NEWS & UPDATES
and ‘recipient’ assumptions about needs and response. The ideal is recipient-led, or at least co-development. However, the reality is often different. The donor has upfront time, resources and theoretical knowledge. The recipient may well have none of these. There are probably only a couple of hundred real decision makers and opinion formers in Sierra Leone and they’re trying to juggle multiple potential donors, methodologies and considerations. There is so much need they don’t want to say ‘no’ to anything, but they don’t have the information, resources or time to investigate, reflect and make considered judgements. Finally, the thinking and approaches of both sides are influenced by values, culture, politics and history. During our visit we obviously heard a lot about Ebola: the anthropological and community inputs to tackling the epidemic; the new focus on hygiene management and infection prevention and control; how the physical and human resources and systems developed as part of the response could be used to reverse the losses to Ebola; and to ‘build back better’. However, we also heard about the achievements despite Ebola: how the College of Medicine and Allied Health Sciences has continued to train and graduate health workers throughout the epidemic, the depth and aspiration of the Kings-Sierra Leone link, the commitment to resume postgraduate medical training across the four hospitals of the Freetown health complex, and the vision of the Welbodi partnership to reverse the status quo, where one in 21 mothers and one in eight infants die in childbirth. These initiatives directly complement
the royal colleges’ expertise in training and a recurrent theme from the clinicians we met during the assessment. There are two to three paediatricans and two to three obstetricians/gynaecologists in Sierra Leone and they all lamented that ‘they are old, trying their best but should be retired’. As is often the case, the need to develop all levels of the health sector has been deprioritised in favour of interventions focusing on lower cadres of health worker. So, there is no ‘next generation’ of medical leaders, and newly qualified doctors either stagnate and ‘teach themselves good and bad habits on the job’ or move outside the country to access postgraduate training in any specialism (irrespective of Sierra Leone’s needs and their interests, aptitude and commitment to the specialism concerned).
O&G November 2015
Princess Christian Maternity Hospital, Freetown: gathering statistics
Princess Christian Maternity Hospital, Freetown: the main equipment table in the labour ward It is very early days and we may not
produce the quick wins and outcomes that funders like, but we hope the royal colleges can help redress this gap and help develop the Sierra Leonean leadership of the future. Clinicians are needed who are able to support front-line workers, deliver and expand quality service provision and enhance robust health governance that will be better placed to meet the needs of Sierra Leone’s population and future global health security challenges. To find out how to get involved in the RCOG’s global health work, visit:
http://bit.ly/1RXY6cT
Rachel Cooper Rachel has been Director, Global Health at the RCOG since 2012. She was
a diplomat with the British Foreign Office for many years, including a posting to Freetown, Sierra Leone as Acting High Commissioner from 2008 to 2010. She has an MSc in Development Studies and is responsible for implementing the College’s global health strategy.
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