Enhancing Resilience: supporting the next generation of health workers in Sierra Leone

Freetown’s College of Medicine and Allied Health Sciences (COMAHS) was forced to shut its doors for nine months during the Ebola outbreak. Finally reopening in June 2015, COMAHS is critical for rebuilding Sierra Leone’s health workforce, despite its limited training capacity, poor learning facilities, and a major shortage of teaching staff in most areas. This essay tells the story of the partnership between COMAHS and KSLP, formed with the goal of building capacity and resilience in post-graduate education in Sierra Leone.

All photos © Katherine Wise/Momenta Workshops 2015

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A Day in Connaught Hospital's Intensive Care Unit

Today we are in the Intensive Care Unit (ICU) at Connaught Hospital where the nurses are conducting their afternoon handover. Alongside Sister Elizabeth Kamara, the ICU sister-in-charge, KSLP’s Dr Ruth is leading today’s handover.

DSC_0071 It’s is a quiet day in ICU so Dr Ruth is taking time to test everyone’s knowledge on the importance of fluids and how to provide oxygen. Her energy is contagious as she asks about each patient:

“Ok, so why might this patient’s condition have changed?”


“Chest Infection?”

“Reaction to the blood?”

“Exactly, it could be any of those things, so if there is a change in the patient condition, we need to think about what might be the cause and what you need to tell the doctor in charge.”

ICU sister-in-charge, Sister Elizabeth Kamara,

Such on the job learning is highly valued in this unit. The daily handover is appreciated as much for ensuring the consistency of patient care, as it is for the opportunity to receive further training.

“Mentoring other nurses is the best part of this job,” said Sister Elizabeth. “It’s great to be able to share my knowledge and understanding with others.”

A close relationship builds between the nurses and their patients. In ICU, they provide ‘complete nursing,’ which includes everything the patient like feeding, fluids, and pain management. Any and every change in the patient’s condition must be recorded. This is a major responsibility, but all of the nurses shoulder it professionally.

DSC_0015 Each provides a detailed history of every patient at the end of the shift. Histories include details of why the patient was admitted, when he or she was last seen, and the critical points in his/her care and management. Despite seeing some tragic cases, optimism abounds in the unit. After all, “ICU is where we treat critically ill patients,” said Sister Elizabeth. They are the ones we know we can revive again and bring back to life.”

From Ebola Isolation Unit to Modern A&E Unit: Transformation at Connaught Hospital

KSLP Emergency Medicine Doctor Rich shares his reflections on the recent A&E refurbishment at Connaught Hospital

The entrance doors were unlocked, revealing dark corridors and empty rooms illuminated only by slivers of sunlight stretching out across the bare floor through broken panes of glass.  My eyes struggle to adjust, pupils dilating as I peer into the shadows. It’s humid and I can already feel beads of perspiration forming at the back of my neck.  The tiles have faded after repeated dousing in chlorine and a fine layer of dust has settled to give the ward an eerie, long-abandoned feel.  This was once part of the red zone, a place of fear and tragedy for many, a place where local staff worked alongside foreigners doing the best they could in a period of great uncertainty.  It is now silent, no one has been here for quite some time.

By the time the epidemic reached Freetown, hundreds of cases a day were being diagnosed across the country and the staff at Connaught needed to act fast to establish an Ebola isolation unit in an attempt to contain the virus and protect its healthcare workers.  Prior to the epidemic King’s had a program in place to help strengthen the emergency services at the hospital and had already introduced a triage system to expedite assessment of the sicker patients that presented to the hospital.   The outpatient department was re-branded as the Accident and Emergency unit to re-inforce the need for timely and effective urgent care for the critically ill and injured patients that attend there on a frequent basis.  An emergency that no one expected subsequently swept across the country at alarming speed and the Accident and Emergency ward was transformed into an Ebola holding unit.

