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'Triage consists of a few tables tucked under the stairs'

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Nursing Times blogger Becky Cridford on paediatric nursing in Sierra Leone

I can’t believe it’s time to write this blog again. Time is flying, but with so much that is new I still feel like I have only just arrived.

I have spent the last two weeks learning about the Ola During Children’s hospital and how it functions. To give you the tour, the hospital has two general wards, an isolation (measles) unit, nutrition centre, SCBU, triage, out-patients’ department (this is more like A&E majors), Emergency Room and an ICU.  I think it’s fair to say that not all of the departments are instantly recognisable to a UK nurse: the Emergency department has no monitors or defibrillators; triage consists of a few tables tucked under the stairs; the ICU usually has 2 children to a bed and at least 12 patients to each nurse.

Usually a patient arrives and is assessed in triage as belonging to one of three categories – emergency (immediate transfer to the ER), priority (seen in outpatients) or routine (sent to a primary health unit about 20 minutes away). Once seen patients can be admitted to one of the wards, the nutrition centre, or the ICU (distinguished from other wards by the presence of 3 oxygen concentrators). Neonates are seen in SCBU.  The hospital also has many of the usual auxiliary departments – xray department (almost ready to take xrays again), lab, blood bank, kitchen, laundry and three pharmacies and a playroom (often showing Bollywood films).

The hospital is extremely noisy, but it’s not the endless ringing of phones and alarming of pumps, monitors and bleepers that I have long learned to ignore. The noises here are almost entirely human, a constant hubbub of young and old, talking, ‘discussing’, singing (sometimes Bollywood), crying and screaming.  There is usually a small crowd outside the ER and ICU, boisterous with concern, frustration or bereavement. So it comes in shocking contrast to open the door and hear – or not to hear - the quiet of the children and parents inside. A whole octave of noise is suddenly missing. This is where the sickest children are treated and the first few times I went in there, I found myself staring at the floor. As soon as you do look, your instincts start to race – call a crash team, oxygen, monitor, vital signs, where is their chart? Fluids? Meds? Flying squad blood?  

Not all of this is available here so if I want to get through the year I must begin to adjust my response. Sadly, many more children die here than I am used to seeing in the UK. The reasons can be extremely complex and not all of them can be addressed through improvements to a health system. Despite this, lives are saved without many of the resources that we find so necessary and simultaneously take for granted.  If there were ever any doubt, the vital importance of good nursing care is obvious here, and many of the nurses show incredible commitment and resilience. I hope I have started to understand how to look up and to see not just what is lacking, but also what is here. The nurses’ work is certainly challenging, made more so by a lack of all sorts of resources, but it is very far from futile.

Becky Cridford is a nurse who is spending the next year working with The Welbodi Partnership in Sierra Leone, a charity that supports the delivery of vital paediatric care.

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