A taste of Sierra Leone: A student report

by Anjali Sastry on April 17, 2009

Anusuya Das wrote an article for the March 2009 issue of MIT’s Graduate Student News. I reproduced it below.

Kusheh! This past IAP, I spent three weeks working on a healthcare project in Sierra Leone as part of the G-Lab class in Sloan. For starters, I would recommend non- Sloan students interested global health delivery issues to definitely try and take the class. It was a great experience. Sierra Leone ranks 177th out of 177 countries in the human development index (2007-2008). Having recently come out of a civil war less than a decade ago, Sierra Leone presents prime examples of post conflict capacity building challenges. In the three weeks there, I got to experience the deepest kind of poverty, the absolute lack of healthcare availability, the cheerful spirit of the people that makes everyday in this West African nation a beautiful day and the underlying hope that things can improve even in the harshest of places!

I was working in a team of four to help develop a sustainable revenue stream for a non profit organization of surgeons based out of New York City whose primary goal is to help establish the surgery residence program in Freetown, the capital city of Sierra Leone. Our project entailed a detailed market analysis and identification of products that will enable the implementation of a cross subsidized model. To this end we interviewed various individuals associated with healthcare delivery in Sierra Leone at different levels. Some of the highlights were not limited to the results of the interviews but more to the process! Though it took a while to schedule interviews, we did succeed in talking to the various mining companies, insurance companies, the very few doctors available in the country, the expatriots living there, the diaspora and the local people. We even managed to connect with the ministry of health and present to them our assessment at the end.

While working on this project, the fact that stood out as a rock in the sand was that infrastructure is imperative to improving healthcare anywhere in the world. The roads in Sierra Leone are probably the worst in the world and the basic amenities like water and electricity are minimal. The streets are lined with tiny houses and the horizon blends in with the smoke due to burning garbage. So, while many individuals and NGOs can be working on improving healthcare, without the ‘support network’, their work will provide negligible impact. When it is so obvious that infrastructure is essential to success, it amazes me to come to terms with the fact that many of the big healthcare grants are forced to be used for medicines! That PEPFAR money cannot be used to establish community projects like community wells that are essential
to provide water to consume the medicines is indeed baffling!

My experience in Sierra Leone was more than just the paperwork and interviews. We lived in the duty house in the main hospital without running water and intermittent electricity. The hospital closed down in the evening because it did not have operating and pharmaceutical supplies and required the patients to buy their own supplies and once the stores were closed, there was no point in keeping the hospital open! The
prevalence of cell phones (like most other developing countries) and the popularity of coke in the country are mind boggling! The cell phone market is pretty interesting- It is not a monopoly because there are about four or five very popular ones- Zain, Africell, Comium, Celltel and Sierracell (about to start). It’s not a very competitive field either because most customers just chose to have three or more cell phones, from different services. So, people travel with three different phones with different ringtones all the time!! Another exciting part of the trip was the chance to travel in a ‘poda poda’. It is a really small vehicle-the size of an SUV and they are most everywhere in Africa apparently… the ones in SL are really small and packed ~ 15- 20 people in one!!

During the weekends, we managed to visit some of the nearby beaches- they were breath-taking, providing hope for the tourism industry. The white sand beaches and the succulent sea food are bound to attract people from all over. The acceleration of the tourism industry will definitely be economically beneficially for the country, but it forces us to pause and ponder. What will happen to culture and the ways of the people, will the beauty of this country be forced to be erased just like it has been in other African and Asian countries that have successfully entered the tourism industry?

After Blood Diamond, many people associate Sierra Leone with diamonds. A country so rich in diamonds is so poor-this is a rather humbling realization. A couple of us went in to the countryside in an attempt to visit the diamond mines. I met miners who worked eight hours a day for ~ 7000.00 Leones (3000.00 Leones ~ $1.00). One of the young miners was studying chemistry and trying ‘find’ diamonds during the weekends so that he could sell them and save money to go to Europe for a higher education! While this hike to Kono via a twelve hour bus ride was very near to being the most dangerous thing I have ever done, it was completely worth it!

Though I spent only three weeks in this tiny nation, it brought to light many concerns and glories of a country striving to improve the lives of its people and I hope the contribution we made via the project will aid them in this monumental challenge. I hope that we as young scientists capable of creating technology and policy will do the right thing in this capacity building process and not create a bigger problem in the quest for finding solutions.

{ 2 comments… read them below or add one }

Joost Bonsen April 18, 2009 at 4:13 pm

Thanks much for sharing your experiences. I was especially moved by the story of the young chemist earning to study. Given your observation of the infrastructural limits to effective development and healthcare especially, I’m curious if you can comment on where you would invest capital first if you could. For instance, is an electricity generator and water storage tank the top priority for the hospital, or rather a store located at the hospital, or rather a teaching program for community health workers, or what? What would you invest in first and then next and then building over time?

–Joost

Nga April 23, 2009 at 1:00 am

Hi Joost,

I was with Anusuya on the same project. I would say that for Connaught Hospital, the first priority of investment is to have a consistent and reliable supply of clean water (be it a designated pipe to deliver water to the hospital directly from the water company or a better and much larger storage tank that would be filled regularly and be sufficient to support the hospital’s daily activities without interruption). The next thing, which is equally important, is an investment in surgical supply such as sutures and gloves so that people will not be turned away simply because the hospital does not have the supplies it needs to perform surgeries. The founders of SOS managed to donate a container of supplies to the hospital last year and that significantly increased the number of procedures performed to date. Things that we take for granted elsewhere are critically important in Sierra Leone.

-Nga

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