tag:blogger.com,1999:blog-23602379596989436572024-03-19T04:12:02.707-07:00KING'S IN THE FIELDStories from the staff and<br>
volunteers of the King's<br>
Sierra Leone Partnership<br>
in FreetownAnonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-2360237959698943657.post-15421706800644081292016-02-23T06:54:00.002-08:002016-02-23T06:54:28.504-08:00Alumni Profile: Ahmed Seedat and the Importance of Building Relationships<br />
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<tr><td class="tr-caption" style="text-align: center;">Former KSLP Clinical Lead and Ebola Volunteer, Ahmed Seedat</td></tr>
</tbody></table>
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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.<br />
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In 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!<o:p></o:p></div>
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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.<o:p></o:p></div>
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I returned to Freetown in August – September for the Ebola
outbreak.<o:p></o:p></div>
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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! <o:p></o:p></div>
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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.<o:p></o:p></div>
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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.<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com4tag:blogger.com,1999:blog-2360237959698943657.post-72148827097690162972016-02-18T08:59:00.002-08:002016-02-18T09:04:31.716-08:00A Passion for Nursing - Connaught Hospital Matron Isatu Kamara<span style="font-size: 14.6667px;">Connaught Hospital relies on its team of dedicated nurses to keep functioning. Isatu Kamara, or as we all know her “Matron,” has been at the helm of this team since 2014. </span><br />
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<tr><td class="tr-caption" style="text-align: center;">Matron Isatu Kamara</td></tr>
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<span style="font-size: 11pt;">Since she was a
little girl “she had a 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.” </span><span style="font-size: 11pt;">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 nursing care is available to all patients.</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: 12.8px;">Matron Isatu at Connaught Hospital</span></td></tr>
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<span style="font-size: 11pt;">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.” </span><span lang="EN-AU" style="font-size: 11.0pt;"></span></div>
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<tr><td class="tr-caption" style="text-align: center;">KSLP Senior Nurse Pat, Matron Isatu, and Deputy Matron Agnes</td></tr>
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<span lang="EN-AU" style="font-size: 11.0pt;">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.”</span></div>
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Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com10tag:blogger.com,1999:blog-2360237959698943657.post-89193649347865332282016-02-12T02:26:00.002-08:002016-02-12T02:27:57.467-08:00Reflections from the Intensive Care Unit - Ruth Tighe<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9FAIUuRKGntbuH5LYwQQ0lwo5f3-N8N6_PEqrTgQqZ0HP2WxOfyW7MUSwD9DcgGVSxMbT1G_S_GsZ6NNtHjkHaa6m2lDXEYugZ-Pe9xjCh0MygvhgkVXBVmq12q96zYxNM8WqDFTG7Vin/s1600/DSC00057.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9FAIUuRKGntbuH5LYwQQ0lwo5f3-N8N6_PEqrTgQqZ0HP2WxOfyW7MUSwD9DcgGVSxMbT1G_S_GsZ6NNtHjkHaa6m2lDXEYugZ-Pe9xjCh0MygvhgkVXBVmq12q96zYxNM8WqDFTG7Vin/s320/DSC00057.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Volunteer Critical Care Coordinator Ruth Tighe with the Oxygen Factory Technician Team: Abu, Amadu, Ibrahim, and Desmond</td></tr>
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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. </div>
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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. <o:p></o:p></div>
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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.<o:p></o:p></div>
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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.<o:p></o:p></div>
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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.<o:p></o:p></div>
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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. <o:p></o:p></div>
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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.<o:p></o:p></div>
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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!<o:p></o:p></div>
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Ruth</div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com5tag:blogger.com,1999:blog-2360237959698943657.post-74934281081950358242015-10-22T03:44:00.000-07:002015-10-22T03:44:35.384-07:00Strengthening A&E at Connaught<div class="MsoNormal">
<span style="mso-bidi-font-size: 5.0pt;">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. <o:p></o:p></span></div>
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<span style="mso-bidi-font-size: 5.0pt;">A&E is an
emerging area of specialist practice in Sierra Leone with potential to
transform how health care is delivered in the country. </span>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. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjBO6i542Nvhm3k_813-w0iBqvfyKyyMNZlAPwWEFRBaLEPDeTN_sMnS-N8h4OgdiLBLe4eE6kV5oCQsYgAIAHo2mbw2DIMVCEOh6YWd1m2J0hO7Y9cmxMpVZsTJxPZXF9jYLKQIbUFJgt/s1600/IMG_1472.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjBO6i542Nvhm3k_813-w0iBqvfyKyyMNZlAPwWEFRBaLEPDeTN_sMnS-N8h4OgdiLBLe4eE6kV5oCQsYgAIAHo2mbw2DIMVCEOh6YWd1m2J0hO7Y9cmxMpVZsTJxPZXF9jYLKQIbUFJgt/s320/IMG_1472.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sister Cecilia and KSLP A&E Nurse Mentor Hedda</td></tr>
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<span style="mso-bidi-font-size: 5.0pt;">The refurbishment includes
the construction of a dedicated minor procedure room so that staff can conduct
urgent surgeries within the A&E department.<span style="mso-spacerun: yes;">
</span>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. <o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">The A&E Team: Sister Cecilia, A&E Consultant Surgeon Dr Seisey, KSLP A&E Co-ordinator Dr Ling and Matron</td></tr>
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<br />
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<span style="mso-bidi-font-size: 5.0pt;">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. </span><span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-size: 5.0pt;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com5tag:blogger.com,1999:blog-2360237959698943657.post-5480209497453323552015-10-13T05:56:00.000-07:002015-10-13T05:58:29.885-07:00Technicians at Connaught <div class="MsoNormal">
We would like to introduce Ibrahim, one of Connaught Hospital’s highly skilled technicians behind the functioning of the hospital’s new oxygen factory.<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiagHbD7g4By37P77CceneXBlPWvPuu0J4ChrXhmmgzdMJS5hXPIl6ojJIUHjjxTTgo7t6vyVyIpDeMOg_1ANDNz-ObX-EKT3orsGQ5SA6_S2jy8OIYb6JtLYPcNOWhJeaebCev3YlIgwcP/s1600/DSC00048.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiagHbD7g4By37P77CceneXBlPWvPuu0J4ChrXhmmgzdMJS5hXPIl6ojJIUHjjxTTgo7t6vyVyIpDeMOg_1ANDNz-ObX-EKT3orsGQ5SA6_S2jy8OIYb6JtLYPcNOWhJeaebCev3YlIgwcP/s320/DSC00048.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
<br />
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”</div>
<br />
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<tr><td class="tr-caption" style="text-align: center;">The Technician Team- (l-r) Abu, Amadu, Ibrahim and Desmond</td></tr>
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<br /></div>
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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.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjarrxph-4SQqqjF0X-8N-PXIUSCu_z8u6Eg-CUH0recey-FI6vP1QV8SfgKzNRwxETMAWqR9JNVDLzPSiPFN5fFzr3q6g6QoGi60_CPeChOqv0RvSNf34l38eSw9lrwHLih74lWFbozxKi/s1600/_DSC0039.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjarrxph-4SQqqjF0X-8N-PXIUSCu_z8u6Eg-CUH0recey-FI6vP1QV8SfgKzNRwxETMAWqR9JNVDLzPSiPFN5fFzr3q6g6QoGi60_CPeChOqv0RvSNf34l38eSw9lrwHLih74lWFbozxKi/s320/_DSC0039.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ibrahim and his fellow technicians demonstrating Connaught's new oxygen factory</td></tr>
</tbody></table>
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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.”<o:p></o:p><br />
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com5tag:blogger.com,1999:blog-2360237959698943657.post-87252782806810255022015-05-15T02:57:00.000-07:002015-05-15T02:57:11.427-07:00An Engineer in Freetown<div class="MsoNormal" style="background: white;">
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<span style="color: black; font-family: Cambria;">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 give 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. <o:p></o:p></span></div>
<div style="background: white; margin: 0cm 0cm 0.0001pt; text-align: justify;">
<br /></div>
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<span style="color: black; font-family: Cambria;">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.<span style="font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">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. </span><span style="font-size: 10.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf0ZtQP58Wr312P7JxzQgCeXOZP3PXsY8rwfqrfdceATQcaR5UJ5dIQCcMZTIBgHi5uMZNpFH24ZhHbDEfkstfpIRu7xGV8sxD_MJMFwKR_FuwhwSvArgFmvD9DtMlRIMwWphGMokdf2I7/s1600/IMGP3037.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf0ZtQP58Wr312P7JxzQgCeXOZP3PXsY8rwfqrfdceATQcaR5UJ5dIQCcMZTIBgHi5uMZNpFH24ZhHbDEfkstfpIRu7xGV8sxD_MJMFwKR_FuwhwSvArgFmvD9DtMlRIMwWphGMokdf2I7/s400/IMGP3037.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Before...</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvlynVsbW6-l2icKaJ9Wkz8dFXcHh3eFq0wU9nFJWU3kLbbKhdAN0IYLYvFfIG2o-Nb7OTAM8P5zAgreOybZ8kxeiLdb6ACCkMyq7yYOjfZc8WGGC8JnfeNZkorgM-D7oPagRAXC_QSsT6/s1600/20150501_032406rev1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvlynVsbW6-l2icKaJ9Wkz8dFXcHh3eFq0wU9nFJWU3kLbbKhdAN0IYLYvFfIG2o-Nb7OTAM8P5zAgreOybZ8kxeiLdb6ACCkMyq7yYOjfZc8WGGC8JnfeNZkorgM-D7oPagRAXC_QSsT6/s400/20150501_032406rev1.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">and after!</td></tr>
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<span style="color: #222222; font-family: Cambria;">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.<span class="apple-converted-space"> </span></span><span style="color: #222222; font-family: Cambria; font-size: 9.5pt;"> </span><span style="color: black; font-family: Cambria; font-size: 13.5pt; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">The previous structure housing the oxygen factory (right) </td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The completed extension and new oxygen filling system arriving</td></tr>
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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
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<span style="color: black;">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. </span><span style="color: black;"><o:p></o:p></span></div>
