From the vantage point of my Royal Air Maroc flight, the sun
rises over the Sahara to the right, which slowly melds into the Atlas
mountains, both landscapes ironically minituare from the air. Maybe it is the
sleep deprivation that is the Royal Air Maroc Freetown – Casablanca experience,
or maybe it’s genuinely a moment of reflection of the end of the first quarter
in Freetown. It’s been a long while since my last blog, for a variety of
reasons, and so much has happened, which makes it even more of a challenge to
encapsulate everything of the last 5 months or so; apologies for the cheesy
title but I think it does fit.
The Kings Sierra Leone Partnership has changed quite a bit
over the time I’ve been here, no more so than in the couple of months. Many
familiar faces who saw through the tough times of Ebola with such remarkable
bravery and skill have moved on and the team is reinvigorated by fresh faced
and energized recruits. Those that have stayed carry on principles of a true
partnership, a characteristic exemplified by the KSLP starters and is, I think,
so unique to our work.
And Ebola is really the place to start; hopefully,
thankfully, possibly we are coming towards the end. Lots has been said, lots is
still to come. The personal losses are horrific, the effects far reaching but,
once all is said and done, fingers are and will continue to be pointed and heads
may roll. But was it such a surprise that such a tragedy happened in West
Africa? Is it a new thing that a humanitarian health disaster has struck a
developing country with such devastation?
HIV, TB, Hepatitis B – all relatively easily identified,
preventable and treatable but are uncontrolled in developing countries. For HIV
and Hepatitis the parallels are clearer, a previously unknown pathogen that was
identified too late and the effect of which were vastly under-estimated. The
ingredients that allow these communicable pathogens to spread can be easily seen
in any short trip around our Connaught wards and Freetown city, they range from
public understanding of disease, to public sanitation, to ward practices. One
of my favourite graphs in medicine shows the number of deaths from TB since the
1800’s in the UK, it shows the dramatic effect of poverty reduction, completely
dwarfing the effect of the invention antibiotics in controlling TB. As our
departed Country Director, Oliver Johnson says – the Ebola epidemic has exposed
the “fatal flaws” in the health system of Sierra Leone. These flaws are
globally driven, they demolish the concept of health in isolation and do not
recognise borders. We can and should solve the crisis for Sierra Leone’s health
system, but that won’t stop the next health humanitarian crisis in another
country.
At Connaught in Internal medicine we largely deal with only
the tip of that iceberg, managing the sick that walk through the door. And we
have really focused on just that – providing the best possible quality of care
alongside our Sierra Leonean colleagues. And, at the end of this first quarter,
I feel proud. We have had our highs and lows, but on the day I left I went down
to the admissions ward at 5:00 pm to review the new cases and was met by the 2
house officers. “Dr Paddy, we’ve clerked
all of the admissions, shall we review them?” We spent 2 hours going over
the cases, discussing, weighing things in the balance and at the end I, and the
team in its broadest sense – drs, nurses, patient and relatives –were left with
a feeling of pride, value and satisfaction that we had done a good job, I’d go
as far as saying a great job in the circumstances. And with that feeling the
sad times tend to fade, maybe that’s the coping mechanism, but it is important
to remind myself and to remind you, the reader, that the inequities in access
to the most basic basic of health needs is the greatest tragedy, even beyond
all eye-catching headlines of ebola. And we, as humanity, should not accept
that. There are stories to illustrate this – they happen every day – but maybe
they are best left for another day. In an echo of Andrew Harding final blog in
post as BBC Africa correspondent – I am a glass half full type of person, but
we should not forget the hardships of the majority.
I hope this blog can start to illustrate how very closely we,
at KSLP, work with our Sierra Leonean colleagues at Connaught with the priority
of treating the patient in front of us. And how, when we work, Connaught’s
problems are our problems and its ups and downs are our ups and downs. Given
the lack of doctors and barriers to care providing the best we can is a time
consuming task and, at times, gives less opportunity to step back and work on
systemic issues. Striking this is a daily balancing act but more often than not
I feel the balance falls in favour of the individual patient. And I think it
falls that way because of days like yesterday, when the system and the team
works - the doctors apply their skills and step up to a role of patient
champion, working with the nursing staff to provide good care and the patient
and their family feeling satisfied and valued. Those moments of functionality
and positive experience are golden. It’s a team and a process that’s been grown
organically and teethed over several months but on those golden days gives the
whole team the gratification of this. Our task now is to use some of this slight
momentum to start solving these systemic issues as a team but, as we say in
Salone “small small” – one step at a time…
