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Medical & Vision Clinics a Success in Sierra Leone!

September 22, 2011

We had a very successful trip for our first medical and eye outreach to Kono, KoiduTown, Sierra Leone, West Africa.

 

Staff at Wellbodi Alliance Amputee Clinic, Kono. There were 2 docs (Dr. Bailor Barrie & Dr. Dan Kelly), 4 nurses and 4 community health care providers that WMP trained in vision screening, refractive eye exams, and splinting.

 

During our 13-day trip, we treated 300 patients and we started the 1st and only eye clinic available in the eastern region through WellBodi Alliance’s Amputee Clinic in Kono (Koidu).

 

We saw loads of cataracts (approximately 40%), an unreal amount of pterygiums (approximately 75%), some really bad corneal ulcers (approximately 10%), and glaucoma. One kid had some eye trauma, and one kid had a splinter deep in his eye that Tom took out. We had a local nurse anesthetist come by and perform conscious sedation and Tom did surgery without Lidocaine, using a needle taped to a Q-tip. The picture of the boy shows the “vital signs monitoring” that they do by simply taping a stethoscope to the person’s chest… wow. The saddest case by far was a four month old girl born with two congenital cataracts; I have to wonder what her future will be like.

 

On our very first day there, we met with the first lady, Her Excellency, Mrs. Sia Nyama Koroma First Lady of the Republic of Sierra Leone. She was very excited to hear about the solar-thermal autoclave invented at Rice University that will be set up and donated through World Missions Possible, Wellbodi and Rice next year for Koidu Government Hospital through her charity. 

 

During our visit, we trained both the staff at the Amputee clinic and also several nurses from the Koidu Government Hospital on eye anatomy, disease, trauma, and eye health, as well as correcting refractive errors of hyperopia, myopia, presbyopia, and astigmatisms. We trained both staffs and donated over 350 pounds of medications, supplies and equipment, including a manual focometer, 540 pairs of eyeglasses, and a vital signs monitor.  During the clinics, we offered the assessment and treatment or referral of cataracts, pterygiums, corneal ulcers, glaucoma, trachoma, etc., and the distribution of prescription eyeglasses. Tom also offered the docs and some of the nurses a short course on treating certain traumas, including splinting and advanced wound care. 

      

During our days of clinic, I was so grateful for my new toy – a Welch Allyn autorefractor. I bought it just one week before the trip, but I couldn’t seem to get the “feel” for its beeps and whistles…it’s rather ticklish. But after the 1st day, the machine & I melded and it was absolutely fabulous, especially when I had a lot of kids that were way to young to use the focometer (manual device seen on left). (All the little “pikin’s” [child] said was “fine”…).

 

The picture below is of a child suffering the obvious effects of malnutrition  :  angular stomatitis, or cracking in the lips and corners of the mouth that is caused by a deficiency of the B vitamin riboflavin; hair dyspigmentation, a condition, found primarily in tropical regions, where children's hair takes on a reddish-orange color due to protein deficiency; sparse, thin hair created by a deficiency in protein, zinc and iron; and anemia, which reflects iron deficiency.

 

The hospitals there are, even for West African standards, beyond ill-equipped, but healthcare staffing may indeed be their #1 problem. As an example, the Koidu Government Hospital with over 140 beds, has no equipment, not even one working O2 tank. (I did see two suction units and one IV pump, but the nurses didn't know if they worked!)

 

When we walked into sterilizing room with sterilization nurses, they stood in front of five stovetop autoclaves (glorified pressure cookers really, that boil for 35 minutes to sterilize). But later we found out that only ONE stovetop autoclave worked (others are broken). They heat the autoclave with an antiquated propane tank.

 

The 2 functioning O.R.'s they use for 15-20 surgeries a week have no electric or running water and zero equipment, not even an O2 tank or one monitor of any kind. If they have an emergency c-section at night, they use a diesel-powered generator. The sad part is they have an ultrasound and an x-ray in boxes that no one knows how to set up or use.   

