In Sierra Leone, 20% of children don’t reach the age of five. Tackling the many causes of infant mortality is a challenge for VSO volunteer doctors who are faced with malaria, TB, and neonatal mortality on a daily basis. Shona Johnston spent the last year working in a Freetown hospital as part of the VSO and Royal College of Paediatrics and Child Health Fellowship. Improving standards and saving children’s lives is not easy in a country with a poor health service and a drastic shortage of medical staff.
Why did you choose to volunteer in Sierra Leone?
I’ve been a doctor for nearly seven years and trained in Paediatrics for five years in the UK. Having spent my elective year in a hospital in Malawi ten years ago, I also have an interest in tropical medicine. I wanted to come and experience it for myself and give something back.
How are the facilities in the hospital where you are working?
There is a drastic, drastic shortage of medical staff, we have only five local doctors in the entire hospital. There are approximately 150 nursing staff, from untrained nursing aides to better trained nurses, but none of them are specifically trained in Paediatrics. Another NGO provides us with in-patient medication which is a great help. A government scheme is meant to offer free healthcare to children under five and pregnant women, but there is a real problem with drug availability in hospitals.
Why are Paediatricians desperately needed in Sierra Leone?
Malaria is endemic in Sierra Leone, so it’s a disease that nearly everybody will have had at least once in their life. Children are at greater risk of getting severe kinds of malaria, because they are younger, have weaker immune systems, and are often treated too late. Education is also a key part of my work here. I have seen quite a number of children who visit traditional healers before coming to hospital - a lot of people believe in them, including a lot of the nursing staff here.
How is your work in Sierra Leone different to your work as a paediatrician in the UK?
I’ve been able to do things I would never have the chance to do in the UK. I have much greater responsibility here than back home and have had far more experience looking after incredibly sick children, witnessing different illnesses and treating children that sadly frequently die. I’ve also had a lot of teaching experience that I would never get back home, plus I’ve been able to engage with the hospital management.
What’s a typical day for you in the hospital?
At the moment, I start my day by doing a ward round. Then I’ll go to the out-patient department, which is nothing like what it is in the UK...there are far more children who self-present, are acutely unwell and need to have tests and treatment straight away. Students are often on rotation so I try to do bedside teaching with them for an hour or two a day. Recently, I’ve been teaching a group of fifth year medical students, there are 27 of them this year and they are going to graduate next year to become doctors. I also work closely with the nursing staff, particularly those in the intensive care unit and the emergency room.
How do you contribute to improving paediatric care in Sierra Leone?
At the start of my placement I lectured medical students on Paediatrics. As they had never studied it before, we covered basic things like cardiology, respiratory conditions, genetics and seizures. Since then I’ve been guiding them to put into practice what they’ve learnt, conducting sessions on triaging children to prioritise who needs to be seen first, and teaching them when to ask for more help. The medical students are really keen and ask me for quite a lot of teaching. I’ve also been doing those sessions with nursing staff so they receive the same basic Paediatric training. I also teach a lot about processes, making sure doctors and nurses go back to review a child and chase up results, a lot of simple routine procedures just don’t happen here.
Successes so far?
I had a patient called Joy who was seriously sick with cerebral malaria and continued fitting. Together with a staff nurse on ICU we made sure the patient got all of her medication, fluids, and nourishment. Against all the odds she recovered and actually came back to see me the following week. She got to see the staff nurse who had cared for her...we were both so happy that she survived and to see her smiling and waving at us!
What has been the most challenging aspect of your experience?
I worked in ICU for about four months and the hardest thing was seeing children die every day. It was emotionally very draining for me, and it’s draining on the medical and health staff here too. Even though there are numerous contributing factors to the children’s deaths, I often felt that I was to blame, which was wrong I think, but it was really hard at the time.
What is your most memorable moment?
One patient I looked after had a collapsed lung and successfully I re-inflated it, which was really exciting. When he came back to see me, it was the best moment of my medical career so far!
What would you say to another health professional in the UK, considering volunteering?
VSO’s work here is important. It’s great I’m not here alone in the hospital as a VSO volunteer, there’s also a nurse, another doctor and a hospital manager, so we’re all working together. We each play a crucial role in terms of training, mentoring and role modelling...I think what I do will have a lasting impact on individuals.