Monday, 8 November 2010

Technology Problems and Traditional Birth Attendant Training

It has been weeks now since I have been able to update my blog. I have had a series of frustrations with technology including problems with computer charging cables, generator and internet modems but am now back in the online world. It brought home to me how much I rely on the limited internet access we normally have here in Kamakwie to feel connected with friends, family and the wider world.

This year has flown by and I can’t believe I only have 5 weeks of my World of Difference Year left. Since writing last I have spent a week training midwives, nurses and doctors who work in faith based hospitals in Sierra Leone on emergency obstetric care. During October I was working with the hospital staff at Kamakwie to complete the work we have been doing on the maternity ward to improve documentation and clinical guidelines. During our final review meeting staff said although they were initially concerned about increased workload, the new system is helping them. They say it is especially useful having more comprehensive information about each woman and baby when shifts change and new staff take over and it makes it easier to detect problems earlier. Medical staff reported that improved recording of the condition of the mother and baby, including treatment and medications given make planning and evaluating care easier. One area that we are still working on improving is recording of care given to women during labour using a partograph – this is a tool used to record information about maternal and fetal wellbeing during labour, it also helps health staff identify prolonged labour. A colleague and I have spent some time teaching the Maternal and Child Health Aides to help them understand it.

In 2008 in Sierra Leone almost half of women gave birth with Traditional Birth Attendants and in the remote communities we work with the number of women giving birth with TBAs is higher still. In a drive to reduce the high maternal and child mortality rates in Sierra Leone the Government launched free healthcare for pregnant women in April this year and is now urging all women to give birth in a health centre. The Government is advising TBAs to refer labouring women to a health centre to give birth instead of helping them to birth at home. At Health Poverty Action we try to take a grass roots approach to improving health of women and babies. We believe strengthening links between the community and the health care system, increasing knowledge of healthy practices at community level and supporting women to access available services are important if the expected results of the free healthcare initiative are to be realised.

We have been working to design a training course and toolkit for Traditional Birth Attendants to enable them to work as Maternal Health Promoters in their remote villages to share maternal health messages to promote healthy behaviour including, seeking of appropriate care during pregnancy, birth and the postnatal period, exclusive breastfeeding and use of family planning. These women are almost all illiterate so we have developed a toolkit of pictorial flashcards which they will use to promote discussion and share health messages. These women will work closely with the health workers in the rural health centres, they will mobilise women to access skilled care during birth and offer them additional support and encouragement during labour. Part of this project is to ensure women in the remotest areas have equal access to health services; we are planning to pilot birth waiting homes close to 8 of the rural health centres we work with. Women living long distances from the health centre will be able to come and stay in these rooms to be close to the centre when labour starts. The Maternal Health Promoters will also give support and health information to the women who stay in the home.

The training was incredibly fun but we had a few challenges. Language was the biggest. During this training the trainees spoke Loko, Temne and some also spoke Krio. There was lots of translation needed to be sure everyone understood. The fun part was the singing; I think we now have a song for every part of the training. The culture of song and dance is incredibly strong here. I was in awe of these women who can rustle up a song on any topic at the drop of hat. I also enjoyed immensely talking to these women and hearing about their work. Many of them although unable to read and write have kept meticulous records of the births they have attended by asking community members such as a teacher who can write to help them. I feel lucky to have the opportunity to work with these women, who hold so much information on the culture and history surrounding childbirth in Sierra Leone.

Sunday, 5 September 2010

Two different lives

I’m back in Sierra Leone having been in the UK during August. In some ways it feels as if I currently have two lives. Moving between the two countries I find it hard to really believe that it is possible to spend only 7 hours on a plane and experience such dramatic contrasts.

I still can’t really comprehend that it is possible for aspects of life in Kamakwie and the UK to be part of the same world. I have left behind electricity at the flick of a switch, water that comes out of the tap, food flown in from all over the world and iphones and other incredible technology at every turn. In Kamakwie, we live without electricity or running water. I see on a daily basis the visible and grinding poverty of many of the families close to my house; where, quite literally, because of the lack of an exercise book costing 10p, children are not going to school. Women needlessly die giving birth and children don't survive until school age.

How can it be possible that only 7 hours travel away many people have so much disposable income that shopping has become a leisure activity (I can’t deny I did quite a bit myself having been away for 7 months – it was stressful, who knew August was already Autumn/Winter season? I live in Africa I need cotton not wool!. That most people in the UK worry about losing weight, rather than how to fill their stomach more than once a day and children refuse to eat things they don’t like instead of ravenously eating anything put in front of them. How can it be possible to cross two countries (including a stretch underneath the sea) on a train so comfortable the journey feels like a holiday in itself in less time than it takes to drive 55 miles between Kamakwie and Makeni. How?

I don’t want to paint a bleak picture of Sierra Leone. It is an incredible country and there are many things in Sierra Leone which we could learn from. The strong sense of family and community means that despite the basic living conditions and almost daily sightings of rats in my house which I am terrified of (my reaction to which, is still a source of great amusement to my colleagues) I genuinely enjoy life my life in Kamakwie. I have experienced such genuine hospitality here in the remotest of areas and poorest of villages, at times I have felt quite overwhelmed by it. It just seems incomprehensible at times though that these two worlds exist side by side.

