Dr. Jim administering IV fluids
What does health care mean when you live in the poorest country on the planet? First, one can pretty much forget about being treated for any chronic health care problems such as high blood pressure, diabetes, asthma, seizure disorders, sickle cell anemia or any anemic condition, rheumatoid arthritis etc. The expertise to diagnose and treat and the availability and cost of medications is prohibitive for most people. If you have a more serious condition such as heart disease, kidney disease or cancer then there is no treatment available other then the possibility of surgical excision by a general surgeon, of which there are only a handful in a country of 6.2 million.
In the area of diagnostics, Sierra Leone has no operating CAT scan machine, a few ultra sound machines and a few x-ray machines. And, this is in the capital city of Freetown. This is as good as it gets. The laboratory situation is even more dire with only a handful of laboratories able to process the most basic of laboratory tests. There is only one pathologist in Sierra Leone and no lab capable of preparing or reading any type of culture.
This means virtually the only health care available is for acute cases of malaria, parasitic infections, upper respiratory infections, skin rashes and basic trauma. The hospitals will do their best for trauma cases and hernia operations, appendix surgeries etc. but supplies are limited and the cost to the average person is very expensive.
The Greatest Goal Ministry clinic is operated in collaboration with the Sierra Leone Ministry of Health and it is FREE to the people of Sierra Leone. Our staff consists of a Community Health Officer (CHO) who sees patients and diagnoses, a nurse who administers treatment such as the cleaning of a wound, giving an injection or distributing medications, and a lab technician who is trained to test for malaria, parasites, and basic red and white blood cell counts as well as pregnancy and urine tests.
Every clinic or hospital in the rest of the country will expect a person to pay for all aspects of their care. There is no health insurance. There will be a registration fee, a medication fee, and test fees. No one will care for you even in the case of an emergency unless those fees are paid. Currently, in collaboration with UNICEF and the SL government those children under five and pregnant and lactating women are to receive free health care.
Let me share two stories with you that will illustrate the desperate need of the GGM clinic and our continued operation in Sierra Leone.
A 4 year old boy arrived at our clinic with a high fever. His lab tests confirmed malaria. We started him on oral antibiotics and acetaminophen but his condition continued to deteriorate. At the time we carried no IV malaria medications. We felt he would be better served at a hospital. With UNICEF’s new health care policy of free health care and medications to all children fewer than 5, all pregnant and lactating mothers we knew they could take care of him better then we could. We located a vehicle and were soon caught in traffic and at a standstill. By this time his breaths were labored, his heart beating fast and his body temperature very high. The projectile vomiting began as we tried to weave through traffic, coating the inside of the vehicle and my clothing. Then he had seizure. The boy was spiraling down hill fast.
Weaving in and out of traffic we arrive at a hospital full of crying children and exhausted mothers. With his limp body in my arms I am unable to find anyone to help us. Finely a “doctor” looks at him, scribbles something down and is gone. My guide takes it to the pharmacy. She comes back in tears, “no medicine” she says, and “what do we do”? We find the doctor again. Something is spoken in Krio that I did not understand. I am told we are to go back to the pharmacy, tell them we have money and there will be medicines. We do as we are told and medications, IV fluids, tubing etc. are given to us. The IV is started and life saving antibiotics begins to flow into his limp body. The next day the young boy is brought to the clinic to tell us thank you. Where was the free UNICEF healthcare? Had we sent mom alone he would have died, one more statistic. His condition to far along without the funding to save him, and yet it should have been free to him. Corruption permeates all avenues of the lives of the people. GGM clinic offers a place where people know they will find the quality health care they so disparately seek.
My second story occurred during my last visit this spring. A young, healthy appearing amputee was helping us paint at the clinic on Saturday. On Monday morning we found him, writhing on a mat on the concrete outside the clinic doors. He could not explain his pain other than it came on suddenly on Sunday after being at the beach. I did not know at that time that he has slept at the clinic on his mat for several years. This was his home. He complained of back pain and little else but the pain seemed to move. The CHO, Nurse and two of us nurses from the USA assessed him. Massage therapy was tried as well as anti inflammatory medications. He finally slept and we moved him to his mat.
Early the next morning I was called that he was in a coma. They had started an IV and were giving him fluids. We instructed them to take him to the only tertiary care hospital in Freetown and we would meet them there.
We found him on a gurney in the hallway with no mattress. When we paid the registration fee they moved him to the “ER”. The door was locked as we tried to enter. He was seen very briefly and moved to an observation ward still in a coma, nothing happening. No doctor ordering anything. I remembered a doctor on staff and called him out of desperation. He asked me to give the phone to another doctor. Prescriptions were written for the medications and treatment items that would be needed and we went to pay for all of them. We left the nurses at the hospital to administer care. He was dead by the next morning. No explanation, no cause of death known.
The people know this may be the outcome of any illness that strikes them. The thought hovers around them and their families each and every day. Compound this with the lack of water and food and it is almost amazing more are not dead.
We know we are but a small clinic, and to the locals we are referred to as a hospital. With a full medical team here in the states working hard on protocols to teach our staff there we are making a difference in the education of the local medical staff. Our WHO community health education program is making a difference in the local community and we hope to take it to the polio villages and amputee resettlement centers around the country beginning this fall.
Construction of our new well at the clinic has just begun and with continued funding clean serviceable toilets will be constructed to serve our patients.
Our three year plan is to construct an outpatient facility that can serve the general population with a mission house where visiting health care professionals can stay and work teaching and serving the people of the beautiful nation.
It is a grand vision but one I believe can become a reality with continued support.
Thank you our valued contributors.
Don, PT with an amputee with schrapnel in his foot
Sydney RN with a sick child
Alicia RN holds a sick child
Sandi Speech Pathologist giving meds
Before 8:00 am more then 50 people in line
US and SL lab tech's sharing ideas
GGM clinic exam room
GGM Clinic building
GGM clinic well