Sierra Leone

Sierra Leone - Surgical Programme Continues

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Although the Nigerian-led ECOMOG force overthrew the military junta in February 1998 and secured the return to power of President Kabbah, many parts of the country remain insecure and fighting continues. The previous nine months of almost total blockade aggravated the steady decline in the health system.
Since the coup d'état in May 1997, MSF has been running a surgical programme at Connaught Hospital in Freetown for war-related cases. The hospital received large numbers of wounded during the February 1998 ECOMOG advance on the capital and performed 15-20 emergency operations daily. Since April, casualties resulting from mass exactions against the civilian population in the east and northeast of the country reached Freetown and required surgery at Connaught (58 on the day of 26 April!). Many, including children, had suffered amputations at the hands of armed groups (70 out of 225 by end-May). MSF is protesting strongly against this practice of terror against civilians.

Also in Freetown, MSF provided medical, logistical and sanitation assistance in the IDP camps at Clay Factory (pop. 7,000) and Kossoh Town (pop. 2-3,000) throughout 1997. Emergency stocks are held in preparedness for a cholera outbreak.

Two MSF staff were kidnapped and held for a fortnight in February when taking medicines and water and sanitation equipment to 10,000 displaced persons east of Freetown. They were able to give medical assistance to displaced persons in the area in which they were held captive. Otherwise, the programmes in and around Freetown have continued during the emergency situation.

Southern Province

MSF is providing support in eight clinics and one hospital in Bo, two clinics in Bonthe, and in one hospital and six clinics in Pujehun. All of these clinics function with both MOH and MSF staff. In spring 1998, MSF began to reduce its involvement in the actual running and management of Bo hospital to concentrate on providing medical supplies, basic logistics, financial incentives to staff and training for maintenance staff.

Financial incentives are essential in a situation in which staff receive little or no salary. A cholera camp is also maintained in Bo. The programmes at Bo and Pujehun hospitals continued with local staff under "remote control" during the emergency as the insecurity forced MSF teams to evacuate.

MSF gives logistical support and provides financial incentives to staff in the effort to re-start EPI in most areas of Southern province where it had been suspended for over a year.

Northern Province

In Kambia district, traditionally the bread basket of Sierra Leone, the MSF therapeutic feeding programme experienced an increasing number of admissions from December 1997, clearly indicating a rise in the level of malnutrition (50 children at the end of April). A further supplementary feeding programme covers 400 children. Other programmes have had to be postponed because of the continued fighting and Kambia continues with local staff under "remote control" during the emergency.

SIERRA LEONE UPDATE 23 OCTOBER, 1998
- RISING NUMBER OF DISPLACED OWING TO CONFLICT AND INSECURITY

Although the Nigerian-led ECOMOG force overthrew the military junta in February 1998 and secured the return to power of President Ahmad Tejan Kabbah, many parts of the country remain insecure and fighting continues particularly in the east and north-east. MSF teams continues to see large numbers of mutilated civilians who have fled the conflict in the clinics and hospitals which they support. The insecurity is such that MSF continues to have major problems gaining access to certain isolated populations.

In the Northern Province, MSF works in Kambia and Portloko districts. This area remains very dangerous because of ongoing fighting. The team often crosses the border into Guinea to spend the night. Here MSF has three main objectives, to continue the therapeutic feeding programme, to prepare for emergencies and to support the Kambia hospital on an ad hoc basis. MSF would like to open a badly-needed paediatrics ward here. MSF also runs a dry feeding programme in eight clinics for under-fives to the west of Kambia. MSF is likely to remain in the northern province for at least another year.

Since the coup d'état in May 1997, MSF has run a surgical programme at Connaught Hospital in Freetown for war-related cases. MSF is protesting strongly against the particularly cruel methods of targeting of civilians. Not even children are spared from mutilation. MSF no longer carries out surgical operations in the hospital as there are now seven inhouse surgeons. The team is focusing on the training of anaesthetists and surgical nurses in pre and post-operative care. MSF provides medical support to two government run clinics which service a wide target population. MSF also runs four other clinics in Freetown. The focus here is on supervision of health care assistance and staff training. The clinics cater for the poor and the displaced.

In the southern province MSF is providing support in six clinics and the district hospital in Pujehun, eight clinics and the district hospital in Bo, and two clinics in Bonthe. Teams are about to start working in Bonthe's Matru Hospital. The teams is based in Pujehun and Bo at the moment. MSF has been or continues to be involved in the rehabilitation of many of these structures. All of these clinics function with both the ministry of health staff and MSFsupport. In spring 1998, MSF began to reduce its involvement in the actual running and management of Bo Hospital to concentrate on providing medical supplies, basic logistics, financial incentives to staff and training for maintenance staff. Financial incentives are essential in a situation in which staff receive little or no salary. A cost recovery scheme has been initiated and a management commitee set up. A cholera camp is also maintained in Bo.

MSF gives logistical support and provides financial incentives to staff in the effort to re-start EPI in most areas of Southern province where it had been suspended for over a year. MSF also offers support to the district medical authorities (in the area of supervision, management, etc.)

An MSF team is currently evaluating the situation in Moyamba, a district which lies to the south of the capital Freetown. MSF would also like to be able to carry out a proper evaluation of needs in the isolated and war-torn areas of Makeni and Magburaka but unfortunately insecurity is such that for the time being a proper evaluation has not been carried out.