good morning Hank it's Tuesday Sara and
I spent last week in Sierra Leone
learning about the healthcare system
there and along the way we visited Kesey
psychiatric hospital a 199 year-old
facility that is the only mental health
hospital in the country this was of some
personal interest to me because I have
been at one level or another a
psychiatric patient for most of my life
the hospital is led by dr. Abdul giallo
one of the only psychiatrists in Sierra
Leone a nation of over seven million
people
he explained that as recently as a year
ago life in the hospital was extremely
dire for both staff and patients no
medication no supply dr. Jawa keeps a
picture in his office to remind him of
what the hospital looked like recently
it was truly horrific perhaps most
disturbingly many patients were chained
to their beds for much of the day and
night as we walked around a staff member
showed me a poster about chaining that
had been sent to the hospital years ago
the poster was really frustrating to the
staff because everyone wanted to end
chaining but without medication or any
functioning infrastructure they couldn't
find another way to keep aggressive
patients from harming themselves or
others they didn't need posters they
needed support the staff walked me
through one ward where the tile had been
broken up to prepare for renovations but
otherwise it looked as it had for
decades we visited what was until
recently the hospital's pharmacy and I
was told that these shelves had long
been nearly empty I mean imagine it no
water for showers or to flush toilets no
medication to treat the immensity of
psychic pain very few clinicians to
offer cognitive therapy and no
electricity there were generators two
huge ones donated years ago by a charity
but they turned out to be much too
powerful for the hospital's electrical
grid and shorted everything out had the
charity asked the staff would have
explained what kind of generator they
needed but no one asked
at least not until partners in health
began working with Sierra Leone's
Ministry of Health along with dr. Joe
Lowe his staff and the patient
population to improve the hospital they
brought in the right generator and now
the hospital's wards have lights and
functioning fans they also worked to
increase staffing at the hospital and
brought medications in hundreds of
medications actually stored in a
climate-controlled room the beds and
mattresses were replaced and running
water was restored so that toilets and
sinks and showers would work again and
because medications and other treatments
are now available many patients have
been able to move out of the hospital
and live at home as one nurse explained
to me just a year ago almost everyone
who received care from kissies stayed at
the hospital now most of their patients
are able to live at home and critically
the practice of chaining has ended
patients now walk freely about their
care area and when patients do become a
threat to themselves or others humane
restraints are used but even that is now
rare several patients took the time to
talk with me and one long-term patient
spoke of how life has changed at kissy
in the past two years
[Music]
of course no one wants to be a patient
at a psychiatric hospital chronic mental
illness is extremely difficult to live
with even in the best of circumstances
and there's still a long way to go at
kisi more areas to be renovated and
opened including this room which will
become a lecture hall to train the next
generation of sierra leonean clinicians
and a soon to be opened ward that will
serve as the country's first dedicated
drug addiction rehabilitation center and
as Sierra Leoneans begin to trust that
the mental health care system can offer
effective treatment the demand for
services will continue to rise which
will lead to new challenges but the
transformation so far is truly profound
and it has immeasurably improved the
lives of the patient population here I
feel a kinship with them
because I owe my life to effective
mental health treatment the kind of
treatment that these patients are at
last beginning to receive we saw again
and again in Sierra Leone that
individual interventions of poster
campaign a donated generator often
failed to be transformative in part
because it's not one thing or another
that needs to change
it's the system the problem is an
infrastructure or chaining or staffing
or medicines or running water or
electricity all of this must change
together isolated investments often
yield isolated results but if you invest
in systems you can get systemic results
and by investment I don't just mean
money I also mean investing the time and
attention to listen carefully rather
than just barging in with preconceived
solutions that's what our community has
learned from working with partners in
health for the last decade PIH is
successful because it builds systems and
because it listens to the people it
seeks to serve it's no coincidence that
96% of PIH sierra leone's employees are
sierra leonian in the coming months and
years hank and i will be focusing more
on providing ongoing long-term support
to strengthen the health care system in
sierra leone and that will be the
biggest project we've ever undertaken on
this channel by far which is
intimidating but the need is immediate
and it is critical and when I look at
what the staff and patients
kissee psychiatric hospital have
accomplished in the last two years I
know that real change is possible we'll
be talking much more about this in the
coming months but in the meantime I
really hope you'll sign up for our new
newsletter about the Sierra Leone
project to learn more there is a link in
the doobly-doo below I will also be in
comments to answer your questions lastly
a huge thanks to everyone at PIH and
Kissy psychiatric hospital for sharing
their time experiences and expertise
with us Hank I will see you on Friday