysitter for the day while her mother, Naomi, was in labor with her second child. Naomi delivered Esther at PIH-supported Koidu Government Hospital at age 15, and was an obstetric “near miss,” having suffered from eclampsia and postpartum hemorrhage. Clinicians saved her life, and Esther’s in turn—Oteju said if Naomi had died, Esther also “would likely not have made it past the first few months of life.” Today, Naomi is in care for seizures resulting from her complicated childbirth, and Esther and her new sister are both healthy.
The PIH team poses for a photo at the groundbreaking ceremony.
In August, we held the inaugural meeting of our Community Steering Committee, comprised of PIH staff, hospital administration, community members, city council members, youth representatives, and chiefs, as a way to regularly collect feedback as we build the MCOE.
In August, leadership from Sierra Leone’s National School of Midwifery visited KGH for the first time, and we forged a partnership to begin training midwives at the hospital—a way to create a pipeline of clinicians to the MCOE and who are dedicated to rural health.
In October, a construction team began the process of clearing the MCOE land, bringing us one step closer to laying the facility’s foundations.
Two Years of Transformative Partnership
In October 2019, John and Sarah Green and Hank and Katherine Green made a momentous announcement: They would partner with PIH Sierra Leone for the long-term to fund our efforts to strengthen maternal and child health systems, including the Maternal Center of Excellence.
This October, we celebrated the two-year anniversary of our official partnership, and the remarkable way our community of advocates for global health equity has grown, to more than 10,000. It’s because of this community that MCOE construction is underway, and that more people than ever before are committed to ending the longstanding injustice of maternal death in Sierra Leone.
With limited travel amid the pandemic, we decided to celebrate the MCOE’s groundbreaking virtually with John, Sarah, and Hank Green and the community we’ve built together that is making better maternal heath outcomes possible.
“If we can make the case in Kono, we can also make the case that we shouldn’t accept weak health systems anywhere in the world.”
A Growing Need
Our progress on the MCOE couldn’t be coming at a better time: In the last year at Koidu Government Hospital, more families have been seeking care at the maternity and pediatric wards than ever before. It’s a testament to the trust PIH and the Ministry of Health have fostered between Kono residents and the health system—and to the improved care available at KGH, as good health outcomes continue to steadily rise alongside patient attendance.
42%
increase in pediatric admissions
36%
decrease in pediatric deaths
38%
increase in the number of major direct obstetric complications managed—with a 34% increase in C-sections
21%
decrease in maternal deaths among women delivering at KGH
Doubled
the met need for emergency obstetric care in Kono, from 20% in 2017 to 40% to date
Higher patient attendance and improved outcomes are a trend across the entire hospital, where, in every department In just one year, clinicians have seen record numbers of patients, with both increasingly complex cases and increasingly positive outcomes.
With these successes, however, come more challenges, in that the hospital’s staff, stuff, space, systems, and social support programs must grow in accordance. The MCOE won’t just provide much-needed additional resources for the maternity and pediatric wards—it will also help shift the entire hospital, opening up new space for other departments in need of equal attention as maternal and child health.
57%
increase in surgeries performed (excluding C-sections)
55%
increase in patients enrolled in chronic, non-infectious disease care
38%
increase in adult inpatient admissions
113%
increase in mental health visits
Expanded Mental Health Care at Sierra Leone Psychiatric Teaching Hospital
Record Admissions
Alongside the Ministry of Health and Sanitation, PIH has been transforming mental health care in Sierra Leone since 2018—notably at the country’s only psychiatric hospital. Thanks to investments in infrastructure, supply chain, and clinical mentorship, Sierra Leone Psychiatric Teaching Hospital is now an equipped facility offering quality mental health care.
The hospital’s transformation has led to an influx of patients from Freetown and beyond. As a record number of patients seek mental health care, the hospital not only improves their health and wellbeing, but also helps disrupt deeply-held stigma against mental health conditions and care.
Inpatient Admissions
Outpatient Visits
Shining a Light on Children’s Mental Health
Encouraging murals cover the walls of the new child and adolescent mental health unit.
The waiting area of the child and adolescent mental heath unit
In efforts to transform mental health care in Sierra Leone, one group has remained overlooked: children. In May, we began to change that, opening the child and adolescent mental health unit at Sierra Leone Psychiatric Teaching Hospital —a first for the hospital and for Sierra Leone.