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<span style="color: black;">In
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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. <span style="font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7z5Q5lVS3FojFC1XHzqJTkiFYNsf_scput2aRAv1rGbCqSctnNeBCTSvwzoAQPZkepR5848r04A8XQU4DS9ZOdVyR85n5xH-nrezShnL8LQZD4qfF71Py9yvfaRPG640fTmfnQwyJv19O/s1600/IMGP3516.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7z5Q5lVS3FojFC1XHzqJTkiFYNsf_scput2aRAv1rGbCqSctnNeBCTSvwzoAQPZkepR5848r04A8XQU4DS9ZOdVyR85n5xH-nrezShnL8LQZD4qfF71Py9yvfaRPG640fTmfnQwyJv19O/s400/IMGP3516.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The current ETU which will be changed back into an A&E department soon</td></tr>
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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. </div>
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Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com6tag:blogger.com,1999:blog-2360237959698943657.post-8004890617950269752015-04-09T06:00:00.001-07:002015-04-09T06:18:10.450-07:00Developments in Mental Health at Connaught<!--[if gte mso 9]><xml>
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<span style="font-family: Arial;">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.</span><o:p></o:p><br />
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<span style="font-family: Arial;">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. <o:p></o:p></span></div>
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<tr><td class="tr-caption" style="font-size: 13px;"><span style="text-align: justify;">Dr Stania Kamara and Jennifer Duncan examine patient records</span><span style="font-family: Arial; text-align: justify;"> </span></td></tr>
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<span style="color: black; font-family: Arial;">When I arrived in Freetown the number of Ebola cases had dramatically reduced. It was great to see that the months of hard work were paying off and there was a sense that things were settling down</span><span style="font-family: Arial;">; however, our clinical leads were, understandably, being<span style="color: black;"> prudent and cautioned against complacency.<o:p></o:p></span></span></div>
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<span style="color: black; font-family: Arial;">I went through a period of training on how to work safely within the Isolation unit at Connaught Hospital including how to wear PPE. Within days I started work in the Unit, a holding bay for patients suspected of having Ebola and awaiting their blood tests. Whilst they await their results, they are given treatments to combat other possible diseases that could have caused their symptoms.<span style="mso-spacerun: yes;"> </span>These duties are performed by both local and international staff. The team is comprised of doctors, nurses, surveillance officers and Ebola decontamination cleaners. It's a great and inspiring team to work alongside. <o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">On the way to the isolation unit one day, I noticed a middle aged man stooped on the walkway clothed in torn pyjamas. He was disheveled and confused. I was told that he was a patient with TB and HIV who had spent some weeks at the hospital displaying bizarre behaviour. He would not take his medication, had absconded from the ward on multiple occasions and had spent the last few days living in the corridors of the hospital grounds.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">It was clear that he was experiencing psychotic symptoms and this was likely affecting his ability to comply with his medical treatment. Following some discussions with senior clinicians, we were able to admit him to the hospital and initiate treatments for his medical problems as well as his mental illness. Despite this, the man passed away, succumbing to his medical condition. <o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">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.</span><span style="color: black; font-family: Arial; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">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. </span><span style="color: black; font-family: Arial; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">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 </span><span style="font-family: Arial;">making great strides</span><span style="font-family: Arial;">. 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. </span><span style="mso-spacerun: yes;"> </span><span style="font-family: Arial;">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.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: black;">Prior to the Ebola outbreak there was</span><span style="color: black; font-family: Arial; mso-fareast-language: EN-GB;"> 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 suppo</span><span style="font-family: Arial; mso-fareast-language: EN-GB;">rt otherwise. This s<span style="color: black;">ituation has worsened during the Ebola epidemic. <a href="http://www.internationalmedicalcorps.org.uk/wp-content/uploads/2015/01/IMC-Sierra-Leone-Dec-2014-Ebola-MHPSS-Assessment.pdf" target="_blank">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.</a></span></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: black;">Whilst I envisioned spending my time here in Sierra Leone sweating through scrubs in full PPE in fact I am now</span> spending mo<span style="color: black;">st 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. </span></span><span style="font-family: Arial; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">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.<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">Using the new official ledger to record patients</td></tr>
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<tr><td class="tr-caption" style="font-size: 13px; text-align: center;">A new department is born</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">We are also supporting Connaught to set up a mental health and psychosocial department, the first of its kind in the country. It will offer an in-hospital liaison service and an outpatient clinic for the local community. It is wonderful to work with the senior management team who are fully committed to providing <span style="color: #262626; font-family: Arial; mso-bidi-font-family: Helvetica;">comprehensive, integrated and responsive mental health services at Connaught. They have shared with us their vision for this service to be the model on which other such units are created throughout the country; thereby providing a much needed service to a greater number of people. </span>We've started seeing patients and the need is clearly visible: our work so far has been varied and has i<span style="mso-font-kerning: .5pt;">ncluded supporting families to facilitate the treatment at home of individuals suffering from acute mental disorders, providing advice to the inpatient medical teams on the management of acute delirium, and identifying livelihood opportunities for patients affected by the Ebola outbreak. </span></span><span style="color: black; font-family: Arial;"><o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">Within the KSLP team, I am also supported by the Mental Health Group; a UK based group of clinicians and non-clinicians, led by Dr Peter Hughes (Consultant Psychiatrist) who meet regularly to support our work here. <o:p></o:p></span></div>
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<span style="color: black; font-family: Arial;">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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com2tag:blogger.com,1999:blog-2360237959698943657.post-38054326558726769482014-07-18T08:07:00.001-07:002014-07-22T01:35:23.669-07:00A physician in Freetown<span style="font-size: small;">By Dr Terry Gibson, Volunteer Consultant Physician at Connaught Hospital </span><br />
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<span style="font-size: small;">I joined the KSLP team in Freetown in April and Connaught Hospital has become my place of work and something of a home. My flat inside the duty house on the hospital grounds is where I sleep, and lets me see how the hospital functions after hours. Being right next door to the mortuary means the trundling mortuary trolley, followed by the sound of grieving relatives is a regular disturbance at night.</span><br />
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<span style="font-size: small;">I arrived without a remit but with a shared expectation that through my long experience of acute and general internal medicine at Guy’s and St.Thomas’ I would be able to contribute to patient care, set standards for myself and act as a role model for house officers and students. That is precisely how it has evolved.</span><br />
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<span style="font-size: small;">During the first week I was asked to share duties with one of the other three general physicians. On the first round together he excused himself to attend a meeting and asked me to carry on. For six weeks thereafter I continued in his place, performing daily rounds, one in three on call and a diabetic/general medicine clinic. When he returned I assumed charge of my own team so now there are four general physicians sharing the task.</span><br />
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<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">Ward rounds with junior doctors and interns</span></span><br />
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Each team includes a consultant and a minimum of two house physicians who have been qualified for one or two years and shoulder responsibilities well beyond their competence. For this reason I perform regular daily rounds and a slow survey on Sundays. If on call for a long weekend I conduct rounds throughout the weekends. Dedicated training procedures are limited. I regularly perform lumbar punctures and other invasive procedures, teaching as I go. Apparently despite the large number of unconscious HIV admissions lumbar punctures are rarely performed. Thus I have set one clinical standard in motion.<br />
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A weekly clinical meeting for medicine with cases of interest or of educational value is now a regular feature of the house physicians' timetable. My colleagues on the King's team had already launched this idea, but the arrival of a Guy's and St. Thomas' physician on the wards gave the meetings a lot more impetus. It has also acted as a forum for the other consultant physicians who rarely meet but now contribute to the clinical meeting as well as engaging in a separate gathering to discuss business issues. Recently the focus has been on improving the performance of the ICU.<br />
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My outpatient session has been connected into a rheumatology/GIM clinic. The number of rheumatic referrals so far has been small. The clinic is supported by two house physicians who have learned how to aspirate joints and examine the fluids under a microscope. Whether I can emulate my time as a visiting professor in Pakistan where I started the rheumatology service in Karachi that flourished 20 years later I cannot say, we shall see. <br />
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In the meantime the support I’ve received from the King’s team and the established physicians here has been nothing but positive. All things are possible and I am optimistic about the likelihood of leaving some sort of legacy behind.
