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!