Professor Cheng joined us in Sierra Leone today! She landed early this morning with a few other advisors and students from other teams. Thankfully, everyone’s luggage arrived safe and sound. The whole team started the day at World Hope and then went to three clinics to continue interviewing.
Our first clinic visit was to Masomgbo PHU where we interviewed a nurse. She was one out of 16 others at the facility. She stated that sickle cell disease was a problem in the bone marrow that complicates blood flow and causes patients to feel bone pain. She emphasized that people come in with bone pain every day, but noted that it could be from other illnesses such as arthritis. The nurse said she receives a lot of patients with sickle cell, and she just saw a pregnant woman yesterday who she suspects to have the disease. The pregnant woman was experiencing severe bone pain but cannot be confirmed to have the disease because the diagnosis would only be by symptoms. The nurse gave her amoxicillin and told her to return the next day but the woman did not. The nurse also told us she treats individuals with sickle cell with a cold treatment, which is keeping an individual cool by tying ice packs around them. However, she knows that that treatment only temporarily relieves the pain. People come to this clinic from 17 attached villages and since it is government-run, pregnant women and children under 5 receive free treatment. The clinic vaccinates every day except Sunday and a baby is required to have its vaccination on day 1 before they are allowed to leave.
We also learned that every clinic will have a map of the nearby villages and other healthcare units along with a weekly schedule.
Our second clinic visit was to Kunsho CHC, where we started with a tour of the maternal unit. There was a counseling room for pregnant mothers and family planning. Further into the facility were 3 delivery beds and 3 postnatal beds. There was also an autoclave for sterilization – the first one we have seen since arriving. The clinic had a total of 6 staff.
We had the opportunity to interview Nurse Adame Kanu, who primarily works with pregnant women and performs deliveries. In this clinic, Wednesday is the designated day for providing care to pregnant women but Adame mentioned they come in nearly every day. She also stated that the clinic can treat most complications but patients with more severe issues are referred to Makeni General Hospital. Examples of these problems include a breech presentation at birth, severe bleeding or anemia, or cases of pneumonia. Using the word ‘anemia’ sparked our interest, but the nurse had little to no knowledge of sickle cell disease. She didn’t believe the disease was a problem in her community and said there was no way to test. Adame also knew about bone pain and mentioned patients come in with it but these patients normally test positive for malaria. This was the first time we had heard that bone pain was a symptom of malaria and it is something important we will note and ask about in future interviews.
We also asked Adame about vaccine days, which are held every Friday at this clinic. She informed us that the vaccines for children under 5 were free and that it was not hard to acquire the vaccines from Makeni. She mentioned that 20 to 30 children were vaccinated a week. This high number is likely due to the clinic’s outreach program which includes nurses going out into more rural communities to teach about the importance of vaccines and information regarding breastfeeding. This outreach program, along with a well-set-up vaccination day, seems like a very good system for our device to be implemented into.
After interviewing the nurse, we went to talk to the Community Health Officer (CHO) about his perceptions of sickle cell disease. He was familiar with the illness but mainly discussed it in regards to the bone marrow. Before even mentioning our device, he talked about how important a similar device would be. He was very happy to hear that we were working on it. When asked if people in the community knew of sickle cell, he seemed less sure. He mentioned that it is likely many people have the disease, but either doesn’t know or dismiss the signs as something else. This problem is especially prevalent in rural areas that are further from the clinic. However, the outreach program, utilizing our device, could help combat this health gap that exists.
The last clinic we visited was Yoni CHP. We were able to interview a nurse and ask her a few questions that were relevant to our study. She stated that sickle cell disease is normally detected when someone feels their bone or joint and these individuals lose blood very quickly. The clinic does not diagnose or treat people with sickle cell disease and they are usually referred to general hospitals. However, they can provide care for patients that come in for malaria, typhoid, cold along with some other health concerns. We also began to start asking questions about the symptoms of malaria. She stated high or frequent fever were common signs and occasionally people with malaria will also feel bone pain. When individuals come in with these symptoms, they will perform a rapid diagnostics test for malaria. She stated around 500 patients come in a month for bone pain but they do not all test positive for malaria. This means some patients could be coming in with sickle cell disease
The biggest takeaway we had was her personal experience with sickle cell disease. Although she was a nurse, she was never taught about the disease. All her knowledge came from her brother since he has the illness. She noticed he would frequently experience pain in his bones and joints and he was never in good health. The worst symptoms would be losing blood, and he would have to go to the hospital to receive blood. He has gone a total of 3 times.
Since the interview was mainly in Krio, we had some difficulties asking insightful follow-up questions. We also didn’t realize she talked about her brother until we translated the interview later. In the future, we will make sure to let Sulaimon inform us if someone mentions a personal experience. We also hope to get in touch with her again to ask some more clarifying questions.
