Sierra Leone Observational Visit

In November 2019, a group of UK-Med members were welcomed by colleagues in Sierra Leone to take part in an observational trip.

Many of our members have never worked outside of the UK health service, so these trips provide a vital insight into healthcare facilities in low-resource settings. Our members can learn from colleagues working in these settings, and so are better prepared when responding in a similar setting during an emergency. We spoke to Advanced Nurse Practioner Lorraine Lloyd about her experience in Sierra Leone.

“It was inspiring to see the great work taking place despite the low-resource setting.”

Tell us a bit about yourself and what motivated you to join UK-Med.

I’ve been an Emergency Department (ED) nurse since 1985 mostly doing Accident and Emergency (A+E) and Critical Care work in some form. I wouldn’t know what else to do with myself, it’s what I do best.

I took part in an A+E course in 1986 with Tony Redmond, UK-Med’s founder when I worked in Stockport Infirmary. I had heard about Tony’s SMART team and how they were going off to different counties to help in disasters which sounded incredible, but I then moved to work in Australia. A few years on in Australia, our department had a visitor from the Red Cross to talk about deployments. I was very interested but a lot of the organisations wanted you to commit to a long period of time and that was difficult I was a mum and leaving my daughter for that length of time just wasn’t an option.

I didn’t hear about UK-Med until I moved back to the UK. It was 2018 and our ED lead returned from Bangladesh with UK-Med after assisting with the Diphtheria outbreak. He came back and gave such an inspirational talk so I threw my CV into the ring and thought I would give it a go- I’ve been very, very lucky. It wasn’t until I got to the deployment course and saw Tony Redmon there and realised that UK-Med started off as Tony Redmond’s SMART team all those years ago!

What was your experience of travelling to Sierra Leone?

One word, amazing!  I was very excited to go because I’ve worked in hospitals all my life with marvellous resources, so the chance to have a different experience was very exciting.  The travel was great as I’d met some of the team before. We had a conference call beforehand so we were very well prepared, knew exactly where we were going and what we would be doing.

Tell us about your first impressions of the hosptial 

It was just phenomenal.  The heat, unusual smells – some of them not good – lots of people hanging around and lots and lots of handwashing going on in every corner of the hospital. One of first things we were hit with was a price list in the reception area of the hospital, that is something of course the NHS doesn’t have.

The first day we arrived was actually a national holiday, so it wasn’t as busy as other days.  We had a walk round and met the Director and two other staff members. The hospital canteen was interesting I have never had water from a little bag before. It was quite tricky trying to use it, you had to bite the end and put it in your mouth and try not to spill it everywhere!

During the trip you were partnered up with staff from the hospital who share your job role- how was that experience?

I was buddied with Sophia who was also an ED nurse and she was absolutely fabulous!

We were a great team together and had a blast. On the second day we went to resus to learn and observe how their working day ran, what kind of patients they saw, issues they have and generally getting some insight from what their experience of their nursing careers and hospital facilities.

On my first morning I was quite upset at the facilities in the resus department. It was the polar opposite of what our resus is in our department in Chester. The beds were squashed together, and overall very little facilities and resources. But there were lot of nurses around which was great to see. They were all lovely and happy to chat and show us what they had and tell us about the patients that were actually in at that time.

Are there any patients who stuck out to you?

We went to triage one day and saw a man being half-carried in by his relatives- he was very, very sick. We followed him from the start of that process, popping in everyday until we left that Friday learning what happened to him along the way which was a very different experience to that of a patient in the NHS.

What really stuck out was the lack of supplies, the fact that oxygen and nebuliser masks are washed and re-used, the lack of oxygen on the wards, the poor quality of the monitoring and the fact that a lot of the nurses actually don’t get paid. I learnt all this through following the patient’s treatment, so it was quite emotional leaving not knowing if he was OK.

With every patient it was really interesting to see what condition they came in with. For example, there were huge number of patients incredibly unwell with HIV and TB, something we rarely see in the UK. It was fascinating to see how they were managed and the payment system in which they had to pay every step of the way for every bit of treatment they had.

What were the most difficult and rewarding aspects of the trip?

Not being able to put a pair of gloves on and help, that was the most difficult thing. We had to resist because that’s not what we were there for. We couldn’t just go in and say ‘’right let me take over” or “I’ll give you a hand’’. We were there to observe how they worked so it was difficult to see some of the patients in the condition they were in. I did with a few hold their hand or say hello- just be a nurse. But we weren’t there to do nursing duties, it would have been so disrespectful to do so. This is their working environment and we had to respect that this is how they work. We weren’t there to impose our views or our nursing skills. The staff were very curious however and interested to hearing about our resources back in the UK and about how we handle cases.

The most rewarding aspect was to see these nurses working for free. The rural clinics in particular were a real highlight they were absolutely superb, tidy and organised. The staff were so welcoming and keen to show us what they were doing for example the different immunization processes, HIV and TB programs. They were great, highly qualified, autonomous nurses running the clinics in very difficult environments.

It was inspiring to see the great work taking place despite the low resources setting. For example, the one-to-one teaching with medical students in the hospital was phenomenal, the trauma and ICU departments were also excellent making in-roads of how they document and monitor patients.  Without a doubt the staff were the winners, seeing their handwork and dedication working in such difficult environments was the most rewarding aspect of the trip.

Would you go again?

Oh absolutely, without a doubt. You apply for these things and hope you will be picked. There’s a wealth of experience within the UK-Med team and everyone wants a chance to go so yes, I would highly recommend it to everyone. I’ll be sharing my experience with my trust this up-coming Friday and hopefully inspire my colleagues to sign up.

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