How we transformed medical training in Sierra Leone in just four years

James Fallah-Williams: Sierra Leone Telegraph: 19 September 2021:

I couldn’t help but laugh when I read the recently released report by the Sierra Leone government, in which it shamelessly praised itself for markedly positive changes in the provision of medical training in Sierra Leone.

The government’s report stated that in the last three years, ‘The President Bio administration gave concurrence for the recruitment of 4,000 health workers of all critical cadres to address the challenge of human resource gap in the sector. Out of this, 2000 have already been recruited by mid-2020 and the final batch is now at an advanced stage for recruitment.’

The report further went on to say that the ‘Ministry of Health and Sanitation has upscaled 200 State Enrolled Community Health Nurses (SECHN) to State Registered Nurses (SRN) and 20 SRN to Nurse and Midwife Tutors.’

Moreover, the report said that ‘the Ministry of Health and Sanitation has elevated 200 certificate Midwives to Diploma Midwives and selected 50 of those for 1 year training as Tutors in Nursing/Midwifery.’

The government’s report, however, did not state what resources they have put into these areas. Nor did it provide any evidence as to how they have managed to achieve these impressive milestones.

I can categorically state here that these milestones were achieved by a local, seven-year-old NGO called Practical Tools Initiative (PTI), which is also a registered charity in England & Wales. Over the past four years, we have worked hard to deliver well over $1m dollars’ worth of medical resources, including cutting-edge medical textbooks and medical equipment, to state-run medical training centres across the country.

Let me start from the beginning:

The Ebola epidemic, which ended in 2016, revealed the woeful lack of trained and qualified doctors, nurses, and other medical professionals within Sierra Leone’s healthcare system, and left the country in shock.

The country had long been dependent on external healthcare assistance, and this dependency was compounded by deep corruption and weak leadership. Before Ebola struck, Sierra Leone had only about 136 doctors and 1,017 nurses/midwives to cover a population of over seven million!

In 2017, PTI launched a five-year plan to equip all state medical training institutions across the country with modern medical training resources – especially key textbooks and practical equipment.

Today, four years on, we have reached out to six state medical training institutions, including Nixon Memorial Hospital Nursing School, National School of Midwifery in Freetown, Connaught Hospital Nursing School, Njala University Medical School, College of Medicine & Allied Health Sciences, and 34 Military Hospital’s Defence Medical School.

I can now tell you HOW we achieved our goals, school by school:

Nixon Memorial Hospital (Segbwema, Eastern Sierra Leone)

Nixon Memorial Hospital is severely underfunded by the Sierra Leone government, even though the nursing school produces over 75% of nurses for the entire eastern region of the country. In 2015, the government told the hospital management that unless they improved their library with modern textbooks and computers, the nursing school would be closed. This was a very serious threat, but the hospital management had no means of replenishing the nursing school’s library with contemporary textbooks and computers. We decided to get involved. At the time, the nursing school had 260 students.

Photo: Nixon Memorial Hospital’s new library.

In addition to providing a first tranche of textbooks, we established the first computer lab for medical training at the school. A few weeks after I returned to the UK, we sent out four UK medical volunteers (three nurses and one IT expert) to provide teaching support to the nursing school and to help set up their IT system.

The medical volunteers also worked with two rural clinics to provide teaching support on issues of health and sanitation for the period that they were there. Since then, we have delivered over 2000 new medical textbooks to the school. Furthermore, we delivered cutting-edge equipment such as microscopes to the hospital. The support provided by PTI was a reprieve for the nursing school and, without doubt, the hospital itself.

In early 2018, Nixon Memorial Hospital Medical School was assesed by the midwifery authority in Sierra Leone, which stated that the school was ‘the most equipped nursing school in the country’. A higher nursing training qualification was then approved.

National School of Midwifery in Freetown

After succeeding at Nixon’s, we moved to support The National School of Midwifery in Freetown. This is without doubt the most significant midwifery training school in the country. Its status, nonetheless, was a gimmick – it wallowed in decadence and neglect. When I entered the library, I was utterly shocked; it had only TWO bookshelves, which contained very old medical journals and books from the 1970s! I could not believe my eyes.

Photo on the left: This is the only ‘library’ they had at The National School of Midwifery before we intervened. Photo on the right: The matron and her students displaying their new training resources.

The school’s highly committed director, Dr Shephard, together with the matron, had been working hard to make do with what they had. Then, one morning, our fully loaded truck entered the school’s premises. We didn’t tell them we were coming. As waves of new boxes were offloaded, the matron beamed. My colleague told her that the school was receiving its first delivery of new, state-of-the-art medical training resources. She quickly mobilised her students to help carry the boxes to the hall.

This was part of our large-scale medical training resources drive, through which we aimed to improve standards in the teaching of medical practitioners in the country and, as a result, improve their performance. We had identified that the major contributing factors to the downward spiral in the provision of good healthcare services in Sierra Leone were neglect, the familiar corruption, and state incapacity to prioritise training of national medical professionals who can deliver the government’s vision.