I am not yet back in Kamakwie, I am in Freetown which feels a bit like a bridge between these two worlds in some ways. Going for a Chinese meal last night, sitting in a café having lunch today, followed by a trip to the supermarket I could almost be in London. Walking back home past children filling water buckets from the stand pipe, a power cut last night and having a wash with a bucket of cold water reminds me I am not.

I have to admit to feeling sad as my holiday came to an end, I realised how much I have missed all my family and friends when I saw them at home. Arriving back in Sierra Leone on Sunday felt good though. It is hard to describe the sights, smells and slightly chaotic feel of Freetown but it feels like I have come home, which is funny really, as that is the same feeling I had arriving back in the UK 4 weeks ago.

If anyone is interested in donating to Health Poverty Action go to their webpage or my justgiving page

Friday, 23 July 2010

An afternoon in the Baray

It has been a while since I have had a chance to update this blog. I have been writing regularly for the Royal College of Midwives website click and also for the Vodafone World of Difference webpage. I have written more on what I have been doing during June and early July on the RCM page here and the WOD page here.

This week I have had my first experience of the traditional justice system. The justice system in Sierra Leone comprises of three separate systems. The traditional system presided over by the Paramount Chief (PC), each district (similar to county) is divided up into Chiefdoms and is ruled by a PC who has a number of other Chiefs (including Town and Section Chiefs under him), then there is the local court system which mainly deals with land issues or personal disputes and finally the Magistrate court system which deals with criminal cases.

Our main project is the ‘Kombra en Pikin Welbodi Community Project’ focusing on improving maternal and child health and reducing maternal and under 5’s mortality. We have a number of smaller projects which run alongside this including a Sexual and Gender Based Violence (SGBV) project. Sexual and gender based violence has been common in Sierra Leone and often seen as something that is between a husband and wife, or to be settled within the family or in a traditional way through the Chief. Three Gender Acts were passed as law in 2007 and sexual or gender based violence is now an offence and punishable by law.

We now have an extremely dynamic field officer who is the focal person for our SGBV project. Our project aims to support survivors of SGBV, including paying for medical treatment, offering a safe home with women we have trained as ‘community hosts’ and supporting the woman to access justice through the legal system if she wishes to do so.

It is important to change attitudes of community members, community leaders and the police towards SGBV. HPA has been doing this in a number of ways, through holding a rally to raise awareness of women’s rights and the gender acts in Kamakwie. T shirts were printed with slogans such as ‘Nor fose ooman na bade’ (do not force a woman into bed) ‘Ooman na posin jus lik man’ (A woman is just like a man and should be treated equally), airing radio discussion programmes and conducting trainings with community leaders and police. We work closely with the Family Support Unit section of the police which deals with these matters.

It is a big step for women to seek justice through the legal system. She may well be doing this against the wishes of her family and community who would rather resolve the matter within the family or through the Chiefs. Since our SGBV officer started work in May we have had many women coming to our office reporting that they have been victims of SGBV and asking for assistance. Some of these women have required hospitalisation. Not all of them have taken the perpetrator to court but some women have been clear that they wanted justice even if it is not an easy decision for them personally. Two perpetrators have now been successfully prosecuted and given custodial sentences which is an important step as it will hopefully be an example that the law can and will be upheld and that women have a right to a life free of violence.

One of our field officers was summoned to the PC this week through the traditional justice system as a result of a local councillor being unhappy at how he publicly defended this part of the organisations work in response to a statement made by the councillor. Of course we went along to support him.

The hearing was held in the Paramount Chief’s ‘Barray’ which is a round building with low walls, a tiled floor, open sides and a conical thatched roof. The Paramount and other Chiefs gather to hear both sides of the case. Other people can also sit and listen. We do not have this kind of forum for settling disputes at home. The person summoned has to pay money (in this case 15,000 Leones about £2.60 which is a fair amount of money in a country where a large percentage of people are earning less than £1 per day) before appearing at the Barray.

The two individuals with the dispute sit in front of the PC and other Chiefs, they each have to pay money for the case to be heard (30,000 Le) they then each have to say how much they want the other person to compensate them if they win the case (100 -150,000 Le in this case). They are each allowed to call witnesses, every witness is given 2,000 Le by the person who called them as a witness and before they give their statement they are asked to hold the money and state that if they tell the truth they will 'eat' the money to get ‘welbodi’. Everything is done orally, there are no notes taken and written evidence is not permitted. The person who summoned the other tells his story first, the other person and the Chiefs can then ask him questions; this is followed by the person who was summoned doing the same thing.

The witnesses wait outside and are called individually to give their account of events and can be asked questions by either of the people involved in the dispute or any of the Chiefs. Once this has all taken place the Chiefs go and ‘hang heads’ to decide on a verdict. In this case the Chiefs ruled in favour of the councillor although they emphasised they have full support for the work that HPA is doing around SGBV in the community and they were deciding on a personal dispute which has no bearing on how they felt about the issue of SGBV.

The family of the person who summoned our field officer decided that he should not pay the compensation money as they felt the situation should not have gone this far. This whole situation highlights what sensitive and emotive work supporting victims of SGBV. As one of the Chiefs rightly said if they community is to ‘go before’ (Krio for develop/improve) it is crucial that violence against women stops and those responsible are punished

Monday, 14 June 2010

Changing Seasons

It suprises me how clear the changing seasons are here. The rainy season is coming, although more slowly than it seemed at the beginning of May. Mostly the days are still hot and sunny and although we get the occasional rainy day, mostly the rain is still coming at night which makes sleeping much more pleasant. Every evening the sky is incessantly lit with bursts of lightning, it is a bit like falling asleep with a strobe light outside the window, and very beautiful to watch as we sit outside our house in the evenings.

