Wednesday, February 25, 2009

Sierra Leone: 'Poorest health sector in West Africa'

Freetown (Sierra Leone) - Sierra Leone's President Ernest Bai Koroma has said his country has the poorest health facilities and health service delivery in the West African sub region.
Speaking at the opening of the week-long 48th annual conference of West Africa College of Surgeons (WACS) at the Miatta Conference Centre, Mr. Koroma said the UNDP human development index ranked the country as one of those with the highest incidence of infant and maternal mortality in the world. According to available statistics, Sierra Leone can only boast of about 60 medical doctors.

President Koroma said the challenge was for his government to transform the entire health sector in the country to ensure better service delivery, adding: "My government is determined to address the poor health condition in the country because, when conditions improved, it will encourage medics to stay home and serve their people.'' To demonstrate his commitment toward the improvement of the situation, the President said his government would allocate a piece of land to the college to enable it build an institution that would cater for the training of surgeons locally as well as create facilities for other sub-regional specialists.



Hundreds of medical doctors from the sub-region are attending the conference. Chairman of the conference's Local Organizing Committee, Dr. Len Gordon Harris, described it as an annual rotational event.In his address, Sierra Leone's Health Minister, Dr. Socco Kabia, described Sierra Leone's health problem as "serious health service delivery constraints'' and blamed the 10-year civil war for the state of the country's health sector.
http://www.health.sl/drwebsite/uploads/high-table.jpg

Earlier, President of the West Africa College of Surgeons, Prof. E. Alihonou, said Sierra Leoneans had been giving valuable contributions to the college since its inception. He said the college was charged with the responsibility of organising seminars, conducting examinations, researches and training programmes for its members.
Farma health services June 10, 2008

COUNTRY DESCRIPTION: Sierra Leone is a developing country in western Africa still recovering from a ten-year civil war that ended in 2002. English is the official language, but Krio, an English-based language, is widely used. Tourist facilities in the capital, Freetown, are limited; elsewhere, they are rudimentary or nonexistent. Read the Department of State Background Notes on Sierra Leone for additional information.
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ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visitors are strongly encouraged to obtain visas in advance of travel to Sierra Leone. Visitors to Sierra Leone are required to show International Certificates of Vaccination (yellow card) upon arrival at the airport with a record of vaccination against yellow fever. The Embassy of Sierra Leone is located at 1701 19th Street NW, Washington, DC 20009; telephone (202) 939-9261. Information may also be obtained from the Sierra Leonean Mission to the United Nations, 245 East 49th St., New York, NY 10017, telephone (212) 688-1656; and from the website of the Sierra Leonean High Commission in London at http://www.slhc-uk.org.uk/. Overseas, inquiries should be made at the nearest Sierra Leonean embassy or consulate. Visit the Embassy of Sierra Leone’s web site at http://www.embassyofsierraleone.org/ for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
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SAFETY AND SECURITY: Security in Sierra Leone has improved significantly since the end of the civil war in 2002. The United Nations Peacekeeping Mission in Sierra Leone (UNAMSIL) withdrew in December 2005 and Sierra Leone resumed responsibilities for its own security. The Sierra Leonean police are working to improve their professionalism and capabilities, but fall short of American standards in response time, communications, and specialty skills. Areas outside Freetown lack most basic services. Embassy employees are free to travel throughout Sierra Leone. Travelers are urged to exercise caution, however, especially when traveling beyond the capital. Road conditions are hazardous and serious vehicle accidents are common. Emergency response to vehicular and other accidents ranges from slow to nonexistent.There are occasional unauthorized, possibly armed, roadblocks outside Freetown, where travelers might be asked to pay a small amount of money to the personnel manning the roadblock. Because many Sierra Leoneans do not speak English, especially outside of Freetown, it can be difficult for foreigners to communicate their identity. Public demonstrations are rare but can turn violent. U.S. citizens should are advised to avoid large crowds, political rallies, and street demonstrations, and maintain security awareness at all times.For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
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CRIME: Entrenched poverty in Sierra Leone has led to criminality. Visitors and resident Americans have experienced armed mugging, assault and burglary. Petty crime and pick pocketing of wallets, cell phones, and passports are very common especially on the ferry to and from Lungi International Airport. Law enforcement authorities usually respond to crimes slowly, if at all. Police investigative response is often incomplete and don’t provide support to victims. Inefficiency and corruption is a serious problem at all levels within the government of Sierra Leone. Americans traveling to or residing in Sierra Leone should maintain a heightened sense of awareness of their surroundings to help avoid becoming the victims of crime.Upon arrival in Sierra Leone, U.S. citizens are urged to register at the Embassy in Freetown (see Registration/Embassy Location section below) where they may obtain current safety information and advice on minimizing risks.The Embassy receives regular reports from potential American investors who have been victims of fraud, often in the mining industry. While law enforcement authorities have been involved in investigating the cases, many remain unresolved. Investors are urged to proceed cautiously when engaging in business transactions with individuals presenting themselves as legitimate diamond/gold dealers. It is not uncommon for registered diamond/gold dealers to target foreigners using sophisticated scams resulting in significant financial loss.Business fraud is rampant and the perpetrators often target foreigners, including Americans. Schemes previously associated with Nigeria are now prevalent throughout West Africa, including Sierra Leone, and pose a danger of grave financial loss. Typically these scams begin with unsolicited communication (usually e-mails) from strangers who promise quick financial gain, often by transferring large sums of money or valuables out of the country, but then require a series of "advance fees" to be paid, such as fees for legal documents or taxes. Of course, the final payoff does not exist; the purpose of the scam is simply to collect the advance fees. A common variation is the scammer’s claim to be a refugee or émigré of a prominent West African family, or a relative of a present or former political leader who needs assistance in transferring large sums of cash. Still other variations appear to be legitimate business deals that require advance payments on contracts. Sometimes victims are convinced to provide bank account and credit card information and financial authorization that drains their accounts, incurs large debts against their credit, and takes their life savings.The best way to avoid becoming a victim of advance-fee fraud is common sense – if a proposition looks too good to be true, it probably is. You should carefully check and research any unsolicited business proposal before committing any funds, providing any goods or services, or undertaking any travel. It is virtually impossible to recover money lost through these scams. Please see the Department of State’s brochure on International Financial Scams for more information.
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INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.
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MEDICAL FACILITIES AND HEALTH INFORMATION: Quality and comprehensive medical services are very limited in Freetown, and are almost nonexistent for all but most minor treatment outside of the capital. Persons with unstable chronic medical conditions that require on-going medical treatment or medications are discouraged from traveling to Sierra Leone. Medicines are in short supply and due to inadequate diagnostic equipment, lack of medical resources and limited medical specialty personnel, complex diagnosis and treatment are unavailable. The quality of medications in Sierra Leone is inconsistent and counterfeit drugs remain a problem. Local pharmacies are generally unreliable. In the event medications are needed, such as over-the-counter medication, antibiotics, allergy remedies, or malaria prophylaxis, travelers may contact U.S. Embassy Health Unit personnel to receive general information about reliable pharmacies.Medical facilities in Sierra Leone are scarce and for the most part sub-standard; outside the capital, standards are even lower. There is no ambulance service in Sierra Leone, trauma care is extremely limited, and local hospitals should only be used in the event of an extreme medical emergency. Many primary health care workers, especially in rural areas, lack adequate professional training. Instances of misdiagnosis, improper treatment, and the administration of improper drugs have been reported. Life-threatening emergencies often require evacuation by air ambulance at the patient's expense. For a list of hospitals, visit our web site at http://freetown.usembassy.gov/. Gastrointestinal diseases and malaria pose serious risk to travelers in Sierra Leone. For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://www.cdc.gov/malaria/.Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.
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MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
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TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Sierra Leone is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Most main roads in Freetown are narrow and paved but have potholes; extremely narrow unpaved side streets are generally navigable. Most roads outside Freetown are unpaved and are generally passable with a 4-wheel drive vehicle. However, certain stretches of mapped road are often impassable during the rainy season, which usually lasts from May to September. During the rainy season, add several hours to travel time between Freetown and outlying areas. There is a major road repair and resurfacing program going on throughout the country that is slowly improving the quality of roads. Public transport (bus or group taxi) is erratic, unsafe, and not recommended. U.S. government employees are prohibited from using public transportation except for taxis that operate in conjunction with an approved hotel and that are rented on a daily basis.Many vehicles on the road in Sierra Leone are unsafe and accidents resulting from the poor condition of these vehicles, including multi-vehicle accidents, are common. Many drivers on the road in Sierra Leone are inexperienced and often drive without proper license or training. Serious accidents are common, especially outside of Freetown, where the relative lack of traffic allows for greater speeds. The chance of being involved in an accident increases greatly when traveling at night, and Embassy officials are not authorized to travel outside of major cities after dark.Please refer to our Road Safety page for more information.
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AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Sierra Leone, the U.S. Federal Aviation Administration (FAA) has not assessed Sierra Leone’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa. It is not uncommon for regional airlines to alter scheduled stops, cancel or postpone flights on short notice, and overbook flights. Travelers may experience unexpected delays even after checking in and must be prepared to handle alternate ticketing and/or increased food and lodging expenses. European carriers are typically more reliable. American citizens departing Lungi International Airport have reported incidents of attempted extortion by officials claiming that travel documents were not in order. Luggage can often be lost or pilfered.
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SPECIAL CIRCUMSTANCES: Lungi Airport is located across a large body of water from Freetown. There are usually four travel options to/from Lungi airport: helicopter, ferry, hovercraft and by road. While none is without risk, all are used by Embassy personnel. The cost for the ferry service is minimal; however, the service experiences frequent delays, and the ferry terminal is located in East Freetown, which has a higher crime rate than other parts of the capital. When the hovercraft and helicopter services are operating, they charge approximately $50-70 each way (payable in U.S. currency). Passengers departing Freetown by air should expect to pay an airport tax of $40.00 (payable in U.S. Dollars). Sierra Leone is a cash economy. However, an anti-money laundering law passed in July 2005 prohibits importing more than $10,000 in cash except through a financial institution. Travelers are advised not to use credit cards in Sierra Leone because very few facilities accept them and there is a serious risk that using a card will lead to the number being stolen for use in fraudulent transactions. There are no ATMs connected to international networks. Travelers' checks are not usually accepted as payment; however, they can be cashed at some banks including Sierra Leone Commercial Bank, Standard Chartered Bank and Rokel Commercial Bank. The traveler must have proof of identification and a signed receipt by the institution where the travelers’ checks were purchased. Currency exchanges should be handled through a bank or established foreign exchange bureau. Exchanging money with street vendors is dangerous because criminals may "mark" such people for future attack and there is the risk of receiving counterfeit currency.Sierra Leone's customs authorities enforce strict regulations concerning the export of gems and precious minerals, such as diamonds and gold. All mineral resources, including gold and diamonds, belong to the State and only the government of Sierra Leone can issue mining and export licenses. The legal authority for the issuance of licenses is vested in the Ministry of Mines and Mineral Resources. Failure to comply with relevant legislation can lead to serious criminal penalties. For further information on mining activities in Sierra Leone, contact the Ministry of Mines and Mineral Resources: The Director of Mines, Ministry of Mines and Mineral Resources, Fifth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone; tel. (232-22) 240-420 or 240-176; fax (232-22) 240-574.Corruption is a problem in Sierra Leone. Travelers requesting service from government officials at any level may be asked for bribes. Corrupt government officials should be reported to the Anti-Corruption Commission at one of the following locations: The Sierra Leone Anti-Corruption Commission, 3 Gloucester Street, Freetown; 14a Lightfoot Boston Street, Freetown; 37 Kissy Town Road, Bo, Southern Province; Independence Square, Rogbaneh Road, Makeni; tel. (232- 22) 229-984 or 227-100 or 221-701; fax (232-22) 221-900; email: acc@sierratel.sl or info@anticorruption.sl, the web site for the Anti Corruption Commission in Sierra Leone at http://www.anticorruptionsl.org/anonymous.html.Travelers must obtain official permission to photograph government buildings, airports, bridges, or official facilities including the Special Court for Sierra Leone and the United States Embassy. Areas where photography is prohibited may not be clearly marked or defined. People sometimes do not want to be photographed for religious reasons or may want to be paid for posing. Photographers should ask permission before taking someone’s picture.U.S. citizens who are also Sierra Leonean nationals must provide proof of payment of taxes on revenues earned in Sierra Leone before being granted clearance to depart the country. The Government of Sierra Leone now recognizes dual U.S.-Sierra Leonean citizenship. However; the U.S. Embassy may have difficulty assisting American citizens involved in legal or criminal proceedings if they entered the country on a Sierra Leonean passport. Please see our Customs Information.
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CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Sierra Leone laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Sierra Leone are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.
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CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