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com4tag:blogger.com,1999:blog-2360237959698943657.post-85865113706535949922014-06-04T04:54:00.001-07:002014-06-05T02:54:39.354-07:00The Eye of the Storm: Ethical Challenges at the Front Line of an Ebola Outbreak<style>
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<span lang="EN-GB" style="font-family: Arial;">By Dr Oliver Johnson</span><br />
<span lang="EN-GB" style="font-family: Arial;">Programme Director</span><br />
<span lang="EN-GB" style="font-family: Arial;">King's Sierra Leone Partnership</span><br />
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<span lang="EN-GB" style="font-family: Arial;">Last year I had
the opportunity to spend time in Boston with Dr Paul Farmer, founder of
<a href="http://www.pih.org/" target="_blank">Partners in Health</a>, who generously gave me a copy of his recent book <i style="mso-bidi-font-style: normal;">Haiti After the Earthquake</i>, an account
of the response to the devastating earthquake in Haiti in 2010.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Reading his
description of their early work in the main hospital in Port-au-Prince, a
sprawling colonial compound in need of a major revival, surrounded by urban
slums, I was struck by the parallels with our own partnership with Connaught
Hospital in Freetown – and have been kept awake at night since by an unresolved
question: what would we do in similar circumstances, if disaster hit Sierra
Leone?</span><br />
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<span lang="EN-GB" style="font-family: Arial;"><span lang="EN-GB" style="font-family: Arial;">On 25<sup>th</sup>
May 2014 disaster did arrive, not in the form of an earthquake, but
with the confirmation of the first ever cases of Ebola in Sierra Leone.</span></span><br />
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<span lang="EN-GB" style="font-family: Arial;">The news was not
a complete surprise – since the outbreak started in Guinea in March, the Ministry
of Health & Sanitation had been on high alert, organising regular National
Emergency Ebola Taskforce meetings to coordinate preparedness and contingency
planning.</span></div>
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<span lang="EN-GB" style="font-family: Arial;"><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-size: small;"> <span style="font-size: x-small;">Myself with <span style="font-family: Arial;">Connaught staff</span> <span style="font-family: Arial;">Dr Martin Salia</span> and<span style="font-family: Arial;"> Sister Cecilia (Sister-in-charge of A & E) </span>preparing the isolation ward.</span></span></span></span> </span><br />
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<span lang="EN-GB" style="font-family: Arial;">The King’s team
were invited into this process within hours of the first Taskforce meeting,
advising Connaught on how to adapt international guidelines to develop a
Hospital Preparedness Plan that detailed how to identify cases, set up
isolation facilities and safely protect staff and dispose of medical waste. </span><br />
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<span lang="EN-GB" style="font-family: Arial;">These guidelines
were held up as a model for other hospitals, and King’s was asked to act as
technical advisors to the Ministry’s wider national Ebola Case Management
committee, along with groups such as Medicines Sans Frontieres, Emergency
Hospital and the World Health Organization.</span><br />
<span lang="EN-GB" style="font-family: Arial;">We then had two
months of relative calm and many began to believe that, even as Ebola had
spread like wildfire across Guinea and into neighbouring Liberia, Sierra Leone might
have dodged a bullet and avoided the outbreak entirely. The confirmation of
cases within Sierra Leone quickly dispelled that hope, pushing us all to lift our game.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">As the King’s
team worked to urgently provide refresher training to nursing and medical
staff, suspected cases began to emerge. Sierra Leone has been awash with
rumours and misinformation for weeks about Ebola and, with a nurse having been
one of the first Sierra Leonean victims, the sense of fear amongst hospital
staff was palpable. We therefore found ourselves amongst the first responders
to these suspected cases, alongside heroic Connaught colleagues such as Sister
Cecilia (Sister-in-Charge of the Accident & Emergency Department) and Dr
Eva Hanciles (Head of the Intensive Care Unit) who did not hesitate to step
forward and manage the response.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-ai0-9TLx9jD_2x7jHa31hDGVKmmWwaHLer9kepqSd54AjwfJDrhExefbHngFYWK-7tqXGy3kDSim4UYmiXklaAAC4i8MoAldtSkpAvR8YWkfAPV6fLSxiZ-upHCgmO9AvAvaEl0XR1jW/s1600/Low_res_Karlin_Nurse.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-ai0-9TLx9jD_2x7jHa31hDGVKmmWwaHLer9kepqSd54AjwfJDrhExefbHngFYWK-7tqXGy3kDSim4UYmiXklaAAC4i8MoAldtSkpAvR8YWkfAPV6fLSxiZ-upHCgmO9AvAvaEl0XR1jW/s1600/Low_res_Karlin_Nurse.jpg" height="480" width="640" /></a></div>
<span style="font-size: x-small;"> <span style="font-family: Arial,Helvetica,sans-serif;"> King's volunteer nurse Karlin Bacher works with Nurse Susan to review the Ebola guidelines</span></span></div>
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<span lang="EN-GB" style="font-family: Arial;">Our volunteer clinical
team were all re-tasked to provide support including consultant physician Dr
Terry Gibson, junior doctors Dr Paul Arkell and Dr Sakib Rokadiya and nurse
Karlin Bacher. They have been working late into the night to set up an expanded
Isolation Unit and to provide treatment and take blood specimens from
suspected patients. It has been sweaty and exhausting work, scrubbing floors
with bleach whilst wearing gowns, masks and other personal protective equipment
in the intense heat of Sierra Leone’s humid rainy season.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">As we approach
the end of the frenetic first week of the response, we are finally getting a
chance to reflect on our response and the whole team has engaged in deep debate
about a number of ethical challenges we have been confronted with.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">The most
fundamental question is whether we as an organisation should be involved in the
response at all. Just like our Boston colleagues in Haiti, our work at
Connaught Hospital is not aimed at providing hands-on clinical care to patients
or at directly managing clinical services. Instead our focus is to support the
long-term strengthening of the health system by providing training and
technical advice. This represents a fundamental distinction between
humanitarian and development work. </span></div>
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<span lang="EN-GB" style="font-family: Arial;">We’re therefore really
not set up to provide a humanitarian response, it’s not what our team
specialises in and we don’t have access to the sorts of funding or medical
equipment that are needed for this. On the flip side however, we have a highly
professional team of experienced clinicians, with two
consultant-level physicians, two junior doctors trained in tropical medicine,
two nurses, a pharmacist and a hospital manager, we have one of the largest and
most senior international medical teams of any organisation in Sierra Leone.
With that comes our close working relationships with local counterparts and our
relative familiarity with the hospital facilities, culture and the Krio
language. And we are on the ground already – whilst other international organisations
take weeks to recruit a team and prepare for deployment, we are able to respond
within minutes to a request for support.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Helping to
respond to an outbreak of a viral haemorrhagic fever (VHF) is not a standard
request for support however - it requires specialist expertise. We were lucky
to have Dr Colin Brown on hand, our Infectious Diseases Advisor in the UK, who
is well trained in VHF response and can draw on technical support from Public
Health England and beyond. Even so, are we acting beyond our competency and
putting ourselves and others at risk by taking on roles that we’re not set up
to handle?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">After discussing
this as a team, with our local partners and with our senior colleagues back at
King’s we decided, on balance, that we had a duty to respond and that we did
have the capacity to do so safely and effectively – provided we coordinated
closely with other specialist partners (such as the Lassa Fever Centre in
Kenema and the World Health Organization).</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGgXt3K7J0NLVDrIzPTVxrTou3i3HqHBxdhoU7R8ArCht9-2HE199eJRH8en-nWHMZ_fp0FamCH9AmdVkFz7yzVtWP9tRzDjYVTY8lCA5ZScpJQFjmIn_jDPQ5QRffSFAdSHqrWPUDsKRh/s1600/isolation_ward.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGgXt3K7J0NLVDrIzPTVxrTou3i3HqHBxdhoU7R8ArCht9-2HE199eJRH8en-nWHMZ_fp0FamCH9AmdVkFz7yzVtWP9tRzDjYVTY8lCA5ZScpJQFjmIn_jDPQ5QRffSFAdSHqrWPUDsKRh/s1600/isolation_ward.jpg" height="480" width="640" /></a></div>
<span lang="EN-GB" style="font-family: Arial;"> <span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"> Setting up the isolation ward at Connaught Hospital</span></span></span></div>
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<span lang="EN-GB" style="font-family: Arial;">The decision to
respond opened up a question about whether or not to put our staff on the front
line. Ebola is highly contagious, particularly through exposure to body fluids
such as blood, saliva or urine – this means that health workers are
particularly at risk. Effective use of personal protective equipment (such as
gowns, masks, goggles and gloves) and effective cleaning and waste disposal can
significantly reduce this risk but at the start we didn’t have all the
materials we needed available and you can never eliminate the risk entirely.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Different
organisations in Sierra Leone have responded to the outbreak in different ways.
Some immediately evacuated international staff when cases in Guinea emerged.
Others said they would do so if there were confirmed cases locally. Some put
restrictions on their staff, banning them from undertaking clinical work or
going into clinical areas. One organisation actually closed their entire
hospital to all patients.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">This is a moral
dilemma in the truest sense, every option available involves moral wrong and
ethical compromise making it a matter of judgement about how to weigh up
competing responsibilities. </span></div>
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<span lang="EN-GB" style="font-family: Arial;">As organisations
we have a duty of care to our staff, not to put them at unnecessary risk. We
also have to be mindful of reputational damage; many NGOs worried that if one
of their staff members died of Ebola they would open themselves up to being
prosecuted or to funding being withdrawn, damaging their wider efforts to help
patients. </span></div>
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<span lang="EN-GB" style="font-family: Arial;">As health
professionals however, we have a duty to our patients. Withdrawing from
clinical activities would not only harm patients who are suspected of Ebola,
but (particularly in the case of the hospital which closed) would have
enormously detrimental impacts on the care of other patients. One NGO stopped
doing outreach clinics in a local urban slum – a clinic which was the only
health service available to many vulnerable patients, some of whom will
certainly have died as a result. And having made this decision, at what point
do you decide it is safe enough to return – for how many weeks, months or years
do you stay away?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Most of the
decisions made by international NGOs hinged around their international staff –
but what of Sierra Leonean health workers? Is it not discriminatory to withdraw
internationals whilst expecting local staff to stay at their posts and face the
challenge alone – especially when international staff are often better trained
in how to wear protective equipment and are at a lower risk as a result. </span></div>
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<span lang="EN-GB" style="font-family: Arial;">One senior
colleague at the Ministry of Health articulated this clearly – to him and his
staff on the ground, it felt like the civil war all over again, as NGOs packed
their white SUVs and abandoned their local colleagues at the first sign of
danger, often without even telling them of their plans. In this context, was
closing the entire hospital, and providing the same protection for all staff, a
more ethical decision – even if a greater number of patients ultimately died as
a result?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">At King’s,
following extensive discussions with senior colleagues in London and Freetown,
we took the decision not to restrict the clinical activities of our team. We
were aware however that all our staff are volunteers and that this isn’t what
they originally signed up for – so we gave them the option to withdraw from
clinical activities if they wanted to, asking only that they make this decision
in advance so that we could communicate it to partners and put contingencies in
place. All of our team have decided to continue clinical work for the moment –
but has this put unfair peer pressure on individuals to agree to remain, since
everyone else in the group has decided to do so?</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiISEfjPIw1G2rjENGcgfGO5F1fDQi49CdBowi9WwSE4xW6vvYUbhMU30vNJD0n4EAl_ZzYJJq7xulGsAgKpn0qes0V0FAsH7EiZOkggLAPlqwCW4Ak5lSSV_5xkHowdH87wyHRApmR9C54/s1600/Sakib_low_res.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiISEfjPIw1G2rjENGcgfGO5F1fDQi49CdBowi9WwSE4xW6vvYUbhMU30vNJD0n4EAl_ZzYJJq7xulGsAgKpn0qes0V0FAsH7EiZOkggLAPlqwCW4Ak5lSSV_5xkHowdH87wyHRApmR9C54/s1600/Sakib_low_res.jpg" height="640" width="480" /> </a></div>
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<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">King's volunteer Dr Sakib Rokadiya dressed in protective clothing before assessing a suspected Ebola patient </span></span></div>
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<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">(who later tested negative to Ebola</span>).</span></div>
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<span lang="EN-GB" style="font-family: Arial;">The moral maze
does not stop here though. The only way we can test for Ebola is to send a
blood sample to Kenema and results can take anything from six hours to days. When
a patient comes to the hospital who fits the agreed case definition we have to
isolate them immediately. The case definition is broad, so most suspected cases
turn out to be negative, in which case the patient is likely to have another
critical illness such as malaria. But those patients cannot have any other
diagnostic tests until their Ebola result comes back negative, because it’s too
dangerous to expose lab staff to potentially hazardous samples. </span></div>
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<span lang="EN-GB" style="font-family: Arial;"><span style="color: black; font-family: Calibri,sans-serif; font-size: x-small;"><span style="font-size: 14px;"></span></span>The range of
treatments we can offer them is also severely limited – in particular, the
National Case Management Committee agreed that it was usually too dangerous to
perform surgery on a suspected case. For example a woman in obstructed labour or a patient with a surgical emergency like appendicitis might well have symptoms that match the Ebola case definition.</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Patients and
their relatives are, understandably, deeply unhappy about being placed in isolation
and are often terrified by being kept in an Isolation Room and treated by staff
in masks. They are angry about not receiving better care and therefore <span style="mso-spacerun: yes;"> </span>often try to escape with the assistance of relatives.