What really indicates the changing season however is the baskets carried on women's heads as they walk past our office on the way to the market. At home it is difficult to get a sense of the changing seasons from our food as although I go to the local farmers market sometimes my sense of what is in season is diluted by regularly being in the supermarkets where everything is available all year round.

It is exciting here enjoying a new delight and I feel sad as delicious things come to an end. We are almost at the end of the mango season; to me it seemed as if there were mangos galore, although I have been told that this year was not the most plentiful. They have been incredibly delicious and we have been eating them every day. There are now virtually none on the trees and I will miss this treat.

Our office is very conveniently on the main street in Kamakwie which means that people from surrounding villages pass on the way to the market, we are lucky to be able to meet the sellers and buy things such as avocados which never reach the maket. John our security guard (who is my Saloneon father - due to the fact he is my fathers namesake!) has a keen eye for trading women. We have been lucky enough to get pineapples, bananas and often bread fresh from the oven and still almost too hot to hold. The baker lives very near us and kamakiwe has the best bread I have had yet in Salone except for the home baked bread we ate in Sanya.

We have just seen the first of the oranges which will be the next thing to arrive after the mangos; they are green on the outside and orange inside and are delicious. The saloneon way to eat them is to peel the skin down to the pith, cut a small slice off the top and then suck all the juice and flesh out until there is an empty shell, there is a definite knack to this - I don't really have it yet.

Food feels much more real here than at home and it reminds me of being a small child on my parents farm where meat was obviously from an animal rather than something you buy in a plastic box from the supermarket. Sometimes we have been given gifts of chickens and cooking and eating these birds is a very different experience from eating chicken at home. There is so much preparation involved in killing and preparing the meat before you even start with the cooking. I often feel completely useless here as no self respecting women in Kamakwie would be unable to prepare a chicken and I have no idea what to do with a just killed chicken. The meat bears absolutely no resemblance to the enormous fleshy, pink chicken breasts that are for sale every at home, I suppose because the chickens here are truly 'free range', but it seems as if they come from a different animal. It makes me realise that even food I don't think of as being processed has been to a certain extent.

I am learning how to cook with some of the local ingredients, on Saturday when we were not working Isha and I went to the market and then spent the afternoon cooking rice, with fish and cassava leaves. At home I really enjoy cooking, there are so many ingredients I don't know here and have absolutely no idea how to prepare or cook them so it is nice to have someone to show me what to do with them.

I started writing this morning and I think the weather must have heard me saying that the rainy season was coming slowly as we had torrential rain for about 7 hours in the evening, it felt like autumn in England, sitting inside in the early evening with the sky dark, rain lashing down, drinking cups of tea, this morning it was cold enough at 6am when I got up to mean I couldn't face a cold bucket wash and I warmed some water on the gas for the first time, it felt like a real treat washing my hair with warm water.

Tuesday, 1 June 2010

Village Life

It has been a while since I have posted an update, having time out in the field, problems with internet access, limited electricity and a week of training last week has meant that it hasn’t been possible. The fieldwork for our survey went well, we gathered a huge amount of data from households, Community Leaders, Traditional Birth Attendants and health workers. I really enjoyed the opportunity to get to know some of the Community Health Volunteers (who work with Health Poverty Action to promote ‘welbodi bisness’ in their remote communities through facilitating weekly health club meetings. Covering topics relating to maternal and child health and raising awareness of issues such as human rights and sexual and gender based violence). It was a good team building opportunity all round, both for us working in Health Poverty Action and also developing links between the CHVs across the 5 Chiefdoms.

Our operational area is made up of some remote and difficult terrain and we have had some adventures along the way, breakdowns, flat tyres and some interesting river crossings involving many people knee deep in the water! During our 9 days of fieldwork, we covered large distances on some of the poorest roads in the country, the discomfort has been worth it though as the landscape is incredible we have passed through lush jungle, with mountains rising out of the early morning mist as the dew sparkles in the sunlight all around, gone through the rocky gold mining areas, through National Parkland and through the customs and immigration post at Sanya, which is almost on the Guinea border, the phone network and money used here are Guinean.

Everywhere people have been working on their farms as it is planting season with pepper, tobacco, cassava and cocoa all being nursed or planted out. Some of the remotest villages the researchers could only reach on foot and had to walk for miles, some villages sadly lack even basic sanitation facilities including clean water. The challenges that communities and health workers face in areas with poor road networks, no mobile phone coverage and long distances to the referral hospital mean that it is essential for organisations such as Health Poverty Action to work to support the government to improve health in these remote areas.

What village life in rural Sierra Leone lacks in luxuries it makes up for in abundance with what one of my colleagues describes as ‘solidarity’. He rightly said ‘isn’t Africa great’ as we arrived in a village at 6.30 and the nurse offered us a place to sleep, relit the fire and organised food to cook for us all without a second thought. I was constantly overwhelmed by the hospitality of people we met. Life here is more communal and seems in many ways friendlier than at home, everywhere we went we were given fruit, chickens or plates of food to share. It is the custom for a household to share from one plate and myself, Souleymane, Ibrahim and Moses who were supervising the fieldwork and carrying out the research with health workers have been one ‘household’ for the time we were away. Sharing all our meals in this way means that eating from individual plates begins to seem unfriendly. I am growing to love Sierra Leonean food, and rice which was never my favourite food is now my staple diet. In Sanya we had ‘pot roast’ which is a bit like satay chicken. We ate it with bread cooked by creating an oven by heaping hot coals onto a large pot. It was delicious and since then Ibrahim arranged for someone to teach me how to make it, so I will be able to recreate a taste of Salone for some of you later this year.

