Alumni Profile: Ahmed Seedat and the Importance of Building Relationships

Former KSLP Clinical Lead and Ebola Volunteer, Ahmed Seedat

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.

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!

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

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

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

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

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

A Passion for Nursing - Connaught Hospital Matron Isatu Kamara

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. 

Matron Isatu Kamara

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.”  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.

Matron Isatu at Connaught Hospital

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.” 

KSLP Senior Nurse Pat, Matron Isatu, and Deputy Matron Agnes

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

Reflections from the Intensive Care Unit - Ruth Tighe

Volunteer Critical Care Coordinator Ruth Tighe with the Oxygen Factory Technician Team: Abu, Amadu, Ibrahim, and Desmond

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

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

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

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

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

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

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

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

Ruth

Strengthening A&E at Connaught

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

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

Sister Cecilia and KSLP A&E Nurse Mentor Hedda

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

The A&E Team: Sister Cecilia, A&E Consultant Surgeon Dr Seisey, KSLP A&E Co-ordinator Dr Ling and Matron

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

Technicians at Connaught

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

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

The Technician Team- (l-r) Abu, Amadu, Ibrahim and Desmond

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

Ibrahim and his fellow technicians demonstrating Connaught's new oxygen factory

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.”

An Engineer in Freetown

My name is Gerard Dalziel and my title here is Volunteer Site Engineer for Connaught Hospital, Freetown Sierra Leone.  I came to volunteer with KSLP through Engineers Without Borders in February for a six month period. On any 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. 

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.

Planning the stations of the new chest clinic

The medication station shown left as finished

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. 

Before...

and after!

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.  

The previous structure housing the oxygen factory (right) 

The completed extension and new oxygen filling system arriving

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

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

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

The current ETU which will be changed back into an A&E department soon

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. 

Gerard and Abdul, connaught's Biomedical Mechanic