The Laboratories: a Perfect Representation of Both History and Change at Connaught Hospital

“Let me show you… So you take this cartridge, be very careful not to touch or damage the barcode when you put the sample in, otherwise it won’t scan. Then, we put 1ml from this vial in the cartridge and then place it in chlorine for 20 minutes. This kills anything from the sample that’s on the outside of the cartridge so when we put it in the machine it’s the deactivated virus being scanned.” We are in the laboratory department at Connaught Hospital and our colleague Mohamed is demonstrating how he uses the newly installed GenExpert machine donated by WHO to screen surgery patients for Ebola. This test, which takes only 90 minutes to process, can have a dramatic impact on the safety of both the surgeon and patients.

Mohamed_Labs

Mohamed demonstrating laboratory techniques

The laboratory department is a perfect representation of Connaught’s history and change in progress. In one room sits the original Microtome machine from when the hospital was opened in 1912; it is still processing histopathology samples (sectioning) to test for conditions like cancerous or malignant cells.  In another room, Mohamed is running the fully modern GenExpert machine to screen patients for Ebola and HIV, as well as other infectious diseases.

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KSLP Labs Coordinator Billy in the Connaught Hospital Labs

Through Sierra Leone’s post Ebola recovery plan, we expect that the way labs operate will continue to undergo substantial changes. Billy, KSLP’s lab co-ordinator, will be working with the Labs team to drive improvements to help navigate this process.

Alumni Profile: Ahmed Seedat and the Importance of Building Relationships

I initially volunteered with KSLP as clinical lead from September 2013 to March 2014, having spent the previous six months volunteering with VSO (Volunteer Services Overseas) in Sierra Leone.

Amed SeedatIn those early days it was just Oliver and me, shortly joined by Suzanne, so our roles were a little more fluid and we had a bit more space in the office!

My role mainly involved supporting the Connaught Hospital Improvement Committee, particularly in strengthening the Accident & Emergency Department, supporting colleagues at COMAHS in delivering teaching and training for undergraduate medical students as well as working on postgraduate training with a focus on strengthening the internship programme.

I returned to Freetown in August – September for the Ebola outbreak.

Back in the UK I’m a Respiratory Registrar trainee based in South London but left for an OOPE (out of programme experience) in November 2015 – I managed to stay in the UK for just over a year!

Currently I’m in Yida, Unity State, South Sudan working as a medical doctor for MSF. In Yida, MSF are providing medical care for the refugee population affected by conflict in South Sudan and the disputed South Kordofan region.

Although the context is very different requiring a different approach and perspective I find that as with KSLP, relationships between national and international staff, the wider community and other key stakeholders are extremely important. This can be less than straightforward in an unstable region or area affected by conflict. Nevertheless, building relationships particularly with colleagues and the local community lays the foundations for trust, mutual learning and knowledge exchange which is not only helpful for us as individuals but hopefully translates into wider health gains for the local population.

A Passion for Nursing – Connaught Hospital Matron Isatu Kamara

Since she was a little girl she had Connaught Hospital relies on its team of dedicated nurses to keep functioning. Isatu Kamara, or as we all know her as “Matron,” has been at the helm of this team since 2014.

Since she was a little girl she had “the passion to become a nurse.” She started her career as a Registered Nurse at Connaught so she knows all the “nooks and crannies of Connaught.” She left Connaught to continue her career working in Kambia Government Hospital, Ola During Children’s Hospital, and Kabala Government Hospital. Before returning to her home at Connaught, she had been the Matron of Kenema Government Hospital for three years. She uses her extensive managerial and technical experience to ensure that the highest quality of nursinc care is available to all patients. 

When asked if she has advice for future nurses, her answer is that “you should be willing to perform, you should have the capacity to perform and have the opportunity to perform.” A strong enabling environment is particularly important to Matron who explains that “if we have the basic equipment, skills and motivation then the enabling environment is there for nurses to perform.”

Matron is very proud of the recent changes to the hospital, especially the cleanliness of the wards after the recent IPC training that has been conducted. “Connaught Hospital is such a different place, I encourage all people, partners and staff to make the most of the facilities available such as the Oxygen factory, the A&E Department and the Infectious Disease Unit.

Reflections from the Intensive Care Unit – Ruth Tighe

I graduated from Nottingham Medical School in 2004 and after many years out exploring countries and specialities, I finally decided on Anaesthetics/Intensive Care Medicine.  In the past most of my experiences working abroad have been aimed at improving my clinical skills, to ensure I have been exposed to extreme cases to hopefully make me a better registrar.