The last two weeks have been full with preparing proposals for funding, writing reports from our work in the field and carrying trainings. We have trained 30 women to be fistula advocates (more info on this here) and 10 women to become community hosts. Sexual and Gender Based Violence is a big problem and we currently have a one year project aimed at reducing SGBV and supporting victims. These community hosts will raise awareness in their communities of the issue of SGBV, its negative impact on victims and the community and the Gender Acts which came into effect in 2007.

Saturday, 8 May 2010

Village Life

We are well under way on our baseline survey and over the last two days have visited 6 villages to support the teams of researcher and another 4 villages to visit health posts and interview health staff. This is our last night in Kamakwie, as tomorrow we start to cover some of the more remote villages and will be staying out for the next 6 days.

I would love to be able to upload some pictures but it is just not possible, I have been unable to in Freetown, let alone here in Kamakwie. Instead I am going to try and describe the images I have in my head.

Today I woke up to the sound of persistent rain and had mixed feelings, as being able to sleep under a cover for the first time in weeks was lovely; but a cold bucket bath and hairwash at 6.30 when it really doesn't feel that warm is not so tempting. I braved it none the less and it was worth it as the steady drizzle and cool weather for the rest of the morning was a welcome relief from the oppresive heat we have had throughout March and April.

We started this morning with a flat tyre so went to the lorry park to get it fixed, it was raining and the steam coming off the plates of food at the small, corrugated tin shack (which is the cookery shop) looked really inviting as the woman served people rice and cassava leaves for breakfast.

After getting our tyre fixed we were on our way, Sierra Leone is incredibly green and since the rains started a couple of weeks ago, everything has started to grow and ever where are vivid, different shades of green, tobacco seedlings, pepper seedlings (under symetrical rows of palm fronds shelters) rice, lemon grass, mango and breadfruit trees with fruit in abundance and the landscape stretching into hills, bush and palm trees. The contrast of all the greenery with the red earth is striking and this morning with the rain clearing and the light which you get as the day moves between rain and sunshine it was especially beautiful.

Along the road to get to the village we were heading for we pass small mud houses some with straw and some with tin roofs with people sheltering from the rain whilst cooking or sitting outside their houses. We pass goats skip away from the car at lightening speed and sheep which always seem to run towards the car or stand in the road, people carrying 3 metre long bundles of firewood on their heads, or walking along with brightly coloured umbrellas.

I'm going to run out of battery on my computer so I'll describe the villages when we are back next week....

Tuesday, 4 May 2010

An update from April

I am back in Kamakwie typing whilst sitting under my mosquito net listening to the sound of the frogs and crickets outside. We arrived on sunday afternoon, yesterday was spent finalising plans for the fieldwork of our fistula project baseline survey.

We have a team of 12 volunteers who will conduct interviews and facilitate focus groups in 30 villages. Three of us will supervise and support the volunteers, alongside conducting interviews with health workers in 27 health posts. The villages and health posts cover all 5 chiefdoms which Health Poverty Action is operational in. We started our 3 days of training with the 12 volunteers today, covering general fistula information, background information on the fistula project and an introduction to research and communication skills. Tomorrow will be practising interviews and focus group facilitation both in our office and in the field to iron out any last problems and pre-test the interview guides.

Click here to read my blog update for Vodafone which has more information on my work during April.

Tomorrow is International Day of the Midwife, which is a day for midwives to think about others in their profession and raise awareness of what midwives do for the world. The theme is 'the world needs midwives now more than ever' which is certainly true in Sierra Leone. Care from a trained midwife here is a luxury many women do not have.

The Royal College of Midwives is raising awareness about obstetric fistula for The International day of the Midwife. I have written about this condition and the work that we are doing at Health Poverty Action to prevent it and treat women who are already affetced and you can read it here.

Dinner tonight was at Mr Bah's roast meat stand in the town, skewers of goat meat cooked over charcoal with fresh baguette and a hard boiled egg is a simple but delicious Kamakwie staple!

Monday, 19 April 2010

Snacks and street vendors

I’m still in Freetown, it is only 8 days until free healthcare for pregnant or breastfeeding women and children under 5 is launched on 27th April which is also Independence Day. I have been back in Freetown for 3 weeks the first two weeks were mainly spent working on our fistula project, helping an epidemiology intern who is working with us to plan a baseline survey to evaluate community knowledge and perception of obstetric fistula in Northern Bombali.

Last week I was working again with the Liverpool School/Ministry of Health, Life Saving Skills course training 28 retired midwives on emergency obstetric and newborn care. There was a great team spirit amongst the trainers as many of us had worked together on the last course in Bo. The midwives we were training have been brought back into service to help meet the existing need for more trained health personnel which is anticipated to increase further once the free healthcare initiative is launched. It was really enjoyable and the midwives all seemed motivated and committed to reducing maternal and infant mortality.