Seven suspected patients escaped from Kailahun hospital last Saturday, with lab
results later showing that some of those were confirmed cases. This creates a
massive risk of spreading the disease. </span></div>
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<span lang="EN-GB" style="font-family: Arial;">At Connaught our hope
was that by providing better conditions and clinical care in the isolation room
and communicating effectively, patients would not attempt to escape. But so far
this hasn’t proved enough and the police have been called in for support. Do we
now lock suspected patients in the isolation room or call in the army to
contain them at gunpoint? Or do we respect their right to leave and risk letting
the outbreak spread out of control?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">Managing this
outbreak has been an enormous undertaking for all involved – from senior ministry
staff holding daily meetings, to health workers leaving the wards to attend
training and money has been reallocated from other programmes. But is this disproportionate?
People die from malaria every day in Sierra Leone – but there have only been a
total of three confirmed deaths from Ebola so far. We know that Ebola is killing
people, but is the Ebola response killing people too? Should we instead be
putting our efforts into preventing other bigger causes of death?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">None of these
questions have easy answers. We at King’s have done our best to identify the
ethical dilemmas we face and to respond to them with integrity, in consultation
with our own team and our local partners. I don’t doubt that we’ve got some of
our decisions wrong. Part of a rigorous approach though has to include opening
them up for debate, so we welcome your feedback and suggestions and hope to
initiate a broader discussion on how we can provide organisations and
individuals with better guidance and advice for future scenarios. As the rainy
season starts, concerns about a repeat of the 2011 cholera outbreak in Sierra
Leone are emerging and Connaught Hospital has been asked to start contingency
planning. Should we be repeating the same role for cholera, or position
ourselves differently?</span></div>
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<span lang="EN-GB" style="font-family: Arial;">In the mean time,
we’ll be back on the frontline in Connaught Hospital doing what we can to
support our Sierra Leonean colleagues to control this deadly outbreak.</span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com9tag:blogger.com,1999:blog-2360237959698943657.post-2420851476427957272014-05-16T08:39:00.000-07:002014-06-04T05:00:03.588-07:00Connaught Fashpack<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">As a part time communications consultant working with the King's Sierra Leone Partnership I have very little to offer in the way of innovative management ideas, clinical skills and curriculum advice. However as someone who has a preoccupation with Sierra Leonean fashion (I have turned it into a serious hobby through my blog <a href="http://www.freetownfashpack.com/">Freetown Fashpack</a> I do feel qualified to comment on the uniforms of Connaught Hospital.</span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">The Hospital is in many ways like stepping back in time.The uniforms remind me of the old photos my mother occasionally pulls out from her early nursing days in the 1960s. At Connaught, uniforms are worn with a deep pride and carefully reflect the hierachy within the hospital. According to Matron Kamara "There is a lot of dignity in our uniforms, they help with staff morale and self esteem. When I put on my uniform I look cute, and I feel very proud". </span></span><br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I recently developed a chart which displays the many uniforms worn by Connaught staff so that staff can be identified by visitors. In doing this I learned about the rank and file of Sierra Leone's hospital workforce and was able to photograph several willing models who all looked perfectly groomed and were more than happy to pose for the camera.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEx26I-2j1esfbdVMIGUXV27un4Jh4KigtCDURT-yb9AJ02r_l3ui3XJDcvXQnalzrk2lSUuU4IBuq3Lh5HrvUpjifKjrNwtfDOzeld4Yty_umVUg-TGKoqSxFfKPuPdAwEP0OJIS-h6VH/s1600/Nurses+Aid.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEx26I-2j1esfbdVMIGUXV27un4Jh4KigtCDURT-yb9AJ02r_l3ui3XJDcvXQnalzrk2lSUuU4IBuq3Lh5HrvUpjifKjrNwtfDOzeld4Yty_umVUg-TGKoqSxFfKPuPdAwEP0OJIS-h6VH/s1600/Nurses+Aid.jpg" height="640" width="425" /> </a></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Nursing aide Susan Sandy looks smart in her distinct green uniform.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj9Mkn7xm3xLQ5vPFnz20xI7LoA4rqzq54pQQfNLwWua7PxIoISyVpnCPxMtEXKn0tPKvFb0ttoL_tJGpMPw9Xoews8kk-0AJhw7INaPwF3KZMEr1hz493AmkzBDc9LXtW6tXXwgn2o9HJ/s1600/firstyear_pupil.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj9Mkn7xm3xLQ5vPFnz20xI7LoA4rqzq54pQQfNLwWua7PxIoISyVpnCPxMtEXKn0tPKvFb0ttoL_tJGpMPw9Xoews8kk-0AJhw7INaPwF3KZMEr1hz493AmkzBDc9LXtW6tXXwgn2o9HJ/s1600/firstyear_pupil.jpg" height="640" width="425" /></a></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Fatmata is a first year state enrolled community health nursing student (SCHN). Each year she will add an extra blue stripe to her nursing hat
but will remain in the blue and white until she becomes a trained nurse.<span lang="EN-US"> The 2.5 year SCHN course at COMAHS requires three O Levels to take the entry exam. </span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn_tQu2LLeADB3o5hIWM441pPsQSN59EK6Ie4SQsa1gQFAuCEQnF_BrixotKIdo2xzYSGty88m7nktd7Q-p8audHopQOH1teUmJYyC01MzlnkLnlm_MbTumwff5eZb6jlSjpYz93NuwgUk/s1600/nursing+pupil_male.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn_tQu2LLeADB3o5hIWM441pPsQSN59EK6Ie4SQsa1gQFAuCEQnF_BrixotKIdo2xzYSGty88m7nktd7Q-p8audHopQOH1teUmJYyC01MzlnkLnlm_MbTumwff5eZb6jlSjpYz93NuwgUk/s640/nursing+pupil_male.jpg" height="640" width="426" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="font-size: small;">Benson is also a SCHN student studying at COMAHS. The three blue stripes on his white shirt show that he is a third year nursing pupil.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn_tQu2LLeADB3o5hIWM441pPsQSN59EK6Ie4SQsa1gQFAuCEQnF_BrixotKIdo2xzYSGty88m7nktd7Q-p8audHopQOH1teUmJYyC01MzlnkLnlm_MbTumwff5eZb6jlSjpYz93NuwgUk/s1600/nursing+pupil_male.jpg" style="margin-left: 1em; margin-right: 1em;"></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRGUjDZYOXJgVcG7WmrOLCxNMzpxQRVrW338JFzhnPBQRQkDNF8ghr6ejFX7STC3StpgmccVX8GXgY0Q2X2V7VrJYIbZK05RsMCAjI9-JfS4ttHW_RNpxnJLq17_shJgNXdUNBo0BpkLLF/s1600/Low_res_student.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRGUjDZYOXJgVcG7WmrOLCxNMzpxQRVrW338JFzhnPBQRQkDNF8ghr6ejFX7STC3StpgmccVX8GXgY0Q2X2V7VrJYIbZK05RsMCAjI9-JfS4ttHW_RNpxnJLq17_shJgNXdUNBo0BpkLLF/s640/Low_res_student.jpg" height="640" width="425" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">State registered nursing students (which requires a higher entry qualification than the community nursing students) wear this pink uniform every day of class. Their year of study is identified by the stripes on their nursing hat. You can see Mariatu has three stripes on her hat showing that she is a third year student.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYi7ejeup7Qwx9fR3MLNGlPqBSDiuZjTAC2e6zC1E2a5yPBc_yriQD0rE1csTbE5rS6VHcB2mmfJwYwCDGTib1pmaZyfJBJzrb3cYRSXUgY_Md0Kxj71dnXP9t7ms5v6iRytMBNRREt-jo/s1600/COMAHS_Ignatius.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYi7ejeup7Qwx9fR3MLNGlPqBSDiuZjTAC2e6zC1E2a5yPBc_yriQD0rE1csTbE5rS6VHcB2mmfJwYwCDGTib1pmaZyfJBJzrb3cYRSXUgY_Md0Kxj71dnXP9t7ms5v6iRytMBNRREt-jo/s640/COMAHS_Ignatius.jpg" height="640" width="426" /></a></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Ignatius models the crisp white male version of the state registered nursing student uniform. The single stripe across his pocket shows that he is a first year student. </span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikGa_gyoGR7Fv76-dC1fKb8BdkoEa-IEMDiN7EaG9hHbky1b5ymnNNulbnwaDqVWBr4b8b_yzWFFGlO8bgo0_iZTlVssrComKSoRayjuPPgL3mz_VoCcL-Fb50FsGk1boyWDv-wENXO3fW/s1600/Trained_Nurse_Man.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikGa_gyoGR7Fv76-dC1fKb8BdkoEa-IEMDiN7EaG9hHbky1b5ymnNNulbnwaDqVWBr4b8b_yzWFFGlO8bgo0_iZTlVssrComKSoRayjuPPgL3mz_VoCcL-Fb50FsGk1boyWDv-wENXO3fW/s640/Trained_Nurse_Man.jpg" height="640" width="426" /> </a></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Mac Joe graduated from the blue and whites many years ago ('don't ask it was a long time ago) and is now a state enrolled community health nurse. Trained male nurses always wear these light brown pants teamed with a white shirt.</span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">As a fully trained state enrolled community health nurse Adiatu has also broken free of the blue and white and now wears a grey uniform with lace edged and white hat to work each day.</span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Agatha is a fully qualified state registered nurse and required five 0 Levels to be accepted into the three year nursing course at COMAHS . State registered nurses wear all white uniforms with a red belt. There are no hard rules about the type of belt, I've noticed the elasticized variety with a jeweled clasp is quite popular. Agatha picked hers up from PZ market in town, Freetown's shopping epicenter.</span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Dura Kamara shows us the male version of the staff nurse uniform - crisp, white and simple. As is the custom in Sierra Leone, he likes to keep his shoes spotlessly clean, "I try and clean them every day after work". </span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbwnUkqMxrAdqxV-7_ftoNG6ECD-CnY2xRfhWmEWiJcaZ9SVtxGOtF4jeuAYMPxZUwGXtboEoJXEHarw7YI2FNxge1kPoqZ7KErUllDUBF6pqAvZrWrL976WGm_zGFo0c7lagACeA46-9F/s1600/Sister+Kargbo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbwnUkqMxrAdqxV-7_ftoNG6ECD-CnY2xRfhWmEWiJcaZ9SVtxGOtF4jeuAYMPxZUwGXtboEoJXEHarw7YI2FNxge1kPoqZ7KErUllDUBF6pqAvZrWrL976WGm_zGFo0c7lagACeA46-9F/s640/Sister+Kargbo.jpg" height="640" width="426" /></a></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Sister Fatmata Kargbo, head of the pediatrics ward holds a Bachelor of Science degree and is known as a BSc ward sister. These senior nurses who deputize the matron wear an off-white uniform with blue detail. They don't have to wear a cap.</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEig4qfFQ7rO201J8qARfzAfw0CxtmZzj1bifGVYkEpAtSeqTizqMWxly9cs1rVMU9WQFPkO0uZq2zuex9j2fBy8NhE2a8UkdtdfHNyBqDeOInwcAsosW0-4GZuPvUw0ayDwjL994lnliXcl/s1600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEig4qfFQ7rO201J8qARfzAfw0CxtmZzj1bifGVYkEpAtSeqTizqMWxly9cs1rVMU9WQFPkO0uZq2zuex9j2fBy8NhE2a8UkdtdfHNyBqDeOInwcAsosW0-4GZuPvUw0ayDwjL994lnliXcl/s1600/1.jpg" height="640" width="480" /></a></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">The boss lady Matron Kamara is identified by her white hat and blue belt. The four stripes on her epaulette indicate that she is the most senior nurse in the hospital. </span></span>Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com2tag:blogger.com,1999:blog-2360237959698943657.post-2590255888117661972014-05-07T06:29:00.002-07:002014-05-08T04:26:13.147-07:00Theory to Practice - My Elective with the King’s Sierra Leone Partnership<style>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">by King's elective student James Barnacle</span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">I had been interested in Global Health for several years
