Sierra Leone: Insight

opinion

One of my contracts just ended, and in the past eight weeks, my company's revenue has shrunken by 80%. After May, there is a strong possibility that the partial salary I paid staff last month will go down to zero. Today is Mother's Day, but I don't know when next I will see my mama or my son as borders remain closed in Sierra Leone and Ghana. In every way, the COVID-19 Pandemic has ruined my personal and professional life. Still, as a citizen of Sierra Leone, this crisis has also given me hope and reaffirmed my belief that this country of ours has the capacity and potential for greatness. The only thing standing in our way is that we give up before we start, and we blame before we act.

After 30 years, I went to a public hospital in Sierra Leone because a doctor made a Facebook post asking for medical supplies. People like us don't go to hospitals that the masses use. We travel out to see our doctors, or for the premium platinum elite, you have health insurance and go to Aspen. We don't know how our hospitals manage, what they need, or who works there. And the honest truth is we really were never going to know until the COVID-19 crisis.

For the first time in three decades, there is only one place to access health care. No government official can travel out to the UK for the NHS. No one can go to Ghana to get treatment from Korle-Bu. There will be no trips to India for surgery. And if you happen to get COVID-19 like hundreds and hundreds more will over the coming weeks, the only facilities that can treat you are the ones we have neglected.

But do not despair.

Citizens like you and I are stepping forward to ensure that we use this crisis as a catalyst for quality healthcare in our public health facilities. And it is in this united collective action that Sierra Leone has a chance to be great. I believe it was Aristotle who said something about how to be human is to participate and engage in the community.

A lot of what we mistake for engagement, especially those of us who are educated, exposed, and of a noble stock is ordinary talk. And thanks to technology, this talk can now gain instant amplification. If you know that the government as an actor is bereft of excellence and ingenuity, then how do you serve the community by merely talking? If they don't know what they are doing, why not fix it yourself?

Yes, there is a scale that perhaps individual citizens' actions can never reach, but collective people-powered action is the only force that has ever transformed nations. Discourse is great, we have to exercise our mouths and show our book learning, but during a crisis of this proportion, that talk has to be matched with ideas and execution.

Like I said up top. I don't have money. What I have learned is that none of us need to have money to bring about change. As unoriginal as it might sound, that is the truth. What we do need is each other. Maybe you have the idea and the plan, someone else has the time, another person the contacts, and another the resources. Everyone knows someone who has something to contribute. And when people unite for collective action and social good, the money will come, because yes, even in a place like Sierra Leone, there are people with wealth who are looking for ideas to invest. Since Monday (six days ago), we have raised 60 million leones in private individual donations, this separate from the $12,000 that we raised online in the same period. Also, a local company, Frellor, that manufactures tissues sent us over 300 rolls of toilet paper. Friends of Education Sierra Leone bought equipment for 12 beds at the Covid-19 Isolation Unit at Connaught Hospital.

With the donations we have received, we have already seen the impact on health care facilities. A 100-bed hospital in Lungi has electricity after being in the dark for five days. The generator now powers the hospital and the 20-bed treatment center in Port Loko District. Jui Hospital and its 50-bed treatment center have fresh bed sheets for all its beds, medication to treat patients, baby food for a 1-year old orphan with congenital disabilities, medical tools to make sure there is no cross-transmission.

When we got to Jui to do the supplies, Dr. Kabineh, who is the lead there said, "you don't know what you are doing with this Dignity Project, you're changing everything. I am so happy I want to cry."

I don't believe we are changing everything, but it is my sincerest hope that beyond the supplies, those who see what we are doing begin to think that they, too, have the power to change this country. You don't have to change everything, but one person, one citizen, can start a movement that leads to a positive and lasting change.

While there is excellence here, Sierra Leone's health system is broken. It didn't start with COVID-19, but it can end here. Our hospitals need those of us who have the means to opt-out of the public health system to CARE about what happens to our fellow citizens who don't have a choice. We need to reject the notion that a hospital without electricity is acceptable or beds without clean sheets are okay, or that a doctor here should not do the best they can to save a life because the equipment and the medication are not in supply.

We are all going to die, but in Sierra Leone, life expectancy is 52, our people die before their time. It robs our country of whatever productivity years they could have put into their community. So far we have 18 deaths with just over 300 positive cases, Ghana with over 2000 cases also has 18 deaths. The difference is that they've made sure their COVID-19 facilities have the medical tools and medication to treat. We can do the same here. Every life is precious, and at all times, our health facilities should have the tools they need to keep people alive.

There will always be a time to blame and criticize. We should never give up our right to speak truth to power. Speak up! Tweet at the President! Write an OP-ED! Facebook Live! You can even Whatsapp government officials and let them know your disappointment. I do this regularly. I am not afraid to say, "tide yone dis wan e noh fine," sometimes we agree, other times they don't respond, but I call back because as a citizen it is my right to talk.