In time, a purpose designed isolation unit was established alongside the hospital and the old unit, after decontamination, became redundant and stood empty; a dark reminder of painful recent events.  When I arrived, just over six months ago, we were isolating and managing suspect patients in the new unit.  I had heard some very upsetting accounts from colleagues, from both Freetown and abroad, that were around at the height of the epidemic and I struggled to imagine how challenging the conditions must have been. Before Christmas, it was opened up and I was able to enter inside.  Renovation work would soon be starting on a new A&E Department and I was curious to see what would be required to transform a place where the grief was still tangible into a facility that will aim to revolutionise emergency care for inhabitants of the city and beyond.

Dr Rich working on the A&E refurbishment at Connaught Hospital

During the epidemic, the emphasis of the government and international agencies was focused out of necessity in containing the disease.  This was no doubt to the detriment of other health related issues.  Maternal and child mortality rates will have increased, surgery throughout the country was suspended and I have seen many HIV and TB patients that defaulted on treatment.  Most health facilities shut down but Connaught remained open, providing a much needed service to those that were sick but not suffering from Ebola.  The A&E, in its temporary facility, continued to deliver essential care at the front door, at great personal risk to the brave staff that served throughout.

We have seen the country declared free of Ebola twice now since I arrived and with recent cases in Guinea, it seems unlikely that the country will never see another case.  The skill and expertise now exists in Sierra Leone to manage the situation and gain control rapidly, the focus is now on re-building and strengthening the health care system.  This is now the main emphasis of the work of King’s at Connaught and of my role in the Emergency Department.  The lasts few months have seen huge steps forward in the delivery of emergency care and much of the credit should be given to my colleague Ling who has worked tirelessly over several years now to develop the A&E in conjunction with the hospital staff and Ministry of Health.

Before: the future A&E unit pre-refurbishment
After: Dr. Ling stands in the newly refurbished A&E unit

The end of February saw work complete on the old isolation unit and the new A&E, along with resus and medical admissions units opened to patients. Equipment and patients were transferred seamlessly, coordinated by Sister Kamara, in under 2 hours and there was impressively no delay or impact on patient care and safety. Several of the staff came in early of their own volition to prepare the department and I was told off for being late by one irate nurse who had been there since 6am.

Ling is now back in the UK and is sorely missed by all the staff she worked with at Connaught, although she has left a strong legacy.  Several high profile figures have visited the department in the last few weeks including the deputy health minister, chief medical officer and chief nurse; all have been impressed.  The staff are revitalised and proud of their new department, they are eager to learn how to use the new facilities and equipment.  We have a new enthusiastic and motivated medical officer and Emergency medicine is enjoying a raised profile in Sierra Leone currently.  I’m sure that this is all having a positive impact on the care of the patients, who seem to be attending in ever increasing numbers. The big challenge now will be to sustain and build on this momentum and ensure that the ministry can support the hospital to develop systems and maintain a supply chain that will keep the acute care facilities functioning effectively for the benefit of the patients.

A lot has taken place over six months and a great deal more is to come. While work has the potential to become all-consuming at times, it is the down-time and the support of those who are close that is important to maintain a sense of balance and perspective. My personal highlight has been the visit of Alice, who arrived in Freetown last month as my girlfriend and went home as my fiancée. I was really pleased to be able to share my experiences and show her the highlights of what can be, at times, a beautiful country. In a place that offers tropical islands and idyllic beaches in abundance, I felt the most appropriate spot for a proposal would be in the jungle surrounded by howling chimpanzees. Fortunately, my gamble paid off and she agreed to marry me!

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 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.

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.

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.

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)

William Pooley joins the King's team in Freetown

Will1 The King’s Sierra Leone Partnership and King’s Health Partners warmly welcomes British nurse Will Pooley to their team in Freetown, Sierra Leone who are working on the frontline to halt the Ebola outbreak.

Will was previously working as a nurse treating patients in a government hospital in Kenema before being flown home from Sierra Leone in August after contracting the Ebola virus. He has now made a full recovery and flew out to Freetown today (Sunday 19 October) to join the team from King’s Sierra Leone Partnership where he will resume his nursing role. He will be working in the isolation unit at Connaught Hospital, training local staff and helping to set up new isolation units.