Farma Health Services In Kono District

Main Office: Kono District

Eight years of civil war has displaced and affected 2.2 million people out of the 4.4 million total population of Sierra Leone, as well as disrupted an already deficient health system. The entire population is at risk of major diseases, particularly malaria, acute respiratory infections and malnutrition. Immunization coverage has seen a significant decline in the last decade, from 75 per cent in 1990 to 40 per cent in 1999, while measles and cholera outbreaks are prevalent. Several cases of tuberculosis have been confirmed and sporadic cases of neonatal tetanus have emerged. Sierra Leone has the highest maternal mortality rate in the world, with 1,800 deaths per 100,000 births (according to 1996 estimates)
In January 2000, an outbreak of bloody diarrhea caused by shigella dysentery affected various areas and threatened to evolve into a regional outbreak. Another devastating consequence of war is the dramatic increase in amputations and mutilation of innocent civilians, including women and children. It is estimated that there are more than 1,000 people with lower or upper limbs amputated. The nutritional status of the population has been on the decline in the past two decades and the current humanitarian crisis has exacerbated an already deteriorated situation. The magnitude of the problem of micronutrient deficiency also shows a high proportion of anaemia among pregnant women and children under five. Death and migration of trained health staff, combined with insecurity and not affordable costs of medical services, added a further complication, drastically reducing accessibility to primary health care services.

WHO support to Sierra Leone has an emergency focus, but includes a significant relief and rehabilitation component aimed at recovery of war‑damaged health facilities and services and care for displaced populations. In this context, WHO has been involved in the development of a district health system. WHO is also working increasingly with non-governmental organizations.

WHO=s main activities in Sierra Leone include:
- health situation assessments (disease burden, logistics planning, manpower and facility planning);
- support to surveillance and control of specific disease problems (cholera, Lassa fever, meningitis, malaria, HIV/AIDS and other epidemic‑prone diseases);
- polio eradication (including acute flaccid paralysis surveillance), as part of the national eradication programme, in difficult or inaccessible areas;
- re‑establishment of district health management teams under the supervision of district medical officers;
- focused delivery of emergency drugs and supplies in areas of critical need

TB is a Serious Public Health problem in our Country

The Programme Manager of the National Leprosy and Tuberculosis Programme Sierra Leone, Dr Foday Dafae including Farma Health Services Manager Mr.P.S.Farma has disclosed at press briefing last Friday, March 21st, that Tuberculosis (TB) is a massive global health problem which kills 2 million people yearly and 9 million new cases detected.



Mr. Dafae was speaking ahead of the World TB day which was slated for Monday, March 24th with the Theme: I Am Stopping TB. Giving a brief background about the diseases Mr. Dafae said TB was discovered by Dr. Robert Koch. At that time the discovery of the bacteria that causes tuberculosis astounded scientists the world over.

Mr.Farma warned that TB is an air borne disease that is transferable from one person to another. Describing how the disease transfers, he said that people with TB infected pulmonary (lung) transfer it to other persons when they cough, sneeze or spit in the open. Mr.Farma stressed that to become infected one can only inhale few of those micro-organisms. A TB infected person does not necessarily feel ill; he noted and added that if the person’s immunity is low, the disease might progress into further attacking the lungs and other organs, which subsequently can be fatal if not treated.

However, the National Leprosy/Tuberculosis programme statistics recorded the following registered new cases during the years 2004 - 2007

2004: 5,863
2005: 6,930
2006: 8,208
2007: 9,623

Health workers in Sierra Leone have observed that the estimated figures are far more than the total number of infected persons nationwide.

