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!