before being lucky enough to study the intercalated degree at King’s College. It
expanded and developed my interests, looking at how and why countries developed
and the relationship between development and health. It was on the course that
I first heard about the King’s Sierra Leone Partnership, and met Oliver Johnson, who at the time was teaching and tutoring on it.</span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">Until my elective I had never been to sub-Saharan
Africa and a year of narrowly spaced exams meant that I was reluctantly losing
touch with the global health world. A medical elective with the partnership was
a fantastic opportunity to consolidate what I had learnt, emerge myself in
global health once again and see the theory and principles from the course put
into practice. With this in mind, Anna (a colleague from Cardiff who had also
studied global health) and I found ourselves outside the KSLP office on the
second floor of the administration building at Connaught Hospital, not really
knowing what to expect but very excited to find out. </span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;"><span style="font-size: x-small;"> Myself and partner in crime Anna Davies at Connaught Hospital</span></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">What the KSLP office lacked in space it made up for with
filter coffee, wifi and an incredibly friendly atmosphere. On our first day many
of the faces were already familiar after we had joined several of the team the
night before in a desperately empty national stadium to watch Malian singer
Salif Keita! Oliver introduced the partnership’s work in Freetown and I was
surprised at how discussions and seminars from the course were flooding back to
me as I heard about KSLP’s recent achievements and future plans.</span><br />
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNdQt60d2yCpMUdI_jD5whzZen2gXx7Snvhhw5p9AKN58iV-h9iyX3YJ9fHbrzu-tds9mGlDxW-jt__4Yc2CeGk8iFfhWJqxbzY51vYdFe7UKyJukwqykelpIJLIDOYQhwu5e3e82SX02P/s1600/Lowres_triage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNdQt60d2yCpMUdI_jD5whzZen2gXx7Snvhhw5p9AKN58iV-h9iyX3YJ9fHbrzu-tds9mGlDxW-jt__4Yc2CeGk8iFfhWJqxbzY51vYdFe7UKyJukwqykelpIJLIDOYQhwu5e3e82SX02P/s1600/Lowres_triage.jpg" height="480" width="640" /></a></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;"><span style="font-size: x-small;"> The new triage pilot at Connaught in action.</span></span><br />
<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;"><span style="font-size: x-small;"><br /></span></span></div>
<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">We were given several projects during the six week placement
including collecting timings and demographics of those presenting through the
front gates before and after the introduction of a triage system aimed at
prioritising sick patients. In addition, we evaluated the nursing skills lab by
performing an inventory, talking to nursing staff and students and identifying areas
for improvement. The partnership works closely with the nursing school, and
more effective use of the skills lab will improve nurse training. We presented
recent KSLP research at the annual Health and Biomedical Sciences (HBIOMED)
national conference to leading academics in Sierra Leone. Finally, we helped
analyse epidemiology data from over 350 patients to identify key presenting
complaints, investigations, diagnoses and drugs. This will help direct the free
emergency drugs initiative being introduced at Connaught, but in the future
will be a reference for lab test requirements, disease burden and drug
prescribing.</span><br />
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">As well as liaising closely with
the KSLP team, working with local staff and students was an integral part of
our projects. Two nursing students, Benson and Sahid, worked closely with us
collecting the inventory. In A&E, we had a strong rapport with Dr Cole and
the nursing team who played a crucial part in the data collection. On ward
rounds, we developed friendships with the medical students, some of whom had even
visited Wales on their elective. They were enormously welcoming and always
willing to answer questions about their challenges and experiences.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGQKws-MSrEpidTz-ZlvFp9e2A_DJ9_jReEEarL6tULdHZDo8worT5Os229DUsYPB1sovovV3a9c1yJsYRHbkR41NZ4gSsd8Cm-HMeb-qYeeNrwx2idUBLhitwZjOLggzWmj37qYpK2G1Z/s1600/Outside_triage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGQKws-MSrEpidTz-ZlvFp9e2A_DJ9_jReEEarL6tULdHZDo8worT5Os229DUsYPB1sovovV3a9c1yJsYRHbkR41NZ4gSsd8Cm-HMeb-qYeeNrwx2idUBLhitwZjOLggzWmj37qYpK2G1Z/s1600/Outside_triage.jpg" height="480" width="640" /></a></div>
<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;"> <span style="font-size: x-small;">The entry of the triage at Connaught.</span></span><br />
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<span lang="EN-GB" style="font-family: Arial; font-size: 12.0pt; line-height: 115%;">The autonomy we were given forced me to draw from the skills
I had gained on the course, notably critical reflection in the context of health
system strengthening, development and policy. Our time there gave us a window
into an organisation working closely with the government to put the principles
I had learned about into action. I could not imagine a more engaging and
enjoyable way to put the ideas I had developed on the global health course into
practice. I will stay closely linked with the partnership and hope to return to
Sierra Leone in the future.</span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com0tag:blogger.com,1999:blog-2360237959698943657.post-79963191359045318182014-04-30T12:34:00.001-07:002014-05-07T06:38:20.531-07:00My student career at COMAHS<style>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">By COMAHS student Asad Naveed</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">My name is Asad Naveed, I am
originally from Pakistan but I have stayed most of my lifetime in Sierra Leone
and underwent my secondary education and now my tertiary education here. I
have now applied for naturalisation. </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">I joined the six year Medicine programme
at COMAHS, University of Sierra Leone in 2008 and will hopefully graduate this
year. Since starting my course at COMAHS I have been involved in student union activities. I
have served as the information and communication officer in the student union
for three years. When I was in 4th year, I had the opportunity to meet Oliver
Johnson of King's Sierra Leone Partnership and from the very start I was keen to
be involved in the Kings Student programmes, one of which included participation
in a research project by a King’s global health student- Danny Mclernon Billows
on the problems affecting students at COMAHS such as high dropout rate and
learning methodologies.</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">In
August 2013, when I was in 5<sup>th</sup> year, I had the privilege to be selected
to do my electives at King’s College Hospital in Denmark Hill. This was an
important milestone as I was able to experience health care delivery in
developed settings. <span style="mso-spacerun: yes;"> </span>On our visit we received
a warm welcome from Catherine Marshall and Victoria M. Bakare from the King’s
Sierra Leone Student Partnership (KSLSP). In our first day, they showed around
the hospital and introduced us to our supervisors. Later on they took us
bowling ( my first time) and for pizza. We were also able to discuss issues
about the KSLSP partnership.</span></span></div>
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<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheyT_t75XW8J0XnNr7HJO0X3X8FwWt1FoXpK_-Tr1xFwPydUOczqhJ-pCpEm1McsiidaFVps6voiGYonPtVDzmPgx-DOnEvE-nBO12MtAs1xkffMUC_wixedoiJDDu2t5wflq3qzZykmmv/s1600/1003050_10151801024967760_1209855984_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheyT_t75XW8J0XnNr7HJO0X3X8FwWt1FoXpK_-Tr1xFwPydUOczqhJ-pCpEm1McsiidaFVps6voiGYonPtVDzmPgx-DOnEvE-nBO12MtAs1xkffMUC_wixedoiJDDu2t5wflq3qzZykmmv/s1600/1003050_10151801024967760_1209855984_n.jpg" height="480" width="640" /></a></div>
<div style="text-align: center;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span dir="ltr">Catherine Marshall, Mustapha Kamara, myself and Victoria Bakare in front of Hambledon wing, KCH</span></span></span></div>
</div>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">Recently,
I was part of the Sierra Leonean delegate to visit the International Federation
of Medical Students Association (IFMSA) General Assembly in Tunisia. Tunisia is
great country with beautiful scenery. For the very first time, I was able to
meet a huge number of medical students from many countries in a single platform.