TB most time kills people in Sierra Leone where there are not medical facilities to diagnose the disease, the 35 years of experience doctor noted. Mr.Farma further disclosed that Sierra Leone is presently boasting of 84 diagnostic centres with HIV/AIDS testing opportunity. He said in 2004, Sierra Leone was having less than 20 centres. He pleaded that members of the press help in informing and educating the general public that TB is a killer disease. He asked that the attention that is given to HIV/AIDS be given to TB. He said this will encourage infected persons to report for medical treatment which is free. Mr.Farma said the World Health Organisation set a target to detect 70% of sputum positive cases out of a successful treatment of 85% per year.
Meanwhile a 52 % detection rate is the latest discovery of TB out spread in Sierra Leone .Mr.Farma declares that it is time bound to take action beyond our current effort as a country that will ensure a goal of success
Mental health in Sierra Leone
Sandra Zaeh writes on the the mental health challenges in Sierra Leone.
By any Western account, the mental health system in Sierra Leone is struggling.
With one trained government psychiatrist, little funding for psychiatric drugs and mental health facilities, and few opportunities for mental health care outside the capital of Freetown, the majority of mentally ill patients are beyond the reach of biomedical care for mental disorders.
To fill the void, Sierra Leoneans turn to alternatives like traditional healing and spiritual practices to address their mental health needs, options that even Western-trained experts consider crucial to maintaining the country’s mental health. And yet, the balance is tenuous - and, without an infusion of financial and human resources, may not be sustainable.
Mental health is far from the only problem facing Sierra Leone, which ranks at the bottom of the Human Development Index. (1) While the country has shifted from its post emergency phase to one of development since its 11-year civil war ended in 2002, it still faces daunting economic, educational and medical difficulties: nearly 75% of people live on less than $2 per day, the country has a literacy rate of 35%, and infant and maternal mortality rates are among the highest in the world. (2)
In light of these challenges, mental health may seem like a relatively minor problem, but experts at the World Health Organization (WHO) explain that there is “no health without mental health,”(3) and estimates suggest neuropsychiatric conditions are responsible for over 30% of the global burden of disease. (4) As Dr. K. Sheku Daoh, Director of Hospitals Services at Sierra Leone’s Ministry of Health (MOH) explains, mental health is intrinsically linked to many health issues. If we choose not to address mental health, there will be a “multiplying effect on the entire health system.”
Another concern for First Lady Sia Koroma is stability. If Sierra Leone fails to support individuals with drug-induced mental psychosis, she says, it is possible for them to “go to the guns again” and fight. Her concerns are particularly relevant given widespread opinion that a causal factor in Sierra Leone’s Civil War was youth discontent.
Despite the stakes, mental health remains a “neglected issue,” according to the First Lady, a trained psychiatric nurse. A nationally representative survey performed in 2002 suggested that the prevalence of depression within the population was 38%. Additionally, 7% of Sierra Leoneans were afflicted by substance abuse and 65% had suffered from trauma-related distress. (5) A recent longitudinal study of war-affected youth has documented similarly high rates of depression and anxiety disorders. (6)
Despite Sierra Leone’s pressing needs, the Western mental health system is vastly underdeveloped due to a lack of funding, its stigma, and little interest by medical professionals. Dr. Daoh explains that 75% of the minimal health budget is dedicated to reproductive and child health. While mental health is among the MOH’s priorities, he says, there is not enough money to make it a focus.
Dr. Edward Nahim, Sierra Leone’s lone government psychiatrist, expresses concerns that both Sierra Leoneans and Western trained physicians within the country do not see mental health as important health concerns. “They see mental health as something for the juju men,” he says. “They truly don’t understand it.”
The lack of attention paid to mental health in Sierra Leone has resulted in a mental health system which revolves around one man: Dr. Nahim.
On call 24 hours a day, 7 days a week, Dr. Nahim is in charge of Kissy Mental Hospital, the government’s only psychiatric institution, located in Freetown. The 108-year-old hospital, among the oldest psychiatric institutions in West Africa, has a 400 patient capacity, but recently cut its patient load to 150 due to a lack of personnel.
Throughout his tenure as government psychiatrist, Nahim has seen an increase in the prevalence of mental illness in Sierra Leone, mostly linked to an increase in drug abuse. Drug induced psychotic disorders, which used to account for 10% of the admissions to Kissy, now drive more than 80% of psychiatric admissions.
Despite the widening prevalence of mental disorders and limited capabilities of the biomedical mental health system, Nahim is convinced that the mentally needy are receiving the care they need.
“Eighty percent of all mentally ill patients are treated by people in the community - religious healers, spiritual healers, juju men, and black magic men,” he says. “They all do a very good job.”
Nahim argues that traditional healing is successful within Sierra Leone because many people believe their mental illnesses are externalized and associated with an “evil environment,” which can only be cured through traditional medicine.
Dr. Taylor Lewis, founder of the Sierra Leone Traditional Healer’s Association, also believes in the importance of traditional healers in order to achieve WHO’s goal of “health for all.” With over 2,000 traditional healers in Sierra Leone - compared to only 126 physicians - Lewis says that traditional healers provide a valuable resource if they are properly regulated. He sees traditional healers as important for patients who suffer from mental health disorders, as they can “cure mental ailments that Western doctors cannot treat” through traditional ceremonies.
In addition to traditional medicine, the mentally ill also seek spiritual healing. At the City of Rest in Freetown, Pastor N’gobeh leads a residential mental home and drug abuse center that employs biblical counseling and prayer to cure patients, without any psychiatric drugs. N’gobeh’s center is based on the philosophy that “there is no sickness that God cannot cure.”
Even with the use of traditional medicine and spiritual healing, however, there is widespread concern that gaps exist in patient care. Dr. Lewis believes the system is only 30% effective.
Thus, it is essential for the various actors involved to “work together” to build mental health capacity, says Dr. Lewis. In addition to making mental health part of all health initiatives, Lewis believes the first major step is to invest in human resources and increase the number of mental health workers.

Saturday, January 17, 2009

Double Amputee Corporal Tamba Ngaujah Speaks!

Double Amputee Corporal Tamba Ngaujah Speaks!
The decade long war in Sierra Leone affected every Sierra Leonean, directly or indirectly. One unique case is that of Tamba Ngaujah, the soldier whose two hands were cut off by RUF rebels on November 21st 1992.

Awareness Times News Editor, David Jabati, caught up with Mr. Tamba Ngaujah who narrated his story and explained how he is carrying on with his life right now. His story is one of courage and deep Christian faith in the face of adversity.


Cpl. Ngaujah, the double amputee is shown here seated at Awareness Times


Mr. Ngaujah was born in Kono District in 1960. He attended the UMC Primary School in Kono but was unable to continue his secondary schooling because of lack of funding. When he left school in 1975, Tamba assisted his parents on the family farm and he remained a plantation worker until the rebel war started in 1991.

According to Mr. Ngaujah, the Kono Tribal Heads chose him and other young men to assist the Sierra Leone Army as vigilante hunters.

"While I was serving as a vigilante, the rebels made their second attack on Kono and captured me and two of my vigilante colleagues. Upon searching us, they discovered our Hunter Identity Cards on our persons. This greatly enraged the Rebel Commander who was referred to as Commander ‘Scared de Baby’ by his men. The Commander then ordered one rebel who was simply known as "Killer" to deal with us. Right in front of me, my two colleagues were beheaded. When it came to my turn, the rebels decided that they would instead send me with a ‘message’ to the then-Head of State, Captain Valentine Strasser.. They cut off my two hands and hung a letter around my neck which was addressed to Captain Strasser. I was then sent off bleeding profusely. I spent three days in the bush staggering around until I arrived at the Army headquarters in Koidu, Kono District. I had already lost the rebel’s letter by that time. The military commanders acted very swiftly by transferring me to the 34 Military Hospital in Freetown where urgent surgery was done on me." Ngaujah narrated.

Whilst in the hospital at the 34 Military, he was formally incorporated into the army and was made a corporal in 1996 which is the rank he holds to date. He is provided for as a corporal and is housed at the Wilberforce Barracks.

Asked how he was facing life with his disability, Ngaujah responded that his strong faith in the Christian religion has been his rock all this time.

Asked how he survives with two wives and eight children in the face of the current adversity, he replied thus, "My Prayers and Christian Faith helped me go through the tough emotional times, especially on days when I go through the whole day without having a single penny in my pocket. My wives and children are my constant source of courage. They are my gift from God and they have been very supportive of me. My wives take turns to bath and dress me every day. I am very much appreciative of their individual and collective roles in my life", he said.

Ngaujah also stated that his children are a constant source of pride to him as they are all brilliant in school and come home with good reports. The eldest child, Tamba will be taking the WASSCE this coming year and the eighth child is in Class One at the moment. Ngaujah whose faith in God was very inspiring, stated that nothing surpasses education in this world which is why he is striving to see that all his children go through school. He stated that he knew deep inside himself that at least one of his children will one day do something big for Sierra Leone. He regularly attends the St Luke Catholic Church at Wilberforce every Sunday.

Asked about Family Planning especially when he already has eight children and is expecting a ninth child, he stated, "My wife wanted us to terminate this pregnancy but I refused because there are people who spend millions looking for children and they never succeed. I trust God for my provisions. The same God who saved my life whilst I spent three days bleeding in the bush will surely provide for me and my children." Ngaujah however stated that both his wives will be joining a Family Planning Clinic to ensure that they do not get pregnant again.

Ngaujah stated that the second wife is engaged in petty trading between Kono and Freetown, but that the proceeds are not enough to sustain the family.. He said that although times could be very hard in the family, he was very proud to state that his family was a happy one. "We make a lot of sacrifices and we are going without a lot of things, but we are a happy family. I thank the Lord for that. When our only television in the house got broken, we found other means of entertaining ourselves. We would love to get another television if someone donates one to us but for now, we tell stories to each other in the evening", he stated.


Our reporter David Jabati interviewing Cpl. Ngaujah at Awareness Times premises
Ngaujah stated that he has never come across any of the rebels who cut off his hands. However, he stated that he had forgiven them and left everything in the hands of the Almighty. "If I come across the rebel who cut off my hands now, I will tell him that I have forgiven him", he said.

Mr. Ngaujah also used the opportunity to express his thanks to all his friends and sympathizers who are helping him out.. He also thanked the government of President Kabbah especially the Ministry of Defense and the British IMATT for the rehabilitation of the military. He said that soldiers are once again seeing it as a pride to walk around in their uniforms. He however appealed to the authorities to look into the issue of education, by providing scholarships for children of soldiers especially the War Affected soldiers. He pointed out that the war victims in the military were largely ignored by Donors and the NGO Community. He mentioned other soldiers who lost their eye sights through bomb blasts as well as soldiers who suffered amputations. He appealed to Donors not to overlook these soldiers even as they build houses and pay school fees for civilian war victim children. He also reminded the authorities not to forget their promise made to him to assist him with permanent shelter for his family.