King’s Sierra Leone Partnership is an initiative of King’s Health Partners Academic Health Sciences Centre, a 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. The in-country operation was launched in January 2013 by Dr Oliver Johnson and aims to strengthen Sierra Leone’s health system.

The King’s team has played a vital role in responding to the Ebola outbreak since the virus first emerged in the country in May. The role of the team has rapidly extended beyond its initial management of a 16-bed isolation unit at Connaught Hospital.  They have 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.

The team was recently awarded £1 million by the Department for International Development as part of the UK Government’s response to the outbreak. The money will allow the King’s Sierra Leone Partnership to greatly expand its activities working with local and international partners in a clinical and advisory role to help stop the spread of Ebola.

Speaking ahead of his flight to Freetown, Will Pooley said:

“I am delighted to be returning to Sierra Leone to join the King’s Health Partners team. I would like to once again thank the team at the Royal Free Hospital and the RAF who provided me with such excellent treatment and support. But the real emergency is in West Africa, and the teams out there need all the support we can give them – I am now looking forward to getting back out there and doing all I can to prevent as many unnecessary deaths as possible”.

Welcoming Will to the team, Dr Oliver Johnson, Programme Director for the King’s Sierra Leone Partnership said:

“It is fantastic that Will has chosen to join our small team here at Connaught Hospital. The situation here in Freetown is getting worse by the day and so Will’s experience and commitment will be vital as we do everything we can to stem the flow of cases. The best way of stopping Ebola spreading even further is to fight it at its source and I look forward to working with Will to do just that.”

King’s Health Partners are raising funds to help support the ongoing Ebola response in Sierra Leone. For more information please visit http://alumni.kcl.ac.uk/about-the-ebola-emergency-appeal

Will spoke to Michael Carden of King’s Health Partners about his “unfinished business” in Sierra Leone, and you can find that interview here.

Notes to Editors

  • Will is returning to Sierra Leone to focus solely on his role as a volunteer nurse fighting Ebola. As such, neither Will nor his family will be available for media bids. We ask that you respect this desire for privacy from both parties.
  • King’s Sierra Leone Partnership is part of King’s Health Partners Academic Health Sciences Centre (AHSC), a pioneering collaboration between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts.
  • King’s Health Partners is one of six AHSCs in England and brings together an unrivalled range and depth of clinical and research expertise, spanning both physical and mental health. Our combinedstrengths will drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity. For more information, visit www.kingshealthpartners.org
  • To find out more about King’s Sierra Leone Partnership visit http://kslp.org.uk/
  • For all other media enquiries about the work of King’s Health Partners in Sierra Leone, please email Michael Carden, Head of Communications at michael.carden@kcl.ac.uk / 07825 546177 or email media@kslp.org.uk

Statement: Gambia Bird flights suspended

King’s Sierra Leone Partnership Programme Director, Dr. Oliver Johnson, had this to say on the decision by the UK Civil Aviation Authority:

“The decision of the UK Government to withdraw permission for Gambia Bird to operate direct services to Sierra Leone is very disappointing, particularly as it is inconsistent with the current travel advice from both the World Health Organisation and the UK Foreign Office. King’s Health Partners and the other organisations fighting Ebola in Sierra Leone depend on flights from overseas to provide us with vital resources, including both personnel and equipment. The reopening of direct Gambia Bird flights between London and Freetown would provide a much needed route for urgent support. We had an urgent shipment of critical supplies and two volunteers due to arrive on Friday with Gambia Bird that will now be delayed, a tangible example of how this decision will impede the response in West Africa and put UK nationals supporting the response on the ground at greater risk. Whilst it is completely understandable that the UK government is doing everything it can to ensure the country is ready for any potential cases of Ebola, preventing flights from West Africa will not help with this. Regular, direct flights from the affected countries are easier to monitor for potential cases than indirect flights routing through many different airports in Europe. The best way of stopping Ebola arriving in the UK is to tackle it at its source and I would urge the Government to reconsider its decision.”