Hi. Today is Sunday, August 13th, 2023. This was the Ukweli 2023 team’s seventh full day in Sierra Leone.

Slow days are bound to happen when you are handling a big team project. These days are when your stamina as a group is tested. It is when your motivation that is typically natural is no longer apparent. Everyone could be frustrated and tired. Our Institutional Review Board is taking much longer than expected for approval. Keeping our fingers crossed and hoping for the best is getting a bit tough–yet it is during the emptiest days that our strength in creativity shines.

At breakfast, Professor Khanjan Mehta came to our table quietly. We could tell from the look on his face that something was frustrating him. He asked us if we wanted to hear the good or bad news first–how great. The good news was that the Sierra Leonean Institutional Review Board office had gotten back to us with some word–finally! The bad news was that they claimed our protocol was different from last year’s. This is a huge issue as we submitted our protocol under an amendment ($100), which is a less costly and busy update process, rather than a whole new study ($400). So from what we’ve heard, our study should have to be treated like a new protocol and not like an amendment. Paperwork, new cover letter, Lehigh’s verification, et cetera–do these things matter? Of course. But from the tone in Khanjan’s voice, and with a confirming nod from Lorraine Rwasoka, they knew what the barrier truly was: the bottom line is we have to pay more. 

Lorraine says this is Africa. This is what happens when you are engaging with a bureaucratic system. They will frustrate you and delay everything until you pay up. It is all about paying, paying, and more paying. You have to force your way through, often with dollars. This is what is always going to happen when trying to implement change. It is never going to be easy, but that is the whole point, right? It sustains uneven power structures, although the work we are pursuing is so wholly important for the health of Sierra Leoneans that the painful process evidences how all issues, from systemic health crises to poverty, are rooted in the extractive institutions of bureaucracy.

Nothing about this is not easy–but that is exactly why we are here. Slowly but surely, we will accomplish our goal because it was never meant to be easy. That is why our issues exist! Today evidenced how deep the systemic crises of a low-resource setting are at interplay–health, government, education, poverty, and all.

Today, Brooke Lee and Lorraine took an exciting journey and took us to Makamba Hospital alongside the Mothers of Sierra Leone documentary team. While we anxiously await research approval, they took the opportunity to explore the heart of a healthcare facility in a rural area. They get to engage with a healthcare professional, and grasp the essence of healthcare in this distinct environment, helping us understand the education and healthcare resources we can anticipate to hear about from our interviews.

The contrast between Makamba Hospital and the wealthier Holy Spirit Catholic Hospital was immediately apparent. Makamba’s three rooms spoke volumes: one was dedicated to nutrition and checkups, another was bustling with the presence of dedicated nurses, and a third was a haven for women’s health and childbirth. The sight of a bed equipped with leg stirrups in the women’s health room stood as a testament to the multifaceted care provided within these walls, often doing so much with not enough. Makeni has been a deep lesson in the privilege and luck we are afforded, simply to be born in a different setting. The hospital’s patient manager relied on a comprehensive booking system, emphasizing the importance of appointments. When the hospital is an uncharted journey for a new expectant mother, the compassionate nurses seamlessly guide them to the main general hospital. This procedural synergy ensures that every woman receives the care she requires, full of love.

In the central part of the building, there were a few benches that each team utilized as an opportunity to have a conversation and ask questions with the healthcare professional there. Her name was Sister Makbenti. Amidst the diverse questions raised by the Sickle Cell Education & Diagnostic team and the Mothers of Sierra Leone documentary team, our Ukweli 2023 team was focused on human papillomavirus A glance at the wall poster revealed a plethora of disease statistics, including human papillomavirus, which made the group hope that the hospital conduct testing. The hospital’s testing focus encompassed hemoglobin levels, human immunodeficiency virus, and urinary tract infections, surprising us with a poignant connection to our work.

The Ukweli Test Strips we created are utilized for testing at Makamba Hospital! This was a full-circle moment for us. It was so surreal to see all the years of hard work and dedication by each team member through the history of our project pay off and help women. Next Tuesday is antenatal day at Makamba. On this day, the nurses will demonstrate the application of Ukweli Test Strips. However, this timing might conflict with our research approval and interviews (hopefully).

Lorraine and Reeza got a chance to head to the market today, for Lorraine’s first experience. They said it was a busy Sunday! Sterling Salmini and Brooke were able to write the foundation of our eventual cervical cancer research publication. We began by outlining our abstract, going in depth to the background of the cervical cancer crisis in Sierra Leone, as well as the value that our quantitative and qualitative data will provide in forming effective education initiatives for low- and middle-income country governments and non-governmental organizations. They were able to get about seven pages in, which is a great start. We cannot wait to fill it with data.

The rest of the day was quite mundane. We went to dinner, saw a beautiful sunset, and had a long program-wide meeting tonight. The weather in Makeni tonight was lovely. It didn’t rain so much today, but it was still cool without being too cloudy. It’s the first night we can remember seeing a sunset this week! All the teams got an opportunity to give pitches of their project with a stakeholder audience in mind. Everyone had the opportunity to receive feedback on problems they are confronting, ways to present their value proposition stronger, and actionable steps to complete our goals. After that, we shared some drinks and played card games, having a great night and laughing. The nights make it all worth it!

Despite difficulty, today was a productive day to be grateful for. Reeza and Lorraine got to experience the excitement of the marketplace, Lorraine saw a Sierra Leonean hospital as well, and Sterling and Brooke made great progress on the cervical cancer research paper. We are hopeful to see what tomorrow holds, and if Khanjan and Professor Michael Kramp’s expedition to Freetown (that has a stop at the Institutional Review Board Office!) can get our research approval through. Fingers crossed, yet again. Regardless, tomorrow will be a great day!

Until next time, yours truly,

Ukweli 2023