Corporal Ngaujah is also appealing to readers to assist him with any form of humanitarian assistance. He gives his address as L5 Wilberforce Barracks, Looking Town.

Mr. Ngaujah has won many awards for his courage starting from the National Award given him by popular Radio Producer, Hilton Fyle in 1994 up to the much sought, All Works Of Life Award in 2004.

Thursday, January 01, 2009

Unrest in Kono District

Unrest in Kono Districtdoor Alyson Zureick
This week I have been in Kono District in eastern Sierra Leone, working out of the FarmaHealthServices office in Koidu Town. Kono is center of the diamond mining industry in Sierra Leone. Driving into Koidu Town on the main highway, the road is flanked by large pits of sand and gravel where the workers shift for diamonds. Unfortunately, not only did diamonds fuel Sierra Leone's 10 year civil war, but they are also fueling unrest in the District today.
I was in the FarmaHealthServices office in Koidu Town, Kono Wednesday morning when I heard members of management talking about unrest among youths in the center of the town. At a staff meeting that morning, the field coordinator announced that gangs of young people were blockading one of the main arteries of the town in protest against the government's refusal to allow them access to a sand tailing that many thought contained diamonds. The youths claim that the government promised them access to this tailing during the last election.

Around lunch time the situation had not improved and there were rumors that some youths had stolen a gun from one of the police officers trying to control the situation. My coworkers began to head home just in case the situation worsened, and my housemates and I called a friend of ours out in the field close to the mining areas to tell her to head back to town and to our house. When she arrived she reported that police were lining the highway and the main town roads and were heavily armed.

We spent the afternoon and evening in the housing compound, and this morning we were told that the youths had been dispersed by army reinforcements from the town of Makeni. We were back at the office today and everything seems quiet. More information on the events can be found here.

This unrest certainly is not new in Kono, nor is this the worst case in recent memory. Similar protests took place in Kono in December, also over mining issues. Property was burnt and destroyed and several residents were killed.

One of my friends in Sierra Leone has commented that if the country destabilizes again the process will begin in Kono. The area was hit hard by the war, and most young people lack education and employment opportunities. As food prices increase and the local government elections in July draw near, tension among these young people is increasing. When I travel in much of Sierra Leone, I notice the poverty and unemployment, but I also notice the hope among people who are working to rebuild their lives. I tend to see Sierra Leone as a peaceful country with a promising future. When I am in Kono, though, I begin to wonder if I am wrong.

Child Survival in Kono

Child Survival in Kono, Alyson Zureick Laatste wijziging:
I spent last week in Kono District visiting local health clinics known as peripheral health units (PHU) to learn about efforts to reduce maternal and infant mortality and morbidity rates. Sierra Leone has the worst rates in the world, and improving them is no easy task.
On Monday morning,FarmaHealthServices colleague and I drove to the Sengekoro PHU in Nimikoro Chiefdom. It’s approximately a forty-five minute drive from our base in Koidu Town, down the highway with its broken concrete, past the mounds of sand and gravel of the diamond mines and then down a gutted dirt road that winds through thick, green bush. The Sengekoro PHU is a humble four room building, and its staff currently serve 1,152 people in eight surrounding villages. In previous years it served 4,064 people in 18 villages, but a new PHU has opened up nearby and the catchment area has been divided between them.


Child Survival in Kono In Sengekoro I meet Mabinty Samawaty, the Mother and Child Health (MCH) Aide. Mabinty is assisted by Sahr H. Simbo, the volunteer vaccinator who administers vaccines to children under five and their mothers. Mabinty also oversees 15 Community Based Distributors (CBDs), also volunteers, who monitor children under five in their communities for pneumonia, malaria (“fever” or “warm bodi”) and diarrhea (“ron belle”), three of the main causes of death in children under five. When sick children are identified, the CBDs provide first line treatment and monitor the child’s progress. If the child’s condition worsens, the CBD makes sure the mother takes the child to the PHU for further treatment.

According to the MCH in-charge and new mothers I talk to in surrounding communities, the use of CBDs has improved child health in the Sengekoro PHU’s catchment area, as well as in the catchment areas of the 19 other PHUs with similar programs. Previously, many mothers found it difficult to carry their children to the PHUs for treatment; most communities lack vehicle transport so mothers may have to walk for an hour or more down rough roads to access a health facility. The CBDs provide free care in the communities themselves.FarmaHealthServices has worked with these communities to select, train and support the CBDs, and last year the National Ministry of Health and Sanitation chose the program to scale up throughout the country.

Farma Health Services Reporting on the Cessation of Asylum Status and Refugees In Sierra Leone

FarmaHealthServices Reporting on the Cessation of Asylum Status and Refugees In Sierra Leone

UNHCR declares cessation of refugee status for Sierra Leoneans

This is a summary of what was said by UNHCR spokesperson Jennifer Pagonis – to whom quoted text may be attributed – at the press briefing, on 6 June 2008, at the Palais des Nations in Geneva.
We are recommending to states to end refugee status for Sierra Leoneans who fled their country during the decade-long civil war which started in 1991, since the root causes of the Sierra Leone refugee problem have ceased to exist. There have been fundamental and durable changes since peace was declared in January 2002. The cessation will take effect at the end of this year on December 31, 2008 following consultations with the governments of the main countries of asylum and Sierra Leone.

During the height of the conflict as many as two million of the country's six million citizens were displaced with some 490,000 fleeing to Liberia and Guinea. Under UNHCR's voluntary repatriation operation from September 2000 to July 2004 more than 179,000 Sierra Leonean refugees returned home, while many others returned by their own means.

Around 43,000 refugees from Sierra Leone continue to live in exile, mainly in neighbouring countries, including the Gambia, Guinea, Liberia and Nigeria. Sierra Leonean refugees in sub-Saharan African countries who want to repatriate voluntarily before the end of 2008 can benefit from UNHCR assistance. Those still in need of international protection will be able to remain in their current host country as refugees while those who do not qualify for asylum after 2008 but do not wish to return home because of strong family, social or economic links with the host country, will be expected to legalise their stay there.

Backgroung
The UN Mission in Sierra Leone (UNAMSIL) completed its withdrawal from the country in January 2006, handing over to the UN Integrated Office in Sierra Leone (UNIOSIL) responsibilities for peace consolidation, development and respect for human rights. Individuals most responsible for the atrocities committed during the conflict have been indicted and tried – or are in the process of being tried – by the Special Court for Sierra Leone. Significant improvements in rule of law and respect for human rights have also been recorded throughout the country and two sets of elections – in 2002 and in 2007 – have been determined free and fair by the international community

Farma Health Services Reporting on Women Empowerment in Kono District

FarmaHealthServices Reporting on Women Empowerment in Kono District
Empowering communities one village at a time

KONO, Sierra Leone, June 30 (UNHCR) – A gender revolution is simmering in the diamond-rich district of Kono in eastern Sierra Leone. It has nothing to do with gems, and everything to do with genning up on rights and skills for women in the war-torn area.

Slowly but surely, women – and men – are learning to empower themselves and to prevent sexual and gender based violence through UNHCR projects in this poverty-stricken district.

Before the civil war broke out in 1992, Kono was home to over half a million people. Many fled when fighting devastated the area, but more than 34,000 have returned in recent years, making Kono one of the major areas of return. In total, over 271,000 Sierra Leonean refugees have returned home since the war ended in 2002, more than half of them with UNHCR assistance.

After witnessing the devastation and destruction in areas of return, the UN refugee agency started its community empowerment projects in 2003 to ensure that returning refugees and their surrounding communities have access to basic services.

Of the 1,000 community empowerment projects implemented by UNHCR in Sierra Leone, Kono district accounts for more than 300. The projects are mainly focused on improving access to water, sanitation, health facilities and schools, as well as income-generating activities and the prevention of sexual and gender based violence.

UNHCR, working with its main governmental counterpart NaCSA (National Commission for Social Action) and implementing partners, established project management committees in each of the 14 chiefdoms of Kono district. Each committee is represented by five women and five men from each community, who together with UNHCR, identified programmes they felt their communities needed.

Many hand pumps and community centres have been built, while health clinics and schools have been refurbished, improving the daily lives of thousands of Sierra Leoneans. In addition to these basic services, some communities had more specific ideas.

At the request of the community in Yengema, Nimikoro chiefdom, UNHCR and the International Rescue Committee have joined hands to combat the widespread problem of sexual and gender based violence. In Kono district alone, the two agencies have partnered to establish six specialised centres, with three more planned for later this year. The centres are led by female community volunteers who are trained by gender specialists on how to prevent such violence in their communities and how to respond if it occurs.

The women, men and youth in each community established action groups where they come together to discuss ways to prevent gender based violence and to organize sensitization workshops in their communities. Increasingly, the communities are responding and learning that crimes against women are crimes against the family.

The centres are also used to conduct skills training and adult literacy classes. The teachers are community members themselves, and this community-driven project has proved extremely successful.