The conference was truly international in every way. Every country had a say in
the IFMSA decision making process which was great. We unexpectedly met Victoria
in Tunisia as well who was part of the Medsin-UK delegate. She was able to link
the Sierra Leone Medical Students’ Association (SLeMSA) with Medsin-UK a
connection which helped SLeMSA get full membership with IFMSA. Upon return from
the visit, I stood for presidency of SLeMSA and have successfully become the
new President of SLeMSA. </span></span><br />
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<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidUsL1cCSe-6LbLIHQsoFz-XH5ifIGS8DguoY2uCyh1zJ7AJvLfX56R6NWVLYZy716HQLkAFp6CuJ90GvlNqUgUj2kcIBLIQrFItG7Jqd27_ltIOvaaEC4P4Tay7_dOgNB4xzaUvUVykc8/s1600/DSC07548.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidUsL1cCSe-6LbLIHQsoFz-XH5ifIGS8DguoY2uCyh1zJ7AJvLfX56R6NWVLYZy716HQLkAFp6CuJ90GvlNqUgUj2kcIBLIQrFItG7Jqd27_ltIOvaaEC4P4Tay7_dOgNB4xzaUvUVykc8/s1600/DSC07548.jpg" height="480" width="640" /></a></div>
<div style="text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;"><span style="font-size: x-small;"> In Tunisia with my fellow COMAHS students</span></span></span></div>
</div>
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<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 12.0pt; line-height: 115%;">King’s
has made a positive contribution to my professional and personal development. I
am much awakened now about public health issues which make a difference in our
society and I look forward to further involvement with the partnership in the
future. </span></span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com1tag:blogger.com,1999:blog-2360237959698943657.post-34730125318663050102014-04-11T06:56:00.000-07:002014-05-07T06:40:29.932-07:00Ebola was not part of the plan<style>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">By Dr Marta Lado</span></span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">Three weeks ago, I flew from Madrid to Freetown to start my new role with
King´s Sierra Leone Partnership at Connaught Hospital. I was nervous and
excited about what was ahead - but my Terms of Reference made no mention of what
I was about to be involved with. </span></span></span><br />
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSERRPfXOFi7-bKLI5P3d6Pa0f7UzKmzWpSaFrCW5_E428B_QZUhffusPE5SDyJwrqqjgbgh3kMLs5nLV1dWkC5360frG0F2s6bybtkjHSF4e1oRh8O1OhzM3SJLxCJYRZXt84W-ziVuCh/s1600/Marta.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSERRPfXOFi7-bKLI5P3d6Pa0f7UzKmzWpSaFrCW5_E428B_QZUhffusPE5SDyJwrqqjgbgh3kMLs5nLV1dWkC5360frG0F2s6bybtkjHSF4e1oRh8O1OhzM3SJLxCJYRZXt84W-ziVuCh/s1600/Marta.JPG" height="480" width="640" /></a></div>
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<span lang="EN-US" style="font-family: Arial; font-size: small;"> Taken the week I arrived at Connaught</span></div>
<div class="MsoNormal">
<br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"><span lang="EN-US">T<span style="font-weight: normal;">he day I landed news broke about an Ebola outbreak in Sierra Leone’s
neighbour Guinea. As a specialist in infectious diseases, being involved in an haemorragic
fever virus outbreak response is both an incredible and threatening experience.
</span></span></span></div>
<div class="MsoNormal">
<br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"><span lang="EN-US">Fortunately, we have not found any confirmed cases yet in Sierra Leone,
but being part of the National Ebola Taskforce within the Ministry as a KSLP representative
is fascinating, but also quite daunting. </span></span></div>
<div class="MsoNormal">
<br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"><span lang="EN-US"><span style="font-weight: normal;">This role puts me at the forefront of the preparedness response. The Taskforce
is regularly updated on the current outbreak and we participate actively in the
preparation of the population and of health care workers in case the disease
spreads to Sierra Leone. We gather at least once a week to improve the
communication between the different health care units and prepare training
courses for health workers. </span></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: xx-small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRxqZ22IgBbDLzUc6KfSHuKp6nHmYadOGA0pGgA1YDIjcheY9DJqC31bADNZwOBPeNqwp8lc3Hv9kGfu589FpzISB9Ob-AwqMVfUbauoG5tZjGJC8pUCsu4gHu3o5C6nkb6xHzX6RJi-HR/s1600/IMG_7750.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRxqZ22IgBbDLzUc6KfSHuKp6nHmYadOGA0pGgA1YDIjcheY9DJqC31bADNZwOBPeNqwp8lc3Hv9kGfu589FpzISB9Ob-AwqMVfUbauoG5tZjGJC8pUCsu4gHu3o5C6nkb6xHzX6RJi-HR/s1600/IMG_7750.JPG" height="480" width="640" /></a></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: x-small;"> A lecture presented to staff at Connaught and students from COMAHS by </span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-size: x-small;">WHO Ebola expert </span></span></span></div>
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<br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: small;">Arranging isolation of suspected cases and preparing personal protection
equipment (PPE) for the health care staff is very challenging in this setting
and especially in rural areas, where basic equipment like gloves and gowns can
sometimes be hard to get hold of. Our work must be therefore focused on
adjusting all the protection and management protocols to a specific low
resource setting but without underestimating the risk and the importance of every
measure.</span></div>
<span lang="EN-US" style="font-family: Arial; mso-ansi-language: EN-US;"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: xx-small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7UhdN4lTQwbGaR2-jTGvYLfaEnqCo7qm4pBBwXwGUEyr52QAqsNqar9jqjqifaTsmHRDcqDNZqYbIX1klwVU0UFJMBH8dEf-Qm8qomMXfQUX6nlUAOce4FS2cuJ5H5l0w8AtHBV8AaMMg/s1600/Gloves.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7UhdN4lTQwbGaR2-jTGvYLfaEnqCo7qm4pBBwXwGUEyr52QAqsNqar9jqjqifaTsmHRDcqDNZqYbIX1klwVU0UFJMBH8dEf-Qm8qomMXfQUX6nlUAOce4FS2cuJ5H5l0w8AtHBV8AaMMg/s1600/Gloves.jpg" height="480" width="640" /></a></span></div>
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<span lang="EN-US" style="font-family: Arial; font-size: xx-small;"><span style="font-family: Arial,Helvetica,sans-serif;"> Gloves are some of the supplies that have been pre-positioned in readiness for a potential outbreak. </span></span></div>
<div class="MsoNormal">
<br />
<span lang="EN-US" style="font-family: Arial; font-size: small;">It is also critical to supply healthcare workers with extensive
information through basic guidelines as well as sanitation and isolation PPE kits
to reduce the risk of transmission. Ebola is transmitted by body fluids (blood,
excrement) and therefore protecting every centimeter of the body and skin when
a care giver or health worker is looking after a sick patient is essential. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgO26aftdElrGlIqDs4sFSnxilMH7BthqjccM5VZG4jFIgIUWyIGkF1wJiBIxZn-DaqqKn8xS58qPgEcmYQfG-Kx9zH82z6hMNOdJh-4wby3bbIrfzQYP9oeYTiDqXFZImwNifPx8Nk_jwT/s1600/Isolation_sign.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgO26aftdElrGlIqDs4sFSnxilMH7BthqjccM5VZG4jFIgIUWyIGkF1wJiBIxZn-DaqqKn8xS58qPgEcmYQfG-Kx9zH82z6hMNOdJh-4wby3bbIrfzQYP9oeYTiDqXFZImwNifPx8Nk_jwT/s1600/Isolation_sign.jpg" height="480" width="640" /></a></div>
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<span lang="EN-US" style="font-family: Arial; font-size: x-small;"> An isolation room has been set up at Connaught Hospital in case of an outbreak</span></div>
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<br />
<span lang="EN-US" style="font-family: Arial; font-size: small;">According to our current guidelines and the WHO protocols, a suspected
patient must be immediately isolated.
The doctor in charge must then communicate nationally and coordinate for
blood samples to be taken. The patient is to then be referred to the Lassa Fever
Centre in Kenema District to be managed by experts in haemorrhagic fever
syndromes. </span></div>
<div class="MsoNormal">
<span style="font-size: small;"><br /></span>
<span lang="EN-US" style="font-family: Arial; font-size: small;">While this unexpected role has been extremely challenging, I have also
learned an enormous amount and gained invaluable experience. We hope that the
efforts made will help to prevent the spread Ebola in Sierra Leone and we will
be on hand to support and counsel at any situation that arises during the next
months. </span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com3tag:blogger.com,1999:blog-2360237959698943657.post-36630617734577637602014-03-10T06:39:00.000-07:002014-03-11T02:26:25.446-07:00Setting up a triage 101<div class="MsoNormal">
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-</style><span lang="EN-US" style="font-family: Arial; font-size: small;">by
King’s volunteer Mike Bradfield</span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhivimr-70JA-HX8gTss-1lGcJrYNI8CrZNrnvBH0XgmRNrKIGyhqA-k1bxIAWLVN2ZDGZ1kYnvH0rsy2Kjk3WjovSn6B982Ax5eGBmgjIoZqd8TX_gVXaysTjlCemlZcTHUI3YultbFjg1/s1600/Team.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhivimr-70JA-HX8gTss-1lGcJrYNI8CrZNrnvBH0XgmRNrKIGyhqA-k1bxIAWLVN2ZDGZ1kYnvH0rsy2Kjk3WjovSn6B982Ax5eGBmgjIoZqd8TX_gVXaysTjlCemlZcTHUI3YultbFjg1/s1600/Team.jpg" height="426" width="640" /></a></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"> <span style="font-size: xx-small;">Myself and the triage team </span></span>
</div>
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<br /></div>
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<span style="color: black; font-family: Arial; font-size: small;">Prior
to last week, Connaught had no functioning triage - a system used in the Accident and Emergency ward to determine </span><span lang="EN-US" style="font-family: Arial; font-size: small;">the priority of patients' treatments based on the severity
of their condition.</span><span style="color: black; font-family: Arial; font-size: small;"> Setting up a triage is a
major project of the Connaught Hospital Improvement Committee and King’s has
been working with key staff from across the hospital and the Ministry to lay
the foundations for this project. My background as a paramedic has (hopefully)
placed me in a good position to work with hospital staff to prepare for its
launch and help it get off the ground. </span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYW3xEbRR0AiVRZH9WCPKJt_Cti0RVjSx-urgp0f9HaKBb3KHD6KbHz0HXZAI0vFVs6wNDBUgHBaqXlNGPgCM2XP30xCEoSmdzskMS8SCkeNNiuTew4EStOyKsrBiDVg-Q9jKcEDmjrwGi/s1600/Ahmed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYW3xEbRR0AiVRZH9WCPKJt_Cti0RVjSx-urgp0f9HaKBb3KHD6KbHz0HXZAI0vFVs6wNDBUgHBaqXlNGPgCM2XP30xCEoSmdzskMS8SCkeNNiuTew4EStOyKsrBiDVg-Q9jKcEDmjrwGi/s1600/Ahmed.jpg" height="426" width="640" /></a></div>
