Concern in Sierra Leone 2008

Vlog: Rush hour in Freetown

Mon, 2 Jun 2008 13:16:15 -0400

You might think that in the world’s least-developed nation they would at least has the world’s least-developed traffic jams. You’d be wrong.

The worldwide trend toward urbanization is hurtling forward in Sierra Leone, too, helped along by the wartime displacement of hundreds of thousands of people. Experts estimate that more than a quarter of the nation’s six million people now live in Freetown – that’s more than a million people in this incredibly under-developed city.

So you can imagine what rush hour traffic is like in a city with few paved roads, no public transport and only a tenuous rule of law. Oh, and did I mention the diesel fumes?

Vlog: James Kiernan’s commute

Mon, 2 Jun 2008 13:10:21 -0400

There’s little that’s easy about living in Freetown. Even if you have a car, getting to work can be a challenge.

Concern Assistant Country Director for Systems James Kiernan has it down to a science – he manages to avoid the worst of the traffic by going far off the beaten path. Following his favorite route to work gives you a good idea of the development challenges Sierra Leone faces even in its most developed city.

So, fasten your seat belt (in accordance with worldwide Concern policy) and come along for a bit of the ride.

Accountants rule!

Fri, 30 May 2008 10:08:37 -0400

I have never seen so many accounts is so many strange places as at Concern.

Every country office has several staff accountants, and many of the field offices have accountants, as well. I’ve seen them in emergencies, as in Liberia, and way out in the hinterlands, like rural Niger.

It’s a further sign of how accountability is baked into the Concern culture. At the highest levels, Concern believes in accounting to donors about where their money has gone, but at the other end of the line, Concern believes it must also be accountable to beneficiaries.

“We can show you right down to the exact family in the remotest village what we gave to each beneficiary,” says Concern systems manager James Kiernan. “We keep track of everything at every distribution and report it all back. There is a paper trail... Except in Pakistan (during the emergency relief after the 2005 earthquake there), when we were just heaving tents into military helicopters and having them dropped in the high mountain villages.”

Inventory control is strict; procedures are even stricter. Everyone at every level knows they are merely handling other people’s money, gasoline, piping and concrete. Absolutely every item – down to the crappiest mirror in a staff house – is logged with an inventory control number and tracked through the project’s life.

Anyone can make grand pronouncements about honesty and accountability, but actually living up to those words takes a lot of hard work. Once you’ve seen field staff sorting through pipe fittings on the floor as the storekeeper marks down the totals, you know everyone here can walk their talk.

Keeping children alive

Fri, 30 May 2008 05:46:53 -0400

The average life expectancy in Sierra Leone is one of the lowest in the world: 41 years.

But that is somewhat of a misleading statistic. Everywhere you go, there are plenty of old people. Even in rural areas where life is hardest, villages have several people well into their 60s.

What skews the number is the alarming number of children who die. Sierra Leone has the world’s highest death rate for children under 5 years old: nearly 300 of every 1,000 children die before their fifth birthday. This is the worst place on earth to be a child.

Knowing this, Concern has put maternal and child health at the top of its priority list in Sierra Leone. Work with traditional birth attendants to spot high-risk pregnancies, community health volunteers to spread hygiene and diet messages and even increasing food production are all helping to drive down death rates for children and pregnant women.

But a major focus for Concern’s work on child survival has been government-run public health clinics, like one we visited in Makoni Line village. There’s a good reason for this, says Franklin Surian, the Concern health program staffer for the 12 villages in this chiefdom: “The idea is to develop sustainable capacity here by improving the government clinic. So when Concern leaves, these services can still be delivered.”

That’s why so much of Concern’s community work is aimed at getting people to government health clinics like the one in Makoni.

Concern’s community health volunteers are trained to spot common illnesses, malnutrition and difficult pregnancies and encourage families to get help from the local clinic. They also work to support government clinics by raising money to fund operations; the Health Management Committee runs a five-acre garden plot to support the clinic.

These clinics are under-resourced, to say the least. So Concern works closely with the nurses staffing them to get them materials, training and help.

Take the Under-Five program at Makoni for example. It’s a special weekly clinic targeting young children for regular check-ups and monitoring. Concern works with traditional birth attendants and village health volunteers to urge women to enroll their kids in the free program. The hope is that early detection and treatment of common childhood killers like malaria and diarrhea will decrease deaths.

On a recent Friday in Makoni, the clinic is packed with women and their young children, including several newborns. There are 80 children enrolled in the Under-FIve program here.

The place is staffed by just one nurse, a big limit on what can be done. But today, Concern’s local health staffer Franklin is helping, as well as several rural midwives who’ve been working in the Concern birth attendant program. They keep order in the line, measure and weigh the children and generally support the nurse so she can concentrate on diagnosis and treatment of any problems that come up.

Each child has a large yellow card tracking their visits, vaccinations and treatments. Newcomers are given the full spectrum of shots and then weighed and measured each time they return. If their growth is below normal, they’ll be enrolled in a nutrition program. Any illnesses are treated right away.

Memanatu Karoma, 18, is here with her son Isatu, her first child. He was born at home five days ago. Building on the tradition of rural midwives’ handling deliveries in rural areas, Concern has worked with traditional birth attendants, training them with new skills and integrating them into the overall health care system. That’s why Memanatu is here with her son: her birth attendant told her it was a good idea. And the local Concern volunteer in her village also came by during her pregnancy to give tips and urge her to visit the local clinic.

Today Isatu will be enrolled in the Under-Five program, weighed, measured and given some vaccinations. His mother, too, will get a checkup to make sure she is recovering well from childbirth.

“I realized how important it is to do this,” Memanatu says. “immunizations can prevent so many illnesses and keep my son healthy. I will come back.”

Sixteen-year-old Mariatu Karoma has been bringing her eight-month-old son Camatu here since his birth. But today he’s not feeling well – high fever and coughing. The nurse suspects malaria and a respiratory tract infection, two of the three main killers of young children here (the third is diarrheal disease like cholera). She prescribes antibiotics and malaria pills, treatment he probably never would have received in the past.

Work like this is having an effect: a chart on the clinic wall tracks common diseases reported here from January through March of 2008. For children under five, cases of malaria, respiratory infection and diarrhea have gone from a high of 166 to just 19.

And overall last year, Concern’s work helped reduce deaths in those under 5 years old from 193 per 1,000 to 88 in targeted areas like Tonkolili district.

“I’m very pleased with the program,” says government nurse Adama Kargbo.

Vlog: Makoni health clinic

Fri, 30 May 2008 03:10:08 -0400

Concern’s work at the government clinic at Makoni has led to a decrease in common diseases. We visited the day of the Under-Five child health clinic, a key Concern and the government are working together to drive down the world’s highest child mortality rates.