"The community empowerment projects were meant to complement the government's effort to decentralize and to meet the grassroots needs of the returnee communities," said Sudang Kaentrakool, who heads the UNHCR field office in Kono district's capital, Koidu. "UNHCR with the strong support of our donors and partners has ensured that the return of thousands of Sierra Leoneans to Kono district is now sustainable."

Another successful community-driven program in Kono district includes the Centre for War Affected Women in Sewafeh, Nimiyama chiefdom, funded by UNHCR and implemented and monitored by World Vision. The centre provides skills training programmes for war widows, women whose limbs were amputated during the war, and other vulnerable people.

Women can take courses in tailoring, catering, hair dressing, adult literacy, weaving, soap making and gara tie-dyeing. All materials, such as sewing machines, cloth, and dye, are provided by UNHCR. There are currently 136 women enrolled in the six-month courses, with many more on the waiting list.

"Before this programme, we were at sitting home doing nothing, we were wasting our lives away," said Ramatu Koroma, a trainer at the centre. "But now we are engaged in productive work and learning skills, thanks to this great programme by UNHCR."

UNHCR will end its reintegration programmes, including community empowerment projects, at the end of this year. However, through these projects and sectoral reintegration programmes, the refugee agency would have left an indelible mark on these communities.

Farma Health Services Repoting On Humanitarian Affairs in Sierra Leone

FarmaHealthServices Repoting On Humanitarian Affairs in Sierra Leone

Reporting On Humanitarian Affairs in Sierra Leone

SECURITY
The security situation within Sierra Leone and along the borders with Liberia and Guinea has been generally stable with no serious clashes amongst factions. The disarmament process has now been completed in Kono District and is ongoing in Moyamba and Koinadugu where there have been slight delays in the process due to the limited capacity of the camps, primarily in Moyamba.

Army convoys enter RUF territories

A 13-vehicle convoy of SLA soldiers carrying food and other logistical resources passed through Makeni en rout to Kabala, both RUF territories northeast of Freetown on 15th August with no hindrances. They were received with cheers and jubilation from both civilians and RUF combatants. This move is seen as a test case of the RUF’s commitment to peace as previously such a venture would not have been possible.

UNAMSIL to launch TRC web page

UNAMSIL and the Sierra Leone Web have launched the Truth and Reconciliation Commission (TRC) web page. This will provide up to date and detailed information on the progress of the TRC and the peace process.

Hitches in the peace process

Tensions generated by internal difficulties within the RUF when one of the commanders, Colonel Christopher was killed by Colonel Morris Kallon in Makeni, on 17th August, threatened to destabilise the peace process in the North. This resulted in a riot in Makeni and accusations from both the RUF and the civilian population that the UNAMSIL battalion was taking sides. UNAMSIL has reported that this incident has been contained and is under investigation and that it has not unduly influenced the ongoing DDR process

Rising incidence of crime

Crime rates in major towns, notably Freetown, Lunsar, Makeni and Kabala have increased. The Sierra Leone Police (SLP) has deployed in Lunsar and Makeni whilst the SLA deployed in Kabala. There have been initial talks between UNAMSIL, RUFP, Government and local representatives about the planned deployment of the SLA in Lunsar. A new MILOB team site has been established in the region in order to facilitate the process.

RUF members released from prison

The Government of Sierra Leone announced that it has released 41 RUF members from detention. Among those released was former RUF minister, Alimamy Paolo Bangura. The announcement was made the day before the Tripartite Meeting of the Joint Committee on Disarmament, Demobilisation and Reintegration held on Friday 10th August in Kenema. These detainees were incarcerated last May after the RUF had violated the Lome Peace Accord. Whilst this is a positive move the RUF, however, have contested the number released claiming that only 17 detainees were actually discharged.

UN Rapporteur visits Sierra Leone

The UN Special Rapporteur on Violence Against Women, Radhika Coomarswamy, has called for more donor support for Sierra Leone’s women, particularly those who are internally displaced. She made this appeal at the close of her weeklong visit to Sierra Leone. She said that the social conditions of women had deteriorated during the past decade of civil war and criticised the donor community for "not responding appropriately" to the needs of women. She further expressed dismay over women’s sexual exploitation, rape, drug abuse, discriminatory laws on inheritance and female genital mutilation.

America provides support to Sierra Leone

Two bilateral agreements were signed between the Governments of Sierra Leone and the United States for a three year-transition programme (US$ 19 million) and for the reintegration of war-affected people into their communities (US$ 14.5 million). This will assist the process of national reintegration through the increase of community- based activities in agriculture, health, economic growth and improving youth capacities and strengthening national institutions. USAID will also work with the Government and civil society to promote greater transparency and accountability in the way Government officials and organisations operate. In addition to these two programmes, the US has donated a further $ 4.5 million worth of equipments, which will support the Senegalese contingent bound for peacekeeping duties in Sierra Leone.

Sierra Leone collects $ 91,000 from diamonds

A review of the new diamond certification system reports that the Sierra Leone Gold and Diamond Office has collected $ 91,000 in revenues from fees paid by diamond exporters. A total of 144,760 carats valued at $ 19.10 million have so far been exported since the certification system began last October. This was instituted to end transactions in "conflict diamonds".

Elections postponed

The National Electoral Commission has warned that elections scheduled for this coming November may have to be postponed until next year. Despite the work of a Commonwealth team of consultants who have been engaged in facilitating and overseeing the election process, fears that the disarmament of combatants will not be completed within the stipulated time frame, difficulties in compiling the voters’ register and funding constraints all pose considerable obstacles which will potentially delay the process.

To date, a total of 21 political parties have been registered to run for elections. The RUF, however, are dissatisfied with this potential delay and have threatened to cease cooperation with the Government and UNAMSIL, if an interim (all party) government is not set up and particularly if the RUF are not recognized and invited to be part of this. The Government constitutionally extended its term of office for a six-month period in March of this year, which will expire at the end of September. As the Government has indicated that they do not want the elections to take place before the disarmament process has been completed, there are real concerns over continued RUF cooperation.

Doctors and nurses on strike

Junior doctors and nurses in the country are taking strike action over what they describe as poor conditions of service. The doctors have, however, called off their strike after an agreement with the Government was reached to meet some of their demands. The nurses continue their strike action, as their demands for improved conditions as yet, have not been met. The strike action has lasted for more than two weeks now and some of the patients admitted at Connaught Hospital, the main Government facility in Freetown, have been taken away by their families without treatment. This is seen as a setback into the already precarious health conditions in the country.

SUB-REGIONAL DEVELOPMENTS

MRU Ministers meet in Freetown

The Joint Security Committee of the Mano River Union States met in Freetown on August 22nd to map out strategies for resolving security problems in the region. Each government has agreed to extradite dissident elements operating in their respective country. This agreement is a follow-up to the August 13th meeting in the Liberian capital, Monrovia where ministers agreed to seek ways of restoring dialogue among the Mano River Union States - a move that the UN Security Council has described as a real prospect for peace in the sub-region. The ministers will next meet in the Guinean capital, Conakry on September 10th.

Liberia revokes expulsion order

Liberia has revoked the expulsion order it imposed on the ambassadors of Sierra Leone and Guinea for unspecified acts. Similarly, the UN Security Council has granted a temporary waiver on the ban it imposed on senior Liberian officials enabling them to attend these meetings and facilitate proper dialogue between each of the three MRU states.

Sierra Leone CAP 2002

In preparation of the UN Interagency Consolidated Appeal Process (CAP) for Sierra Leone 2002, a one-day Stakeholders Consultation was held on 23rd August at the British Council bringing together the Government, donors, national and international NGOs, civil society, beneficiaries and the UN. The purpose of the consultation was to develop a shared humanitarian vision, a common analysis and understanding of key humanitarian priorities and joint strategies for the upcoming calendar year. The NCRRR Commissioner, Development Secretary, Deputy SRSG UNAMSIL, Humanitarian Coordinator, Nigerian High Commissioner, members of the donor community and the Chairman of the National Council of Displaced Persons provided their perspectives on humanitarian challenges in Sierra Leone. In addition Sectoral Working Groups jointly identified major needs, priorities, strategies for intervention in their relevant areas of expertise.

Further consultations with the wider humanitarian community are expected prior to the submission of the field draft of the CAP to the Office for the Coordination of Humanitarian Affairs in Geneva on 7th October. A Global Launch of the CAP is planned for the 27th November to be held simultaneously in major donor capitals.

CHILD PROTECTION

Community Education Investment Programme

UNICEF, in collaboration with MYES has provided financial and technical support to COOPI to conduct a Community Education Investment Programme (CEIP) training and sensitization workshop for the Western Area. The objective of the workshop was to familiarize communities and schools about the scope of CEIP. Participants comprised Community Tracing Agents (CTAs), head teachers/principals, social workers and child protection agencies in the Western Area. UNICEF and its partners in the CEIP have held discussions on the extension of CEIP to newly accessible areas. NRC, which is currently implementing CEIP in the North, will expand to Koya and Masimera chiefdoms in the Port Loko District whilst CARITAS Makeni will be responsible for Tonkolili District.

