Looking forward to going again!

The team that went in March 2010

Many of the team of 2010 are looking forward to visiting Freetown again in 2011 in late Spring to continue the medical training.  We hope to add training for teachers at the school and in the area of micro-enterprise.

We are looking to expand the team and if you are in the Derby area we invite you to a meeting on Monday 6th December. Please contact me on tswindaleuk@yahoo.co.uk for further details.

If you want to help financially please read on

Money isn't everything, but neither is oxygen.  In other words - we can't do without it!

If, after reading about the work of restoration going on in Looking Town, you wish to contribute towards the cost of some of our projects, please donate to our general fund via the Links International Site.

http://www.linksinternational.org.uk/Give.html
Please make payments to the Links International Projects account, and mention Sierra Leone or our ref: 3030   and if you are able to gift aid your donation a form can be downloaded from the site.

Our grateful thanks to the many people who do support us already.

Goodbye to the old clinic

Earlier in the year our team were looking forward to visitng the clinic that NEEDEP had set up.

It was doing useful work, but in a far from ideal environment which the leadership agreed did not reflect the standards that are needed.

The somewhat dark and cramped entrance lobby lead into a room with a couple of beds, a table and chair.

No glass in the window and for post-operative care,  a good scrub with disinfectant would be in order.

Not quite sure what we have here. Medicines, yes. Rubber gloves, radio, exercise book, fish head? Is this where operations are carried out?   

We did meet a couple of people down from the provinces who had had their appendices taken out.  Both appeared to be doing well.  The clinic is continuing to run, but no longer under the name of NEEDEP, who are hoping to establish a new teaching health centre in the new building.

New Building is starting to take shape!

I am delighted that walls are now going up at the new building which will give much needed extra classroom space and has the potential to also have a health education room/clinic.  For too long the building site has stood with the building blocks ready and waiting.

Now those blocks are in place and it is looking much better.

We now await concrete for the roofing of this building and to provide a floor for a second storey.  The completed building should look like this:

What it there to see in Freetown?

We did our best to let the team see something of central Freetown on our last full day.

If you know the area, you may have suggestions of other places to visit, but for us the first stop was the Museum, officially closed as it was Saturday, but a kind curator agreed to let us in! It contains many items associated with local culture and the history of Freetown.

A picture of Freetown in 1792 with the Cotton Tree in the centre. The Cotton Tree is an historic symbol of the city.  On March 11, 1792, Nova Scotian settlers landed on the shoreline and walked up to a giant tree just above the bay and held a thanksgiving service there, gathering around the tree in a large group and praying and singing hymns to thank God for their deliverance to a free land. The land was dedicated and christened 'Free Town' according to the instructions of the Sierra Leone Company Directors.

Many believe that the present Cotton Tree is the site where this happened.

The Cotton Tree today.

Alpha Kargbo next to a model of Bai Bureh, a man many believe to have been the greatest leader in the history of Sierra Leone. He was the chief of the Loko tribe to which Alpha belongs. Bai Bureh (February 15, 1840 – August 24, 1908) was a ruler and military strategist who led the Temne uprising against British rule in 1898 in the Northern part of the country. A gifted man with many admirable qualities, he deserves a separate mention in the blog. We shall leave the museum here and move up the hill to the British Council.

Approaching the British Council building. Was it open? Well at least the bit producing light refreshments was, which is what we wanted.

Very British! Enjoying a cup of tea. The British Council's remit is "to build mutually beneficial cultural and educational relationships between the United Kingdom and other countries, and increase appreciation of the United Kingdom’s creative ideas and achievements."

Then on to the Big Market in Wallace Johnson Street. A large building which is home to numerous sellers of local arts and crafts. Unfortunately the ratio of sellers to tourists is not in the traders favour, after all I understand that last year the country attracted only 5000 tourists. Therefore a buyer is the subject of many people's attention and it can be rather unpleasant.  In spite of this many of us were able to buy some attractive objects. Anne Marie was very satisfied with her dress.

