Poverty strikes no matter how beautiful the country

A beautiful shoreline greeted me this morning. We arrived safely back in Freetown late last night after a 7 hour bus ride across the country. We passed gorgeous country side and witnessed a magnificent sunset:

But, not far from our thoughts was the chaos we had left behind in Bo. Though many of us have been physically challenged by the surroundings, from GI upset to Asthma exacerbations, these were small challenges that we were prepared for and will never stop us from continuing our work. How easy it is for me to reach for my inhaler or antibiotics when needed—a fact I appreciate more than ever after spending a week here. We are lucky and privileged to have the embarrassment of riches in our own country, should it not then be our responsibility to give back whatever we can?

Leaving these missions always induces a mix of complex emotions. I selfishly feel glad I will sleep in my own bed and eat, free of stress over whether or not this meal is the one to send me to the bathroom for days. Simultaneously I feel awful that I have a choice. We will all think back to the harrowing sights that stay with us and motivate us to do more, because the inflictions on the human condition do not rest. Meanwhile in Yemen a famine rages, and we wonder how can we give more, how can we contribute. The day I opened my eyes to the devastation that our fellow human beings undergo, and I mean really open my eyes and SEE it in person, was the day I vowed to never take my comfortable life for granted—that those of us who are lucky to be the “haves” should logically be the ones to to help the “have-nots”. 

Let us not forget what we have seen, what we are capable of and how much there is to do. 

On this mission we had a team of surgeons both Ob/gyn and general surgeons who were able to provide life saving surgeries as well as help teach and train the local surgeons. Some of the challenges they faced were the lack of operating room lighting. Can you even imagine!? That an error from surgery may be due to lack of light. How quickly I change a light bulb in my own home when it dies. There are no retractors to help maintain a large field of exposure—one of the keys to surgery is being able to see as much as you can in your field so you know what blood vessels and organs are nearby. Both of these things are easy enough to arrange and MedGlobal is working on how to potentially provide these.


On the medical side our docs have seen and treated diseases from typhoid to malaria to diabetes and high blood pressure. We were able to provide free medications and donate a very large supply of medications upon our departure. Challenges faced were numerous—misunderstandings and stigma behind certain diseases, the instinct to turn to herbal remedies for life-threatening diseases with a cure. Our team did a wonderful job treating and counseling patients, each of them working with a local community health worker. 

On the educational side we provided training for over thirty health care providers, from doctors to nurses to community health workers. The challenges we faced revolved around tailoring our training to the paucity of resources. This meant getting creative and brainstorming ways to improvise with what IS available.  We were able to provide a brief ultrasound training to those with access to ultrasound and focused heavily on the recognition of sick patients and intervening early. We trained local physicians so that they could then re-administer this course thereby creating a path to sustainability. The most exciting part for me is the ability to stay in touch through social media and communication apps such as WhatsApp. Already I have received requests to share educational materials and training videos! 

As I sit here and reflect on this trip I can’t help but think about where I’ll go next and how I’ll take the lessons I have learned here with me. I am hopeful that we were able to start something here in Sierra Leone that will have a lasting impact as MedGlobal continues to come back. I am hopeful that in training one person to manage acutely ill patients that we have saved the lives of those they encounter. I am hopeful that I will return soon and continue the work as there is still so much left to do.

Signing off from Sierra Leone. Up next, Dhaka, Cox’s Bazaar and Khatmandu in February. 

“People go to the hospital not expecting to make it out alive”

The health care system here is riddled with problems. I don’t think I have ever encountered such a limited setting and so much poverty. We each came with a role, some to perform surgeries, some to see patients in primary care, and some, like myself, who came to train local physicians. We each felt the frustrations of working in such an impoverished country where the supplies we bring are coveted like diamonds. To be clear this country does not lack the human resource nor the ingenuity and sheer intelligence it is the physical and financial resources that are missing. We cannot swoop in with just money or physicians for such a short time without a plan. The plan is we come, we work, we scout and collect data so that we can make this a successful site in future visits. The first visit is always a bit rocky and we have had our share of hiccups but each hiccup was a lesson learned. 

While so many cases were devastating, such as the children dying of treatable diseases like malaria with complications such as cerebral malaria, or a patient with meningitis who didn’t survive the night or the case of a woman with cervical cancer who has no options for chemo or radiation—our docs saw some incredibly painful cases. Yet there were some incredible saves like the young patient with appendicitis who had her appendix taken out by one of our surgeons or the diagnoses of acute HIV before significant complications. Then there was the unbelievable gratitude and appreciation from the local physicians and community health officers who sat through four days of lectures and practical skill building sessions, hanging on to every word and asking for more—there were successes and there were learning opportunities but never any failures.

In the end we realized that the poverty here is at a level that feels insurmountable, presenting challenges in the delivery of our care and educational interventions, however that has just made us all want to work harder to figure out how to come back and do more, create more impact and hopefully help the Sierra Leoneans slowly chip away at health care inequities. 

Pictured here: the crowd of patients waiting to be seen. 