I would have always claimed global health was an interest but until January 2015, I wasn’t planning to adventure out to Africa again until I’d become a consultant.  But then the idea of Sierra Leone came up via one of my best friends, Ling – Emergency Co-ordinator for the King’s Sierra Leone Partnership and I couldn’t resist.

I chose to work with King’s because it proposed a unique way of developing intensive care in a low income country that has no post-graduate training and less than 5 anaesthetic doctors in country. The King’s approach thinks more about the system and the professionals you are working with rather than your own skill progression.  King’s encourages a gentle approach via role-modelling for staff working in the main governmental tertiary hospital, to instil comprehension and propagate behaviour patterns that will continuing after I’ve left. Essentially it is about being incredibly patient, building relationships, and working together to spot holes in the functioning of the Intensive Care Unit. Most solutions are achieved without huge changes in practice; the focus is rather on training, education, and monitoring outcomes to demonstrate efficacy.

Although we are mostly volunteers, we are trying to tackle large-scale projects to impact on the entire health system. One of my first tasks as Critical Care Co-ordinated was to support the ICU to improve the provision of oxygen in Connaught. My first four months were focused on the development of the first fully functioning oxygen factory in the country. The results have been impressive. In the three months since we got the first piped oxygen in the country, we’ve seen mortality drop by nearly 30%.  My dream is that my colleagues and I can start a program that shares our experiences with the five non-functioning factories in the districts so that all of Sierra Leone would have access to simple oxygen therapy. Our next project is to implement non-invasive ventilation and again hopefully see another fall in mortality and potentially expand this out to districts. It is incredible to work in a system where simple changes can produce such a drastic change in outcomes.

While I’m not necessarily getting awake fibre-optics or ECMO experience, I am getting more teaching, management, research, and quality improvement opportunities than I thought possible. Being passionate about this cause easily motivates me to work hard to get one project finished so I can start the next one.

Sierra Leone has been through a lot, yet there is an overwhelming sense of gratitude that they’ve come through the war and Ebola. Everyone here has such a strong faith, which is probably what holds them all together through such tough periods.

My respite is knowing I get weekends surfing at Bureh Beach – every week by the time Friday comes I’m so excited to get back in my new-old defender and bounce along the coast, hang out with friends to attempt to stand on my foamie board in the white water – it washes away any stresses from the previous week and gets me refreshed for the next.

I’d be lying if I said this wasn’t stressful.  Witnessing the poverty and the needless deaths of people who can’t afford their health care is extraordinarily draining. But any time it starts to break me, I reflect on our wonderful NHS (long may it last!),  and that I am lucky to be healthy, to have received a full education, and to be trained in a job that I love that lets me travel the world!

42 Days Ebola Free

Today is a day for celebrations, as Sierra Leone achieves its goal of 42 days without a new case of Ebola.

Throughout the epidemic, we have been privileged to work alongside and learn from our partners as they have responded to this challenge. Congratulations are due to all the health care workers of Sierra Leone who faced personal danger as they worked ceaselessly to stem the outbreak. Your bravery and dedication during this period has been inspiring.

isolationwardWe commend the Government of Sierra Leone for their leadership and management of the crisis. We look forward to working together in the recovery process to build a strong and resilient health care sector.

King’s Sierra Leone Partnership would also like to give a special thanks to all of our volunteers and supporters, who offered such amazing support during this time, both in Sierra Leone and abroad.

Ebola don don, leh wi take am so

Ebola is gone, let us keep it this way.

Strengthening A&E at Connaught

On 21 October, the Minister for Health and Sanitation, Dr Abu Bakr Fofanah, visited Connaught Hospital to discuss plans for the refurbishment of the Accident and Emergency (A&E) Department.

A&E is an emerging area of specialist practice in Sierra Leone with potential to transform how health care is delivered in the country. Connaught staff have been working with King’s Sierra Leone Partnership to reform how A&E care is provided. Recently the hospital has successfully implemented a new triage system to prioritise the urgency of patient treatment.

The refurbishment includes the construction of a dedicated minor procedure room so that staff can conduct urgent surgeries within the A&E department.  There will also be new water and sanitation facilities for hand washing, improved waste disposal provision, and drainage to support improved infection prevention & control processes.

Through the improved capacity of the A&E department, Connaught Hospital will be better able to respond and prevent future health crises such as ebola, as well as manage casualties from other health emergencies.

Technicians at Connaught

We would like to introduce Ibrahim, one of Connaught Hospital’s highly skilled technicians behind the functioning of the hospital’s new oxygen factory.

Since the rejuvenation of the oxygen factory he says, “I feel more secure in my job and that my team are needed and will continue to be supporting the hospital in the future.”