Check out this clip for a tour of the market and a view of many of the items on sale.

Across the road from the market is the coolness and calm of St. George's Cathedral, completed in 1828 for the  Church Mission Society Anglican. 

It was the main centre of the religious life of the colony and the memorials show the difficult conditions that were encountered before the discovery of quinine in the fight against malaria. Here are two of them.

Sacred to the memory of Robert Corley, RAC Corps, who survived the Battle of Waterloo and perished in this unhealthy climate, June 16th 1837, in the 39th year of his age.

This memorial was erected at the desire of the afflicted parents of John Mansfield, mate aboard HMS The Scout, in token of their untimely and irreparable loss from the effects of a season sickly beyond example, in a climate pre-eminently fatal to the health and life of Europeans. May 6th 1833.

The Queen attended a Thanksgiving Service in the Cathedral to mark the Independence of Sierra Leone in 1961, and left her signature in the visitors' book.

Then to the beach. We have been there before in past posts - but it is always worth it.

Lumley Beach

The end of a perfect day, and for Sam and Susie, the week was to be the start of a new and growing relationship! Congratulations and Best Wishes for the future. The photo I liked best of you is

Good times from our last visit - with photos! Accommodation.

As we look forward to visiting old friends and seeing what progress is being made in healthcare, probably in February 2011, it is good to look back at some of the good times from the last visit.

We were fortunate in our accommodation. Because the official Foreign and Commonwealth Office advice is not to use the ferry at night, we spent our first night at the Harmony Hotel near the ferry terminal at Tagrin. Well worth it. Good welcome and a very fine meal - fish was fantastic!  Comfortable rooms and air-conditioning so efficient that in my room we woke in the night absolutely freezing! They were also good at getting us an early breakdast for the morning ferry.
Highly recommended. http://www.harmonyhotelsl.com/

Owner Saidu Turay at the front of his hotel

Evening view from the hotel

Waiting for our evening meal - the freshest fish I have tasted!

Morning breakfast - not even light yet!

Colourful scene as we wait for the ferry to dock.

Arriving at Freetown after a pleasant crossing.

Hotel 5/10 at Kissy

Getting together in the lounge for morning prayers, afternoon tea or de-briefing in the evening were highlights of the day for all of us. Here are the full team apart from Anne-Marie who took the photo. Ruth is showing only an arm!

The start of every day. Breakfast in Hotel 5/10.

Some thoughts on Father's Day

Here in the UK it is Father's Day, 20th June 2010.  I have been thinking of my own Father and his influence on my life, particularly in my early days when he often talked about his experiences as a doctor in the Second World War.  As our medical work expands in Sierra Leone, I am sure that if he was still with us, he would be cheering us on. I was aware of a world outside England from the many items he brought home with him - Indian rugs, brass work, pictures, models and (from those less enlightened days) a tiger skin rug and ivory carvings. I was also aware of the distinguished medical career that he had pursued.

In 1940, Alfred Swindale was in North Africa commanding a Field Ambulance, where he had as his Transport Officer Christopher Landon, who later drew on some of his experiences to write a novel, published in 1957, called Ice-Cold in Alex. This was made into the 1958 film which starred John Mills. A recut version of the film, 48 minutes shorter than the original, was released as "Desert Attack" in 1961 in the US.

My Father was then posted to India where towards the end of the war he was responsible for setting up what was then the world's largest hospital. 'The Mail' for Wednesday, 7th February 1945 records a visit by the Viceroy's wife, "Lady Wavell, accompanied by Lieut-General Sir Noel and Lady Beresford Pierce visited the Hospital Town which is under construction at Jalahall, outside the Bangalore Municipal Limits. It is claimed that, when completed, this will be the biggest Hospital in the world with 10,026 beds. ......

Lady Wavell was received by Col. Swindale (Asst. Director of Medical Services) ... and shown around the works completed and in progress."