Though there are so few resources their intelligence and ingenuity abounds

Today we launched the first day of the BASIC course in Developing Health systems, with health care providers from all across Sierra Leone. The group was close to 50 people who have come from up to 6 hours away in the name of education and improving the delivery of health care. This group includes physicians and nurses and community health workers (CHW). The CHWs are folks who have finished their primary and secondary schooling and then have attended three years of training. They may see patients in the clinic or in-hospital and trust me when I tell you, they can diagnose malaria and several other disease processes endemic to this area than any physician plucked out of the US and placed here. We are not only teaching them but we are learning from them. Today I learned that while Malaria is a huge problem here it is of course treatable but often times those inflicted will not seek medical attention out of potential distrust for medical services, instead they may seek out herbal remedies and then when they potentially do seek medical attention they are then presenting with evidence of herbal toxicity AND malaria! 

In our session today we talked a lot about how to recognize sick patients and being able to prioritize who needs attention first. We received all sorts of relevant questions regarding how to manage patients within the limitations of each hospital. The frustrating part is to see the sheer intelligence and motivation to do good but the limitations often feel so insurmountable. 

Regardless of the fact that so many of the health care providers seen here work in settings without an ICU, the truth is the same level of sick patients exist regardless and this leads to a significant degree of ingenuity. One of the skills we will review is the insertion of a chest tube into the pleural cavity to drain fluid from around the lung. These are tubes with holes on the end that goes into the pleural cavity, and they usually come in a kit and are attached to a drain that collects whatever comes out. These kits are most definitely not available here but urinary catheters are available—and they similarly have holes on the end. These urinary catheters are easily available and are used in lieu of expensive chest tube kits, the drains are make-shift as well and the solution is a successful one when needed. 

While many issues are not possible to overcome with just ingenuity the importance then shifts to discussing when a patient is too sick to keep where they are, and discussing where they should be referred for a higher level of care, but this comes with high expenses and several transportation limitations. 

By the end of the day we had reviewed several key concepts regarding how to manage sick patients. The local trainers that we have helped prepare were running the simulations and skill stations with ease, proving to us that they are more than ready to run this course in their respective cities and hospitals, which means this course could have exponential impact in a short period of time!

From the US to Freetown to Bo—two days of travel and we have arrived

Departed Philadelphia at 630 pm on 11/2, reached Paris in 6 hours where I met several of our 25-person group. Immediately greeted by friendly faces, as if I knew them all from a prior life. 

Sharing stories from prior trips, sharing our apprehensions and glowing about our supportive families and/or significant others left behind led to a quick bond. We each reminded each other to take our anti malaria prophylaxis and shared war stories from the slew of vaccines we took prior to our departure.

Finally we arrived in Freetown, Sierra Leone close to a 24 hour travel day later...with a ferry ride from the airport to the hotel as the only thing left between us and our beds. The hospitality in this country is immediate, a crew of Sierra Leoneans ready and waiting to receive us, smiling and grateful. We were taken to the ferry dock and greeted by this bridge—dark on the other side, slightly rickety—a metaphor for this trip...it’s the first mission to Sierra Leone for Med global and of course there’s always an aspect of the unknown no matter how much planning, and let me be clear there was A LOT of planning on the side of our fearless leaders here! 

We arrived at our hotel, a beautiful little place by the ocean called Sierra Palms, scurried to dinner and then put to bed to prepare for the next morning. The next morning our Sierra Leonean liaison Josephine (without whom this trip would not be possible), introduced to a rep from the Health Ministry and the two of them discussed cultural sensitivity. The topic is so crucial, there are so many gestures that we find common and “normal” may seem offensive—the simple act of a female shaking a male’s hand. Although some of this came from the Ebola era and encouraging folks to practice strict hand hygiene, the fact remains that what we may find a polite gesture may come off the wrong way. Furthermore keeping in mind that Ebola left a huge scar on the people of this country—families wiped out, nearly 30% of physicians wiped out, communities crippled, people are still healing, PTSD is not uncommon secondary to the atrocities this country has seen in the last 20 years. 

After the morning session we set off for Bo town, a near 6 hour drive through lush country side, rich with greenery a stark contrast to the poverty within it. We passed some towns that appeared completely abandoned and I wondered if this was an area that was effected by Ebola—what a clear nightmare to the region, a country so beautiful it feels so cruel to have undergone such devastation. 

Though these trips have mixed sentiments, often feelings of hopelessness and frustration, can we really do enough? The saving grace is the company, my fellow bus buddies, like-minded folks with similar energy and passion. The ride was long but full of inspiring stories and ideas for how to make the world a better place—and quickly I’m reminded, of course we can’t ever really do ENOUGH, there’s always more, but we are all in this together, along with so many others across the globe, from all walks of life. 

We are all brimming with excitement for what the week brings, and looking forward to sharing it with you all. 

Bo town in Sierra Leone, the next stop!

Looking forward to the next installment of sustainable global health education as a team of us from Med Global embark on the first mission to Sierra Leone!

My role in this trip is to help train local physicians in the management of acutely ill patients using a template  called BASIC developed by a wonderful group in Hong Kong. We are using the version for developing health systems which is being tweaked based on available resources. The key is to build capacity not build physical resources that over time can’t be maintained.

Taking off from Philadelphia tomorrow so stay tuned with more to come!