Ibrahim first started working at Connaught Hospital 5 years ago. Since then he has become a specialist in handling medical equipment like ECGs, monitors, anaesthetic machines and, of course, oxygen concentrators. Ibrahim enjoys his job and is always looking to improve his skills. He and all the technicians are hoping that in the future they will continue their training so they can maintain the full range of specialised medical equipment needed at Connaught.

Ibrahim is very positive about Sierra Leone’s future. “So many sad things have happened but we are strong people. Ebola exposed weaknesses in health care so we are improving from now.”

King’s Team Receives Awards

Ebola in Sierra Leone Dr Oliver Johnson, Programme Director of King’s Sierra Leone Partnership, has received an OBE in the Queen’s Birthday Honours List for his services in the fight against Ebola. Will Pooley, a nurse who worked with the team for a period, has also received an MBE.

Dr Johnson has been leading a small team of clinicians and support staff in West Africa since January 2013. The team, made up in a large part by volunteers, was originally in Sierra Leone to help build and strengthen the local health system but has played a vital role in responding to Ebola since the virus first reached the country in May 2014.

They have provided a full clinical response to Ebola at Connaught Hospital in the capital Freetown.  Dr Johnson and his team worked closely with the Sierra Leone Government and local and international partners to increase the local capacity to identify and treat Ebola patients, provide essential clinical training, spread best practice quickly and, by helping set up an Ebola Command Centre in Freetown, manage the effective flow of patients across the city. Dr Johnson and colleagues also played an influential role advising the UK Government about the ongoing response.

Dr Johnson, says that: “I am humbled to receive this award, which I accept on behalf of all those I have worked with in Sierra Leone. Everything we achieved is due to the efforts of extraordinary local health workers and international volunteers, who have bravely led the fight against Ebola and did not hesitate to put their lives at risk to save others. They are the real heroes of the response, and I would like to dedicate this award to them, especially those friends and colleagues who lost their lives to the disease. We will continue to fight the virus until we have seen the last case, and to work with our local partners to rebuild and strengthen their health system in the coming years.”

The King’s Sierra Leone Partnership is an initiative of King’s Health Partners Academic Health Sciences Centre, an innovative partnership between King’s College London and three of London’s leading NHS foundation trusts – Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley.

Professor Sir Robert Lechler, Executive Director of King’s Health Partners and Vice-Principal (Health) at King’s College London says that: “This award is a reflection of the outstanding dedication and leadership shown by Dr Johnson during the past year. I am incredibly proud of what Oliver and the team have achieved in responding to such a tragic disease outbreak.”

Dr Johnson and the King’s Sierra Leone Partnership team remain in Sierra Leone and continue to respond to the outbreak, working alongside local partners to restructure and stabilise the healthcare system, helping to protect against a crisis like this ever happening again.

(cross-posted from the King’s Health Partners website)

An Engineer in Freetown

My name is Gerard Dalziel and my title here is Volunteer Site Engineer for Connaught Hospital, Freetown Sierra Leone. I came to volunteer with KSLP through Engineers Without Borders in February for a six month period. On any given day the duties can range from repairing a centrifuge to consulting with the Sierra Leone Fire Brigade for a fire safety assessment of the hospital wards.

The Site Engineer’s major function is to assist in the planning and in preparation of contract documents to refurbish and or re-purpose portions of the hospital campus for the post-Ebola rebound of the Freetown health care system.  The international community has realized that the weakness of the health care system was one of the causes of the severity of this particular epidemic, and is therefore determined to put the resources here to bring the health care facilities up to a minimum standard of infectious disease prevention and care (IPC) so that the system is better prepared for the next epidemic.

We are currently in the process of building a new chest clinic where patients with a range of illnesses, particularly TB, can access care, along with HIV counselling as this is a frequent co-morbidity. The building had been abandoned for some time so was not in a good condition, but we’ve recently completed it and it now looks very smart.

We have also just completed a new safer structure to house the hospital oxygen generation factory, which was previously unusable because the structure it was in was too small to prevent overheating. We are also upgrading the oxygen delivery system with portable tanks and oxygen concentrators to support a CDC trial of a new Ebola vaccine.

Next week we will be putting the construction of a new infections disease (ID) holding unit out to bid, so that what is now being used as the Ebola holding centre can go back to its previous purpose.  After that we will be planning a possible campus expansion to add additional ID capacity to the hospital.

