Visit to Sierra Leone ’23

In November 2023 Trustee nurse, Esther Wigmore, and her friend and former colleague, Sara Stevenson-Baker, visited Sierra Leone, to see first hand the work of the two services we support; The Shepherd’s Hospice (TSH) and The Connaught Hospital Palliative Care Team. (See also Visit in 2019)

These are two very different services. The Shepherd’s Hospice, whose main site is in MacDonald Village, is a private health care facility, which provides primary care services to the local community. Most people who come to TSH, have never heard of palliative or hospice care. They come because there is a local health care facility. The team, therefore, provide health care services that meet the immediate needs of patients, such as treatment for malaria, hypertension, arthritis and infections. They are also caring for many patients who have an underlying infection of HIV and/or TB. Some of these patients require palliative care and pain relief. The majority of patients pay for the services provided, those who cannot afford the fees are helped by donations from Palliative Care Sierra Leone.

Following the peninsular road expansion, the old site in Allen Town was partially demolished. However, one building is still useable and after some refurbishment was reopened in August 2023. This is welcomed by the local community, who can visit this clinic to be assessed and treated by a Community Health Officer. The clinic in Allen Town also has some laboratory facilities, so continues the important work of identifying people with HIV/TB infections and getting them onto treatment.

The Shepherd’s Hospice at Allen Town
Esther Wigmore and Sara Stevenson-Baker at the main hospice site in MacDonald Village
Teaching at The Shepherd’s Hospice main site in MacDonald Village

The Connaught Hospital Palliative Care Team, is a team led by Dr Mary Bunn, and includes nurses Patience and Grace who work full-time as palliative care nurses. Other health care professionals, including Dr Melvina Thompson, Dr Greg Foday and pharmacist Ivan, all support the work of this team.

They are part of the government-run healthcare services and only palliative care patients are seen by this small team. As we accompanied the team to the wards, they were warmly welcomed by patients, families and staff. All appreciative of their expertise and care.

In October 2023 they celebrated their 5th Anniversary, with over 800 patients referred to this service. Most of their patients have advanced cancer. Although there are some treatments available for cancer, many people come too late for treatment or cannot afford the surgery and chemotherapy offered. Palliative Care is their only option and crucial to ensure they get the pain relief, help and support they need. The team have developed an expertise in pain control and in ‘breaking bad news’, helping the patient and their families to understand their situation. The team teach family members how to care for the person as they become less well. The support this teams provides is crucial.

During our visit, we heard about the many challenges this team faces but also the commitment and passion with which they care for those referred. We discussed resilience and self-care during our teaching session, important to ensuing the team can continue this essential work.

The Connaught Hospital Palliative Care team with Esther and Sara
Dr Mary Bunn and Grace on the ward round
Patience assessing a patient’s pain control

Visit of Dr Melvina Thompson

Trustees with visiting doctor
Ruth, Jacqui, Melvina, Esther

In February 2023 some of the Trustees were delighted to meet up with Dr Melvina Thompson in London. She has been working with the Palliative Care service at The Connaught Hospital, Freetown, and does this work alongside her other duties in the hospital. Melvina was in London to spend a month on a stroke unit having won a scholarship from King’s College Hospital.

Trustees Ruth Cecil, Jacqui Boulton and Esther Wigmore met Melvina for lunch and enjoyed hearing all about her experiences. Her visit to the UK included seeing how patients are cared for following a cerebral vascular accident (stroke) and the rehabilitation that many people require. She saw new ways of working as a team and plans to take her ideas back to implement at The Connaught Hospital.

During our time with Melvina she talked with great enthusiasm for her work with the palliative care team and the patients she cared for. It was clear that she had found her ‘passion’ in medicine and is keen to further her studies in palliative care. All of the trustees who met her were encouraged by her commitment and clear understanding of the importance of the palliative care service.

Visit to Sierra Leone ’19

In November 2019, I was fortunate to be able to return to Sierra Leone. The purpose was to visit The Shepherd’s Hospice as well as meeting up with Dr Mary Bunn and her team of nurses at Connaught Hospital in Freetown.

Since my last visit in 2016, at the end of the Ebola epidemic, much has changed at The Shepherd’s Hospice. The hospice has moved from its original site in Allen Town to MacDonald village, about an hours drive outside of Freetown. The site is beautifully situated below a range of hills and provides a much more peaceful environment set back from the main road.

hospice with hills
Hospice with surrounding hills

The hospice in-patient building is built around an open courtyard, with the capacity for  12 in-patient beds. Each in-patient unit contains 3 beds, with its own shower-room attached. The laboratory, out-patient clinic and staff canteen are also located here. During my visit I met four patients who had been admitted, one for the management of her pain and wounds related to advanced breast cancer. The team demonstrated a good knowledge of basic palliative care and it was good to see this lady smiling and planning her discharge back home.

