Training the future doctors of Sierra Leone while saving lives

The Ebola outbreak - that started mid-2014 and was declared over in June 2016 - left Guinea, Liberia and Sierra Leone in dire conditions. Three years on, the countries are still struggling to rebuild their health care system, which was already substandard before the outbreak. In Sierra Leone, the Ebola virus was not only responsible for the death of 3,956 people, but the loss of thousands more who died as a result of the health system breakdown.

The consequences of the outbreak are still present. In Sierra Leone, 7% of the country’s health workers lost their lives to the epidemic, leaving a country already deprived of medical staff with an even larger deficit. In Belgium, we have 1 physician for about 330 inhabitants. In Sierra Leone, there is 1 physician for about 50,000 inhabitants.

To respond to health care needs, MSF decided to invest in the construction of a hospital in Kenema, southwest of Sierra Leone and to embark on a training programme for medical staff. “The government’s post-Ebola recovery plan is making good progress but we wanted to do more. MSF’s aim is saving lives, and women are dying daily while giving birth in Sierra Leone. The child mortality rate is one of the highest in the world,” says Sandra Simons, Hospital management medical coordinator.

May 2019, a hospital with pediatric care containing 150 beds opened its doors.

Building up a medical workforce

Sierra Leone needs more doctors, midwives and nurses. The Kenema hospital will be a training hospital, providing health care and training local medical staff at the same time. Simultaneously, it will enable MSF workforce to prepare better for possible epidemic outbreaks in the future, as well as improve MSF’s hospital management and training skills.

“Upon opening, 350 staff will start working in the hospital, including 30 international staff. After a year, services will evolve from only pediatric to pediatric and maternal care and we would like to have over 500 personnel by then, of which 35 international staff,” says Sandra. “This means we are aiming to reduce the ratio of international staff versus local colleagues as the skills and autonomy of the latter improve.”

To kick-start the hospital, MSF is planning to hire international doctors and nurses with coaching and training skills or a keen interest in training. “We are looking for professionals in pediatrics, malnutrition, emergency room care or infection prevention and control. We are also in need of very specific management profiles for the Management team of the hospital with at least 3 years of experience in a management role,” adds Sandra. The hospital will provide all staff with learning opportunities but the mission could be emotionally heavy warns Sandra. “What I found the hardest when working in the field was dealing with needs far bigger than we could handle. To have to transfer children to another hospital or refuse them because all beds are full, this does not get easier no matter how many times you do it. Or worse: seeing children die, is very tough.”

Worrying conditions in Kenema region

Kenema was not a random choice of location. MSF was running a hospital in the nearby city of Bo when the Ebola epidemic started. It was a small hospital that was quickly set up and expanded afterwards. Unfortunately, MSF was forced to close it down because it was not possible to prevent infections and guarantee the safety of the staff. “The construction of this new hospital is well-planned, with a prepared design, solid construction materials and a long-term mindset,” according to Sandra.  

“We did not only pick Kenema as a location because Ebola struck hard there. Kenema is located in what we call the ‘Lassa belt’, where there is a high risk of Lassa fever, an acute and often fatal viral disease,” explains Sandra. Lassa fever symptoms are often confused with malaria, leading to a delay in diagnosis and therefore the right care.

Natassa, Hospital Management Human Resources Advisor, is equally convinced of the pertinence of the hospital in Kenema. “We want to contribute to improving pediatric and obstetric care. To reach this objective, we need to ensure availability of sufficient qualified health staff. Therefore, it is important to improve the competencies of the local health workforce through a complete training plan that will unfold gradually,” she states. “This long term approach of reducing Lassa victims and improving child- and maternal mortality through training of local staff is new to MSF but necessary to have a lasting impact in Sierra Leone.”

Comprehensive and continuous training programme for staff

All national hospital staff will receive pre-hospital training of 6 weeks before starting their job. Of course the training does not stop there. Everyone receives individual follow-up and personalized training given through mainly on-the-job training but also lectures, skills laboratory sessions (practical simulations) and self-education. “We call it continuous professional development in which we will follow up everyone individually and will enable them to develop their competencies,” says Natassa. The content of the training will vary from sterilization, Infection prevention and control, data management, laboratory skills, early recognition of lassa fever, etc.

International staff will receive a ‘training of trainers’ upon departure that will facilitate the on-site pre-hospital training for the national staff. They also receive a prepared curriculum and a training schedule.

For all medical and non-medical profiles, we are looking for people with a keen interest or experience in working in hospitals, in providing training and a willingness to leave on mission from 6 to 12 months. On our website you can find the general criteria and more information about the application process.

Medical & paramedical profiles

• Medical Doctors
• Pediatricians
• Nurses: pediatric nurses, nurses with experience in malnutrition, Emergency Room/Intensive Care Unit and Infection prevention and control. We are also looking for nurses with experience in managing wards.

Non-medical profiles

• Biomedical specialists
• Energy specialists (with a specialization in HVAC)
• Water, hygiene and sanitation engineers
• Laboratory technicians

Hospital management

We are in urgent need of a management team for the hospital, composed of hospital directors, medical directors, nursing directors, HR directors, and hospital facility directors.