He then moved to Burma, also as ADMS. I can remember a pennant from the Rangoon Yacht Club hanging up on the wall at home! Finally, I understand that with the acting rank of Major-General, he had overall responsibility for the repatriation of all the Japanese prisoners of war back to the UK through Singapore, including those who worked on the construction of the Burma Railway in 1942–43.

My Father, Alfred Swindale at the time of his investiture 1948

My first visit to London, a city I love, was to go to Buckingham Palace to see him receive the C.B.E. from King George VI. As a small boy, I was mortified that I needed to go to the lavatory in the middle of the ceremony, and encouraged by my Mother, set off past rows of Yeomen of the Guard to be escorted by a tail-coated courtier for a considerable distance to the required room!

However, to return to the topic in hand, I am proud of him and acknowledge the influence that his work, dedication and six and a half years service overseas must have had on me. It is part of my world-view to wish to see good health and prosperity come to those in need of it. Thank you, Dad!

Free Healthcare has come for the under 5s and pregnant and new mothers

You will have seen earlier in the blog that Sierra Leone has some of the world's highest maternal and child death rates.

On 27th of April, Independence Day in Sierra Leone, the President announced that going to the doctor will become free for children under five and pregnant women, and new mothers. The new plan will save lives as many have died because they were unable to pay health service fees and the cost of medication. In a country where life expectancy is 46 (men) and 49 (women), one in eight women risk dying in pregnancy or childbirth, and for every 1,000 children born, 140 die. Indeed it has the highest mortality rate in the world for children under five.

The programme's main donors have been the UN and the UK and there have been some teething troubles.
Ratiszai Ndlovo, Sierra Leone's UN Population Fund representative, told the BBC that although medical equipment had been ordered and some drugs distributed around the country, everything was still not in place at the launch of the healthcare plan.

"It's not perfect, it's not 100%," she said. "But I think we cannot start the programme with everything in a perfect condition."




In this video, Sunkari Conteh describes how her baby died because she could not afford the £15 fee that the doctor who visited her was charging. Although the problem here is seen as poverty, the training that our healthcare team provided in March could have shown how the problem could be solved without outside medical involvement.

Other problems in making free healthcare a reality have included:

• Pay and conditions which produced a two-week-long strike in March staged by the country's public health workers. They feared free care would result in more patients and longer working hours. The dispute was settled when the government offered salary increases of between 200% and 500%.  It appears that the Free Care Initiative has done well on salaries and stopping direct fees, but drug distribution is still inadequate at present.
  
  
  
  The entrance to the Children's hospital, Freetown

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in Freetown. Her observations of the implementation of the programme have included -

• Crowd control.  "As the only paediatric hospital in the country, with a huge deprived population on our doorstep, the children’s hospital was always going to find itself very popular once user fees were removed. Nonetheless, I have to admit that I froze, my heart in my mouth, as I swung through the gates on the first day and saw the throng of mothers filling the car park. But we hadn’t quite foreseen how large the crowd would be or how keenly they would press on the doors. Our few security staff were taken by surprise and found it hard to cope."
• Sheer numbers. "Some people brought kids who were not sick; some apparently believed that talk of a “basic healthcare package” meant that they would, literally, be given a package of goodies if they attended. Some believed that they needed to register before a certain deadline to be able to use the free services in the future."
• Cheating.  "Someone was arrested for selling drugs obtained by taking the same child to several health facilities."
• Prioritising. "The hospital and its staff can only provide care of any quality to a certain number of patients per day.  We decided that we had to start going through the queue and, based on WHO criteria, start sending only the “priority” cases inside and advising the “routine” cases to go to their local health centre. Emergency cases went straight up to the ER as usual.  It wasn’t easy. These are people who might never have brought their children to government health services before because of the fees. And now they’re being told that they can’t come in to the hospital."

If you would like to read more about Dr. Spry's work, please go to   http://blogs.bmj.com/bmj/category/emily-spry/

• There have been problems distributing the correct drugs in the right quanties. However, with the help of the Sierra Leone government, donors and partners, more than £6,745,000 worth of drugs have been distributed to the 1200 Primary Healthcare Units and other health facilities in the country. Completing such a task in a country that still suffers under poor infrastructure will not be easy.
• Sierra Leone's bad roads and the lack of ambulances means pregnant women living in the more isolated parts of the country are often slow to receive attention.
  
