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  • Another sick boy in the clinic in Jimmi, Sierra Leone. The ability to diagnose an illness is challenging. The clinic has the ability to test for malaria and run urine dipsticks to look for protein and sugar. The needs outstrips what the clinic can offer. The clinic had antibiotics for children, but none for adults. Supplemental nutritional packets for children were running low.
    Sierra Leone_27.jpg
  • Pregnant women come to the clinic 1-3 weeks before their due date. The problem is that the clinic cannot feed them, so families must make the walk to the clinic each day with food. When this doesn't happen it is not uncommon for the women to walk into the main village area and beg for food. All pregnant women are tested for HIV, and antenatal consultation rates are good.
    Sierra Leone health care_20.jpg
  • The health clinic and staff in Jimmi, Sierra Leone. Recruiting trained medical staff is a challenge for the clinic. There is no electricity, no generator, and supplies arrive only every 3 months when the Ministry of Health ships, and those get used up before the next shipment. Requests for additional supplies go unfulfilled.
    Sierra Leone health care_1.jpg
  • In-patient beds. Here, a woman has been in the clinic for a few days now with a fever of unknown origin. The Community Health Officer in charge believes she might have Lassa Fever. They cannot do anymore for her. The clinic has no way to diagnose the disease. There are no antibiotics for adults in the clinic, only children.
    Sierra Leone health care_10.jpg
  • The health clinic in the village of Jimmi does what it can, with few supplies or equipment. Supplies are delivered by the Ministry of Health every 3 months, and requests for more go unfulfilled. Malaria, diarrhea, malnutrition are big problems. Here, a child is hospitalized for a fever. His father sits at his side.
    Sierra Leone_26.jpg
  • Malaria is a severe problem, especially among children. But keeping out mosquitoes is impossible. The doors to the clinic are left open, and where there are screens there are holes.
    Sierra Leone health care_5.jpg
  • A billboard stands outside the clinic to teach the villagers about Lassa Fever and how to prevent it.
    Sierra Leone health care_23.jpg
  • No privacy in giving birth. A thin wall with an open doorway separates the in-clinic patients from the mother giving birth. Children suffer from diarrheal illness from contaminated water, respiratory illnesses, and gastrointestinal parasites. They are given deworming medications during 1-5 years of age, but how successful this is and if it really helps is not known.
    Sierra Leone health care_9.jpg
  • The SLAWS team of young, dedicated veterinary staff. No veterinarian is among them, but they are trained to spay, neuter, and vaccinate dogs and cats. Reducing the dog population is one part of the solution to reducing rabies and saving lives.
    Sierra Leone Rabies_11.jpg
  • The Sierra Leone Animal Welfare Society is led by the only veterinarian in the entire country who works on animals. Supported by grants, the SLAWS teams travels primarily around Freetown to spay and neuter dogs and vaccinate them against rabies. With just 5 veterinarians in the country, and all of them near retirement, Sierra Leone will soon be without veterinary care, which will further jeopardize food security in an already poor country.
    Sierra Leone Rabies_10.jpg
  • Maternity waiting house
    Sierra Leone health care_21.jpg
  • Inside the hospital, check in desk where history and patient information is written down.
    Sierra Leone health care_3.jpg
  • During the 2 weeks I was in Sierra Leone, approximately 5,000 dogs and 400 cats were vaccinated. Cats are much less common.
    Sierra Leone Rabies_12.jpg
  • The surgical suite. Wash basins are to the right, instruments are in the cabinet on the left, next to the autoclave.
    Sierra Leone health care_18.jpg
  • A malaria antigen test kit (purple box) rests on the table closest to the window in the under 5 exam room. Sharps and needles are put in the taller box. An examination book lies open.
    Sierra Leone health care_17.jpg
  • Exam table. Just the bare minimum.
    Sierra Leone health care_6.jpg
  • Keeping the rabies vaccine at the proper temperature is important. It's no good  if it warms up. It has to be thrown out. So keeping the "cold chain" intact, from time of manufacture to time of administration, is crucial. Here, workers do a great job keeping the vials of vaccine cold on ice.
    Sierra Leone Rabies_15.jpg
  • This room is for seeing children under 5. The room is better supplied than the adult version.
