A momentus effort to get the basics in place

Reading the reports on the state of buildings, equipment, drug availability, staffing levels etc in SL is not light reading. There are 13 Districts and most have only one government hospital, Western area covering Freetown has 5/6 and Port Loko has 2. So maybe 20 small, generally poorly equipped hospitals for a population for almost 6 million, although this excludes the charity hospitals. There is virtually no priviate sector here (no profit to be made) although government hospitals charge for a number of things.

For the last 6 months, the Free Health Care (FHC) initiative has focused on rapid improvement across the board because most hospitals lack the basics amentities. Few have regular electricity and turn on a generator when necessary or use solar panels. Running water is a big problem has most hospitals manage with a standpipe or well for the whole site. Many dont have regular blood supplies or the ability to always keep drugs cool or even store safely. There are no xray machines or even lab tests in some places, Doctors are doctors, they havent the luxury of specialising, although there are some specialists here and there. There may only be one doctor in a hospital. Other staffing levels are so low too, especially qualified nurses and midwives. So at the end of launched almost 6 months of planning and coordinating improvements eg more and better paid staff, free drugs, new equipment, renovating the building and improving basic utilities (some staff have even been encouraged to come out of retirement to work) the contry is heading towards the launch next week on Independence Day (27th April).

I am going up to one of the northern districts tomorrow with my boss to assess their 'state of readiness' at the hospital and the 5 primary health care referral facilities. All Ministry senior staff have been assigned a district and are going this week. So I will get to see the realities for staff and patients alike.

So 27th April is the launch when children under 5 plus pregnant and breastfeeding women will no longer have to pay for their care. There is so much effort and hard work and (mainly international) money going into this there will be a launch with lots of pomp and fanfare and a milestone along the long road to recovery. My colleagues have a gigantic challenge ahead if we are going to make a real difference to the child and maternal death rates but there is also a tremendous amount of commitment and dedication that I see around me to make this work. Watch this space for a blog about my trip.

My job is 'in development'!

To be honest, its hard to say what my job is at the moment. The grand description may be an extra skilled pair of hands in this frenzied time before the Free Health Care (FHC) initiative is launched on Independence Day (27th April). In the last 2 weeks I’ve got to do some fun things…

Last Friday (9th April) I helped out with a big workshop for all the people involved in launching Free Health Care in the Districts, ie the District teams, including local councillors. By the end of the day, every team from all 13 Districts had a costed action plan. The plans to get out the key messages were very similar and included town parades, radio jingles and phone-ins and going around the villages with a loud hailer!

On Monday I helped to write two documents. One was a briefing to the President about an aspect of the Strengthening District Health Services Project (SDHS, every health system loves its aconymns, see below!!) which is focusing on 5 districts, with an emphasis on child and maternal health (infrastructure/buildings and training & development and health systems). This 5 year project is partnership funded between ADB (African Development Bank), UNFPA (The UN population fund) and GoSL (The Govt of Sierra Leone) till 2011. My boss, Dr Seisay, is the overall project sponsor. Then on Tuesday I went to Makeni to help with a financial and planning 4 day workshop for all of the districts as part of the same SDHSprogramme. I summarised the first 2 days and then fed back to the 80 or so delegates. I also got to know the UNFPA guys and intend to get far more involved with this programme to support my boss. So the job is shaping up (kind of!!) and I have some ideas about strengthening management which I’ll start to develop soon.

A word about Makeni, which is the 3rd largest town in SL and 150 miles ‘up country’ but with one of the few good roads in the country linking it to the capital. The conference and accommodation was in Hotel Wusum (check it out on the internet) a rather nice hotel, albeit a bit run down. But my room had aircon, a fridge and hot water! First time in a month that I slept with a sheet over me! Met some Welsh road builders in the bar! It was odd to see this hotel in a small rural town. I managed to meet up with Ann, a VSO who is a midwife working in Makeni and got some of the low down on the realities of hospital life here. Check out her blog and come to this blog to see photos of the funny statues in the hotel!! Also Makeni is home to 'Gara' a type of tie dyed and waxed fabric, see the women making gara, who are relatives of Peter, Dr S's driver (I went to meet Peter's mum, chief gara maker!)

Hopefully a typical weekend!

Last Friday it was Henning’s birthday bash (one of my flatmates) at the local bar restaurant called Balmaya. Nice food and beers and we played games. Board games are big here (due to general lack of a TV!!) So we played a game called Werewolves. There were 3 werewolves and 14 villagers and it’s a battle for survival (it’s a bit like a sophisticated version of wink murder!). I was a werewolf and survived the longest, by the time I was horribly killed only 4 villagers were left standing. Obviously I have some skills at bluff and deception!!!

Saturday was a relaxing day and I got my computer fixed. It had mysteriously stopped working and I expected the worst, ie thought I'd fried it at Friday's workshop by plugging it into an unprotected socket (voltage fluctuates alarmingly here and can damage almost anything electrical). Luckily there is usually someone here who will help you, this time it was Howard to the rescue. I also visited the UN complex which is at Congo Cross, 5 mins walk from home. They have a big pool (great) and a gym (too sweaty) and I can join for $20 per month. So that’s a sort of plan. Lets see when I get around to it! I love to wonder around the Congo Cross area and see the women with almost anything for sale balanced on their heads, the unroadworthy taxis and podas with all the funny slogans and bursting at the seams with people. I buy fresh, sometimes warm bread at the Congo Cross roundabout for 1000Le (about 15p) and go to the fruit and veg market close to me for a look and possible purchase. Got 4 bananas for 500lLe last week and they were good! I’ve spent 4 weeks trying to buy a nail brush, this has now become a shopping challenge as they are nowhere to be seen!