  
  
  
  

Football pundit Chris Kamara is changing his name. Why?

It is reported this morning that Chris Kamara, best known for being a presenter and football analyst on Sky Sports, is changing his name to Chris Cabanga after he learned that the word could have a positive effect on the England players during the World Cup. 'Kamara' is a well-known name in Sierra Leone, and indeed in other West African nations, so why change it?

Well more than 22,000 people joined an internet campaign to get Kamara, a retired English footballer who ended his playing career in 1995 and last managed a club in 1998, to change his name by deed poll. Scientists said the word cabanga, derived from the Zulu word for imagine, will unite the team when it is chanted by fans.

Internet comments have not been favourable:

"biggest load of BS I've ever heard"
"I see. Nurse! Those people have got out of their jackets again!"
"What a complete plonker ! We have 'bout as much chance of winning world cup as the pope has of becoming a jew !"

In spite of this, Kamara is a well-loved commentator, even through his gaffs. Have a look at this one from April 2010.




Chris Kamara was born 25 December 1957 in Middlesbrough to a father of Sierra Leone origin. Yet another person with roots from Sierra Leone who has enriched the life of this country. Can you think of others? My friends from the Sierra Leone Association will have to be excluded from this one, there are too many of you!

One person who comes to mind is Samuel Coleridge-Taylor (15 August 1875 – 1 September 1912) who was an English composer and achieved such success that he was once called the "African Mahler". Coleridge-Taylor was born in Holborn, London, to a Sierra Leonean Creole father, Daniel Peter Hughes Taylor, and an English mother, Alice Hare Martin. Coleridge-Taylor was 37 when he died of pneumonia. His widow gave the impression that she was almost penniless but King George V granted her a pension of £100, evidence of the high regard in which the composer was held.

Samuel Coleridge-Taylor in 1905

He called himself an Anglo-African and fought against race prejudice all his short life. He incorporated black traditional music with concert music, with such compositions as African Suite, African Romances and Twenty Four Negro Melodies. The first performance of Hiawatha's Wedding Feast was described by the principal of the Royal College of Music as 'one of the most remarkable events in modern English musical history', and this work was acclaimed on both sides of the Atlantic.

Who elso would you like to see remembered here?

Mercy Ship for Sierra Leone in 2011

We are delighted to have Dr. Matt Walters of the Derby Royal Hospital with us at the Riverside on the evening of Tuesday 8th June when he will be talking about the role of Mercy Ships alongside our 2010 Healthcare Team, who will share their experiences in the country in March 2010. Details from tswindaleuk@yahoo.co.uk



This is an inspiring video to the song "Deliver me" from the David Crowder Band. The before and after pictures of the work of the medical teams are indeed inspiring!

Much of the following is taken from http://www.mercyships.org.uk/.
Mercy Ships has selected Sierra Leone as the site for the 2011 Field Service for the world’s largest charity hospital ship, the Africa Mercy. This will be the fourth time that Mercy Ships has delivered free world-class medical care to the impoverished West African nation.


Healthcare in Sierra Leone is unaffordable and often unavailable. The country ranks 180 out of 182 nations on the 2009 Human Development Index, and the majority of the population lives on less than £1.40 per day. Infant mortality in Sierra Leone is 160 per 1000 births as compared to the UK at 4.8 per 1000 births. (UN Population Division). 

The ten-month 2011 Field Service will once again bring hope and healing to Sierra Leone. The state-of-the-art hospital ship, the Africa Mercy, contains six operating theatres and will provide free medical care. The off-ship Eye Clinic and Dental Clinic will offer additional medical services.