However, if talking is all of what we are willing to do during and after this crisis, then we are not fulfilling our responsibility as citizens. Whether it is to stop COVID-19 or improve health care until we take individual responsibility and activate our citizenship this country of ours will remain unchanged.

Vickie Remoe

Founder - C19 Dignity Project

Improving dignity and quality of care in Sierra Leone's public health facilities by giving frontline staff the resources they need to treat COVID-19 patients.

www.vickieremoe.com/mission#COVID - 19 Face - Mask or Face - Covering in public #

Let's get it straight:

Some countries and businesses across the globe have taken different approaches to fight COVID - 19. For example, Czech Republic, Scotland, Sierra Leone, Yugoslavia, etc. they have suggested not necessarily imposed face-mask wearing as a population health measure in public or in some unavoidable situations. Although it's a very low risk but it has paid off for some of these countries who have implemented it. Studies have shown that the virus spreads in droplets. However, several countries e. g England, Northern Ireland, etc. think that the evidence and science are weak therefore it's not required.

But what are the needs assessment meaning the risk and benefit of wearing face-mask in public? Does the benefit of wearing it outweigh the risk? On one hand, there is also a feeling or no harm in wearing face-mask if you find it reassuring, confident or neither.

Benefit

Wearing Face-mask in public has a very modest benefit from health perspective (Public Health England,2020), but however limited or modest, it can save lives. The evidence suggests that it helps prevent more asymptomatic spread. This is particularly so if you are in a crowded area i.e. unavoidably shops, transport and where physical distancing is limited.

There is some evidence you may gain some benefit. In other words, it about preventing what we breath out, cough out or sneeze out heading towards somebody else. More or less face-mask catches those droplets from people who are infected, and can help stop them from infecting so many others.

The other benefit of face-mask wearing is about assurance and confidence about going to work, because many people are very anxious going about their daily business in a very safe way.

On the one hand either "my mask or face covering protects you and yours protects me".

Risk

So all we need is a simple face-mask or covering, but it does not make you safe or super safe nor does it make you special or not to do the other things.

Some studies are sceptical about the value of face covering in public and in some enclosed spaces. They proffer that the risk side of face covering doesn't give an adequate protection to the wearer nor does it stops the virus getting to you. In other words, it's not a "risk free option" there is any material impacts outside the body apart from covering the mouth and nose. It is also limited in outdoor settings therefore, it's not a substitute for social distancing or self-isolation or hand washing it's an addition to all that.

Wearing it also has got some health and safety issues (hand washing and so on... ) Basically face-mask can potentially increase the risk of one getting the virus if used wrongly. Somebody who hasn't put it on may contaminate the outside of your mask. For example, wear it out and about touching your face, ears and eyes, not washing hands, etc. How you put on and take off the mask is key.

So, those droplets on the contaminated mask stays on it and can be infectious the long time. Unless it's being washed or put straight into a cure water. After washing, it can again be put into a surface which contaminate the surface which can be touched by other people and therefore the transmission increases. This will be especially for people who are wearing in to work where there is not going to be probably facilities of cleaning the mask properly.

The other risk issue is some people feel they are less infectious because they are wearing face mask or covering which has usually quite a lot of ways which the virus can be spread. They may pay less attention to the absolutely crucial measures of physical distancing of at least 2-meters, keep your hands regularly washed with soap, not touching your eyes, face and nose, and uses tissue for coughs and sneezes.

The strong evidence... .

Face-mask wearing in public is very equivocal according to some studies. Many have proven that the virus spreads through droplets i.e. when an infected person coughs or sneezes. What is hidden is how far the corona virus can travel? Possibly it can travel more than the 2 metres we need to stay apart from each other. Are we putting ourselves at risk in the public despite wearing face-mask?

Use of local cloth face-mask: It is a good idea. However, they may reduce or they may not reduce the risk particularly in passing the virus on. The evidence is a little bit patchy. For example, cloth masks are likely to get wet which the virus can go straight through it and out.

In terms of getting the virus, the cloth mask doesn't fit very well, lots of air gets around the edges especially the least resistance edge. Highly unlikely somebody coughs straight on; you are going to reduce those virus particles getting to you.

Therefore, face-mask is not a substitute for social distancing. It's just a precautionary measure. The strong evidence includes: hand washing regularly, stay at home, physical distancing, don't touch your eyes, nose, mouth, ears, etc.

If the value is limited then everyone must not be asked to put it on, otherwise the demand will increase and those who needs it (Dr, Nurses, HCA, etc.) will find it hard to get the protection they need.

Putting face mask or face covering into perspective, people think they are safe. Well use whatever you can and do the basics (strong evidence).

After all it's about fighting against humanity challenges meaning: more pain; more suffering; more fear and more death. Therefore, our worries and our strides are shared in this new way of life which is about feeling through torrid time. But as COVID - 19 inflict it worse on us all we can only reflect our very best and staying safe.

©Sylvester Caulker

Sustainability Living Initiative CEO, UK

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