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  • 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
  • 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
  • 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
  • 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
  • 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
  • Exam table. Just the bare minimum.
    Sierra Leone health care_6.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 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
  • 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
  • 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
  • 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
  • A child is hospitalized for a fever. His father sits by his side.
    Sierra Leone health care_13.jpg
  • A table holds a scale to weigh the newborn and to clean up.
    Sierra Leone health care_8.jpg
  • A placenta pit
    Sierra Leone health care_22.jpg
  • Surgical scrub basins
    Sierra Leone health care_19.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
  • A billboard stands outside the clinic to teach the villagers about Lassa Fever and how to prevent it.
    Sierra Leone health care_23.jpg
  • Patients and family can wait here.
    Sierra Leone health care_15.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
  • 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
  • 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
  • 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
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