Dan Kelly examines Kaikai at the Mobile Kono Medical Clinic. Once a month, an amputee family from one of the amputee camps in the Kono area loans his home to the National Organization for Welbody (NOW) for use as a mobile clinic. Dr. Barrie brings medical
© Sarah Bones/Global Action Foundation 2007
As the sun rose across the diamond-mining district of West Africa’s Sierra Leone, Suma awoke worried about his son. All night 8 year-old Kaikai had been breathing rapidly and unable to sleep. Kaikai’s options stood bleak after 2 weeks in Kono Government District Hospital without improvement. In despair, Suma flipped on the UN radio. The news levied moderate distraction. Thoughts drifted to his farm – to his family – to his… The radio caught his attention. “…Today, Saturday, March 24th, a mobile health clinic will be held at Kuyo Amputee & War-Wounded Community…” Suma lurched from his seat and left assuring his son. At eleven o’clock in the morning, Suma and Kaikai arrived to an overwhelmed clinic on foot.
After attending twenty-two patients, Dr. Mohamed B. Barrie, a Sierra Leone medical graduate, and Dan Kelly, a fourth year American medical student and founder of The Global Action Foundation (GAF), took a break in the unbearably hot outside waiting room to estimate the remaining patients. “Ten… twenty… thirty… forty… fifty… and they are still coming,” said Dr. Barrie. Dan responded, “Typical but we have that groundbreaking ceremony at two in the afternoon.” “Let’s get to work, man,” commented Dr. Barrie.
As they passed registration, Suma held Kaikai while providing routine details. Noticing quick and heavy breathing, Dr. Barrie and Dan ushered Kaikai inside. After the history, exam, and some discussion, Dr. Barrie told Suma, “Your son may have a serious lung infection and an abdominal problem requiring surgery, but we need to do further investigations.” Suma nodded silently. “We want to send Kaikai to the hospital where we work,” Dan announced. “Our organization will pay for his hospital bill and transportation costs.” After some emergency therapies, Suma left with Kaikai. A six-hour journey on public transportation lay in front of them. The time was eleven-thirty in the morning.
“Eighty-two patients today and one hundred one yesterday,” Dan reported en-route to the groundbreaking of GAF’s Kono Health Clinic. Chief Kamanda, administrative head for local government, led the ceremony as chairman during which he admitted some initial reservations.
“If I knew that you were going to do such great work for those amputated in the war, I would not have given you such awkward land. In appreciation, I hereby gift you with ten additional acres of flat land,” announced Chief Kamanda amidst thunderous applause from the amputees.
The ceremony climaxed with honored guest, Dan’s father, John P. Kelly, striking the first pickaxe into the ground. “This pickaxe represents our hard work and dedication to providing free health services to the amputees here in Kono,” concluded Dan.
The Amputee and War-Wounded Organization is a vulnerable group of citizens who suffered some permanent or partial disability by the loss of one or more limbs during the eleven-year rebel war. As a provisional remedy for amputee health problems, Dr. Barrie and Dan started a monthly mobile clinic in the Kono amputee and war-wounded communities and run it with the help of one nurse and their logistics officer.
That night Dr. Barrie phoned the on-call pediatrician to inquire about Kaikai’s arrival and prevailing condition. “Kaikai arrived near death with impending respiratory failure. Fortunately, his right lung was tapped, and one-liter of fluid was drained. It seems that he has tuberculosis,” reported Dr. Barrie to the concerned group.
Dr. Barrie and Dan returned to the Mabesseneh Hospital and conducted more investigations, including a screening for severe malnutrition. “Tuberculosis causes wasting and, in children, wasting can be an indication of severe malnutrition,” Dr. Barrie explained. Dan continued the dialogue, “Kaikai is emaciated, we were shocked to find from his nutrition screening that he is underweight – not severely malnourished. This distinction,” he said, “means we will not have to enroll Kaikai into the malnutrition eradication program we partner with UNICEF.”
Meanwhile, dring the course of these events with the young boy, Dr. Barrie and Dan spent their days coordinating and teaching women trainers at a workshop co-sponsored by GAF and UNICEF. Dr. Jalloh, President of Sierra Leone’s International Red Cross, chaired the workshop and opened with some pertinent remarks, “Nutrition is an issue that diffuses across all Ministries, so it is of utmost importance we work together to tackle one of Sierra Leone’s greatest problems.” The workshop formally launched GAF’s Malnutrition Eradication Program in Port Loko District through the community-based approach of empowering mothers.
On the evening of the workshop’s day one, Dan took sick with malaria. He recuperated enough to return day three and taught a class on pediatric HIV/AIDS. “Having malaria was an unexpected first for me,” Dan confided to his colleague, Dr. Barrie. “It was much worse than I expected. However, I now consider my year-long experience in Africa complete and understand why it is the number one killer of children in Sierra Leone.”
Over the three-day workshop, attending women were trained about the effects of severe malnutrition and also about public health interventions critical to a child’s survival until age five. Examples of these interventions include vitamin A supplementation, exclusive breastfeeding, and testing salt for iodine. After each day, Dr. Barrie’s responsibilities continued at the hospital. He tended patients in the evenings and remained on-duty overnight.
Traveling to the workshop for the final day, Dan noted Dr. Barrie’s red eyes and asked, “How was the night?” Dr. Barrie sighed noting, “Well, there was a caesarean section at one-thirty in the morning and then, at three-thirty, I lost a patient to malaria.” “Rough night, I’m sorry,” Dan responded sympathetically even though he knew this was a rather common night.
During this time, Kaikai’s condition improved marginally. He told Suma, “Generally it takes about two weeks for patients with tuberculosis to display modest improvement. Kaikai will remain in the hospital for the next month under observation and we will continue his medications for six months,” stated Dr. Barrie.
At the workshop’s conclusion, Dr. Barrie addressed interested parties eager to hear his assessment of what was accomplished. “These women inspire me. From their motivation, they created and sang us a song in their tribal language of Temne about testing salt for iodine. Today these women will return to their communities. They will hold initial public gatherings near each health center in order to report on their experience and future work.
“Then, they will train other women who will visit each house in the district in order to educate mothers about severe malnutrition and other child survival interventions. If a child is identified as severely malnourished, they will be referred to the health center. At that point, the staff calls the transportation team from GAF’s Malnutrition Treatment Center. Everything, including treatment, is free for the family.”
After the workshop ended, Dr. Barrie and Dan followed two women back to their chiefdom. On his return Dan to the local GAF office, Dan reported about the events that ensued. “We needed to take a canoe to travel one of the remote health centers in their region. When we arrived, I was overwhelmed with the community response. Over one hundred mothers with their children, plus others, came to listen to the trainer’s report. After perusing the crowd, I spotted at least seven severely malnourished children in one health center area. They will be treated and restored to good health.” GAF is responsible for ninety-two areas. This represents a major undertaking but, to Dan and Dr. Barrie, it is worth every moment of they give to it.
They will face many challenges in the future, but Kaikai will not be one of those. Kaikai’s life was saved at the Kono mobile clinic. Sarah Bones, a renowned photo journalist on assignment in Sierra Leone, reminisces, “I remember when Suma arrived with Kaikai. He looked angry in every picture. When I next saw him at the hospital, Suma appeared a different man – quite easily the happiest person at the hospital.”