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  • 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 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
  • With just 5 veterinarians in the entire country, and those will retire in 3-4 years, there is a desperate need to provide basic animal health care services to the animal owners of Sierra Leone. Animals are vital for survival. While many in the rural parts of Sierra Leone grow crops, others raise goats, chickens, maybe even cattle or sheep. Now there is an effort to select and train someone who is local, someone who is excited to learn more about animal husbandry, animal health, basic medical care for animals. These CAHWs will provide those services that are lacking or hard to find. Better animal care means healthier animals, means more growth, better reproductive rates, better survival, more milk or eggs, more meat, and more money. Better animal health = better human health & prosperity.
    Sierra Leone_15.jpg
  • A future community animal health worker in Koromasilya, Sierra Leone. He, with others, will be trained to provide basic animal health care to the animals of his village, with the hope that improved animal health means more food and more prosperity for the families, including his.
    Sierra Leone_19.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
  • Africa, Animals, Dog, Sierra Leone, puppies, Veterinary, boy, rabies, world rabies day, health, medical, child, public health, Kenema
    Sierra Leone Rabies_23.jpg
  • What does it say when a pawn shop is adjacent to a medical clinic?
    State of America_2.jpg
  • The Chief holds the seeds of the Moringa tree. Many parts of the Moringa are used for different purposes, from animal feed to dye to medicine to everyday food. The leaves are high vitamins, calcium and protein. The health and medicinal benefits are numerous and include reducing blood pressure, improving the immune system function, treating stomach ulcers, and more. The seeds are high in oil, which is used in some cosmetics.
    Sierra Leone_29.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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • This room is for seeing children under 5. The room is better supplied than the adult version.
    Sierra Leone health care_16.jpg
  • A child is hospitalized for a fever. His father sits by his side.
    Sierra Leone health care_13.jpg
  • A placenta pit
    Sierra Leone health care_22.jpg
  • A table holds a scale to weigh the newborn and to clean up.
    Sierra Leone health care_8.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
  • Surgical scrub basins
    Sierra Leone health care_19.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
  • Patients and family can wait here.
    Sierra Leone health care_15.jpg
  • _NZ74515.jpg
  • This young woman in Koromasilya, Sierra Leone, is very enthusiastic about becoming a CAHW.
    Sierra Leone_18.jpg
  • A husband and wife display one of their goats that now provide them a bit of security in their lives.
    Sierra Leone_20.jpg
  • In the village of Robombeh, not far from Mabamboo, I meet the only woman in the village who can read. She proudly displays her visitor log book, which I sign before I take this picture. She was very nice, very sweet woman.
    Sierra Leone_14.jpg
  • Before I leave Mabamboo, they want a quick group shot. They rush to join the picture. I'm rushed. We have to leave to visit another village and make it back to Freetown before the traffic gets too bad. 
    Sierra Leone_13.jpg
  • Children in the village of Mabamboo, about an hour and a half outside of Freetown, show off their goats that Heifer International has provided. The animals are a source of pride, and a bank account in hard times.
    Sierra Leone_7.jpg
  • The villagers of Mabamboo create their own salt licks for their goats out of multiple ingredients, including ground up ant hills and ground up fish bones.
    Sierra Leone_8.jpg
  • In Sinkunia, a vibrantly dressed woman (here in black and white) and her baby stroll down the main road. The child glances back at the strange white man with a camera. Wonderful.
    Sierra Leone_16.jpg
  • A boy in Bo, Sierra Leone, sells peanuts to make money.
    Sierra Leone_6.jpg
  • A family in Mabamboo shows off one of its goats and goat house. The young girl is shy here.
    Sierra Leone_11.jpg
  • In Sinkunia, a vibrantly dressed woman and her baby stroll down the main road. The child glances back at the strange white man with a camera. Wonderful.
    Sierra Leone_17.jpg
  • A mother and child in Koromasilya, Sierra Leone
    Sierra Leone_21.jpg
  • The girl is proud and fond of her goat, and less shy now.
    Sierra Leone_12.jpg
  • Adults in Mabamboo are proud too. Goats are bred, and the offspring given away to another family in need. Here, a family shows off its goats, but also the salt lick they made from natural ingredients: ant hill, dried plants, ground fish bones, and other things. Very affordable, and the goats love it.
    Sierra Leone_9.jpg
  • A family in Mabamboo shows off one of its goats and goat house. The young girl is shy here.
    Sierra Leone_11.jpg
  • 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
  • The Chief of Mabamboo village stands proudly in front of his goat houses. Goats should be confined, otherwise they roam and eat the crops of farmers, and then there is conflict within the community.
    Sierra Leone_10.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
  • Some key elements to preventing rabies in people are: vaccinating dogs regularly, reducing stray dog populations, and educating people on what to do if they are bitten by a dog. Here, one of many children learning about dog bites and rabies as part of World Rabies Day celebrations pauses during a long speech to give me a look. Overall, the event was a long one, trying the children's attention.