The training was held in The Princess Christian Hospital which is the main government maternity hospital in Freetown, it is across town from where I live and our journey to get there took between 30 minutes to almost 2 hours depending on the traffic. The journey across town in rush hour traffic is an experience in itself and driving this route could probably pass as an adventure sport. I am very happy that Mohammad our logistics manager was driving as negotiating the cars, poda podas (minibuses), motorbikes, people, carts, wheelbarrows and a array of street vendors takes considerable concentration and skill, many times it appears as if we are going the wrong way up a one way street as the roads are so narrow and there is constant honking of horns to alert pedestrians as we inch our way along.

The beauty of Freetown is when you drive through the city it is a little bit like a drive through supermarket/department store. Along our journey are many tiny street stalls, a constant stream of traders carrying baskets on their heads and many people pushing cold drinks in coolboxes in old prams (which I have never seen a baby in as they are always snugly tied to their mother’s backs). Here is a short list of a small number of the things which were for sale along our journey bridesmaid dresses, flip flops, bathroom scales, rubber plungers, vaseline, cotton buds and other toiletries, CDs, trilby hats, material, cold water, ginger beer, plantain chip, groundnuts, chewing gum, biscuits, mangos, bananas, mobile phone credit vouchers, notebooks, pens ….. the list could continue almost indefinitely. Being able to buy packets of cold water, salty plantain chips and small packets of groundnuts (peanuts) is great when you are tired and hungry.

Tuesday, 30 March 2010

Too much wildlife!

The links to my latest blog for the RCM magazine are here and the World of Difference webpage here which describe more about what I have been doing over the last few weeks.

I am back in Freetown for a couple of weeks doing some work in the office. It is different to my life in Kamakwie, electricity 24 hours, constant internet access and supermarkets. It's nice, especially the delicious choice of salad and vegetables which it is just not possible to buy in Kamakwie. I miss the laid back feel of Kamakwie though. Drinking a cup of tea outside my house looking out at rice swamps and banana trees, listening to the neighbours kids squabbling over who will get water next from the well opposite my house, people passing the house calling out greetings in Limba and Krio, Walking to work and greeting Abibatu, Salimatou and my other neighbours as they sit outside their houses preparing food in the morning.

I am not missing the rather abundant wildlife though I had a mouse in my house (at least it wasn't a rat), a tarantula in my bathroom (I'm not a spider expert but I have only seen one like this in a zoo before) and a snake in the road outside my house (must block up the hole in the bathroom wall when I go back!). I tried to upload some new pictures today but the internet is too slow, so pictures another day.

Friday, 12 March 2010

Celebrating International Women's Day 8.3.2010

It was International Women's Day on Monday. I have been in the midwifery school this week, to celebrate IWD and highlight the impact that skilled birth attendants can have on reducing maternal and infant mortality we made a short film of a skit performed by the students, they originally acted it in January for the opening of the Midwifery School. It powerfully shows the different delays which lead to poor outcomes for women and babies in Sierra Leone, these include a lack of knowledge of the significance of danger signs by both women and untrained birth attendants, poor access to health care facilities because of the poor road network and limited availability of transport, the financial barrier and the attitude of health care professionals.

The government is implementing free healthcare for women who are pregnant or breastfeeding and children under 5 at the end of next month. I am hopeful that reducing this financial barrier in conjunction with training midwives to work in rural areas will mean that outcomes for women and babies in Sierra Leone will gradually begin to improve.

Friday, 5 March 2010

Training on emergency care in Bo

I have spent the last five days in Bo, I have barely spent much more than a week in one place since I arrived in Sierra Leone two months ago. My first two months here have flown by and I am enjoying my work immensely, I do feel a bit like a tortiose carrying it's house around as I am permanently living out of my rucksack!

I got back to Freetown last night having spent the week in Bo, at the Government Hospital, as one of the facilitators of a four day training course. The course is designed specifically for health workers providing maternal and newborn care in low resource countries by the Liverpool School of Tropical Medicine [LSTM]. It is an extremely comprehensive course aimed to equip health workers with the skills to recognise complications and effectively manage maternal and newborn emergencies in order and reduce the high number of deaths of mothers and babies.

The participants were made up of four midwives and 27 MCHAs - who although are not as highly trained as midwives are the frontline workers in Sierra Leone; they deliver a huge amount of the care of women and babies and are the ones who are working (often as the only health worker) in remote, rural areas. It is essential for them to have the skills being taught on this course both to enable them to be able to identify when a case is outside their scope of practice and needs referral but equally importantly how to manage these emergencies whilst transfer to a hospital is arranged. Transferring a woman or baby to hospital can take many hours because of the poor infrastructure and limited transport options here. Women and babies lives will be saved if these health workers can implement life saving measures.

We were 8 facilitators in all, half from in country and the others who facilitate the courses for LSTM from UK and Nigeria. I really enjoyed working with the other facilitators and there was a great team spirit throughout the week. Jen, Jo and I enjoyed walking around Bo, some fabric shopping and cold drinks together in the evenings. We were all lucky to have Alpha with us who now lives in the UK but is from Bo, he made sure we got to and from the hospital everyday and brought us delicious home cooked food from his family.

The enthusiasm and committment from the participants (many of whom are only just completing their training and were being taught many of the skills for the first time), was inspiring and enabled us to get through an intense four days of training in 30+ degree heat, trying to be heard over the noise of two generators with smiles on our faces and a real sense of achievement. Especially as the pre and post course assessments of the participants knowledge and skills showed a marked improvement.