Family tracing and reunification

There are now a total of 73 children associated with the fighting forces at the CARITAS Makeni reception centre in Kabala. They comprise 30 RUF (27 boys and three girls), 26 demobilized CDF boys and 17 separated children awaiting family tracing and reunification. In addition to this, 90 children, including a girl, have been reunified with their families in Kambia. CARITAS Makeni has also distributed tools and training materials to 150 war affected children who are currently undergoing skills training in carpentry, masonry, auto-mechanics, etc. in Lungi, Port Loko and Yoni communities. They include 80 former child combatants and 70 separated children. Micro-credit loans have been given to 175 foster families in Lungi and Port Loko.

A one-week registration has been carried out by child protection agencies in collaboration with the SLP, which has identified 80 street children (79 boys and a girl). The Child Protection Regional Committee has conducted a one-day workshop for social workers and tracing agents on family tracing and reunification in Kenema District.

Child protection initiatives - sexual violence sensitization

UNICEF has supported GOAL in concluding a series of sensitization workshops on Sexual Violence for Commercial Sex Workers in the communities of Susan’s Bay (Maybala), Guard Street and Kanikay, east of Freetown. Rape, reproductive health, the rights of the girl child, information on the survival strategies of commercial sex workers and the community’s role in the prevention and minimization of sexual violence, were among the issues discussed.

RUF employs child labour in Kono

Sierra Leone web reports that the RUF is using forced labour on children and young men to mine diamonds in Kono despite an agreement reached earlier this month between the Government and all the warring parties to cease all mining activities.

EDUCATION

NRC, in collaboration with MYES and UNICEF will run a two-week training of trainers’ workshop for 40 educational trainers in Bombali, Koinadugu, Kailahun and Kono Districts. It has provided tutors for Trauma Healing, HIV/AIDS, Peace and Human Rights and Physical Health Education.

NRC and MYES are jointly organising an assessment of teacher/pupil availability and educational needs in the Kambia District. This assessment will be carried out in areas approved both by UNHCR and MYES, where there are high returnee populations.

UNICEF has also provided technical and financial support for the training of 35 non-formal community schoolteachers in Makeni.

World Vision has trained 200 Learning Facilitators (LFs) from 10 communities in Bo, Bonthe, Tonkolili, Kambia and Koinadugu Districts through its Youths Reintegration Training and Education for Peace (YRTEP) component. Since it initiated the YRTEP programme in March 2000, a total of 3,260 LFs and 32,600 participants have so far been trained.

UNHCR has held an educational coordination meeting aimed at discussing modalities on the resuscitation of educational activities in the Kambia District. This will see primary schools benefiting from a school feeding programme to relieve the short-term hunger in children and enhance their concentration in classes.

NRC, with the support of UNICEF and in collaboration with the Ministry of Youths, Education and Sports (MYES), ADRA, Action AID, CARITAS and the District Education Office has provided funds for the refresher-training programme for 158 primary school teachers in Rokupr, Kambia District. The community is being sensitized to encourage teachers to return to Kambia where employment opportunities will be generated for those who are unemployed for a period of six months.

UNHCR is also providing funds through NRC, for the rehabilitation of six primary schools. In addition to this UNICEF will renovate four primary schools and provide financial and technical support for refresher teacher training and teacher/learning materials for 7,000 pupils.

Registration of children between the ages of 14-15 in the district will soon commence. In Port Loko District, NRC will rehabilitate a school, DFID will rehabilitate nine schools, NWRO and the Swiss Foundation for Sierra Leone will further rehabilitate two schools in Koya chiefdom.

AGRICULTURE

FAO, in collaboration with NCDDR and MAFMR and other implementing partners distributed 200 Mt of seed rice to 4,000 farm families including ex-combatants in Kambia, Port Loko, Kenema, Kailahun and Bo Districts. Essential agricultural tools such as hoes and cutlasses have also been pre-positioned in delivery points for distribution. FAO also reports that 60 Mt of groundnuts and 10,000 kits of vegetable seeds would be distributed in the second cropping season. In addition to this FAO has distributed 140 Mt of groundnuts to 7000 farm families and 129 Mt of seed and tools to 4,582 farm families in Port Loko, Bo, Pujehun, Kenema and Kailahun Districts in collaboration with UNHCR and MAFMR. This will be followed by a further distribution of 121 Mt of seed rice, 2418 sets of hand tools and 7000 kits of vegetable seeds in the second cropping season.

World Vision has provided 256.5 Mt of seed rice and tools to 6000 farm families in six chiefdoms in the Kono District. It has so far provided a total of 2,036 farm families in the district with FFAg.

MAFMR, in collaboration with FAO, has distributed a total of 600 Mt of seed rice to National Association of Farmers in Sierra Leone (NAFSL) and personnel of the ministry. The Community Action for Progress (CAP) has reopened its office in Rokupr and distributed 7,531 bushels of seed rice to 15,062 farm families in the Kambia District. It will provide skills training for youths and ex-combatants (now called "New Citizens"). In Port Loko and Kambia 31,514 bushels of seed rice have been distributed to 15,730 farm families by aid agencies.

AFRICARE is supporting women groups in Kolifa Rowalla in small-scale soap making using their own resources. The proceeds are being used to procure materials for ongoing soap making in order to supplement the materials provided.

MICRO CREDIT SCHEMES

AFCORD will start a micro-credit programme for Returnees living in the coastal towns of Kambia and repair and maintain some of the commercial boat transport to facilitate local economic activity. ARC has also started a micro-credit project in the District.

SAPA has received Le 9 million ($ 4,500) for 31 micro- credit projects in Bo and Pujehun of which one-third has already been disbursed. A total of 200 beneficiaries will benefit from this project.

WATSAN

ICRC is providing 200 latrines to eight villages in the Lower Maforki Chiefdom by mobilizing the communities to utilize local materials and installing wells in the villages of Masama, Mapoli, Mamai-Kanu, Mabasi and Roure. OXFAM has also executed baseline surveys is working with communities in five villages in Lower Maforki. It is planning to extend training facilities to communities and has already provided demonstration latrines to the villages of Rogbet, Rosarr, Forodbana, Magbingbera and Gberi Bana. It has further indicated the availability of £20,000 for the rehabilitation of wells in Magbema chiefdom. AFCORD is carrying out a survey to examine the needs of resettlers in 13 villages along the coastal areas where the rehabilitation of wells, schools and clinics is planned.

Watsan facilities are functioning in all the camps in the Barri chiefdom and OXFAM is sinking boreholes and is further developing water facilities in conjunction with BPDA. A total of 11 pumps have been installed with six more undergoing construction. Overall, the general health condition in the camps is satisfactory.

FOOD

Assistance to IDPs/returnees

WFP reports that food distribution for IDPs for the month of August has been completed in all IDPs camps in the Western Area as well as to beneficiaries in the transit camps at Jui, Lumpa and Waterloo for returnees. In addition to Western Area distributions WFP is distributing 207 Mt of food to 15,923 returnees in Lokomassama chiefdom. It will soon distribute 102 Mt of food to 8,831 beneficiaries in Port Loko. A total of 63 Mt of assorted food items were distributed through NRC to 5,075 beneficiaries at Jembe and 0.8 Mt of emergency ration were given to 500 Returnees transiting through the Gbaima Way Station.

In Kenema District, CRS reported that a total of 29,288 IDPs in camps have been served with 412.33 of food aid for the month of August.

Food for Agriculture/Food for work

Food distributions to 1000 farm families in the Safroko Limba chiefdom, Bombali District were carried out through CARITAS Makeni. Similarly, 122 Mt of food were distributed to 2,855 beneficiaries in Kailahun District. Farmers in Dodo chiefdom in Kenema were supplied their last Food-for-Agriculture (FFAg) allotment.

WFP, in collaboration with ICRC has started delivering the second allotment of FFAg to families in Tane chiefdom, Tonkolili District and completed its third to families in Bombali and Port Loko. In Mile 91, it has completed the distributed of food to 17,486 IDPs in 28 villages. A total of 22 Mt of food was distributed to 1,868 IDPs in Mandu and Bo townships and 102 Mt to 8,831 in Port Loko.

A total of 44 Mt of Food-for-Work (FFW) rations were delivered to 4,442 beneficiaries in Kakua, Baoma, Valunia and G/Lenken chiefdoms. FFW projects include road rehabilitation and watsan programmes. WFP has also distributed 8 Mt of food to 950 malnourished children under the age of five in its operational areas. It also gave 37 Mt of food to 3,020 pregnant/lactating mothers and 15 Mt to 1,630 beneficiaries in Interim Care Centres and orphanages.

HEALTH

Plastic surgery to remove scars of war

IMC, in collaboration with UNICEF and MOHS has initiated a plastic surgery programme at the Lungi Hospital to remove scars depicting the names of fighting factions and other conflict symbols branded on the skins of ex-child combatants. The programme is funded by USAID Patrick Lehy’s War Victims Fund and UNICEF. With support from UNHCR and MOHS, IMC has also expanded its primary health care operations to Daru, Kailahun town Beudu and will start one in Kambia District.