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<span style="color: black; font-family: Arial; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-font-kerning: 0pt;"><span style="font-size: xx-small;"> Dr Ahmed Seedat trouble shoots like no other</span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: small;">We decided to </span><span lang="EN-US" style="font-family: Arial; font-size: small;">start with a pilot to allow us to
resolve any issues before the wider training and implementation takes place. In
preparing for the pilot we </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">identified </span><span lang="EN-US" style="font-family: Arial; font-size: small;">four nursing staff recommended by
A&E Matron Kamara. It was also decided that it might be worth checking with
these staff that they actually wanted to do this, but following a brief meeting
with Dr Ahmed and I, all seemed to have a firm grasp of what triage would involve
and supported the idea. It was encouraging to see how much enthusiasm there was
for change and improvement</span><span lang="EN-GB" style="font-family: Arial; font-size: small;">.</span><span lang="EN-GB" style="font-family: Arial; font-size: small;"> </span><span lang="EN-US" style="font-family: Arial; font-size: small;">So far, so good. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKbLiVC3cM-ycVlnGpBNziKxqfblfVuN4E0lC-ZYxf3SUr3R6af6N4nk_LOYzbwcRL35vDzfjUZ6aLjesKB3nl1zttfPGw-0VGYZZGSN9kAvNt2wDvzdeGBXvs7w71K39t1sGd9JHodAL/s1600/reading.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKbLiVC3cM-ycVlnGpBNziKxqfblfVuN4E0lC-ZYxf3SUr3R6af6N4nk_LOYzbwcRL35vDzfjUZ6aLjesKB3nl1zttfPGw-0VGYZZGSN9kAvNt2wDvzdeGBXvs7w71K39t1sGd9JHodAL/s1600/reading.jpg" height="425" width="640" /></a></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"><span style="mso-spacerun: yes;"> <span style="font-size: xx-small;"> Triage training</span></span></span></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"></span><span lang="EN-US" style="font-family: Arial; font-size: small;">The
</span><span lang="EN-GB" style="font-family: Arial; font-size: small;">South African Triage Scale (SATS) tool </span><span lang="EN-US" style="font-family: Arial; font-size: small;">appeared to be relatively
straightforward (note to self, no triage system is straightforward), and with a
day </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">assigned</span><span lang="EN-US" style="font-family: Arial; font-size: small;"> for teaching later in the week a training package was put
together, handouts printed and a plan for the day written. </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">A</span><span lang="EN-US" style="font-family: Arial; font-size: small;">nxious to avoid death by
PowerPoint, the training included a walk-around of the new triage area of the
hospital and some discussions around the practicalities of how the new system
would work. We also wanted as much input
from the nursing staff as possible and for them to be involved in decisions
around the way it would be used. </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">It </span><span lang="EN-US" style="font-family: Arial; font-size: small;">seemed important to spend time
ensuring staff have a good understanding of the rationale for triage and its
importance at Connaught rather than </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">focus only on </span><span lang="EN-US" style="font-family: Arial; font-size: small;">the minute details</span><span lang="EN-GB" style="font-family: Arial; font-size: small;">. But we still needed to cover how the SATS
tool functions. Let’s be honest, it isn’t really first date material, however
enthusiastic we all are about it.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7fzzJx8prIDkXIWsNP5QS9XLsnwHu_ZeuQmpS2cUSyxrSz84_vhU3NYFP3hQDbolHwna84LQF7h4guNX3ljNYpuSOTdlbt0MYRH_tGGP4Z6FJT10JNJZBn-Si0_eMfJuhpz8cBEBZwgu5/s1600/Poster.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7fzzJx8prIDkXIWsNP5QS9XLsnwHu_ZeuQmpS2cUSyxrSz84_vhU3NYFP3hQDbolHwna84LQF7h4guNX3ljNYpuSOTdlbt0MYRH_tGGP4Z6FJT10JNJZBn-Si0_eMfJuhpz8cBEBZwgu5/s1600/Poster.jpg" height="424" width="640" /></a></div>
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<span style="font-size: xx-small;"><span lang="EN-US" style="font-family: Arial;"> We used the </span><span lang="EN-GB" style="font-family: Arial;">South African Triage Scale (SATS)</span></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: small;"> In a warm room with no air conditioning, </span><span lang="EN-US" style="font-family: Arial; font-size: small;">an hour session was extended
</span><span lang="EN-GB" style="font-family: Arial; font-size: small;">to several </span><span lang="EN-US" style="font-family: Arial; font-size: small;">due to </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">a </span><span lang="EN-US" style="font-family: Arial; font-size: small;">large number of questions and discussions. </span><span lang="EN-US" style="font-family: Arial; font-size: small;"> </span><span lang="EN-US" style="font-family: Arial; font-size: small;">In a bid to liven things up, we recruited Senior Nurse Nyama</span><span lang="EN-US" style="font-family: Arial; font-size: small;"> </span><span lang="EN-US" style="font-family: Arial; font-size: small;">to role</span><span lang="EN-GB" style="font-family: Arial; font-size: small;">-</span><span lang="EN-US" style="font-family: Arial; font-size: small;">play a difficult patient
wanting to know why she was not being seen in turn. Nurse Salamata was far better able to explain
the triage system than I had been able to that morning and Nurse Hajara faced
down any criticism of the system with a very succinct and direct summary of the
reasons for waiting (which would be </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">used by her </span><span lang="EN-US" style="font-family: Arial; font-size: small;">again the following week
to </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">excellent effect</span><span lang="EN-US" style="font-family: Arial; font-size: small;">).
It was beginning to feel that with this level of engagement and
enthusiasm, we could make this work.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5mVBR01VVP9lTjEaMehbx2fYg2zZeILPaAx3sA9zLuGbPVODLIfbXH-N4-3ZCSz36UP5EzIkwu78CTEZGN2Y1o0pHuZbWoXzxTD_Q9RGG-vWBfrL87t9bNZxUXD6l48MJ1W3bDWjFByGS/s1600/Nurses_Low_res.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5mVBR01VVP9lTjEaMehbx2fYg2zZeILPaAx3sA9zLuGbPVODLIfbXH-N4-3ZCSz36UP5EzIkwu78CTEZGN2Y1o0pHuZbWoXzxTD_Q9RGG-vWBfrL87t9bNZxUXD6l48MJ1W3bDWjFByGS/s1600/Nurses_Low_res.jpg" height="426" width="640" /></a></div>
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<span style="font-size: xx-small;"><span lang="EN-GB" style="font-family: Arial;"> Our triage students .</span></span>
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<span lang="EN-US" style="font-family: Arial; font-size: small;">With
the training started, the building work complete and the Facilities and
Maintenance staff (Willie and Abdul, you know who you are, even if we rarely
know where you are) working very hard to repair and clean the necessary
equipment and areas, 3rd March was confirmed as a start date for the triage
pilot. The Friday before the Monday that the pilot was due to start, we had
very little equipment but we did have a desk. And we had a lot of phone calls
and many more promises of equipment to be delivered yesterday. The list was not
long, but it was important. Given that we had no blood pressure cuff,
stethoscope and clock with a second hand, the whole process would be
impossible. </span></div>
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<span style="font-size: small;"><br /></span></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"><span style="mso-spacerun: yes;"><span lang="EN-US" style="font-family: Arial; font-size: small;">With
so many people having worked so hard to get to this stage, we had to get it right.
Enter Dr Ahmed Seedat, medical doctor and troubleshooter with an impressive
medical CV that also includes sourcing equipment, </span><span lang="EN-GB" style="font-family: Arial; font-size: small;">knowledge of
</span><span lang="EN-US" style="font-family: Arial; font-size: small;">plumbing,
tiling, grouting and tireless negotiation. Ahmed soon helped smooth out those
final few details just in time for Monday launch.</span> </span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAb_0JIXwNmcN1JhOnGvlkcLd82oqfvvMoyvjUopgBsTYNJlVYciuusUxWZqMp0WCceLTKQrVsmSTm7i1hjafMHQl5dKxDfXBzHuWUCOKVl8yaFIlHlmaoSIbDXryaFhLVyB3XLKjF3ikt/s1600/Triage_sign.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAb_0JIXwNmcN1JhOnGvlkcLd82oqfvvMoyvjUopgBsTYNJlVYciuusUxWZqMp0WCceLTKQrVsmSTm7i1hjafMHQl5dKxDfXBzHuWUCOKVl8yaFIlHlmaoSIbDXryaFhLVyB3XLKjF3ikt/s1600/Triage_sign.jpg" height="426" width="640" /></a></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"><span style="mso-spacerun: yes;"><span style="font-size: xx-small;"> The final preparations for the triage room are made</span></span></span></div>
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<span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;"></span><span lang="EN-US" style="font-family: Arial; font-size: 10.0pt;">Setting
up a triage takes time and contributions from many people, and I’m happy to say
there was no reluctance from anyone to step up and help. With set up complete,
now we just needed to start….</span>
</div>
<br />Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com0tag:blogger.com,1999:blog-2360237959698943657.post-90296460737201508292014-02-11T11:00:00.000-08:002014-03-10T06:43:53.510-07:0098 % Human: two interesting patients in Sierra Leone<span style="font-size: small;">In the middle of January I flew out for my fourth trip to Sierra Leone to spend a week with the KSLP team to support a two-day faculty workshop to kick off a process of overhauling and modernising the medical curriculum at COMAHS.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjURMddE-wkQqBW81z3Z79C96EtLkKDmb9BjcKC4gpgin4orrv7pJUW0eI6_KIddZNhhHVTXBzQz0-hzhzkOT-q5xwK64AJxnZsTEYhu7awiNwDnsPDzG06cKZQfNnbo4MD0UGTYiMGC6TM/s1600/John.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjURMddE-wkQqBW81z3Z79C96EtLkKDmb9BjcKC4gpgin4orrv7pJUW0eI6_KIddZNhhHVTXBzQz0-hzhzkOT-q5xwK64AJxnZsTEYhu7awiNwDnsPDzG06cKZQfNnbo4MD0UGTYiMGC6TM/s1600/John.jpg" height="640" width="435" /></a></div>
<span style="font-size: x-small;">In action at COMHAS in Freetown</span><br />
<span style="font-size: small;"><br /></span>
<span style="font-size: small;">On my last day, in what I thought would be a break from work, I decided
to venture out to the Tacugama Chimpanzee Sanctuary on the outskirts of
Freetown. Each month the sanctuary has a birds and breakfast walk on a
Saturday morning consisting of a three hour stroll through the bush with
two guides and then a cooked breakfast. My KSLP colleague Suzanne
Thomas decided to take part. The sanctuary is a 30-40 minute drive out
of Freetown for a 7.15am start.