While medication is the typical treatment for adult patients at the hospital, clinicians at the child and adolescent unit try to avoid the pharmacy where possible, instead emphasizing family education, counseling, and play and enrichment. Parents are trained to provide specialized care at home, connected to social support, and encouraged to keep their children enrolled in school, even in the face of stigma. Children receive counseling and are sent home with a book or toy after each visit.
The unit provides care to young patients who were previously untreated, for conditions ranging from ADHD to autism to depression. Amid an absence of data around pediatric mental health in Sierra Leone, clinicians are also seeking answers about the conditions children face and how factors of genetics, poverty, inherited trauma, and access to nutrition and education are shaping mental health generationally.
“If we create this base of services to respond to the mental health needs of young people, we will reduce the burden of mental health in the adult population. And we know the burden of mental health on adults trickles down to young people,” explained Mental Health Program Manager Chenjezo Gonani. “So if we are able to strengthen this aspect of care, we can have a significant mark on the history of this country.”
At age 13, Mabinti developed epilepsy and had seizures in accordance with her menstrual cycle. Trying to protect her, her parents pulled her out of school. Housebound while her peers were in class, Mabinti developed depression. But this year, her sister took her to Sierra Leone Psychiatric Teaching Hospital, where clinicians at the child and adolescent mental health unit placed her on epilepsy medication. They monitored her health closely to get the dosage just right, provided counseling for her depression, and closely involved her family to ensure they understood that epilepsy can be easily managed. Two months later, Mabinti smiled during a check-up as she reported, for the first time in two years, a month with zero seizures, and plans to return to school.
Care and Support Through Addiction
Abdul Dumbuya, PIH’s mental health nurse supporting addiction care, stands in the recently completed drug rehabilitation ward.
One of the fastest growing public health issues in Sierra Leone, as in many countries around the world, is drug and alcohol addiction. This year, we strengthened drug and alcohol rehabilitation care at Sierra Leone Psychiatric Teaching Hospital, to strengthen support for those living with addiction.
Before 2020, care around substance abuse was available at the hospital, but was not a formal program and instead was provided on a volunteer basis by a local mental health and addiction specialist. Last year, we formally hired the specialist and, this year, we employed a nurse specialized in drug and alcohol rehabilitation. Together, this team provides screening, counseling, and other psychological services to patients affected by substance abuse. They also provide educational sessions for all patients about addiction and harm reduction. And they receive further support from the three psychosocial rehabilitation technicians we hired at the hospital, who assess patients’ social, emotional, environmental, and financial needs and support their independence and reintegration into their communities.
This year, we also supported the construction of the hospital’s first drug and alcohol rehabilitation unit, giving these specialized clinicians a dedicated space and further strengthening support for patients recovering from addiction.
Improved TB Care at Lakka Government Hospital
A Lifesaving Lab
Harry Koroma, lab technician at Lakka Government Hospital, adjusts a microscope in the hospital’s first-ever clinical lab.
Four years ago, in partnership with Sierra Leone’s National Leprosy and Tuberculosis Program, PIH introduced never-before-available treatment for multidrug-resistant tuberculosis (MDR-TB) at Lakka Government Hospital, the only dedicated TB hospital in the country. Ever since, we’ve worked together to strengthen staff, stuff, space, systems, and social support at Lakka and continued improving care for a disease that was once a death sentence for countless Sierra Leoneans every year.
In September, we opened the hospital’s first-ever clinical laboratory, transforming a building on the hospital campus into a modern, high-quality lab space, with equipment and lab technicians provided by the Ministry of Health.
Before the lab opened, Lakka was able to test for and diagnose TB onsite, but had to send all ancillary tests, meant to monitor patients’ health through harsh treatment regimens, to private labs. Outsourcing these tests cost PIH up to $6,000 per month. More importantly, it delayed the results and kept vital information from reaching clinicians and patients in a timely way.
Now, thanks to the clinical lab, lab techs at Lakka can perform all necessary tests onsite—translating to faster results and better care for patients, as well as time and resources saved for further investments to TB care at Lakka and beyond.
Comprehensive Patient Care
MDR-TB Treatment Success Rate (%)
This year at Lakka, we added clinical capacity, training new doctors placed at Lakka by the Ministry of Health & Sanitation; introduced new infrastructure, including the laboratory as well as a new triage unit and indoor kitchen; continued our social support programs to eliminate nutrition and transportation as barriers to completing treatment; and supported the implementation of the new MDR-TB treatment guidelines we helped develop in 2020, through which every MDR-TB patient admitted in 2021 has been prescribed all-oral treatment regimens that are less toxic and allow for shorter hospital stays.