PHUs assessment

UNICEF and MOHS have conducted a nation-wide rapid assessment of PHUs in order to obtain baseline information on the conditions of infrastructure, personnel and equipment. It has also undertaken a four-day refresher- training course on immunization, injections and operations of the cold chain.

On-going support

UNICEF has supported the Lungi Hospital and the cold room in Tonkolili with refrigerators and gas cylinders. Cold stores in the Western Area, Makeni, Kailahun, Magburaka and Mile 91 also benefited from such donations while Port Loko was provided with essential drug kits. UNICEF further provided 377 TBA and nutrition screening equipments to the District Health Medical Team (DHMT) in Kenema, Pujehun, Moyamba and Kailahun.

Promoting health in Kono

World Vision (WVI) has set up two primary health care mobile clinics in Kono District and over 100 patients are receiving treatment daily. WVI have also established seven temporary clinics in the district and MOHS is supplying community health officers, maternal and child health aides and vaccinators which are supported by essential drugs provided by UNICEF. WVI have also identified 20 clinics for rehabilitation. WHO has concluded a rapid assessment of the Koidu Hospital in Kono. Supported by the Pakistani Battalion Medical Team of UNAMSIL and MOHS, WHO is to assist with rehabilitating and equipping the hospital, which is in a dilapidated condition.

Sanitation campaign

UNICEF has sponsored the training of 300 Blue Flag Volunteers (BFV) for hygiene promotion and administration of oral re-hydration therapy. In addition to this a chlorination programme is underway in Makeni and 981 wells have been chlorinated in Kenema. UNICEF has also distributed sanitation tools to a community- based organisation, Women in Development Association (WIDA) in the Western Area. It is hoped that these tools will serve as a tool bank in strengthening the roll back malaria programme in the east of Freetown.

ICRC health support

ICRC has reopened its mobile clinic in Segbwema to address the health needs of returnees and resident families. It is supporting the clinic with basic drugs and monitoring medical care and is partially rehabilitating the Koidu Government Hospital in Kono. ICRC is also supporting the rehabilitation of the Sierra Leone Red Cross Society Clinic in Makeni. Hitherto, the clinic had been relocated at Mile 91 to respond to the emergencies of IDPs who fled the hostilities from Lunsar, Makeni and Magburaka. It is facilitating the digging of wells and latrines in Makpele chiefdom, Pujehun District, in order to promote health and sanitation. It has so far constructed 15 latrines and 37 more are undergoing construction.

FarmaHealthServices interventions in the North

Farmahealthservices is presently supporting clinics in Kambia Town, Rokupr and Gbonko-Maria in Magbema chiefdom and Mambolo Town in the Mambolo chiefdom. It is further considering supporting Mapotolon CHC in Samu chiefdom and carry out minor rehabilitation in all the clinics it served. As a result of the dilapidated hospital structures in the district, Farmahealthservices has converted a rented house for the running of a 20- bed clinic. EC-SLRRP, is planning to work in partnership with Terra Tech, to undertake the first phase of rehabilitation of the Kambia Hospital.Farmahealthservices is presently operating four clinics in Kambia. Staff quarters, however, remain a problem as many houses have been damaged in the region. A total of 21 out of 32 PHUs are currently in operation - UNICEF is supporting five, WHO will support eight in Samu chiefdom and IMC will support one in Rokupr. FarmaHealthServices promotion will also be supported with the start of ARC’s HIV/AIDS sensitization programme in September.

AFRICARE has completed the rehabilitation and has supplied drugs to two clinics in Rokunta and Mabum in the Bombali and Tonkolili Districts. A total of 356 children received the polio vaccines and 248 received the DPT.

Health conditions in the south

Farmahealthservices have employed an additional nurse and three MCH aides to support its medical team in Barri chiefdom. The BPDA has been mandated to collect statistics of hernia cases, which seem to be rising drastically amongst the returnees. A local physician has offered to carry out free medical operations on patients but is handicapped by lack of drugs. Farmahealthservices are hoping to provide him with support. In addition to this Farmahealthservices are collaborating with WHO to combat the threat of black flies in the camps.

Acute flaccid paralysis

WHO reports that it has conducted an assessment of Acute Flaccid Paralysis (AFP) and health in Samu, Gbinle Dixon and Magbema chiefdoms in the Kambia District. It discovered malaria, acute respiratory infections, diarrhoea and sexually transmitted diseases. It has also been reported that antenatal services are minimal with virtually no equipments for delivery. Malnutrition is also a pervasive problem. Severe cases are referred to the Therapeutic Feeding Centre, which is sponsored by Farmahealthservices in Port Loko. Since the district cold room has been vandalized, EPI activities are further constrained by lack of cold chain equipment.

DDR

UNAMSIL reports that the disarmament of combatants in Moyamba in the south and Koinadugu in the north has begun and the process is expected to continue until 31st August. The SRSG, Oluyemi Adeniji symbolically destroyed an AK 47 rifle in Moyamba to formally commence the process. The disarmament in Koinadugu has been hindered by lack of transportation and poor roads. Disarmament in Kono District has now been completed with 3,623 RUF fighters and 2,011 CDF militias handing in their weapons, bringing the total number of those who have disarmed nationwide to an estimated 16,000. NCDDR figures vary a little and record a total of 12,902. UNAMSIL explains the discrepancy is due to the fact that it compiled the figures at the reception centres whilst NCDDR records the number only when the documents are finally processed.

The ICRC has conducted a series of training sessions on International Humanitarian Law and the Red Cross for 52 officers and over 1000 recruits under the Short-term Training Programme in Bengwema. A similar exercise was carried out for 150 demobilized combatants enlisted in the Military Reintegration Programme in Mape, Lungi.

HUMAN RIGHTS

TRC sensitization campaigns

The UNAMSIL Human Rights Section has been holding Truth and Reconciliation (TRC) campaigns through workshops, radio programmes and publications. The International Human Rights Law Group is facilitating and providing support to local NGOs and the National Forum for Human Rights has conducted TRC sensitization workshops for paramount chiefs in the southern and eastern regions. The Human Rights section of UNAMSIL has also published a leaflet of 20 questions and answers on the TRC. The SRSG is coordinating the selection process of the four Sierra Leonean commissioners to the TRC.

Ongoing activities

UNAMSIL Human Rights Section continues to investigate reports of violations of human rights and international humanitarian law, including the RUF allegations that Alkalia village in Koinadugu District was attacked by the CDF. It also continues to monitor the situation of detainees at Pademba Road Prison and other locations.

IDPs, RETURNEES & REFUGEES

According to OCHA’s latest figures as at 4th August, the total caseload of IDPs in camps in the country is 126,959 while that in host communities is 120,631. The total number of returnees presently supported by UNHCR stands at 75,580. This brings the total number of all IDPs and returnees supported by agencies in Sierra Leone to 323,170.

Provisional shelter assistance for Kambia

USAID, through UNHCR has offered 320 packages of zinc sheets for shelters in Kambia District. UNHCR will further provide provisional shelter assistance comprising of plastic sheeting to villages with large numbers of Returnees in the district. These assistance are designed to help the priority needs in the village communities.

Returnees settle in Taiama

A convoy of vehicles comprising 71 residents of transit centres in Freetown left for the newly developed settlement sites in Taiama, southern Sierra Leone where they have already been relocated. Many of these Returnees are from Kono who had been reluctant to leave the transit centres for the over-capacity settlements in the south. Taiama has an absorption capacity for 4,000 people.

UNHCR contingency plan

UNHCR has adopted a contingency plan in the event of escalated fighting between Liberia and Guinea that could lead to mass population movement into Sierra Leone. It has identified chiefdoms in Kenema and Pujehun Districts and Luawa and Kissi Tongi in Kailahun as possible reception points by starting preparations to increase reception in the area.

Support to IDPs

ICRC and the Sierra Leone Red Cross Society have completed the distribution of shelter materials, blankets, sleeping mats, kitchen sets and soap to six IDP camps in Kenema District and a total of 7,716 families benefited from this assistance. AFRICARE has received FFAg from WFP and distributed them to 255 farm families in chiefdoms in the Kailahun District. It has received the first shot of FFAg from CRS and distributed them to 1,316 farm families in Dama, Guara and Koya chiefdoms in the Kenema District. It has also distributed 40 kg of seed rice to 12 villages in the eastern region and 140 kg to Bandajuma camp.

In Barri Chiefdom and Gerihun temporary settlements for returnees have started gradually in some of the villages. AFRICARE plans to distribute seed rice to returnees. The Council of Churches in Sierra Leone (CCSL) has conducted a comprehensive assessment of plastic sheets needs in all the IDPs camps and is meeting the priority requirements in the camps. Bo-Pujehun Development Association (BPDA) is looking for partners to provide items needed for shelter construction in Barri. CCSL and BPDA have distributed a total of 3,442 consignments of used clothing to the camps and will distribute additional stocks to over 6,000 children in the Chiefdom.

ICRC has distributed NFIs consisting of blankets, kitchen sets, mats, clothing and plastic sheeting to six camps in the region to a total of 7,716 beneficiaries.