Sunday was the best day of the weekend with a day trip to River No2 beach. A long stretch of pristine white sand and beautifully warm sea. Bliss doesn’t even touch it. I managed to cadge a lift off Martin from DFID, who has kindly taken pity on us VSOs with no transport as I’m hoping that 3 of us will go to another beach along the peninsula this weekend. I will let the photos speak for themselves when I can t eventually load them.... having some technical problems! Please come back later!!!

Two Big Trips

Its a whole week since I wrote my blog partly because the internet connection is so slow at work but I'll have a dongle soon(!). Despite being here for less than 3 weeks, I've left the madness and dust that is Freetown twice!

My first trip was to Bunce Island in a Jeep with 7 others. Helen was the very brave driver and we drove around Freetown bay to a small and very poor village called Pepel where we (the royal we, ie not me!!) negociated the cost of a boat trip and tour of the old slave island with the local maritime administrator (young chap in shorts with a vaguely offiical piece of paper). We eventaully got across and had a quite interesting tour withthe local village elder who told us some stories in Krio (ably translated by Helen and Fiona)about the Island and its inhabitants. The trip was a out 3 hours each way, mainly on dirt roads, great excercise for the bum!

Easter was just as much fun. I had dinner with other new VSOs twice, Rey does a mean Phippino chicken dish and then I went to church on Sunday (mum dont shout, it was a Catholic Church!) and you should have seen the outfits people were wearing! Ladies were wearing the some most fabulous dress some like ball dresses. The SL women are seriously stylish, there is no hope for me, especially with being constantly hot, they dont even seem to sweat and how can that be when its always over 30 c?? The (long) church experience was musical and colourful and got to sing some hymns (secretly love singing hymns). But monday was the highlight of the weekend, I eventually went to Lakka beach a few miles south of Freetown and swam in the beautiful warm ocean and then had freshly caught fish for dinner as the sun went down (bliss). There was a funny moment when a seller arrived with a giraffe in one hand and an enormous phallus in the other! Well I ended up buying the giraffe even though there are none here but its christened Alpha Dick after the skilled man who made him and the other carving!

Starting work and the strike is over!

I started work last Monday with slight reservations about my role and what to expect, especially as the strike was the subject of debate over the weekend. Thankfully, by Monday the salary offer had been accepted and the health staff started to return to work. So I started on a really hectic but positive day. The salary offer was approximately to double staff salaries to compensate for the elimination of informal patient payments to health care workers.

Well I'm sat at my desk in the Deputy Chief Medical Officer's office in Freetown. He's my boss, Dr Seisay (all very formal here). All the directors in the Ministry are medically qualified and these guys, I think are all extremely bright, often with foreign degrees too and carry huge responsibilities and are all men. My VSO collegues have given me a figure of 150 or so Drs in the country of almost 6m people and hence I guess they have almost God like status.

Its my 4th day and I am starting to learn who some people are. My role it seems is going to be strengthening the relationships between the Ministry and the 13 Districts in general but particularly comms, planning and performance management. I dont even know how to begin this task yet but the advice is to take it slowly, listen and learn. Dr Seisay called me his strategist and also managment advisor, hope I can live up to these labels! My office colleagues are Patricia(Public Health Sister), Mbalu (secretary) and Jane (nurse). Photos to come!

Some things are familiar here in comparison with the UK but other things very strange, like lots of people sitting around in the corridors outside the office for no apparent reason, The Youyi Building where I work houses some of the government departments and is very run down, but its amazing how quickly you get used to things. In a week I will hardly notice!

The highlight so far was the trip to Cline Town (part of Freetown city but took over an hour to drive about 5 miles) and we met with the Western District Management Team and the heads of the PHUs (peripheral health units). So I was in a room with almost 100 local health care workers and it was really interesting experience.

So almost the end of my first week at work. I dont have alot to do yet but lots of documents to read and I am trying to attend meetings and events to find out what's happening! Lets see what next week brings. Happy Easter from Freetown.

CHOP (Krio for food) and SHOP

So I havent totally mastered buying fresh food from the market and cooking it yet. Firstly I haven't actually been to the little fruit and veg market which is nearby to my house but I'll go tomorrow. The market is next to a big pile of rubbish which is apparently the local tip, where we take all of our own rubbish, no recycling schemes here!!! My diet in the last two weeks has consisted of alot of rice, bread and 'laughing cow' cheese (its the local version of dairylea - doesn't need to be cold) and some pasta dishes, largely with sauces made of of tinned food (tuna, chick pea and tomato pasta). With no fridge and ants waiting to infest the flat if you leave fresh food lying about, it makes things a little difficult! Everything is stored in ziplock plastic bags. So I'm constantly failing on my 5 a day and supplementing with multivitamins! I'm sure I'll get more organised but folks eat out alot here, this however isnt possible on the VSO allowance unless you supplement it.

I had a Calzone yesterday evening in Montana Bakery at one of the VSO's leaving do. A real treat as pizza is so expensive. I could only eat half and so had the rest for 'brunch' with a banana! I read about someone eating pizza for breakfast on a blog before I left and thought it was awful and now I'm doing the same. Alot of local food has a bad effect on me so far but I keep eating it in the hope that I'll stop running to the loo! I think its mainly the spices. Palm oil stew is a favourite and its tasty but deadly! Same with groundnut stew (like peanut soup).

So I need to master the art of buying food, which is tricky with no prices and foreigners usually being asked to pay double unless people get to know you. I have got an idea of what's about right now though so wish me luck! The rest of shopping is the same, most goods you have to agree a price for in the street and in small market areas. There are some fixed price supermarkets but they are more expensive but fine for some things. Last weekend I bought a pair of cotton trousers, some jean shorts and a sleeveless vest for 31,000 Leones total, about 5 quid but I had help! More on work soon....