    Sierra Leone Rabies_3.jpg
  • Chief Abu Khan of Jimmi Bagbo District is also a sharp-eyed healer. He showed me plants for treating malaria, snake bite, dysentary, and fractures.
    Sierra Leone_28.jpg
  • These awesome boys jumped in and the crowd parted as they danced in synchrony to the beat. The dance was vibrant and stirred us all.
    Sierra Leone Rabies_22.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
  • This girls sells peanuts to the gathering crowd watching the World Rabies Day parade. I stop and take her picture, paying her a few servings of nuts. After this, I'm her friend for the rest of the day.
    Sierra Leone Rabies_24.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
  • School girls in Sierra Leone learning about dog bites and rabies during World Rabies Day. Here, young muslim girls watch the skits on stage.
    Sierra Leone Rabies_28.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
  • The Chief on a rice farm.
    Sierra Leone_35.jpg
  • While experts spoke on stage about rabies, these boys found a distraction.
    Sierra Leone Rabies_29.jpg
  • Musicians and groups gather, seemingly without much planning, to put on wonderful displays of song and dance as crowds gather and march in the World Rabies Day parades.
    Sierra Leone Rabies_21.jpg
  • This boy was watching the people and their dogs in line waiting to get them vaccinated against rabies.
    Sierra Leone Rabies_13.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
  • 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
  • Every vaccinated dog got a blue collar signifying it was vaccinated. The collars likely didn't last too long.
    Sierra Leone Rabies_17.jpg
  • This young girl is enjoying the parade she is in. She's learning about rabies and helping call attention to this killer disease, but having fun while doing it. Fun is essential to learning. If it's not fun, people don't want to listen, which makes getting your message across a lot harder.
    Sierra Leone Rabies_7.jpg
  • Our team stopped in a small village after leaving Njala and were instantly surrounded by the people who brought out instruments and sang and danced. We looked at their goat houses, which were quite good. Some of the adults were wearing the Rabies Day shirts. An amazing time!
    Sierra Leone Rabies_8.jpg
  • Moringa plant and seed pods
    Sierra Leone_31.jpg
  • This woman took time to talk with me about her family, pictured here, and going hungry. They eat once a day, usually just rice. She's worried about her youngest, who suffers from malnutrition. The vaccine record of the child sits on the table. Even though she's part of a farming family, they don't have enough to eat. Ways to improve farming, increase yields, and lower the work load, especially for women, need to be found.
    Sierra Leone_37.jpg
  • The hands of a healer and Chief of the village Jimmi, Sierra Leone, rest after working with the pods and seeds of the Moringa plant. The pods and seeds of the Moringa plant on the table.
    Sierra Leone_30.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
  • Feet and hands say a lot about a person. These bright red shoes of a girls just called out to me. She and I had a good laugh as I took this picture.
    Sierra Leone Rabies_30.jpg
  • The plays, or skits, drew laughter and rapt attention from the audience. Here, two girls can't take their eyes off the stages, where a skit about rabies is taking place.
    Sierra Leone Rabies_26.jpg
  • A couple of older school children wait to take part in the World Rabies Day parade. Schools were let out for World Rabies Day in the town of Makeni. Bright uniforms gave the children a colorful, excitable look. This young man quickly came over and tried to claim they were more than just friends. She set him straight.
    Sierra Leone Rabies_5.jpg
  • It was the skits that got the children's attention. They were funny, but still educational. Here, these kids watch a skit with rapt attention and learn about rabies at the same time. No one knows how common rabies is in the country because reporting is not required and no one collects data. But it's too common, we know that.
    Sierra Leone Rabies_4.jpg
  • A child sleeps peacefully in this ingenious portable bed. The family was sitting along the road to the Doctors Without Borders hospital, selling fruit and other items. Kids are often the ones bitten by dogs, so educating them and their parents about dogs, behavior around dogs, and what to do if bitten are important aspects in preventing rabies.
    Sierra Leone Rabies_33.jpg
  • A skit keeps the kids entertained, but they also learn at the same time. Here, this funny skit shows men in drag posing as dog owners, and of course dog bites and rabies is a large component of the play. It was well received by the kids.
    Sierra Leone Rabies_27.jpg
  • The shoes of school girls up on stage during a competition between schools to see which knew the most about rabies.
    Sierra Leone Rabies_31.jpg
  • Everyone, young and old, enjoyed the World Rabies Day festivities. This woman and young girl dance and walk along the side of the road as the parade marches on, music blaring. What a wonderful way to learn and have fun at the same time.
    Sierra Leone Rabies_20.jpg
  • A young boy pretends he is bitten by a rabid dog and goes to the doctor for help. For children, the skits were the most engaging. A message hidden within entertainment.<br />
<br />
Rabies occurs in more 150 countries and claims the lives of over 55,000 people each year. Approximately 40% of these deaths are in children under the age of 15 years. The animal that is most responsible for these deaths is the dog. While the dog strain of rabies has been eliminated in the United States, it circulates widely in Asia, India, Africa and Latin America.