I think Gladys who ensured we were all well fed had a large part to play in the smooth running of the four days too. She served us such huge platefuls of lunch that we were nearly able to feed half the hospital, as we all needed to share our portions. She managed to serve something different everyday and each dish was delicious, especially Jollof rice with fried chicken and pepper sauce. I'll be writing from Makeni next as I leave on sunday for work at the Midwifery School on monday. Pictures to follow, internet not fast enough right now!

Sunday, 28 February 2010

A video from January

Here is a short video which shows the work I was doing with Health Unlimited in January. It is clips from the gender assessments which we carried out in 2 villages in Northern Bombali District. It is my first attempt and the quality is not always brilliant, the camera man (who is really the HU driver) doesn't have the most steady arm and neither do I, so I apologise if you feel slightly sea sick at points where the filming is most wobbly.

Friday, 26 February 2010

February in Kamakwie Wesleyan Hospital and the Makeni Midiwifery School

There hasn't been any updates on here for a while. I had very little internet access in Kamakwie. I have have done a guest blog which I will be doing regularly for the RCM website which is here and has more information on my work at the midwifery school at the begninning of the month.

I enjoyed my first week in Kamakwie after getting over the first night which was a bit of a challenge. We arrived just before dark from Makeni, there is no electricity and I had forgotten to buy matches or candles. I had a battery powered lamp which kept switching itself off so I ended up in bed by 8.30, with my mosquito net very tightly tucked in as when I stayed here in january I woke up in the night to the sound of tiny (mouselike) feet beside my bed!

Kamakwie is a quiet and beautiful place. Only a very small number of people have generators for electricity which means that the stars at night are incredible. there are so many, they are so bright, it feels like you could reach out and touch them. I fall asleep to the chorus of the frogs in the rice swamp next to my house.

I was worried about staying in the house alone but I needn't have been. I was almost never alone. It is too hot to sit inside so I sit on the verandah outside the house. My house is on the roadside so most people walking past stop to say 'Uwaley' - hello, 'Namacotoko?' - how are you? the language spoken here is Limba, I have learnt a few words over the week. People laugh as I write them down in my notebook but otherwise I forget them instantly. The children go to fetch water from the well near my house and come and sit on the wall to watch me read or cook. My neighbours are really friendly and Salimatou across the road comes to say hi. The children below are the audience I had whilst I cooked my first meal in Kamakwie, so meal times are fun!

The hospital is a mission hospital of the Wesleyan Church, every morning the early shift begins with a short service in the chapel. This is normally Pastor Jane giving a sermon followed by prayers. On thursday I arrived and was given a hymn book, every thursday the day starts with 'Singspiration' a service of hymns.

People who have had the misfortune to do Karaoke with me know that I don't have the most tuneful voice. Whilst chatting to the Pastor before the service started I mentioned singing is not my strong point, she assured me that only some people are blessd with a good singing voice, others have the voice of a cockroach but should still sing! there are no instruments, someone hums the tune aloud and then everyone sings. It was an uplifting start to a busy and challenging day. I have just updated the Vodafone world of difference blog page which has more information about my work in the hospital and you can read it here.

Thursday, 4 February 2010

A meeting and a wedding in Makeni

We had our quarterly project steering meeting on saturday in Makeni. It is a really useful meeting to make sure that the 'kombra en pikin welbodi project' (mother and child health project) is on track, staff from Health Unlimited, the District Health Management Team, Kamakwie Hospital and members of the communities which the project is running in all come along.

Once our meeting ended around 3, I headed over to Magbenteh Community Hospital. It was lovely to see all the hospital staff that I worked with when I volunteered with VSO in 2008, as this was my first time back in Makeni since I left a year ago.

The house was a hive of activity when I arrived with around 30 people involved in cooking food for the 250 people coming to Suzie and Bernhard's wedding celebration. Suzie volunteers at the government hospital (she is also a VSO) and Bernhard works at Magbenteh, they met in 2008 having both left Europe to come and volunteer in Sierra Leone, and got married in the UK in December. The preparations had been underway for two days with two cows being bought and killed and huge pots of rice, potato salad and couscous being prepared on fires outside the house.

The party was great fun, incredibly hot and sweaty, very loud music and lots of cold beer. Everyone had made an incredible effort for the party. All the technical staff from Magbenteh wore teeshirts printed with a picture of Suzie and Bernhard on their wedding day in England. Staff from the government hospital all had different clothes made in the same fabric and all the staff from Magbenteh had done the same with a different fabric so it looked amazing to see so many people with different styles of clothes in two distinct patterns.

This week I have organised teaching sessions with the midwifery school in Makneni and I will start on monday for three days before heading off to Kamakwie to spend 8 days in the hospital identifying areas for training and support. I am looking forward to this as I haven't been at a birth since the end of november and am missing midwifery life!

I took part in a really interesting workshop yesterday. MRC which is a local NGO which has created a database of all the NGO's working in maternal and newborn health in Sierra Leone and their activities. Quite a few of the NGO's including Health Unlimited were asked to come and identify activities which should be researched in order to choose really effective ones for scaling up across Sierra Leone to reduce maternal and infant mortality.

Next week news from the midwifery school, I am also trying to put together a video of my first weeks here. I am not technically brilliant at this so it may take a while!

