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• W2068773254 abstract "Electives are a well-established and popular part of the curriculum of medical schools in Europe and North America, offering students opportunities to expand upon prior learning and gain valuable experience in new environments. In the UK, electives occur after either the fourth or fifth year of undergraduate study, and typically last between six to eight weeks. The majority of students travel abroad, with 40% choosing to go to developing countries [1]. The educational benefits of these placements are varied and far-reaching: aside from improving clinical knowledge and procedural skills through direct exposure to novel scenarios, international health electives can increase students’ awareness of global health issues and their determinants, foster independence and self-confidence, and influence decisions regarding future career choices [2–4]. This article describes my elective in Sierra Leone, particularly focusing on the learning points resulting from this experience.I should start by answering a question posed countless times by friends, family and colleagues: why Sierra Leone–a country synonymous to most people with danger and insecurity? Firstly, the country's recent history of conflict and the subsequent rebuilding process interested me deeply, and I wanted to see how these devastating events still influenced the lives of people ten years on from the civil war's resolution. Secondly, I wished to experience the delivery of healthcare in a resource-poor setting and the challenges associated with this. Thirdly, I hoped that working in an under-staffed and over-burdened environment would present me with numerous practical learning opportunities. Lastly, I desired to explore the diverse and rich culture that is so unique and fascinating to Africa, and pervades so many aspects of everyday life.Since the end of the conflict in 2002, which killed 50,000 people and left 2 million displaced [5], Sierra Leone has been making steady progress in a number of areas. Stability is gradually returning to the country, with the 2012 elections being the first in the post-war period to be held without UN supervision. However, Sierra Leone remains one of the least developed nations in the world, ranking 177th out of 186 on the UN Human Development Index [6]. Statistics relating to healthcare are particularly poor: average life expectancy, for example, is 47 years old while the country has just 0.2 physicians per 10,000 population [7]. Nearly 20% of children die before their fifth birthday, with over a third of children under five years being malnourished [7]; while the lifetime risk of maternal death is one in eight and 39% of births lack the presence of a skilled health professional [7, 8].Healthcare in Sierra LeoneSierra Leone's healthcare system comprises a mix of governmental, private and non-governmental organisations (NGOs). There are 13 health districts representing each of the country's administrative areas. A primary care based model, consisting of peripheral health units (PHUs), forms the foundation of healthcare in Sierra Leone; in total there are 1040 PHUs nationwide [9]. In addition, the country has 40 hospitals, of which 23 are state-run [9].The poor health outcomes among the Sierra Leonean population have been recognised by the government, and in 2010 a scheme to provide free healthcare to pregnant and breastfeeding women and children under the age of five years was launched. The abolishment of user fees among these vulnerable members of society has had promising initial results: the number of children admitted to hospital doubled within the first month of the programme's implementation [1], five times more children are now given the recommended malaria treatment [10], and healthcare seeking behaviours for common childhood illnesses have increased [11]. The number of women delivering in recognised healthcare facilities, as opposed to at home, rose by 45% after the first year of the initiative [12], and overall use of health services in the country is up by 60% [10]. Despite these figures providing much scope for encouragement, the scheme is not without criticism, however. There have been reports of inefficient drug distribution leading to shortages, and people being unnecessarily charged for essential medicines [10, 12]; while poor infrastructure including inadequate transportation systems and lack of electricity and running water have hindered what progress has been made [10]. In addition, questions remain over the programme's sustainability,being heavily reliant on foreign donors whose long-term commitment is uncertain [13, 14]. Nevertheless, these reservations should not cloud what so far appears to be a successful commencement to an ambitious project that has the potential to save tens of thousands of lives.My elective was based at Magbenteh Community Hospital (MCH) near the town of Makeni, with a population of around 120,000. The hospital was built in 2006 and is run in association with the Swiss-Sierra Leone Development Foundation–a Swiss-based NGO established in 1996. MCH has approximately80 beds on four wards: male, female, maternity and paediatrics. I spent a total of five weeks at MCH;the first two of these were based on the maternity ward, with the remaining three on the male and female wards." @default.
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• W2068773254 date "2014-01-01" @default.
• W2068773254 modified "2023-09-25" @default.
• W2068773254 title "Lessons from an elective in Sierra Leone" @default.
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• W2068773254 doi "https://doi.org/10.11604/pamj.2014.17.181.3745" @default.
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