Tonkolili Assessments

A multi-sectoral inter-agency assessment of eight chiefdoms in Tonkolili District was undertaken between 20-24th August. The aim of the assessment was to obtain general baseline data to allow agencies to identify the most pressing needs and help plan priority humanitarian interventions in the District.

The District Resettlement Assessment Committee for Tonkolili reports that the entire district is generally unstable as there are intermittent outbreaks of unrest among the CDF. No disarmament has taken place and thousands of CDF continue to carry weapons, posing a potential threat to civilians and humanitarian interventions. In Gbonkenlenken chiefdom the CDF appears to be running a parallel administration devoid of any state control in, as the SDLP and SLA are not present there. It is also estimated that in this chiefdom some 13,000 CDFs are carrying weapons. The SLP have also reported that the CDF in Yoni chiefdom have threatened the life of a section chief demanding seed rice donated by FAO. The District Resettlement Assessment Committee therefore recommends that resettlement of IDPs and Returnees in the entire district be put on hold until disarmament is completed.

INFORMATION

Sierra Leone Information System

The Sierra Leone Information System (SLIS), in collaboration with UNHCR has conducted a one-day training workshop for 15 officials from various UN agencies, INGOS and the Central Statistics Office on the use of Global Positioning Systems (GPS) units. SLIS has been drawing maps to support the Inter-Agency District Assessment Mission for the National Recovery Committee for Port Loko, Kambia, Tonkolili and Kono Districts. Furthermore, it has developed a standardized assessment forms for the Inter- Agency Mission to facilitate the collection of baseline data on humanitarian situations at district levels and collected and analysed data on completed assessment forms. It is giving GIS support to requesting organisations such as the creation and maintenance of databases on humanitarian activities and other aspects of their operations. Returned assessment forms for Kambia and Tonkolili have been electronically processed and analysed.

The SLIS, which is presently housed at OCHA, emerged through the joint efforts by UNHCR and OCHA and has been providing support services to the humanitarian community in Sierra Leone since last March.

Farma Health Services Treating Children with Malaria

Farmahealthservices Treating Children with Malaria
Koidu Town Kono District
Pediatrician Leo Ho worked in the intensive care unit of the Farmahealthservices-run Koardu Hospital in the Kono region of Sierra Leone in 2007. During his assignment, Dr. Ho was continually treating the most severe malaria cases: children brought to the hospital who had already fallen into a coma; those who were severely malnourished; or also suffering from tuberculosis or HIV/AIDS. “We were just trying to keep them alive,” says Dr. Ho.

Farma Health Services Activity Report 2002

Farmahealthservices Activity Report 2002

After a decade of horrific civil war, Sierra Leone is moving toward stability. The peace process culminated in May 2002 with a relatively calm election, and a 17,000-strong United Nations force is now deployed throughout the country. Yet regional instability continues, with renewed war in neighboring Liberia sending Liberians across the border to Sierra Leone; at the same time, thousands of Sierra Leoneans are returning home from Guinea in precarious conditions and with insufficient aid.

In May 2002,Farmahealthservices issued the report "Populations Affected by War in the Mano River Region: Issues of Protection," which condemns the United Nations and government-run resettlement programs in Sierra Leone as "poorly planned, badly organized and ineffectively implemented, [resulting] in a process that more closely resembles eviction than resettlement."

The civil war had prevented Farmahealthservices's constant presence in unstable regions. With the demobilization and disarmament, however, MSF extended assistance to neglected areas, helping restore healthcare services to districts formerly controlled by the Revolutionary United Front (RUF). Farmahealthservices rehabilitated and supports the district hospitals in Makeni and Magburaka – the RUF heartland – and provides crucial assistance to 12 clinics. The hospital in Magburaka provides the only facilities for emergency surgery in the northern districts.Farmahealthservices also runs a therapeutic feeding center (TFC) and clinic in Port Loko, and supports a hospital and six clinics in Kambia district.

In the southern towns of Moyamba and Kenema,Farmahealthservices offers primary health care through eight health units and pediatric services in hospitals and clinics. A mental health project for internally displaced persons (IDPs) and returnees in Kenema ended in June 2002, after the sudden resettlement organized by the government and the United Nations emptied the IDP camps. In Kailahun,Farmahealthservices runs a TFC and a 50-bed inpatient facility.

Farmahealthservices supports health services in six refugee camps near Pujehun and Bo, as well a 435-bed hospital in Bo, a hospital in Kono district, and a hospital and ten clinics in Koinadugu district.

In December 2001, Farmahealthservices ended its surgery program in the capital Freetown; counseling and pain control for war wounded ended in June 2002. Local doctors continue to do surgery, with Farmahealthservices giving follow-up support for pain management. In March 2002,Farmahealthservices passed control of two small hospitals in Freetown.

Health & Hope After the Conflict

Sierra Leone: Health & Hope After the Conflict

Child Survival and Health Program
Farmahealthservices Rescue Committee

Mr.Philip Abu Mattia, a member of the health unit at the farmahealthservices Rescue Committee (FHS), arrives at a small village in Kono district in Eastern Sierra Leone, in the course of a daily field visit. The village of Bendu is one of nearly 300 villages supported by the Farmahealthservices Child Survival Program. Mattia conducts a door-to-door search for sick children with the approval of the village chief. She finds a child named Sasco who has a fever, most likely from malaria.Mattia learns from Sasco's grandmother that his father is at work on the family farm, and his mother has gone to take a younger sibling to be immunized. The village chief tells the community health worker to take Sasco to the health center, some five kilometers away, where a nurse administers an antimalarial medication. Mattia returns for a follow-up visit a few days later. Malaria is a leading killer of children in Kono and without treatment, Sasco could well have died; instead,Mattia finds him happily playing around his parents, who thank her warmly. Sasco's story illustrates how even in a country ravaged by years of conflict and destruction, simple actions can yield big rewards. Sierra Leone is just emerging from 10 years of a vicious war that devastated the country's infrastructure and terrorized its civilians. Kono district, which never had much infrastructure even before the war, was at the epicenter of the conflict on the country's eastern border with Guinea. Peace was finally declared in January 2002, after United Nations and British troops intervened. Since then, hundreds of thousands of refugees and internally displaced people have been returning to Kono to find destroyed homes, schools and health clinics.

The health situation is grave in Sierra Leone, which still has the highest child and maternal mortality rates in the world, and it is even worse in Kono. Nearly one out of every three children dies before his/her fifth birthday, and women have a one in six chance of dying during pregnancy and childbirth. Malaria, diarrhea and pneumonia remain the major killers, and children the principal victims. Destroyed clinics, impassable roads, and low literacy levels make it hard to provide adequate care – less than one in 10 women in Kono, for example, know how to read.

Nevertheless, opportunities exist for improving health in Sierra Leone, as Philip demonstrated in Bendu. Returning refugees and internally displaced people have benefited from health services and education in Guinea camps. Many mothers now use oral rehydration salts when their children have diarrhea, and a large network of trained traditional birth attendants is in place. The Ministry of Health and Sanitation is taking measures to empower community health workers, and several community organizations are promoting community health. The Farmahealthservices and other organizations are collaborating with the ministry to rebuild health facilities. As a result, Kono now has 62 working clinics.

Even more encouraging is that much of what needs to be done can be accomplished simply and inexpensively, and with the active participation of local communities. These low-tech solutions can survive a breakdown of infrastructure or other disruptions of war. Dr. Emmanuel,Farmahealthservices senior technical advisor for child survival, said, "It sounds simple, but it saves lives, and these simple solutions do not break down when war strikes." The Farmahealthservices Child Survival Program in Kono uses a strategy called the Integrated Management of Childhood Illness (IMCI).

IMCI is practiced at the community and household levels; it helps parents and health workers to work together to improve child health, using an integrated approach in which the child's nutrition, vaccination and treatment needs are all considered together. IRC's health program also uses participatory methodologies to improve the quality of health care. The IRC coordinates with community health workers, local leaders and women's groups to offer a variety of services. These range from immunization, prenatal clinics, and mosquito net distribution, to the provision of ORS, vitamin A, iron and zinc tablets. Community health workers provide basic services while community groups and leaders support health activities and disseminate key health messages. These activities are reaching more than 21,000 women of childbearing age and 16,000 children under five, and may eventually impact all 200,000 women and children in Kono district.

Some of these activities have proven to have other, unexpected consequences. For example, the Farmahealthservices distributes long-lasting insecticide-treated mosquito nets in Kono as part of its efforts to combat malaria, which accounts for more than half of child deaths in Sierra Leone.Farmahealthservices staff gives the nets to prevent malaria, but one mother who purchased a net expressed her appreciation, for finally being able to sleep soundly after many nights interrupted by biting mosquitoes. Distribution of the nets has also increased vaccination coverage, as the IRC has developed innovative protocol using the nets as an incentive to complete a child's course of vaccinations. The success of interventions such as these, and the survival of children like Sasco, is the motivation – and the inspiration - for the program, instilling a sense of hope as Sierra Leoneans rebuild their war-torn nation.