Sierra Leone 1998

MSF has 20 expatriate aid workers in Sierra Leone Surgical programme continues Although the Nigerian-led ECOMOG force overthrew the military junta in February 1998 and secured the return to power of President Ahmad Tejan Kabbah, many parts of the country remain insecure and fighting continues particularly in the east and north-east. MSF teams continues to see large numbers of mutilated civilians who have fled the conflict in the clinics and hospitals which they support. The insecurity is such that MSF continues to have major problems gaining access to certain isolated populations. In the Northern Province, MSF works in Kambia and Portloko districts. This area remains very dangerous because of ongoing fighting. The team often crosses the border into Guinea to spend the night. Here MSF has three main objectives, to continue the therapeutic feeding programme, to prepare for emergencies and to support the Kambia hospital on an ad hoc basis. MSF would like to open a badly-needed paediatrics ward here. MSF also runs a dry feeding programme in eight clinics for under-fives to the west of Kambia. MSF is likely to remain in the northern province for at least another year. Since the coup d'état in May 1997, MSF has run a surgical programme at Connaught Hospital in Freetown for war-related cases. MSF is protesting strongly against the particularly cruel methods of targeting of civilians. Not even children are spared from mutilation. MSF no longer carries out surgical operations in te hospital as there are now seven inhouse surgeons. The team is focusing on the training of anaesthetists and surgical nurses in pre and post-operative care. MSF provides medical support to two government run clinics which service a wide target population. MSF also runs four other clinics in Freetown. The focus here is on supervision of health care assistance and staff training. The clinics cater for the poor and the displaced. In the southern province MSF is providing support in six clinics and the district hospital in Pujehun, eight clinics and the district hospital in Bo, and two clinics in Bonthe. Teams are about to start working in Bonthe's Matru Hospital. The teams is based in Pujehun and Bo at the moment. MSF has been or continues to be involved in the rehabilitation of many of these structures. All of these clinics function with both the ministry of health staff and MSFsupport. In spring 1998, MSF began to reduce its involvement in the actual running and management of Bo Hospital to concentrate on providing medical supplies, basic logistics, financial incentives to staff and training for maintenance staff. Financial incentives are essential in a situation in which staff receive little or no salary. A cost recovery scheme has been initiated and a management commitee set up. A cholera camp is also maintained in Bo. MSF gives logistical support and provides financial incentives to staff in the effort to re-start EPI in most areas of Southern province where it had been suspended for over a year. MSF also offers support to the district medical authorities (in the area of supervision, management, etc..) An MSF team is currently evaluating the situation in Moyamba, a district which lies to the south of the capital Freetown. MSF would also like to be able to carry out a proper evaluation of needs in the isolated and war-torn areas of Makeni and Magburaka but unfortunately insecurity is such that for the time being a proper evaluation has not been carried out.