Sierra Leone

Saving lives through streamlined emergency care

FREETOWN, December 15 2017 --- In 2017 a new programme was introduced in regional and district hospitals in Sierra Leone, to accelerate and strengthen emergency treatment for severely sick children. This initative, known as the Emergency Triage Assessment and Treatment Programme (ETAT+), has already shown extremely promising results, including significant reductions in mortality.

Over the course of the year, more than 500 Sierra Leonean health workers have been trained on the ETAT+ approach. Hospital management have also been engaged to streamline processes, so that critical paediatric cases can be screened and treated more quickly, with staff gaining easier access to vital tests, medicines and other supplies.

Fatmata Jalloh is the Matron at the Makeni Regional Hospital, and says the programme has made considerable differences in the quality of care they are able to provide.

“Before we started ETAT, so many children were dying simply because of delays in the system,” she says. “Now, the emergency care and response to these children is very fast, and the time to treatment has reduced. Today I can assure you that within 10 minutes we can resuscitate a child and stabilize a child.”

Staff at the facility explain the delays embedded in the previous triage and assessment processes. After going through triage, they say, patients would be referred to the Under 5s facility, from there to the lab, then back to the Under 5s, and only then would they be referred to see a doctor at the paediatric ward.

“The time it took for the child to reach the ward was far too long,” explains Nurse Kanu.“Now there have been great improvements. When the children come we assess them, we look for emergency signs so that we can quickly identify the priority cases and send them immediately to the ETAT resource room for treatment,” she says.

Prior to ETAT, the average time it took for a child to get treatment at the participating facilities was three hours. This has now fallen to twenty minutes, and case fatality rates have been reduced by two thirds from 15 to 5 percent of admissions.

“The ETAT programme is, quite literally, saving children’s lives, and the programme has achieved truly remarkable results over a short space of time,” says Dr. James Bunn, Child Health Specialist at WHO Sierra Leone. “The focus now will be on cementing these gains and building a national network of ETAT mentors and trainers, while potentially also extending the approach to other critical areas such as emergency reproductive and maternal health.”

The greatest impacts of the programme are of course felt not by the hospital staff, but rather by the young patients and their caregivers. Mariama Kamara attended the Makeni Regional Hospital with her son, Joseph, who presented with signs of severe, complicated malaria. Without timely treatment, she says, he surely would not be here today.

“We were discharged from the facility the day before yesterday and I am so happy because of what I saw. Yesterday he started playing with the other children, they were running around, and I was very thankful to see that. I thank God, my child is alive, and I am grateful to all the nurses for the care they gave him and for making him well.”

ETAT+ is being implemented by the Ministry of Health and Sanitation through a dedicated national ETAT faculty, with support from UK aid, WHO and the UK-based Royal College of Paediatrics and Child Health.