Over the past month or so, things have been changing fast at the children’s hospital, thanks to my new hero, Professor Tamra Abiodun.
As you may remember from my previous posts, there is a desperate shortage of specialist children’s doctors in Sierra Leone. In a country of 6 million people, around 1 million of whom are children under 5 years old, there is only one trained paediatrician in clinical government service. Dr David Baion is the specialist-in-charge of our hospital and therefore has to grapple with enormous administrative, clinical and teaching responsibilities.
At present, there is no training programme in Sierra Leone to produce more paediatric specialists. Some of the young doctors at the children’s hospital have been working there several years and have been on short courses organised by the World Health Organization and the like. But they have not had access to any formal postgraduate training. Under the West African College of Physicians, it takes a minimum of 4 years to train a fellow in paediatrics i.e. someone who could then train others to become specialists. As things stand, however, no specialist children’s doctors are being trained to meet the country’s substantial need.
On this background, the Hospital and the Welbodi Partnership felt it would be helpful to bring in a consultant paediatrician from elsewhere, who could contribute to teaching for medical students and young doctors.
By happy coincidence, Prof Abiodun, a paediatric consultant and associate professor, was in town late last year for a short contract with WHO. She happened to meet one of our medical officers, who told her how desperate he and his colleagues were to get further training and one day become paediatric specialists themselves. She was moved by their story and a train of events was started that led to her arrival in Freetown in January 2010.
It hasn’t been easy. As you will know from my blogs, the hospital is often deficient in basic supplies and systems and staff are not adequately trained. Not to mention the potential political minefield of an outsider coming into a government system, but being paid an “international salary,” way above the pittance that the Sierra Leone government currently pays doctors.
The great thing about Prof Abiodun is that she has been through all this before; she was a founding member of her department in Nigeria, which has gone on to become a fully fledged training centre for paediatrics, accredited by the West African College of Physicians to train specialists. Not only does she know how things can and should be done in West Africa, she has experience of the long road towards the lofty goal of becoming a high-quality teaching hospital.
Her personal qualities are as important as her professional experience. She has this bubbling enthusiasm and warmth, combined with a hard-nosed no-nonsense attitude when important issues are at stake, presumably sharpened by many years as a successful African female.
I have learnt a huge amount from her; as much about African values and perceptions as about how to develop high quality paediatric training. Her faith that we are doing the right thing gives me confidence and strength when the challenges seem overwhelming.
The changes so far are quite striking. The doctors are on a proper rota, rather than having one poor soul on constant nights. Units previously neglected have daily ward rounds by the doctor responsible. Tutorials and clinical meetings happen three times a week; the doctors prepare these exhaustively. There are twice weekly teaching rounds and a specialist clinic. The drug formulary is being revised and prescribing practice improved. Most impressive of all though, is the excitement and can-do attitude amongst the doctors. Some have been in the hospital for a number of years but, for the first time, they feel that they are learning, improving their practice and moving forwards. There is still a long way to go, but it’s fascinating to see what one very optimistic and determined leader can do.
Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.