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Overcoming crises in Sierra Leone: a story of resilience

The St. John of God Hospital in Lunsar, Sierra Leone, survived a ravaging civil war (1991-2002) and an ebola epidemic. This March, it celebrated its 50th anniversary.

​Rosetta Aminata Conteh (38) is a nurse at the St. John of God Hospital in Lunsar, Sierra Leone. During the civil war she was a schoolgirl and volunteered in the hospital, where the sick and the war victims were treated and displaced people from townships and villages took refuge. “Working in the hospital during the civil war was terrifying”, she remembers. “But we had no options. We were here to help the sick and the needy. And we treated the wounded, those who were amputated, those with bullet wounds.” That is, until one of the warring parties invaded the hospital, which was plundered and ravaged. One of the brothers (of St. John of God, who run the hospital - SE) and two Austrian volunteers were taken hostage, and only released after intervention by the bishop of Makeni. After the civil war, the hospital was rebuilt, and, with the help of donors, equipped with a modern theatre and laboratory.

When the hospital was flourishing again, another plague presented itself. This time, the unwelcome guest was called Ebola. Rosette learned about its arrival during a phone call from a German donor partner. Up to that moment, she had never even heard about the disease, but she would soon get to know its ugly face. A patient from Kenema was admitted and treated. When the staff started to suspect Ebola, the patient disappeared, but not before having infected several staff members. They were put under a 21 day quarantine, but this didn’t avoid staff members from dying from Ebola. A Spanish brother, Manuel Garcia Viejo, felt sick and was referred to Freetown because of a suspected malaria infection, but he died from Ebola as well. In his last two days in Lunsar he had still been treating patients. Having worked with him, “we were afraid for our lives”, Rosetta says. All in all, “we lost more than 10 staff members. You can see there pictures on the monument”.

Rosetta reports how everyone was scared of being infected and losing their lives. “Even the brothers were terrified”, she recalls. “We were all afraid.” Nevertheless, brother Michael Koroma took it on him to take appropriate measures and lead the hospital through times of Ebola. A triage system was created to separate the infected from the uninfected patients before admitting them. If patients had no money, their treatment was paid for by the hospital, which developed from a general hospital to an Infection Prevention Centre. Personal Protective Equipment (PPE) was used and a strict system of hand washing put in place. Even those assisting infected mothers during labour were fully dressed in PPE. Regardless of whether an infected mother gives birth vaginally or through a caesarian, the unborn child runs the risk of being infected as well.

The Ebola crisis was a huge setback for the hospital and the country as a whole. The economical situation has deteriorated. Many people are illiterate and live in remote villages where they can hardly sustain themselves through farming. The Ebola crisis has increased poverty and has led people to delay seeking care in hospitals because they cannot afford the cost. Some of them seek the help of herbalists and pharmacists instead, whose businesses have boomed after the Ebola crisis. Illegal medication is sold over the counter and traditional healers at times risk the lives of patients by overdosing them. As a last resort, these patients end up in the hospital, but by then, they are often already in a terminal stage and little can be done to save them.

Rosetta says that in the past 35 years, the biggest challenge for the staff of the St. John of God Hospital has been the patients who don’t have money. They try to treat them anyway, but the hospital’s functioning is highly dependent on donor injections from overseas. Especially the mother and childcare is at stake. Due to financial limitations, mothers avoid travelling to the hospital to give birth there or to let their children be checked, resulting in an even higher infant and maternal mortality rate. The hospital’s safe motherhood clinic, located in a township of Lunsar, tries to address this problem. Women living in surrounding villages are trained to recognize problems during pregnancy and to know when they should go to the hospital.

Although Sierra Leone is now Ebola free, some of the measurements (like the triage system) are still in place, because they are helpful in fighting other infectious diseases such as diarrhea and tuberculosis. Another plague increasingly hitting the local populations is HIV. According to Rosetta, unsafe sex and unsafe medical procedures (like blood transfusions) performed by traditional healers or pharmacies are to be blamed for this rise. The hospital offers free tests and refers HIV positive patients to their HIV counselor. Because of the stigma that comes with HIV, the role of the counselor is quite crucial in getting the patients to accept their situation. Rosetta says: “The way you do the counseling and how you talk to the patient will define whether a patient is willing to accept the situation. You need to convince them that consistent treatment will prolong their lives and that in combination with preventive measures such as condoms, the risk of infecting their partner will be low.”

Asked about the future of the hospital, Rosetta says that “it lies in the hands of the Lord, and in the hands of our donor partners, especially those who live overseas and are helping our hospital. Despite the economic situation, the hospital is improving gradually. So I hope the future will be brighter”.

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The St. John of God Hospital in Lunsar with its in house Nursing School is supported by, among others, the Dutch ngo HospitaalBroeders. The interview on which this blog is based, was conducted by HospitaalBroeders.

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