Part of the reality of the work here is the on-going struggle to eradicate Ebola from Freetown and from Sierra Leone in general.  You wash your hands in chlorinated water every time you enter the hospital grounds in addition to rinsing them off with alcohol gel several times a day.  The Ebola holding unit is near the front entrance of the hospital and is occupying what used to be the emergency area of the hospital.  Post-Ebola, the old holding centre will be upgraded to a new Accident and Emergency Department (A & E) with the addition of new patient treatment capabilities.  My work is therefore linked closely to King’s other projects, in this case providing ongoing mentoring and support for staff on Emergency Medicine, through expert volunteer medics from the UK.

In order to plan for the future A & E Department, we had to measure the dimensions of the existing holding unit.  I was able to measure the outside of the building in partial personal protective equipment (PPE) but trained medical staff had to take the inside dimensions in full PPE.  The tape used to measure the inside was incinerated with other medical waste as possibly being contaminated.  This is one small example of of how Ebola has affected how we do our work here.

The volunteer medical staff from Kings Hospital in London and the in-country Sierra Leonean staff are extraordinarily determined to eradicate Ebola and to come out of this crisis stronger and better prepared to to meet the future health care needs of the city.  I hope to continue to share in that work by lending my engineering skills wherever needed.

Developments in Mental Health at Connaught Hospital

I joined the King’s Sierra Leone Partnership (KSLP) team as a volunteer Doctor in February 2015. Like most people, I had followed the news about Ebola, particularly the devastating effects it was having on Sierra Leone and its people. Having been born in Sierra Leone, the events were particularly personal to me. I moved to the UK when I was 6 years old, but have many links to the country with family and friends still living there and many fond memories of my childhood.

As a Psychiatry trainee at South London and Maudsley NHS Foundation Trust, I hoped to be able to provide not only physical health care but also psychosocial support to those affected. I was keen to come out to support colleagues, both local and international, who had been working tirelessly to control the outbreak. The process of being released from my training programme was straightforward and I was granted a 6-month sabbatical.

This patient reminded me of the importance of good mental health care and how integral this is to any healthcare service. Had his mental illness been identified and treated earlier , his compliance to medical treatment would have been better and therefore more successful. His sister explained that he had been a professional with a well respected job; however, over the last year his mental health had deteriorated. The family had been unable to access appropriate care. She seemed to have reached the point of exhaustion having been the sole person to shoulder the burden of caring for her only brother, and she was comforted by the thought that at least he would no longer suffer.

I found myself in a challenging situation: I had volunteered to be an Ebola outbreak Doctor, albeit one with specialist mental health skills that I was sure would be useful in helping patients affected by Ebola. However, faced with a reducing numbers of cases and a clear and acute need for mental health care, I felt increasingly driven to giving my time to those with mental health needs. I recalled the WHO slogan ‘no health without mental health’ as I contemplated a change in the focus of my work.

I shared my sentiments with Oliver Johnson, KSLP Programme Director and was enthused by the support he expressed for me to do more direct mental health work. Mental health is a priority for KSLP, and one of the key areas in which they have been  making great strides . Prior to the Ebola outbreak, Katy Lowe, a mental health nurse from South London and Maudsley NHS Foundation Trust had been volunteering with KSLP to provide training and supervision to some newly trained mental health nurses. Unfortunately this work ground to a halt with the Ebola outbreak, and Katy switched focus to providing support for staff and patients affected by the outbreak.    It was clear KSLP were keen to resurrect the training and supervision and were committed to working with local partners to develop robust and effective mental health services.

Prior to the Ebola outbreak there was poor provision of mental health services in Sierra Leone. The majority of people requiring mental health and psychosocial support were unable to access it. There is only one Consultant Psychiatrist in the country, now retired, to serve a population of over 6 million people. There is one mental health hospital in Freetown and little mental health or psychosocial support otherwise. This situation has worsened during the Ebola epidemic. A recent study by the International Medical Corps Sierra Leone found that many people affected by Ebola are reporting psychological problems and require mental health care.

Whilst I envisioned spending my time here in Sierra Leone sweating through scrubs in full PPE in fact I am now spending most of time working outside of the Ebola holding unit supporting KSLP mental health projects. It feels like exactly what I should be doing especially as the need is so great.

At Connaught I am fortunate to work with the brilliant and enthusiastic Jennifer Duncan, one of only 20 recently trained mental health nurses posted throughout the country. Together Jennifer and I are providing psychosocial support focused on stress management and psychological first aid principles to healthcare workers at the hospital. Many of the staff have been directly affected by Ebola and lost colleagues, friends and family to the disease; together, they share experiences and promote psychological resilience.

It’s great to be working with KSLP and Connaught Hospital and to know that by developing mental health and psychosocial services we are meeting a crucial, and so far unmet, need. It is exhilarating work, in an exciting and dynamic environment, and I’m proud to be a part of it.