The result of all of these improvements: better patient care and more people cured of tuberculosis and multidrug-resistant tuberculosis (MDR-TB). Already curing patients of MDR-TB at a higher rate than the global average, this year Lakka’s treatment success rate increased further, pointing to the effectiveness of partnership between PIH and the government as well as between staff and patients.
Hassan was born with HIV, and at age 18 was diagnosed with MDR-TB. At Lakka, doctors immediately began him on treatment, then discovered a problem: The drug that would cure his MDR-TB interacted badly with his HIV medication. PIH staff procured an HIV drug safe for Hassan from PIH in Haiti—helping him manage both illnesses and curing him of MDR-TB within 16 months. With his case as a model, the government of Sierra Leone soon added the HIV drug to national treatment guidelines and procured it to be available across the country. Hassan made his last visit to Lakka in February. Today, he is back in school, with all fees covered by PIH, and dreams of being a journalist.
26-year-old Saffiatu Sesay arrived at Lakka paralyzed from the waist down and unable to breathe easily. After two battles with TB, the disease had become drug-resistant, and had worked its way into her spine. Saffi thought she would never walk again, and often asked clinicians to send her home. But with encouragement from Lakka staff, and the right TB drugs, in seven months she began standing on her own. Saffi was soon discharged to outpatient care. 14 months later, in February, she was declared MDR-TB free. Today, at 28, Saffi dreams of becoming a nurse, and is receiving support from PIH to restart her education.
“If it hadn’t been for the help of the good health care workers at Lakka, it would have been a different situation for me. One thing about this health condition is: If you have people who encourage you a lot, you will survive.”
Model Primary Care at Wellbody Clinic
A Model Clinic and Training Center
John Cooper Combey, a community health officer and PIH's primary care clinical manager, provides a training session to Wellbody Clinic clinicians, refreshing them on vital signs.
At Wellbody Clinic, widely considered the best primary care facility in Sierra Leone, we’re continuing to improve care even further, by investing directly in staff.
In April, we introduced a continuing medical education and mentorship program for Wellbody’s community health officers, offering one-on-one training from doctors on skills ranging from conducting physical exams to using an ultrasound machine. These clinicians also completed an online course through the International Diabetes Federation on diabetes management in primary care.
We also provided weekly continuing medical education courses for community health officers, nurses, pharmacy staff, and laboratory staff on topics such as HIV and COVID-19. And we hosted student community health officers from Bo, the second largest city in Sierra Leone, as interns, providing them training and tutoring sessions as they rotated through clinic departments and experienced first-hand our approach to equitable health care.
With these foundations of clinical education in place, we began planning in November how to further establish the clinic as a training center, by implementing formal curriculums and making space to host more community health officers-in-training.
Responding to the Rise of Malnutrition
Families enrolled in PIH’s moderate acute malnutrition program eat Bennimix together at one of the program’s feeding sessions.
In Sierra Leone, where 76% of people live on less than $3.20 per day, malnutrition is a daily threat. As a result, nearly one-third of children younger than five suffer from stunting, or impaired growth, that can permanently damage cognition and overall physical health.
The injustice of malnutrition has only mounted throughout the COVID-19 pandemic, as lockdowns have caused catastrophic losses for families surviving on daily wages. According to one study, between June and August, nearly two million people—a quarter of Sierra Leone’s population—fell into the category of severely food insecure.
31%
increase in children newly enrolled in outpatient malnutrition care
In Kono District, we’ve established treatment programs for children suffering from malnutrition and, importantly, broadened the guidelines for who qualifies. In 2019, we began the moderate acute malnutrition program, which provides treatment to children before their condition becomes severe. This year, this program care has proved more widely needed than ever before.
Every two weeks, children and their caregivers enrolled in the program gather at Wellbody Clinic to prepare mass amounts of Bennimix—a blend of locally-sourced ingredients, provided by PIH, that contains the nutrients children need to restore their health. Guided by Wellbody clinicians, families cook the Bennimix into a porridge to eat together that day—then take home a two-week supply, along with the recipe.
For many caregivers, it is an extreme lack of material resources—not knowledge—that prevents their child from eating well. To tackle this issue, clinicians take note of each family’s health and financial situation and refer the most vulnerable to PIH’s social support program and other health services. And amid the unjust shame and isolation that can come with poverty and malnutrition, the program also fosters community, particularly among teenage and single moms.