 

There is a Methodist Eye Hospital in Kissy, about 20 minutes outside of Freetown, and it's the only real eye hospital outside of Connaught Teaching Hospital in capital city. The surgeon in Kissy said there are only two ophthalmologists in the country right now and there are five "cataract nurses" that also are performing cataract surgeries in the country. There is only 1 hematologist and 3-5 OB/GYN’s in the entire nation.

 

Sierra Leone itself was surprisingly beautiful --- very lush, muddy, and the rains come on quickly and are extreme, sudden downpours! I certainly would hate to see what the “rainy season” (late July- Sept) looks like, the roads must be impassable. Getting around the country can make a sane person rather insane…frustrating, and the absolutely worst traffic jams I have ever witnessed (rivaling Cairo). You have to take an overcrowded and crazy ferry to get to/from airport in Lungi, which is, in itself, a wade into cultural waters that hits you smack upon arrival, jetlagged or not, no matter. The Krio (native language) is quirky – a pidgin English with expressions like “Go fast, small, small”, and kids are “Pikins” and you ask for “dem book yonder dah.” I cannot think of anything good to say about the food, so I won’t!! The main meal is “ko-kri” which is rice (main staple) topped with cooked potato leaves fried in palm oil.       

   

In another exciting note, we got to tour the “Africa Mercy” of Mercy Ships.org…it was a huge organization of 400 crew members (60% medical; 40% other) from 40+ nations. They had 6 OR’s, dental and eye clinics and they run “specialty” sessions for cataract operations, etc. Mercy Ships was showing the award-winning “Pride of Lions” documentary that highlights some of Dr. Barrie and Dr. Kelly’s work with amputees in Kono.

 

We also had two interviews (one live & one taped) on the national Sierra Leone Broadcast Corp. (SLBC) radio…the only national radio station. But we were able to talk about wearing sunglasses with U.V. protection & they invited everyone to the free clinics. People also called in with questions about their eye problems…it was fun as 2 nurses translated into Krio for us.  

 

Pictured below is the happiest moment of the trip. The day before we left, we decided to donate our vital signs monitor (that everyone was soooo in awe of!) to WellBodi Alliance’s Amputee Clinic in Kono—see the happy expressions on Dr. Bailor Barrie and Dr. Dan Kelly!! Dr. Barrie said of the monitor: “This is my heart. We will take great care of it. And when you come back, it will be working and in good order, you’ll see.” 

Maternal Care Outreach, Sierra Leone

 

For a woman, Sierra Leone is one of the most dangerous places on earth to give birth.

In this tiny West African nation, a shocking one out of seven women dies during childbirth. If she lives in a rural area, she may not have the emergency transportation she needs to seek medical care from a midwife or hospital – and if she is lucky enough to get to medical care, she may not have the $3.50 she needs to pay for her medicine and treatment.

In Sierra Leone:

  • 50% of the country lives on less than $1 day;

  • Prior to the 11-year civil war (1991-2002) that left over 50,000 dead, the nation had 500-600 doctors – now there are less than 100; and

  • Sierra Leone has one of the highest rates of maternal mortality on earth: 1 in 7 women die in childbirth, compared to 1 in 4,000 (average) in developing nations

“Thousands of women bleed to death after giving birth. Most die in their homes. Some die on the way to hospital; in taxis, on motorbikes or on foot. In Sierra Leone, less than half of deliveries are attended by a skilled birth attendant and less than one in five are carried out in health facilities.” – Amnesty International

To help combat this appalling lack of healthcare, World Missions Possible is set to launch a “Mobile Maternity Care-A-Van” outreach in Port Loko, northern district Sierra Leone, in an eight-village wide rural village span (Santigiya, Mapeh, Kholea, Sanya, Dentheh, Kipolo & Kontehya) in Kaffu Bullom area…. But we need your help! Please review our list of needs and also ask your local OB/GYN, doctor, clinic, neighbor, or church member to look at our list of basic needs and see what they can do to help.

 

BASIC "Mobile Maternity" Equipment:

 

  1. Blood Pressure Cuffs & Stethoscopes

  2. Hand-held *hospital-grade thermometers (1 tympanic & 1 adult digital = $640): (Recommendation: Welch Allyn “First Temp GENIUS” (approx. $390) takes very accurate temps, esp. kids 100+-degree temps) pediatric tympanic thermometer. Recommendation: Welch Allyn “SureTemp” (approx. $250) for reliable adult temp.

