“We don’t have thoughts of maintenance here in Sierra Leone.  Few people have any idea of that.  If you look at the cars driving around, you can see.  I wonder how they are able to register them.  Yes, you have to adjust your expectations in Sierra Leone, otherwise you can become depressed.”

These wise words are from Mr Bundu-Kamara, a retired pharmacist, who spent much of his career working in the UK, before coming home to establish a quality pharmacy in Freetown.

I have battled to adjust my own expectations about maintenance at the Hospital.

Let’s take the example of the oxygen concentrators.  These have been donated by Welbodi and other Hospital partners.  These machines, which grab precious oxygen out of the air and deliver it to sick children, are Trojans of medical equipment and can withstand continuous use for years at a time.

However, like any machine, they live longer with basic maintenance and can die prematurely if they suffer abuse.

One chamber should contain regularly-changed water, to moisten the gas streaming past.  A sponge filter should be cleaned once a week of the clogging red dust of Freetown.  The nurses know about this.  When I explain, they look impatient and say, “Yes, yes.”

But when I pop into the Emergency Room on an average morning, despair rises in my chest; the machines are caked in dirt and unknown liquids, their tubes trampled, their water run dry, their filters choked.  Their two-pin plugs are jammed into three-pin sockets, the converters and extension cables missing or burnt out.

When a child needs oxygen, the hunt for the “Y connector”, which allows the oxygen to be split several ways, is missing.  Nurses hunt half-heartedly through drawers.  “Eeee bo”, they say and shrug, the Krio expression of regret and resignation.

Now, that isn’t fair, the nurses would respond.  The wonderful nurse-in-charge of the Emergency Room soon sorts the place out when she starts her shift.  She does care about the ER equipment, but finds it difficult to influence what happens when she’s not around.  Matron, similarly, can cajole or shout or issue orders, but has no obvious carrots or sticks to use to improve performance.

But what does all this mean for those who would donate vital and previous equipment to the Hospital?

There are two extreme positions that one might take.  On the one hand, imagine my granny, an upright lady of Colonial times, who would have said “Don’t give them a single thing until they have proven that they know how to look after it”.  On the other hand, I imagine a more contemporary hippy friend who might argue “You can’t punish the kids just because the culture is different”.

Of course, there must be something in-between.  An approach where we try to promote better care of the machines, whilst accepting that complete and lasting success is unlikely.  It is important to avoid obsession with Western cultural and professional norms and falling into the trap of thinking that these are somehow innate to decent human beings.  Being too fixated on having things done your way can jeopardise the relationships that are the key to attitudes and behaviours, if only in that individual.

When I visit the ER, I will try to take time to gently remind and demonstrate, whilst resisting the urge to shriek in annoyance or start frantically cleaning the machines myself.

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.