“Mothers will tell you, ‘I don’t have anything. I’m just giving my child glucose powder.’ We try to let them know that all is not lost. We are encouraging them, talking to them as equals, receiving them with open arms. They’re happy to be around the other women.”
National Accompaniment, Global Influence
Advocacy Through Research
Key to implementing new health initiatives is monitoring their impact—and sharing that impact with the world. “Research is one of the best ways to keep growing and improving the level of prevention and care deserved by everyone in this unequal world,” said Dr. Marta Patiño, clinical services lead.
This year, PIH staff in Kono District published three articles and research studies in international health journals, providing guidance to health leaders around the world and establishing Kono as a blueprint for other rural health programs.
PIH and the Ministry mark World Hepatitis Day ahead of beginning our Hep B study at Koidu Government Hospital.
In the Journal of Health Policy, PIH staff published findings from the first group of patients ever treated at our chronic care clinic at Koidu Government Hospital, and gave recommendations on how care for chronic illnesses—one of the least funded areas in global health, responsible for an estimated 33% of deaths in Sierra Leone—can be implemented in other rural settings of poverty.
In the International Journal of Environmental Research and Public Health, PIH staff published research on speeding up the provision of lifesaving C-sections by reducing the time between a clinician’s decision to perform a C-section and the procedure itself. The research showed that PIH clinicians had shortened that time from 105 minutes to 42 minutes on average—providing a model for health care workers in Sierra Leone and beyond.
In Tropical Medicine and Infectious Disease, PIH staff published a study calling attention to the high rates of health care workers unvaccinated against and/or living with chronic Hepatitis B—highlighting the urgent need to introduce mandatory screening and vaccination policies for all health workers in Sierra Leone.
Strengthening National Medical Education
For decades, one of Sierra Leone’s major barriers to quality health care has been a severe shortage of specialized physicians. To become a pediatrician, an OB/GYN, a psychiatrist, or any other specially trained doctor, newly graduated clinicians from the country’s sole medical school have to leave the country and enroll in specialty training abroad—an impossibly expensive path for most, leaving Sierra Leone without the experts every health system needs.
This injustice in medical education began to shift in 2021, with the opening of the Sierra Leone Postgraduate College of Health Specialties. Formed by the government of Sierra Leone and partner organizations—including PIH—the college is poised to dramatically improve the country’s health workforce, by providing specialized training to Sierra Leonean doctors in their home country.
This year, PIH helped develop the college’s curriculums for pediatrics and obstetrics and gynecology. As of September, there are currently 10 aspiring Sierra Leonean OB/GYNs and six aspiring Sierra Leonean pediatricians enrolled at the College, learning how to provide specialized medical care to women and children and with an eye on their future training site: the Maternal Center of Excellence.
Disaster Relief, for the Long Term
Dr. Marta Patiño and Connaught Hospital staff review the chart of a burn patient in the intensive care unit.
On November 5, PIH staff sprang into action in response to a tragic accident in Freetown: A road collision involving a fuel tanker led to an explosion and fire. What ensued were the brutal consequences of poverty. 98 people died on the scene, many of whom had run to the road to collect the leaking fuel to sell. Hundreds more were transported to hospitals across Freetown, in need of specialized burn care that isn’t available in Sierra Leone.
In the face of this life-threatening emergency, PIH partnered with the government and other organizations to provide the best care possible for disaster survivors. PIH clinicians from Kono rushed to Freetown and began caring for patients at Connaught Hospital, the country’s largest public hospital and where the majority of burn patients were admitted. PIH Clinical Services Lead Dr. Marta Patiño remained there for nearly a month, working alongside Connaught staff to stabilize and care for patients in precarious condition.
PIH psychosocial rehabilitation technician Sandra Turay (second from right) works with fire response volunteer Dominic Sesay to collect Mari Conteh’s (far left) information and let her know she can receive counseling and support after the loss of her eldest daughter to the fire.
As the government developed its disaster response, PIH staff attended all national emergency meetings, taking guidance from top health officials, and donated medical supplies and equipment to bolster Connaught’s laboratory and blood bank capacities.
Our staff also established a social support system for survivors, hiring 12 community health workers and two psychosocial counselors to accompany patients through ongoing medical care and support them through grief and trauma for at least six months.
Patients discharged from Connaught and four other hospitals face a long journey to a full recovery—but are alive and guaranteed long-term support from our dedicated team.
“For me, it’s not about PIH or any organization. It’s about the people of this country, and seeing a health care system we can be proud of, where nobody dies a preventable death.”