Thursday, 28 January 2010

Off to the villages

We have now finished our assessments into gender issues in four of the chiefdoms in which Health Unlimited operates. This is the first update for a while, we have mainly been without electricity and internet since starting the assessments on the 17th until getting back to Freetown.

I was really excited about being a part of the assessments and being able to get a better understanding of life in rural Sierra Leone. There are many reasons why women do not or cannot access healthcare and a better understanding of these will enable us to more effectively improve healthcare for women and children

The two villages that our team visited were very different. We spent 3 days each in Kamaranka and Fintonia (these are the headquarter villages for 2 of the Chiefdoms in which HU is operational in Northern Bombali.)

Staying in the villages for this period of time meant that as well as our planned assessment activities, there was plenty of opportunity for informal discussions. We wanted to explore what community members feel are the main problems they face and how the community and Health Unlimited can work together to address them.

We discovered women in both villages carry huge responsibilities for their families and often carry out all the domestic work, grow food for the family and try to generate income through petty trading.

Kamaranka is on a main (dirt) road and has facilities such as a secondary school, functioning health centre and a purpose built market place. In spite of these facilities poverty rates are high and poor farming yield is an issue meaning that many women have problems feeding their families and generating income.

Fintonia is very remote, so has a different set of challenges. It is in an a beautiful area of National Park but cut off from the rest of Sierra Leone by a river. The nearby ferry crossing point is currently out of action (which means a long detour on a very bad road). If you live in Fintonia and need to go to hospital or get to secondary school the only way to cross quickly is in a wooden canoe - you can imagine what that would be like for a woman being transferred in labour becuase of complications. Fintonia has no mobile phone coverage, so people are unable to communicate, which creates difficulty for trade and other opportunites.

In kamaranka we were shown around the village by Isatu, an extremely bright, confident schoolgirl and Hawa, a determined woman in her 30's. Many people in Sierra Leone had their education interrupted by the war and Hawa is one of them, She tried to go back to school after she had given birth to her second child. Sadly she was teased for being to old and her children were not well cared for by her husband while she was at school, so she stopped attending. There are many stories like this of lost opportunity and wasted potential.

Kadiatu who who we stayed with in Kamaranka told us her house is called 'the strangers house' in the village. Her husband has died and her children have grown up she now has just one grandchild living with her. She is often asked to provide lodging for people who visit the village. Her situation is in complete contrast to another woman who came to talk to us in the village who supports over 20 people in her house. Her husband died and she is single handedly supporting her 9 children who are all at school or college and she now has grandchildren too.

It was really useful for me to see the Health Centres in both villages and meet the health workers as I will be coming to work with them next month. One health centre seemed to be functioning well. The other although the building was new (the old health centre had been burnt down by rebels during the war) seemed very run down and neglected and in need of a bit of TLC. I will be coming back to work with the health staff in these villages soon.

In Fintonia we stayed with one of the Traditional Birth Attendants(TBAs), part of my role will be to work with these women, who are currently providing a large part of maternity care in Sierra Leone, who have had little or no training.

It has been great to meet people in these rural communities, which I will be working in over the coming year. I have even been given a new name in Fintonia - I am now know as Isatu Kamara!

There were many amazing experiences on this trip, not least people making us feel so welcome in their homes and communities. I was a bit worried about what the washing and toilet facilities would be like. I have mastered the art of feeling completely clean and being able to wash my hair all with half a bucket of water. Standing outside, up in the mountains, under mango and banana trees to have your morning wash is actually pretty idyllic.

Saturday, 16 January 2010

Off to Kamakwie and the opening of Makeni's midwifery school

We left early on the long drive to Kamakwie. The traffic in Freetown is terrible and to avoid the morning jams we took the extremely bumpy but very beautiful mountain road. Quite how Charlie and Bridgetta managed to sleep as we drove along that road I have no idea!

We stopped in Makeni to attend the opening of the new midwifery school. It is a very important development for Sierra Leone as currently there is only one midwifery training school for the whole country (which is in Freetown). This means that it is very difficult to recruit and retain staff in the rest of the country. The midwifery school offers more nurses a chance to train as midwives and also those who are from the Northern area an opportunity to train closer to home. There is 75 students in this first intake with another 75 starting later in the year. Students are offered a scholarship for tuition and associated costs if they commit to a 2 year posting following qualification. This will hopefully increase the incredibly low numbers of qualified midwives currently based in the provinces and in Sierra Leone as a whole.

I am meeting with the Midwife in charge of the midwifery school at the end of the month, to arrange working in collaboration with them as part of my year with Health Unlimited. I will be working in Northern Bombali so I'll have the opportunity to provide some of their classroom based teaching sessions and create a link for the students between the classroom and their practical training when they are on placements in Northern Bombali.

The school was opened by the First Lady of Sierra Leone (the President's wife) and the students acted out a powerful sketch highlighting the delays which lead to maternal mortality in Sierra Leone.

Tuesday, 12 January 2010

Preparing for our assessments

I've been in Sierra Leone a week already. I am acclimatising to life here, I have to get used to this life again, after becoming so used to my life of luxuries in London. When I left Sierra Leone a year ago I thought running water, 24 hour electricity and choice, choice and more choices would forever seem like luxuries, I was wrong. Although they were luxurious for a while after a year back home they had become normal again. Bucket washes (we have running water here in Freetown but it's sporadic), filling up the water barrel with 5 gallon drums to have water to wash with, enormous spiders and absolutely worst of all mosquito's (which equals malaria!) all need to become my normality again now. It's all part of life here though and makes me realise how lucky I am, which is in even more sharp focus than at home. I have food to eat and am not hungry, I have good accomodation and a mosquito net to sleep under. I have electricity and water and I don't have to walk 2 miles to a well to get it. I have been to school, I was able to go to university, choose my career and I have a job, so many of these things are out of reach for people in Sierra Leone currently and back home they are common place and sometimes taken for granted. I hope in the future Sierra Leoneons will also be able to take all of these things for granted.