Neglect is at the centre of what the healthcare system is facing in Sierra Leone. Many community hospitals, maternity clinics and healthcare posts are left in a state of decay, with rusty and dysfunctional equipment. Rickety trollies, mouldy ceilings, and broken or uncleaned lavatories with no water supply are common sights in Sierra Leone’s medical establishments. Wobbly and broken hospital beds are still used by midwives to deliver babies. Some of these institutions do not even have electricity to keep medicines under controlled temperatures.

The school’s training programme was ‘upscaled’, as the government’s recent self-congratulating report put it; for example, from State Enrolled Community Health Nurses (SECHN) to State Registered Nurses (SRN) and from SRN to Nurse and Midwife Tutors.

After we had delivered the resources to the school, the then Minister of Health and Sanitation, Alpha Wurie, waited until I had left Sierra Leone to return to the UK before he shamelessly visited the centre for a photo opportunity with the resources to create the appearance that it was the work of the government. He took with him unsuspecting Western funders to show them what the government was doing to improve healthcare training!

In fact, when we had entered the school, the maternity unit staff had begged us for consumables (items such as gloves, umbilical clamps for new-born babies, etc.) I had found myself needing to rush to the truck to get a box of vinyl gloves. Ward 2 of the maternity unit did not even have an oxygen concentrator for pregnant women who were struggling to breathe. We soon provided a modern oxygen concentrator for the ward.

Connaught Hospital Nursing School

In the same week that we delivered medical training resources to The National School of Midwifery, we went to Connaught Nursing Training School, where we presented a first batch of training resources.

Photo: Connaught Hospital Nursing School students in receipt of textbooks.

The library there, too, mostly contained old materials that were largely irrelevant to the students, many of whom were struggling for resources. We did two major deliveries in two years, amounting to about 3,000 new, high-value textbooks. Some of the new texbooks were so expensive that if you were to buy a copy from a bookshop, it would cost you £388.49!

As I stated earlier, the Ebola crisis exposed Sierra Leone’s appalling healthcare system and led to organisations like ours pouring resources into the country to support its failing services. These failing institutions were the frontier for extreme corruption by some in public office within the system – they were diverting the most-needed equipment and medicines to run their own private clinics, pharmacies, and home treatment services for patients. Home treatment for patients is rife in Sierra Leone and is undertaken by the very people who are supposed to uphold and maintain government-run medical centres.

Patients who go to government hospitals are quickly persuaded to return to their homes and be treated there privately with medical equipment and medicines allegedly taken from government-run hospitals. Patients are also referred to private pharmacies run by relatives or associates of medical practitioners who mysteriously acquire the necessary medicines. This is so common that even simple examination gloves, tags for new-borns, and umbilical clamps are not available in some government-run clinics and hospitals. This is what is destroying Sierra Leone’s healthcare system.

By 2019, we had shipped $800,000 worth of medical textbooks to our stores for distribution to government medical training institutions in the country.

School of Community Health Sciences, Njala University, Bo

At Njala, we provided a large consignment of new resources to the school. We were riding on our experience in the east of the country, knowing that targeted deliveries of resources, followed by a comprehensive monitoring system, leads to improved performance.

The centre is one of the most important medical schools in the country. It was previously known as Para-Medical, but it is now part of Njala University, providing training for nurses and delivering degree courses. Our provision was timely, delivering the high-quality, up-to-date medical textbooks which have been so lacking at the school. The first delivery amounted to 557 new medical textbooks.

College of Medicine & Allied Health Sciences

As with other medical training colleges/schools highlighted in this piece, the institution was in need of medical training resources – for example, surgical equipment. The college’s library also was in a stagnant state, and students were complaining about it.

Just as we have done with the other institutions, our truck pulled right at the doors of the institution and offloaded new boxes of textbooks – to the amazement of the principal and her students.

We presented the resources to the college and promised to return with even more.

Defence School of Nursing, 34 Military Hospital, Freetown.

At 34, the story is the same as with the other medical training schools we are supporting. We pulled right up to the doors of the school building and got help from the students. The school trains military and other security forces’ medical practitioners.

Photo: Receiving Medical training items at 34 Defence School of Nursing.

In addition to supporting mainstream medical training centres, we have delivered medical equipment to smaller hospitals and clinics across the country. For example, Macauley Hospital in Freetown have received defibrillators as part of a larger pool of medical equipment. This is the first time they have had a defibrillator!

This is the background to the current surge in improved medical training in Sierra Leone. Between 2017 and 2020, we shipped several 40ft containers of resources from the USA and the UK to suport these institutions. We are fundamentally changing Sierra Leone’s medical training system, and we are doing so independently from the state. We are just about to release another consignment of medical training resources and equipment in Sierra Leone. We do not even entrust these to the state for distribution; we know they would probably disappear.

So, as I said at the start of this article, I couldn’t help but laugh when I read the recently released report by the Sierra Leone government in which it praised itself for the positive changes in the provision of medical training in the country. This is a brazen lie, and it is downright disgraceful!

You have now seen the evidence from us. As 2023 approaches, leading political parties have started throwing absolute lies at unsuspecting citizens. In the next few weeks, I will be releasing a series of write-ups, under the title ‘How We Transformed …’ to challenge the government’s claims to achieving some of these milestones.