Working Towards Health and Equity in Sierra Leone

Rainbow kites in the shapes of fantastic creatures dangled from the ceiling on a late summer evening in Olympia. Space was limited in Traditions Café, and strangers struck up conversations as they crowded the small tables, each covered in unique, brightly colored cloths. The hot summer air did little to dampen the cacophony of friendly chatter. Though this scene took place in Olympia, Washington on Sept. 11, the people gathered there were united in support of a community nearly seven thousand miles away — Sierra Leone.

Mara Kardas-Nelson, the director of community-based programs for Partners in Health in Sierra Leone mingled with patrons, striking in her vibrant red patterned dress. When Kardas-Nelson took the small stage, she asked the audience to call out words or phrases that they might commonly associate with Sierra Leone. Tentatively, and then more rapidly, responses rung out: mud slides, civil war, Ebola, diamonds, poverty. The only positive association was The Refugee All Stars, a reggae band from Sierra Leone. Kardas-Nelson acknowledged that Sierra Leone has been war-torn and beset upon by natural disasters for a long time, but she emphasized the nation’s “incredible history of solidarity and leadership.”

In covering a brief history of Sierra Leone, Kardas-Nelson notes that freed slaves form the UK founded Freetown during the abolitionist movement. She summed up the nation’s history by stating that “Sierra Leone is a country that has had an incredible amount of oppression, but also an incredible amount of resistance.”

The main topic of Kardas-Nelson’s presentation was the organization Partners in Health (PIH), through which she is employed in Sierra Leone. PIH views “health care as an intricately political act” because they make the statement that all people are equally deserving of high quality medical care. To further this end, Partners in Health takes a “health system strengthening approach” that places them in high need areas for 20-25 years at a time. They are not a short-term emergency response organization, but they did respond to the Ebola crisis in Sierra Leone.

They differentiated themselves from other aid organizations by committing to stay in the area for 25 years, partnering with local clinics and Non-Governmental Organizations with the goal of creating a stable and equitable public health system.

According to Kardas-Nelson’s presentation, Partners in Health was founded by Paul Farmer, Ophelia Dahl, Jim Yong Kim and others in 1987. The organization is based in Boston, Mass. and has programs in 11 countries. During the Ebola outbreak, PIH moved to the Port Loko area to work alongside “dysfunctional government clinics,” Kardas-Nelson explained. Their first year consisted solely of Ebola response, but they have expanded their focus to a more holistic approach in the past two years.

A lack of coordination plagued the massive number of volunteers and organizations that flocked to Sierra Leone in the aftermath of the Ebola epidemic and tragic mudslides. Partners in Health sent several employees, including Kardas-Nelson, to work directly with the Ministry of Health to coordinate volunteer and aid efforts. Kardas-Nelson estimates that there are roughly 4000 Ebola survivors currently living in Sierra Leone. The long-term health effects of Ebola are largely unknown, which causes these survivors much uncertainty.

In Kardas-Nelson’s words, PIH strives to “provide immediate clinical care and community based care.” Their support of eye and vision exams has been crucial to Ebola survivors, who are more prone to infections that could lead to blindness if untreated. Partners in Health has also focused on community reintegration, noting that many people had their houses burned and possessions taken, placing them in a position where they require immediate financial support. Kardas-Nelson also hopes that her organization’s strengthening of the public health care system will lower Sierra Leone’s maternal mortality rate, which is currently the fifth highest in the world.

PIH’s community programs reach out to patients on a community level. Community health workers will encourage medical testing then meet with patients in their homes to talk about treatments and offer support. Both immune response and follow up rates in people reached through these programs has doubled in the three years PIH has been involved in Sierra Leone. Kardas-Nelson states strongly that PIH is different from other aid organizations because they view patients and communities holistically, striving to understand and rectify the individual and systemic forces that create vulnerability for the most marginalized in Sierra Leone.

Written by Jessica Varvil, Staff Writer

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