This week is going well. We are spending the week planning our assessments, it is really interesting and I am learning loads. We are going to be using participatory tools (observation, focus groups etc) to gain information from people within the community to learn more about life in the village. Following lots of discussions over the last couple of days we have realised we really want to get a deeper knowledge of community life and the people's views, as without this we will never be able to facilitate local people to create a health service that is useful and effective for them. So our plans have changed and we are thinking we will spend more time in less villages. This will be a completely new experience, I have never stayed in a village community, only visiting whilst on outreach visits. I'm really enjoying being a part of Health Unlimited with their philosophy of working together with communities to find solutions which are realistic and sustainable.

I need to start learning the local languages and fast, there are lots of languages spoken in the Northern area of Sierra Leone including Limba, Loko, Temne. I can manage greetings in Temne, as for the others not a word.

I also met with Abdul from the new midwifery school today. The school is officially opening on friday and I will be involved, both teaching student midwives and creating a link between the school and their clinical placements when they are in Kamakwie.

Thursday, 7 January 2010

Arriving in Freetown

Even though I am really excited about the year ahead. The goodbyes were so difficult. Saying goodbye to my family (especially as it is my dad's 70th birthday tomorrow) and all my friends was hard, even though I know I'll be able to keep in touch with email. I felt really sad saying goodbye to Hassan at the airport. I'm going to miss him and everyone else so much, thank goodness for internet! I had to remind myself that I have been given such an amazing opportunity and will see everyone again later on this year.

The flight to Sierra Leone is 7 hours; my journey was a lot longer, which seems fitting really as London and Sierra Leone are worlds apart. I left home in London at 6am and everything was blanketed in snow. This of course meant delays on the flight. We sat on the plane for two hours waiting for the wings to be de-iced, we were the lucky ones though as we got to take off and flights after ours were cancelled. There are so many contrasts leaving London and arriving in Sierra Leone, stepping off the plane into the warm, sticky, African night is the first!

Life in Sierra Leone has daily challenges for the vast majority of the population. The first challenge on arriving is whether to choose the ferry, hovercraft, helicopter or water taxi to get to the mainland as the airport is in the coastal town of Lungi across the water from Freetown. All of these options have a slightly dubious safety record. I thought I would give the water taxi (which is a new option since my last time in Sierra Leone) a try. We arrived in one piece, although I think everyones alarm bells started ringing when we were given life jackets before boarding! We thought we were going to need them when a horrid noise came from the boat, followed by it stopping, bobbing around for a few minutes, a bit of shouting then we were on our way again. I think at that point eveyone was wondering if we had picked the right mode of transport and was glad of the life jacket !

This morning walking to the tiny tin roofed shop, to buy bread for breakfast, exchanging greetings of 'How di Bodi' (How are you? in Krio) with the shopkeeper, with chickens scratching in the dust and women selling bananas piled high on their heads, all with a beautiful backdrop of blue sea and green, green mountains it felt good to be back in Sierra Leone.

Today I met the Health Unlimited staff here in Freetown. I was made to feel so welcome in the London office and the staff here are just as friendly. I'm going to enjoy working with them all over the coming year. Today was spent planning my work for the next couple of months.

The next two weeks are going to be really busy as nearly all the HU staff are going to be involved in conducting focus groups in a number of communities in Northern Bombali, to get more information on how women and girls are viewed within the community. We will be going to Kamakwie at the end of next week. I am really looking forward to being in the field and meeting the communities in and around Kamakwie. This work is also really important to be able to think about how best to work to improve health for women and children. The status of women and girls in communities affects the health of the whole family, so the coming weeks will be incredibly useful. We will be doing a lot of travelling as it will take us a day to get to Kamakwie and some of the villages we will be working in are quite a distance from our base in Kamakwie and the roads are very bad. Interestingly the beds at our base in Kamakwie are made of concrete, so we'll see how comfortable they are after a long day on the road. I hope the mattresses are really thick!

Sunday, 3 January 2010

It's 2 days until I leave for Sierra Leone now. I have really enjoyed spending Christmas with family and friends and enjoying some of the luxuries which are more difficult to come by in Sierra Leone, although I feel sad saying goodbye to loved ones, I am excited about the year ahead. I feel I have been given an amazing opportunity to do work that I really believe in.

My imminent departure has sparked many discussions, people have incredibly strong and diverse opinions on how best to address the difficulties faced by people in countries such as Sierra Leone. Some people have asked me if I really think it will do any good being in Sierra Leone for this coming year. I do believe training and education is a sustainable way to make change. By involving communities and giving people access to information and education they are able to both use it themselves and share this knowledge with others.

I still have quite a lot of packing to do I think may struggle to fit in everything I want to bring with me for the year. I have books galore, work related and for escapism! Equipment such as gloves, resus equipment and instruments that colleagues have kindly collected or donated. I'm hoping the airline are not too strict on baggage allowance!