    Sierra Leone Rabies_2.jpg
  • Chief Jo Makaya, also of Jimmi Bagbo District, showed me around and put me up for the night. He watched over me as I learned about the hospital needs and the unsafe water supply. He showed me how they grow rice, raise Talapia, and how the rebels had destroyed the water pumping station and water tower.
    Sierra Leone_34.jpg
  • The Chief and healer in the village of Jimmi village, Sierra Leone, shows me how to cure snake bite. Here, rubbing his secret combination of leaves on the wound.
    Sierra Leone_32.jpg
  • Boys entertained the team of rabies experts and guests with a song and skit.
    Sierra Leone Rabies_9.jpg
  • A man on his way to the World Rabies Day festivities in Kenema is chased by 5 dogs while he rides on his motorcycle. One dog bites him. I'm asked to have a look, then I take him and the owner of the dogs around the corner to a nearby home, where we borrow soap and a tea pot. I make the dog owner wash the man's wound for 15 minutes. Did the dog have rabies? I told the city councilman to watch the dog for 10 days. If the dog acted oddly or exhibited signs of rabies or died, then the bitten man was to receive the rabies vaccines as treatment. If the dog was alive and well in 10 days, then there was no need for the man to get the vaccines.
    Sierra Leone Rabies_25.jpg
  • The older brother of this boy died from rabies after being bitten by a rabid dog. That same rabid dog also bit this young boy. Now, 2 months after his bite, we learn about this exposure. The family couldn't afford to travel to Freetown to buy human rabies vaccine to give to the boy to help prevent rabies. They couldn't afford the vaccine either, which is sold at different prices in different pharmacies. We donated money to cover the costs for the family and treating the boy. Unfortunately, there are too many like him who never get the vaccine post-exposure prophylaxis. Africa and Asia remain hot spots for canine rabies. Something has to be done.
    Sierra Leone Rabies_19.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
  • After rubbing the plants on the bite wound, he then rubbed them in his eyes. I never quite understood why, but he knew. He was very protective of the secret plants he used to treat snake bite and wouldn't show any of the other "outsiders" but me. I was honored.
    Sierra Leone_33.jpg
  • Part of the World Rabies Day celebrations was to visit several towns or large villages. Schools were let out, morning  parades with bands marched to the town hall with eager children dancing to the music, banners proclaiming World Rabies Day fluttering. At the destination there would be speeches and skits and more music.
    Sierra Leone Rabies_6.jpg
  • Freetown, Sierra Leone. Nearly half the population of Sierra Leone lives in Freetown. Young people move to the city from rural life in hopes of finding work and a more exciting life, but find making a living difficult. Many take to selling sundry items on the streets. Electricity is unreliable. The roads are good in some areas of the city, but many still need repair. It is estimated that nearly 60% of the country's operating budget comes from donor countries.
    Sierra Leone_2.jpg
  • The last in a trio of boys.
    Sierra Leone_5.jpg
  • Girls carrying local food supplies in Kabala, Sierra Leone
    Sierra Leone_22.jpg
  • There are many wonderful beaches around Freetown, if you can get to them.
    Sierra Leone_38.jpg
  • This energetic young tailor was busy morning until night at his sewing out on the front porch of his house in Kabala, Sierra Leone. Gracious, friendly and in demand, many people stopped to see him, some lingering for hours.
    Sierra Leone_23.jpg
  • Young boys celebrate a goal in a football match behind their school in Kabala, Sierra Leone.
    Sierra Leone_25.jpg
  • Children celebrate a goal in a football match behind their school in Kabala, Sierra Leone.
    Sierra Leone_25.jpg
  • There is little in the way to diagnose rabies in dogs and humans. Here is the old lab, demolished during the war. It has been replaced. Unfortunately, the new lab is not equipped properly, and few people are trained in the laboratory techniques necessary to diagnose rabies. Electricity and refrigeration are lacking.
    Sierra Leone Rabies_18.jpg
  • Talapia ponds of Jimmi, Sierra Leone.
    Sierra Leone_36.jpg
  • The hands of a tailor in Kabala, Sierra Leone
    Sierra Leone_24.jpg
  • Freetown, Sierra Leone
    Sierra Leone_1.jpg
  • These two young men were taking pictures of me as I photographed the football players on the beach. So I turned the tables, and we all laughed.
    Sierra Leone_40.jpg
  • Clothes on a clotheslines in Kabala, Sierra Leone.
    Sierra Leone_41.jpg
  • The mother of the founder of Khadarlis (a US based NGO) sits on her couch in her second floor apartment above shops and busy streets of Freetown. She's calm, peaceful. She's glad I'm there to help, she tells me. I see her twice,  while I'm in Sierra Leone, only for a few minutes each time. Its a nice visit, one I hope to make again.
    Sierra Leone_39.jpg
  • This energetic young tailor was busy morning until night at his sewing out on the front porch of his house in Kabala, Sierra Leone. Gracious, friendly and in demand, many people stopped to see him, some lingering for hours.
    Sierra Leone_23.jpg
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