In one hospital the KGHP team were shown a new ER formed from existing equipment and staffed by a team recently trained on an ER cascade course delivered on site. This was a real highlight of the project for the whole team as our WhatsApp group kicked off with photos and celebratory emojis! Here was our evidence that we had achieved impact.
The visits were valuable for putting the challenges described to us in context. There is no piped oxygen and electricity is unreliable, so there is often no light or oxygen from concentrators. Water is sometimes plumbed but is usually carried inside in buckets for handwashing. In small hospitals there is often only one doctor, supported by a large number of ancillary staff who volunteer without pay whilst waiting years for a paid position to become available. Drugs are often out of stock or too expensive for patients to buy, and diagnostics such as labs and imaging are limited by stock-outs of equipment and consumables, lack of training, and unreliable electricity. Traumas are frequent and deadly, as roads are dangerous, and patients lack the funds to pay for lifesaving treatment. Staff often make themselves available 24 hours a day, 7 days a week - an exhausting work environment.
For some of the Sierra Leonean team members this was also new information. The majority of professional training takes place in Freetown or internationally, so those who had not worked outside of the capital were surprised to find how challenging the environments in which their colleagues were working could be.