The Shepherd’s Hospice continues to function primarily as a health care provider for the local community, treating minor ailments as well as testing for TB and HIV infection. If tested positive, the team ensures that the person is given treatment and is provided with ongoing support and monitoring.

It was very encouraging to meet up with Dr Kelfa Koromba-Kpallu, the Medical Officer, and Magdalene King, Senior Nursing officer. Thanks to the generosity of our supporters, the UK Friends of The Shepherd’s Hospice (UKFTSH) fund their salaries. They were both enthusiastic about the work they do in providing palliative care.

Hospice team
Dr Kelfa Koromba-Kpallu (2nd from right) and team

Having changed our charitable objectives, the UKFTSH can now also support any development of palliative care in Sierra Leone. I therefore took the opportunity to meet up with Dr Mary Bunn and her new team at The Connaught Hospital, the main government hospital in Freetown. She is a palliative care Doctor from the UK, with experience of working in Africa. She is working as a volunteer to establish this new palliative care team. Three nurses, Hawa, Patience and Grace work alongside her.

Connaught Hospital team
Dr Mary Bunn and her team of nurses at The Connaught Hospital

She has made great progress since commencing her work in Sept 2018. In the first year, 133 patients were referred. Most referrals (95%) are for cancer patients, although the team are happy to see any patient with progressive, life threatening conditions requiring palliative care. Sadly, knowledge about cancer is very limited in Sierra Leone and so many patients present with very advanced disease. Sierra Leone has no radiotherapy services and very limited chemotherapy. For the majority of people diagnosed, palliative care is the only realistic option for care and relief of their suffering.

Dr Mary Bunn and her team of nurses also visit the main children’s hospital in Freetown – Ola During and give advice and support to ease the suffering of the children referred. They also conduct community visits, following up on patients too ill to attend the hospitals.

Mary has a vision for palliative care to be introduced throughout Sierra Leone. She wants to train Community Health Officers and nurses working in the government health centres/hospitals. By training a number of staff, she hopes to create a network of small palliative care teams across Sierra Leone. The UKFTSH has committed to fundraise to enable this education and training commencing in 2020.

I was delighted to see that all the nurses in her team were able to do an initial palliative care assessment and make recommendations on care and medications required to manage symptoms. They demonstrated a compassionate and empathetic approach to the patients they interacted with, something I haven’t always seen over the years of nursing in Sierra Leone. This team is helping to educate others in the hospital and they now receive referrals from every ward, as the importance of this service is now being recognised.

I left Sierra Leone encouraged by what I had witnessed and enthused to fundraise to help sustain these services.

Esther with TSH team
Esther with TSH team

If you are interested in donating towards this work, please contact us.

Trustees Visit The Shepherd’s Hospice

trustee visit 2016
Trustee visit 2016

In January 2016 two of the trustees, Jacqui Bolton and Esther Walker, were able to visit The Shepherd’s Hospice. Jacqui combined this visit with her role as part of the Kings College Team who are based at The Connaught Hospital in Freetown.

This was an important visit coming at the end of a deeply traumatic time for Sierra Leone. The Ebola epidemic was thankfully almost over when we visited but restrictions still applied to movement and care of people and the effects of this dreadful time were palpable. We heard from staff about their experiences of responding in the Ebola crisis.

Jacqui having her temperature checked
Jacqui having her temperature checked

The Shepherd’s Hospice had helped establish testing and holding centres, provided education to local communities and the formation of a burial team. Sierra Leone lost 5% of its doctors to Ebola and 221 trained healthcare workers. It is still coming to terms with the impact of this disease. To this end we hoped our visit would provide some encouragement to Gabriel and his team.

It was also an important opportunity for us as Trustees of UKTFSH to assess the situation and the services that the current team can provide. No home visiting of the sick was allowed during the Ebola crisis and therefore the team continue to focus their efforts on running a clinic to identify patients with HIV/AIDS/TB, providing laboratory testing and helping people access treatment.

trustee visit 2016 - esther
Esther Walker with local staff

During our visit we worked alongside our nursing colleagues in the clinic and undertook a number of visits to local hospitals, facilitated by Jacqui’s links to the Kings team. This was an opportunity for Esther to demonstrate palliative care to the team and try to establish links with hospitals that might continue to refer to the team. More formal ‘classroom’ teaching was also undertaken, particularly focusing on pain assessment, management and the use of morphine.

Building Work on new hospice
Building Work on new hospice

We also visited the new site for the hospice in Macdonald village and were able to see work progressing. We met with the architect, builder and team to discuss the services they hope to provide and look at the facilities. It was enjoyable to be able to contribute some suggestions at this stage.

The Shepherd’s Hospice is at a crucial stage for the future development of services and we hope in the years to come to revisit and find a new hospice building providing palliative care services.

MacDonald village site
MacDonald village site