</span><br />
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<span style="font-size: x-small;">All you ever need to know about Chimps</span></div>
<br />
We heard lots of birds identified by the guide, we saw rather fewer but still had some good sightings of bee eaters, paradise flycatchers and sunbirds and a really pleasant stroll around the forest and the dam, where we saw the resident crocodile. During breakfast we were politely ambushed by the veterinarian for the sanctuary with a request for our opinion on two problems. I later discovered that they’d spotted that I was a Professor at the KCL School of Medicine from the footer of my reservation email, and were lying in wait for us.
It's not uncommon to be asked for advice when people know you are medical but advice on sick chimpanzees was a first for us. Patient confidentiality prevents me from naming the chimps involved, but one has chronic osteomyelitis of the radius (ie a longstanding infection of a bone in the arm) after a bite from a friend. He has had lots of antibiotics but we were able to suggest some ideas for choice of antibiotic and length of course.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbrvpVPsEXVs4F6mmuZvHDKAp9ZrbaV61k6gB2V66n6A5PUYQ-aGDr3htm3tQwsv91vRbWIyOjBXu6WogPeulk8IWWU4jftHPe82NEoSnJW8DsYHPFDN5VRyNxAUGoKper_i52HUHGEsuo/s1600/_DSC0496.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbrvpVPsEXVs4F6mmuZvHDKAp9ZrbaV61k6gB2V66n6A5PUYQ-aGDr3htm3tQwsv91vRbWIyOjBXu6WogPeulk8IWWU4jftHPe82NEoSnJW8DsYHPFDN5VRyNxAUGoKper_i52HUHGEsuo/s1600/_DSC0496.jpg" height="640" width="425" /></a></div>
<span style="font-size: x-small;"> One of the famous Chimps of Takugama</span><br />
<br />
The second problem was more challenging and we were not the first to be consulted. They have noticed that some chimps come in from the forest with ataxia, lethargy and vomiting. Some go on to have seizures and some have died suddenly, sometimes in a stress situation after they seem to have recovered. None of the chimps in the small enclosures where they are being monitored after initial rescue from captivity have been affected. In contrast to human patients in Freetown the chimps have been investigated by autopsy, virology including PCR (molecular testing) of various samples, deep frozen tissue sent to laboratories around the world, opinions of plant experts, vets and other experts. The current theory is that this is related to a toxin from a local plant in the forest, which has properties used as a rodenticide.<br />
<br />
We had a chance to look around the enclosures at Tacugama, avoiding a chimp throwing stones at us with accuracy showing he was not ataxic. We were still no clearer on the likely diagnosis but if anyone could tell us we are happy to pass on any ideas that anyone might have to the vet at the sanctuary.<br />
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Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com0tag:blogger.com,1999:blog-2360237959698943657.post-53005712313021143622013-12-13T08:11:00.000-08:002013-12-16T07:59:34.686-08:00Chatting with Tony Blair by Suzanne Thomas<style id="dynCom" type="text/css"><!-- --></style>
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</style><span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">It was an unexpected surprise on Monday morning when Tony Blair
turned up at Connaught Hospital. Like many of the patients who arrive at the
hospital he swung in through the main gate - unlike your average patient though, his
arrival was led by a convoy of police sirens.</span><br />
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">Mr Blair is the founder of the <a href="http://www.africagovernance.org/africa" target="_blank">African Governance Initiative (AGI)</a>, the reason for his visit to Connaught was to see first hand an example of the Free Healthcare
Initiative, which has been a key project for President Koroma's government.</span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">Accompanied by the Minister for Health and several key officials
from the ministry and hospital, he made his way to the paediatric surgical ward
where our partners showed him a brief glimpse of the reality of healthcare in
Freetown.</span><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">While Tony passed us I stood in a small group watching from
nearby, intrigued by the scene in front of us. <span class="apple-converted-space"> </span>Perhaps he was a little intrigued by
us too, turning around to give us a wave and quick hello.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsNosSh4cvn3pdUWVsZ5-uBLioEHGJXtU2LoxzOUQh8t8PuA8Da1uoB3-1RV8AHF9Peq0rx4RjG3zwzz5hN0CszvHfM6XFAtYBsOyFwqwGFG5_oQfUxcCf6ehyphenhyphenOtiMUwyjKa9F66ATl1s7/s1600/Tony_Wallking.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsNosSh4cvn3pdUWVsZ5-uBLioEHGJXtU2LoxzOUQh8t8PuA8Da1uoB3-1RV8AHF9Peq0rx4RjG3zwzz5hN0CszvHfM6XFAtYBsOyFwqwGFG5_oQfUxcCf6ehyphenhyphenOtiMUwyjKa9F66ATl1s7/s640/Tony_Wallking.jpg" width="640" /></a></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;"> <i>Tony gives us a wave on his way to the ward</i></span><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">After he emerged from one of the wards Oliver (our Programme
Director) and the Minister for Health chatted casually to Tony and explained
the work of King's Sierra Leone Partnership. </span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;"> <i>Tony Blair, Dr Briama Kargbo, Oliver and The Minister for Health</i></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;"><span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">The moment seemed like a good
opportunity for the 'snap'! Jo (our Communications Consultant) was
delegated the nerve-wracking task of lining us up for a photo.</span></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">It was then my turn to chat with Tony. He asked if I was part of
the Partnership. I briefly explained my role with <a href="http://kslp.org.uk/partners/college-of-medicine-allied-health-science/" target="_blank">COMAHS</a> </span><span class="MsoCommentReference"><span lang="EN-GB" style="font-size: 8.0pt;"><a class="msocomanchor" href="http://kslp.org.uk/partners/college-of-medicine-allied-health-science/" id="_anchor_1" name="_msoanchor_1" target="_blank"></a></span></span><span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">
which covers curriculum development, teacher training, infrastructure support
and developing new healthcare professions training programmes, hoping that what
I was saying made some sort of sense!</span></div>
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<i><span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">There I am with Tony explaining the many challenges of working at Connaught</span></i><br />
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">He then asked 'What is the biggest challenge of your work here?'
A question like this would normally require a lengthy response. Conscious of
all the important people listening for an answer I kept it brief and talked
about the strong desire for better training and healthcare but that the limited
human resources available results in staff being torn between their training
and clinical roles.</span>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">The Minister for Health then joined the conversation 'So it's
about capacity building'. I nodded, appreciating the interest that was being
taken in our work.</span><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">Our Clinical Lead Ahmed also had his moment with Tony -
explaining what he enjoys about his work at Connaught.</span></div>
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<i><span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;"> The entourage, that's Ahmed on the end in conversation with Tony.</span></i><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">After greeting a small group of enthusiastic smiling patients he
was off and onto his next meeting followed by a flight to South Africa for
Nelson Mandela's funeral.</span><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
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<span lang="EN-GB" style="color: #282828; font-family: "Helvetica Neue"; font-size: 11.5pt;">I turned back to the office with a smile. You never quite know
what's going to happen next here in Sierra Leone.</span><span lang="EN-GB" style="color: #282828; font-size: 11.5pt;"></span></div>
Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com1tag:blogger.com,1999:blog-2360237959698943657.post-19323972455036646992013-11-21T06:33:00.001-08:002013-11-22T10:38:17.875-08:00Red Pigs and White Coats: A Freetown Vignette by B.A SillahWhile surveying the alley between the pharmacy and storerooms for a potential new main entrance, I pause to chase some unwelcomed guests from of the hospital grounds. Three pigs had wandered into the patches of grass and rubbish lying between the fence on Percival Street and the weathered wall of Ward 10. The rusting gates that enclose the colonial era compound could not deter the four-legged vagabonds, seasoned by years of navigating between the tin-roofed Kroo Bay slum dwellings below the cliffs our hospital occupies. After watching them scurry down the road for a while, I return to my work on this misty Freetown morning.
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<b>That's me at Connaught Hospital</b><br />
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The afternoon’s responsibilities fluctuate at a moment’s notice. At times, I round the wards to recruit discharged patients for our daily focus groups. The next minute, I am either mapping out a new construction site or attempting to repair a CT scanner printer with only a ruler and German user manual to my aid. At the end of the day, I climb on the back of a motorbike, preparing to weave through gridlocked cars and potholes on the streets leading to my home in the hills. I playing a nightly game of “is this chicken or fish” at the dinner table and then walk to my balcony to watch the rays from the setting sun as they hit the exhausted-fueled evening haze enveloping the city below. Such is a day in the life of an intern with the King’s Sierra Leone Partnership at Connaught Hospital.
For five weeks over Summer I worked at Sierra Leone’s main tertiary referral hospital between my first and second year of medical school at the University of Pennsylvania. Born the son of Sierra Leonean immigrants in the United States, my first journey to my ancestral home had been 23 years in the making. From the time I stepped off the plane at Lungi Airport to catch the aged ferry that steams across the bay toward city on the horizon, I knew I was in for a journey I would not soon forget.
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<b>Freetown</b><br />
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Sierra Leone has been a country of fascinating contradictions and juxtapositions. Lively shantytowns lie in the shadows of sterile, towering mansions purchased during the recent mining boom. Traffic lights unused for decades dot the city among ruins of construction sites abandoned in the 1980s, haunting reminders of an era of prosperity cut short by eleven years of civil war. The bustling cities rapidly work to catch up with the modern world and just hours away lie timeless, untouched villages carved out of the jungle.
My time in Freetown was more than I could ask both personally and professionally. King’s Sierra Leone Partnership’s unique relationship with the Connaught Hospital leadership and Ministry of Health and Sanitation offered a look into hospital management one could not experience in other settings. The group’s work ranged from clinical responsibilities, to researching staff/patient satisfaction, to strategizing for improved hospital operations and much more. The weeks of work culminated with a meeting with the Minister of Health herself to present our task force’s findings.
Beyond the efforts at the hospital, I immersed myself in the energetic culture of Sierra Leone. I connected with family whom had only been faceless names and stories weeks before. The emerging expat community brought me together with like-minded innovators from around the world who are lending their expertise to Sierra Leone’s development. Afternoons of basking in the sun on miles of empty, untouched beach, wandering crowded markets, and chatting over a Star beer at a local bar gave glimpses into a way and pace of life I have not found elsewhere. All in all, my time in Freetown was the perfect way to spend the summer. I am already looking forward to my next trip to my new home. Swit Salone, a de kam!
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<b>A family reunion in Bo District</b>Anonymoushttp://www.blogger.com/profile/03768957026416449788noreply@blogger.com1