Trustee Visit to Kambia, April 2019

Richard Kerr-Wilson and David Holmes are retired obstetricians and gynaecologists. They are both trustees of the Kambia Appeal, who have long associations with Kambia.

In April this year we visited Kambia for a week on behalf of our fellow trustees. This coincided with Palm Sunday, which was celebrated in style.

The purpose of the visit was to meet the new District Medical Officer (DMO) and to discuss future proposals for our partnership with the District Heath Management Team (DHMT) to improve women’s and children’s health. Kambia district has the highest maternal mortality ratio and adolescent pregnancy rate in Sierra Leone.

We stayed at the Catholic Mission Guest House next to Kambia church. It was positively luxurious, with individual rooms with en suite shower, running water, generator electricity, and air conditioning in the evenings. There was even a fridge and washing machine.

We noticed significant improvements in the infrastructure in Kambia since David’s last visit in November 2016. There are standpipes delivering fresh water throughout Kambia town, many of the dirt roads are now tarmac and there is much new building work going on. We even came across a chicken farm rearing day-old chicks imported from Holland! In the hospital itself, the maternity ward was busy. There are now two additional doctors with obstetric training employed by the Ministry of Health, one from Kenya, and one from Nigeria, but who had trained in Sierra Leone. There is currently an Ebola vaccine trial being undertaken in Kambia. The medical staff for this specifically look after the paediatric ward and some emergency patients, but have no input in to the maternity ward.

Elsewhere in the district, there are now adolescent units based in many of the community health posts. Children and young adults can visit 24/7 for confidential advice on contraception, sexually transmitted diseases, including HIV, and pregnancy advice. There are Maternal Support Groups attached to all the peripheral health units (PHUs) to try and identify all pregnant mothers and encourage them to attend for professional antenatal care and delivery. Mothers and their traditional birth attendants are now fined if they deliver at home, unless they arrive with the placenta still attached.

We had a preliminary informal meeting with the DMO, Dr Mariama Murray, at her house. We were joined by Joseph Kalokoh, one of the senior community health officers (CHOs), and Moses Kabba – our “Man in Kambia”. This was very productive, as Dr Murray was very approachable. She had previously worked at the Ministry of Health and already had a clear idea of the problems facing Kambia.

We discussed the MCHA Mentoring project and the possibility of continuing this. We also talked about the two nurses who we are currently supporting in their midwifery training, and the possibility of increasing their numbers. Dr Murray also asked if we could help in the training of surgical CHOs, which had been requested by the Ministry, but without any funding attached. We discussed possible assistance with refurbishing some of the health centres starting with the worst, and our provision of maternal delivery packs and BP machines for all the PHUs. We also mentioned the ‘Safe Delivery’ app (see blog post) as a teaching aid for downloading on smart phones. The following morning, Dr Murray put these proposals to the DHMT, so that when we arrived they were unanimously approved. We were also able to donate the first of the delivery kits and BP machines, which we had brought with us.

CHO Joseph, a former recipient of Kambia Appeal scholarship and now the DHMT person responsible for infectious diseases, demonstrating the BP machine and contents of delivery kit

We later met with Kadi and Mariatu, the KA sponsored Midwives in training, who expressed their heartfelt gratitude for the opportunity they have been given. They are well advanced in their training and highly motivated to succeed. Other nurses (SECHNs) we met were hoping that we will be able to sponsor them as well in the future.

Over the following days we visited two of the nearer PHUs, and met with some of the participants who had taken part in our MCHA mentoring programme. They were all very enthusiastic about the project. Both mentors and mentees said how much it had improved their knowledge, and gave the mentees confidence to contact their mentors for advice at other times.

However, despite the improvement in the maternity ward staffing and our MCHA mentoring project, the number of women who die in childbirth is still extremely high in Kambia District. The mentoring project is improving the knowledge and skills of the delivery staff in the PHUs, but good obstetric care needs more than knowledge. The physical structure of the PHUs is poor and the basic equipment absent, so that the staff are not able to apply their knowledge in practice.

We hope that by training more midwives and surgical CHOs, improving the PHU buildings and ensuring they have basic equipment, we will go some way to improving the health of mothers and their children in Kambia.

Picture of Rokai Peripheral Health Unit– ripe for refurbishment