Mercy Ships looks forward to their continued partnership with the West African Fistula Centre in Aberdeen founded in 2004. The clinic is now under the management of the Freedom from Fistula Foundation. The Centre offers free surgeries to women suffering from childbirth-related injury and has the capacity to serve between 500 and 600 patients per year.



The hospital ship will also serve as a platform for training African healthcare professionals and for community development teams. These programs ensure that the positive impact of Mercy Ships will continue long after the ship leaves Sierra Leone.

What some of the team thought of their visit!

A team of ten from the Derby and Nottingham area met Linden Boothby at Heathrow for a visit to Sierra Leone from 28th February to 7th March 2010.

The English Group was varied, four different denominations, ages from 18 to 70, medical and non-medical backgrounds. None had visited Sierra Leone before except team leader, Ted Swindale, who had known Alpha Kargbo in Freetown for 22 years and worked with the New Era Evangelism and Development Programme since 1999.

The Sierra Leone Group who took part were from a wide section of society - Male and Female, Christian and Muslim, Pastor and Imam, Western influenced health workers and Traditional Healers.

This made for an interesting time in Looking Town, a deprived area of Freetown in a country which is currently 180 out of 182 on the UN Human Development Index, just ahead of Afghanistan and Niger. Not a good place to be and still suffering from the effects of the civil war, which devastated this area.


After Linden had explained the aims of our time together and those taking part had identified their most pressing health problems, we split into four groups - sharing the health professionals (three doctors and two nurses) among them. Feed back from the those who went has been encouraging.

What did they most enjoy about the trip?

Two Doctors: “Being in small groups, getting to know people. Team
discussions. Watching Linden at work - very inspiring lady.”

“Meeting the Sierra Leoneans in the groups. Seeing all the children at the Sports Day”

Former Teacher “Visiting Africa for the first time. The work the team did - the stance that was taken i.e. local people to take ownership. The people I met”

Nurse “Meeting the locals. The satisfaction of seeing the action plans - they actually learnt from us.”

Psychiatrist “Meeting the people. Their local situation. Making relationships. Support of whole group.”

Business analyst: “Exposure to vastly different culture”.

Young Man 18yrs “The food was delicious. I enjoyed meeting locals and the teaching itself. Visiting the beach was very good.”

In Freetown the four groups are now meeting together and number about 40 in total. Their enthusiasm is keeping up and we look to see results on our next visit.

Since returning to the UK the group have kept in touch and further links with medical workers in Sierra Leone are being forged. Margaret Abbott, a GP and aided by her son who is doing a Graphic Design
degree, is creating a small colourful stand-alone flipchart (small enough to go in a suitcase) with basic healthcare messages.

Out of the ten who went, eight want to go back and the other two “might”. Something has started that is continuing with enthusiasm.

Thank you Linden and Links!

Water, Water but is there a drop to drink?

"Drink plenty of water" was the advice given to the team when in Sierra Leone. There are a number of pictures in which bottles of water feature. Here are some and you will notice bottles of water in many more as you look through the blog.

Break time for Andy and Margaret

Grace learning deportment at the airport

Our first morning in Sierra Leone. Bottle in hand, Linden is setting a good example as we cross on the ferry to Freetown.

However bottled water is expensive and way beyond the reach of many people who have no access to guaranteed clean water. This results in many cases of waterborne disease, sickness and diarrhoea. What are we doing about it?

While in Africa we taught a simple method of making impure water much safer to drink.

Fill a clear plastic bottle with water leaving a couple of inches of air at the top. Seal and shake the bottle to distribute oxygen through the water, then stand in full sun for a minimum of 8 hours. The ultra violet light from the sun will sterilise the oxygenated water.

A demonstration by a group member. To help with teaching this principle, they composed a song to go with the actions.

This method is getting wider acceptance. The web site http://www.worldchanging.com/  reports that in Tanzania, villagers have been placing plastic water bottles full of dirty spring water in the sun on their black tar rooftops. After eight hours (or less in very hot areas), UV rays and heat have killed off the bacteria that cause cholera, dysentery, and typhoid.

