Day 12 we went to three different types of health facilities: two private clinics, a public clinic, and a pharmacy. Branda Hospital was our first stop, and there we interviewed the head doctor and a nurse. The head doctor informed us of the logistics of the hospital and informed us that it was self funded. An outside donor funded the construction, but since then they have maintained the hospital. They were the only facility with an eye speciality center in the surrounding area. The doctor we interviewed had a well rounded education and knew the specifics of SCD so he was able to express his delight for the future implementation of our device. Our second stop was the Makeni old government hospital. There, we were also fortunate enough to talk to two people. We talked to the nurse and a patient in parallel. The head nurse we talked to had a basic understanding of sickle cell disease and said that her clinic does not receive sickle cell patients too often. She stated how most patients they receive are pregnant or lactating mothers and children under the age of five. They conduct family planning and antenatal care services. She supported our venture and stressed the need for our device to save children from dying in her own words. Coincidentally, the patient we talked to was not only a pregnant patient, but also a nurse and had sickle cell. She was at the clinic that day because she was having significant pain in her back due to the combination of sickle cell and being pregnant. She was diagnosed as a child, and moved from a village outside the city of Makeni to continue her schooling and receive better care for the disease. She felt pain mostly from ages 0 to 12, and since then has only had significant issues when pregnant. Serious pain during pregnancy is common among most sickle cell mothers that we have talked to in the past. Some say there are days where they cannot walk. Even though this particular patient hasn’t had pain since she was young, she has continued to take medication such as b co and folic acid everyday. Our third stop was to Poor Mans Pharmacy in the marketplace to get some more answers on different kinds of medication drug retail stores have available for sickle cell disease or bone pain in general. The employees we talked to showed us some common medications they prescribe for bone pain, such as B-co syrup and folic acid. They appreciated our venture and stressed the need for greater awareness on sickle cell, suggesting that more specialized sickle cell centers and developing sites should be developed.
At the police PHU we talked to the head of the PHU who is also the police chief and two nurses who are also officers. One of the nurses told us about her niece who had significant pain due to sickle cell. She moved to Freetown, where there is better treatment for sickle cell. We hear about people going to Freetown for treatment or even uprooting their family and leaving behind other family or friends because there isn’t proper treatment available in areas such as Makeni.
On Day 13th, our whole team trekked out to two private hospitals, Arab Muslim Agency Hospital (DirectAid) and Kalpat Medical Center. At the Arab Muslim Agency Hospital, a few of our team members met with the lab technician, and the others interviewed some members of the community at the facility, including a patient, a friend of a patient, as well as secretary/head of registrations. The lab technician showed Kathleen, Aiden, Anjali, and Professor Cheng his laboratory; the space had a microscope, electronic centrifuge, test tubes, some reagents, and other materials. The lab offers rapid tests for malaria, HIV, syphilis, as well as the sickling test. The lab in this facility often runs out of reagents, sickling powder, and a scale for measurements. Due to this challenge, they often refer patients to be tested for sickle cell disease at the government hospital. In some instances, the government hospital prepares the sickling reagent and brings it to the Arab Muslim Agency hospital for use. The lab technician had a very good understanding of sickle cell disease, explaining it as a disease that affects the blood and is caused by red blood cells that lose their normal shape. He was also aware of the sickle cell trait, as he mentioned that the sickling test does not show whether the patient has the trait. He also informed us that there is a specific sickle cell disease day featured on the radio, based in Freetown and Makeni. While this program exists, he mentioned that many people lack an awareness and understanding of sickle cell disease in the community. We also learned that the lab technician has worked with World Hope International!
Alice, Katie, and Lauryn talked to three others at the Arab Muslim Agency Hospital. The first interview was with a friend of a patient who had come for ongoing care for liver disease. They come once a month to this facility for treatment. The woman we interviewed knew someone closely who had SCD and informed us that she was on daily medication. The next person we interviewed was a man at the registration desk. He informed us of the day to day at the clinic. He told us they cannot treat or test for many things right now and often end up referring patients to the government hospital. He was familiar with SCD and mentioned that they see patients every now and then with the disease. The last person we talked to was a patient of the clinic and was there because she was feeling sick. She knew of SCD but only knew one person in her community who had it. She told us she preferred attending this private hospital instead of closer government clinics to ensure proper care. These three conversations were insightful, specifically to how this clinic was run.
At Kalpat Medical center, Anjali, Lauryn, and Kathleen talked with a manager of the facility with medical training named Anthony, as well as a patient and relative of a patient. The facility is new, having just opened in November 2021. Anthony had an excellent understanding of sickle cell disease, and he stressed the importance of raising awareness about it in the Sierra Leone communities. He explained the disease as a genetic or inherited disorder causing the red blood cells to have a sickled shape, and he was also aware of the sickle cell trait. He stated that symptoms from sickle cell disease include serious bone pain crises, leg ulcers, protruding abdomen, spleen problems, losing weight easily, stunted growth, greater difficulty of normal delivery during pregnancy, as well as greater vulnerability to the cold during the rainy season and susceptibility to malaria. Through the explanation of these types of symptoms, medical practitioners will prescribe a sickling test. The facility offers folic acid, pain medications, and antimalarial drugs for sickle cell patients. In terms of medicine supply, Kalpat receives drugs from the UK, US, India, and local markets. Because the facility is new, they have yet to receive many sickle cell patients. There is currently only one sickle cell patient in their outpatient clinic. Overall, Anthony advocated for the need for more centers specialized for sickle cell diagnosis and treatment, as well as more education programs about the disease and importance of family planning for those with the trait or disease.
Alice, Katie and Aiden talked to two people at Kalpat Medical center: the cleaner and a relative of a patient. The cleaner informed us that this hospital is one of the best and people come from areas as far as Freetown to get the care of the senior doctor here. She gave us a tour of the hospital and it was one of the cleanest that we’ve seen and has running water which is rare among clinics here. As we were walking outside we ran into a girl who was a relative of a patient at the clinic and asked if we could ask her a few questions as well. We found out that she was there to check on her great grandma who had been staying at the hospital for a few days. When we asked her about her knowledge of sickle cell, she said that she had a childhood best friend who had died from the disease at age 17. Her friend had no family with sickle cell and took medication daily before school which was able to ward off the bone pain until later in the evening. The girl also informed us that she wants to go into medicine, which we assumed was a result of having such a close relationship with someone who passed away from chronic illness.