  3. Hand-held vascular Doppler & gel. Example: Nicolet Elite 100 Non-Display Doppler (approx. $500) DOPPLER STOVETOP STERILZER (The purpose of a doppler is to find and confirm the fetal heartbeat by measuring blood flow – this can indicate a possible miscarriage or if the baby is in distress (like low oxygen), which can lead to fetal damage or death.)

  4. Oxygen Delivery: O2 tanks, O2 tubing, nasal cannulas & O2 masks (infant and adult)

  5. Stovetop (non-electric) Autoclave for sterilization ($350) (The ALL AMERICAN Non-Electric Cast Aluminum

  6. Dry Steam Sterilizer model 1925X and has a 25 quart liquid capacity.  These sterilizers have been made since 1930 and there are several million in service all over the world: Fast, 35 minute sterilizing cycle: Calibrated Gauge that shows when sterilization cycle begins. Any outside heat source can be used such as a hot plate or stove top. Lubricated Metal-to-Metal Seal which means no gaskets to wear out.)

  7. Suction: 50 Delee suction cathetersfor suctioning baby’s airway at birth ($120)

Continued “Basic” Needed Supply List:

  • BVM - infant & adult ambu-bags 

  • Umbilical cord tape

  • Exam gloves (Nitrile or heavy grade for HIV patient care)

  • Stainless steel vaginal speculum(s) 

  • Infant scale

  • Pregnancy & HIV testing supplies 

  • Sanitizer

  • Oral rehydration salts

  • Masks: N95 Particulate Respirators for protection against tuberculosis

  • Stainless steel forceps, clamps (Kelley), suture holders & scissors (episiotomy)  

  • Suture: 2-0 Coated Vicryl, Vicryl RAPIDE or Vicryl PLUS Antibacterial

  • Sharps/hazardous waste containers

  • Sterile O.R. towels

  • I.V. supplies: 18 & 20 gauge IV catheters, tubing (macro drip)

  • 10 ml syringes

  • 20 & 22 gauge 1 ½” needles

  • Sterile bulb syringes

  • Battery-powered suction unit

 

Medication Supply List:

  • Prenatal vitamins

  • Lidocaine (injection)

  • Antibiotics (injection): Rochephin, Amoxicillin, Keflex (500 mg)

  • Antibiotics (tablet): Zithromax, Rochephin (250 mg)

  • Ophthalmic (Erythromycin) eye drops

 

To get started, we approximate the cost for all “basic” equipment for the Mobile Maternity Care-A-Van to cost no more than $ 2,000, and the cost for “basic” levels of supplies to be $1,500. The average salary of a licensed and qualified nurse/midwife in the country is $4,500 a year, and the cost of a used van for the transport of the nurse and/or the patient to receive life-saving medical care is approx. $10,000.

Any & all supplies and/or monetary donations are welcome & 100% tax-deductible. Please visit the Donate page to help.

 

“Mobile Maternity Care-A-Van” Program Goals:

  1. A significant (and quantifiable) decrease in infant mortality (rates of death) and morbidity (having disease or ill health) in the Kaffu Bullom region (Port Loko district);

  2. A significant (and quantifiable) decrease in maternal mortality and morbidity in the Kaffu Bullom region (Port Loko district);

  3. A substantial increase in maternal nutrition knowledge, HIV & STD transmission, including nutrition during lactation, and infant nutritional standards;

  4. A decrease in mother-to-infant transmission of STDs (causing blindness, illness and/or death) such as neonatal chlamydia ophthalmia and gonococcal ophthalmia (with the introduction of ocular prophylaxis of erythromycin minutes after delivery).

We hope this report has touched you to reach out to help save the lives of our sisters and their babies in Sierra Leone. World Missions Possible has operated in 16 nations for 11 years and has an outstanding record of fiscal, social, and cultural integrity. If you’d like more information on the project or to talk with either the president or medical director of World Missions Possible, please call us at any time.