Nursing Times blogger Katy Morgan on working in Sierra Leone for the Welbodi Partnership, a charity that supports the delivery of vital paediatric care
I work in a busy children’s emergency department in London and recently spent two months working in Sierra Leone. Emergency care is essentially the same, even though the illnesses and presentations may be different and the available resources to manage these emergencies are vastly different.
The nursing role in the London ED consists of assessing children and initiating treatment and care. One of the four staff on shift will be allocated to look after children brought to the resuscitation room. Usually, there is at least one emergency per shift but there can be more. As a resus team, we are normally able to treat and stabilise the patient and transfer them to the critical care unit or ward. Sadly, of course, we do see children who die, but this is relatively rare.
The department can be extremely busy with a steady stream of children day and night, keeping us on our feet for the full 12 hours of the shift. Not all of these children will be emergencies in the true sense of the word, but they will all be children who need to see a doctor that day and some will need admission to the hospital. However, the number of children who we as nurses would class as “real” emergencies in London is in stark contrast to the large numbers of extremely sick children that arrive each day in the ED in Freetown, Sierra Leone.
To compare the two is, in some ways, as if to compare two different worlds. Arriving at 8am in the ED at the children’s hospital in Freetown, it is not uncommon to see at least one small corpse wrapped up, awaiting transfer to the mortuary. The worst morning I can recall was when we walked in to see five tiny bodies lying there next to each other. One in five children in Sierra Leone do not reach their fifth birthday so, sadly, child death is a daily occurrence. Triage is separate from the ED which is a hot and sweaty environment with seven benches which can (and regularly do) fit three small children on each.
There is no anaesthetic support, defibrillators or ventilators should a child become so sick that they require one. The hospital does have a few oxygen concentrators which provide around five litres of oxygen per minute. The supply from each concentrator is almost always split into four so as to ensure that more children receive this simple but potentially life-saving intervention. This means, however, that they each receive only a very small amount. Had I been in the UK I would have given them oxygen at around 10-15 litres per minute. The nurses do have adrenaline and ambu-bags for resuscitation but even if they re-gain a pulse, without advanced life support there is sometimes very little that can be done. Families in Sierra Leone often try to manage their child’s illness at home, and it is not uncommon for parents to run into the ED with their child strapped to their back only to find the child has died on the way to the hospital. The combination of children arriving sicker, at a more advanced stage of illness, and a lack of facilities and resources to save them is an obvious factor in the hospital mortality rates. Compared with possibly one child per day (in London) being brought into the resuscitation room, the ED in Freetown can see one or two resuscitation attempts per shift and most of these are unsuccessful.
I think that, for me, perhaps the hardest thing was the lack of time, space and resources to allow a family to grieve. When a child dies in my ED in London, the family are given almost as much time as they want to hold their child or just sit with them, take locks of hair, even hand and foot-prints. All of this is done as privately as possible.
In the ED in Sierra Leone there are no screens to use to protect privacy and there is very little time to dedicate to try and explain what has happened. The child is swiftly wrapped in a sheet and the family can take them away or they are transferred to the mortuary. The nurses simply don’t have the time to spend with the family of a child that has died when they often have perhaps five or six other children who are close to death that they need to work to save. A paediatric emergency nurse’s job is not easy in the UK by any means, but we should never forget that we have the luxury of laboratories, blood banks (with blood in them), x-rays, scans, paediatric training - and whilst I’m sure we sometimes bemoan the lack of certain items, largely our patients’ conditions are not worsened by these problems.
I admire the Sierra Leonean nurses for their courage in continuing to come to work despite having to suffer the emotional distress of caring for so many dying children. I admire their skills in improvisation, keenness to learn, spirit and ability to laugh.
Of course, nursing practice is far from perfect and there are many improvements to be made, but this is also true here in the UK and the rest of the world. A nurse never stops learning!
About the author
Katy Morgan spent two months working with nurses and delivering training with the Welbodi Partnership in Sierra Leone, a charity that supports the delivery of vital paediatric care.
She has worked with Becky Cridford, another contributor to this blog. Becky is one of eight 2010 Vodafone Foundation World of Difference International winners. Applications for the World of Difference UK programme, delivered by the Vodafone Foundation, opened on 11 October. The programme gives 500 people across the UK the opportunity to work for their favourite charity for two months and be paid for their time. Applications close on 23 November. To find out more and to apply, visit www.vodafone.co.uk/worldofdifference