According to the site "What remains one of the greatest impediments to wider adoption of this approach is simply education and information. According to an organizer from Plan International, many villagers fear that the water bottles may not be an effective means of cleaning water, or may be vulnerable to further contamination when left sitting on the roof.

For all its potential problems, though, the method does seem to have a lot to offer - it's very inexpensive, and can be implemented by anyone, anywhere that the sun gets hot enough to kill potential contaminants. It's also spurring a new demand for the collection and distribution of plastic bottles."

Good to have our methods verified by what Time Magasine described as one of the world's top 15 environmental websites.

Since coming home we are negotiating with Links International to send some water filters for use in the school. A recent study by a leading UK University showed that use of British Berkefeld® drinking water filters in a community in Zimbabwe slashed cases of potentially fatal diarrhoea (a common problem in Africa caused by pathogenic bacteria and cysts in the water supply) to virtually zero. These water filters have been proven to work in the most demanding conditions. This is why they are used by the major aid organisations and recommended to us by Links.

A study in Zimbabwe and rural South Africa to evaluate the effectiveness of British Berkefeld®

filters found an 80% reduction in dysentery and watery diarrhoea through the use of the filters. General diarrhoea levels were also extremely low. The study concluded, “British Berkefeld water filters are an effective point-of-use intervention for reducing E-coli and diarrhoea in African households". In a Ugandan school in which clean water kits were installed, absenteeism due to sickness dropped immediately from 45% to less than 5%.

Due to a very generous donation that People in Partnership has received a supply of filter kits will be going to Freetown shortly.

Alris - now fully qualified as a doctor.

One of the most touching moments of the trip was the meeting between Ruth McArthur and Alris. Ruth has spent many years supporting Alris through secondary school and then university, as he pursued his ambition to be a doctor. They had never met. Awaiting his final results he made the journey from his work in 91 Mile to Freetown to see her and arrived just as the groups were starting to present their plans. I felt heaven was coming to earth.

Alris and Ruth

Ruth received an e-mail from him today, 25 March, to say he had passed all his exams. and is now fully qualified.

The Community Healthcare Initiative

This is the road up to the Looking Town School where we were to have our first meeting with the leaders and influencers from local schools, churches and mosques, the community elders and healthcare professionals. Note the rubbish at the side of the road, a continual problem.

At the school we were welcomed by the children on our first day, Monday afternoon.

A Greeting from the children

The rest of the week the whole school was practicing at the Field where the Sports Day would be held on the Friday. The teaching and discussions on health lasted for three days after the first session.

After a brief introduction from Linden, charts were put up listing the various concerns of those present. They can be seen around the corner of the room in the photograph.

Linden addressing the delegates.

Participants were asked to put a dot in the section they wished to see discussed. Healthcare came top with 30 voting for it. In my group we started to discuss malaria, high blood pressure and anaemia. It was interesting to find that in a number of groups eating too many oranges was seen as a cause of malaria. Someone had presumeably caught malaria just after eating a lot of oranges, put 2 and 2 together and made 29. The word had spread.

High blood pressure was often seen as a result of stress, and poverty and the aftermath of the civil war had given many opportunities for stress to take over. Explaining to the imam of a local mosque how to overcome problems in his congregation using Christian principles was an unusual experience, and showed that in this area the two religions are able to work well together.

Anne-Marie Gunter handing out name labels in the group she lead with physcologist Richard Lansdall-Welfare and Ted Swindale

                              Dr. Margaret Lansdall-Welfare (R) and Grace Swindale lead a group

L to R, Susie Marshall, Ruth McArthur and Samuel Warwick with their group and below is a group photo.

This group, Action for Health, came up with a plan.

They all received a certificate for completing the course, and here their spokesman, Nabieu Sesay, is receiving his reward from Ted Swindale. He had made an excellent Presentation, and we look forward to seeing how the plan has progressed on our next visit.

The first presentation was by Alfred Fogbawa, who gave a confident report of the plans for the future that were decided by the group with Sarah Frost.