    Sierra Leone health care_16.jpg
  • The patient leaves to go to the Doctors Without Borders hospital thanks to the ambulance they provided. Most Lassa virus infections in Africa are mild or subclinical. Several multisystem disease occurs in 5-10% of cases, and 15-25% of those hospitalized will die. Lassa is also causes serious disease and death in children, but diagnosis can often be missed. A more frightening development is spontaneous mucosal bleeding, which can occur in nearly 17%  of patients. This then begins to resemble Ebola. Hearing loss in nearly one-third of survivors can occur.
    Sierra Leone health care_11.jpg
  • A child is hospitalized for a fever. His father sits by his side.
    Sierra Leone health care_13.jpg
  • On IV fluids, this boys waits for improvement in the hospital's ward for children in-patients.
    Sierra Leone health care_12.jpg
  • The under 5 area. Child nutrition is still a problem, even after harvest. Vaccine coverage of children is good, but they suffer from lack of nutrition and several diseases.
    Sierra Leone health care_14.jpg
  • No microscope. No advanced diagnostics. They can run a malaria antigen test, hemoglobin, and a urine dip stick test for detecting urinary tract infections. That's it. No tests for Lassa. No tests for syphilis, which were provided under MSF (Doctors Without Borders) supervision.
    Sierra Leone health care_7.jpg
  • Every vaccinated dog got a blue collar signifying it was vaccinated. The collars likely didn't last too long.
    Sierra Leone Rabies_17.jpg
  • A placenta pit
    Sierra Leone health care_22.jpg
  • Many worked together to get the dogs vaccinated and keep the lines moving. Kids carried dogs from across town. Some had leashes, many did not. In line, a dog might try to bite someone.
    Sierra Leone Rabies_14.jpg
  • A table holds a scale to weigh the newborn and to clean up.
    Sierra Leone health care_8.jpg
  • Adequate latrines are lacking. Here is an example. A hole in the floor. While the latrine could be in worse shape, we see rat feces everywhere on the floor. Rats in this part of Sierra Leone can carry Lassa Fever, a disease of West Africa. At least 2 species of the rat Mastomys are infected in Sierra Leone. The virus can be spread in urine and feces of rodent, which becomes areosolized via movement or sweeping and the virus is inhaled by people. There has also been person to person transmission.
    Sierra Leone health care_2.jpg
  • The exam room. Supplies are scarce, and so is equipment. Nutritional supplements for children, once abundant under the support of Doctors Without Borders, trickle in under the Ministry of Health. The state of nutrition of women is less than ideal, and no support for them exists any longer.
    Sierra Leone health care_4.jpg
  • Every dog or cat vaccinated was recorded: the owner, address, dog's name, color, gender, and so on. This is important for enforcement of rabies laws as well as for knowing who has been vaccinated and who hasn't. 
    Sierra Leone Rabies_16.jpg
  • Surgical scrub basins
    Sierra Leone health care_19.jpg
  • Patients and family can wait here.
    Sierra Leone health care_15.jpg
  • Dogs roam in Freetown, as seen here. These dogs are lounging just outside the only veterinary clinic in Freetown. There are only 5 veterinarians in all of Sierra Leone, and only 1 of these works with animals, and that is on a part-time basis. Dr. Gudush Jalloh runs the nonprofit organization the Sierra Leone Animal Welfare Society, which strives to reduce and control dog populations through spay and neuter. They also vaccinate the dogs against rabies, when they have the vaccine that is, which is hard to get. Dogs are often used for security, or even hunting in rural areas. But rabies occurs everywhere in the country.
    Sierra Leone Rabies_32.jpg
  • What does it say when a pawn shop is adjacent to a medical clinic?
    State of America_2.jpg
  • The people of Sierra Leone fight back against rabies by educating communities through World Rabies Day celebrations and events in 2010. From song and dance to skits to vaccination clinics to school competitions, word got out. Still, not enough has been done to rid the country of this killer for good. At Njala University in Sierra Leone, the events for World Rabies Day, 2010, kick off with a prayer to an auditorium filled with school kids and adults from surrounding villages. The day is filled with speeches, songs, dance, music and skits -- all about rabies. With no firm way to diagnose rabies in humans or animals, the exact toll of the disease remains unknown. But people do die.
    Sierra Leone Rabies_1.jpg
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