Saving lives in Kono District involves more than clinics alone; referral networks, first responders, health education and home-based support for patients living with chronic conditions are all critical components of a healthcare system. Wellbody trains and supports a corps of community health workers (CHWs) who are trained and hired to provide education, first-line treatments and access to healthcare to some of the most remote and neglected villages in the world. CHWs are respected and trusted members of their communities, and they are in a unique position to address the many social and economic factors that affect people’s health and undermine efforts to improve their quality of life. Each day, they visit hundreds of patients in their homes throughout Kono District. Recruited and trained from within the villages in which they work, community health workers are an effective and compassionate way of bridging the gap between clinic and community.
People living with HIV/AIDS in Kono District are an especially vulnerable population: many do not seek out treatment because of the extreme social stigma faced by those who are known to be HIV-positive. Wellbody has trained HIV-positive individuals, who have a deep understanding of the issues specific to living with this disease, to provide specialized individual care to at-risk patients. They visit patients in their homes for directly-observed antiretroviral therapy, a treatment which allows many HIV-positive people to live normal lives. In addition to tracking adherence to medication and monitoring symptoms, they serve as a much-needed form of social support by providing counselling and sharing their personal experiences of living with HIV. Patients in our HIV program have a nearly 30% higher chance of remaining in treatment and living longer, productive and fulfilling lives with the disease.
Maternal and Child Health
Pregnant and nursing women and children under the age of five are among those who most frequently die from preventable causes. Sierra Leone is the third riskiest country in the world to be a pregnant woman; 1 in 23 women will die during childbirth. Sierra Leone also has the highest under-5 mortality rate in the world: 18% of children will not reach their 5th birthday. In Kono District, with the most decimated public healthcare system in the country, these indicators are most likely significantly worse.
In rural Kono, many women give birth in their homes under the care of traditional birth attendants, and the poor roads and cost of transportation make hospitals inaccessible. Malnourishment and diseases like malaria make complications of pregnancy and childbirth far more common than in the United States, and for women in these situations, even the simplest complications are often fatal.
Basic antenatal care and delivery with skilled attendants in sterile environments can greatly reduce the risk of maternal and child mortality, and Wellbody’s CHWs work to make this care easily available to every woman. Actives they perform include:
- Working closely with our partner health outposts -- small, government-operated clinics staffed by a trained midwife or nurse -- to assist in day-to-day operations, patient evaluation and make women feel comfortable and dignified when seeking prenatal and maternal care..
- Visiting women in their homes to ensure that each goes to at least four prenatal checkups during pregnancy. At these checkups, women receive tetanus vaccine, iron and folate supplements, malaria prophylaxis, and anti-parasitic medication. They are tested for HIV and also for malnourishment, anemia, and hypertension; high-risk cases are identified early and can be referred to the hospital in time.
- Educating mothers about hygiene, infant nutrition, symptoms of common childhood illnesses and more through both community education initiatives and individual counselling
- Ensuring all children receive childhood vaccinations
- Growth monitoring and referral of underweight or malnourished children for supplemental feeding
- Helping to manage health crises, like a recent outbreak of cholera, through community education and distribution of first-line treatment
- Facilitating ambulance transport, initiating an emergency care cascade through Wellbody's central clinic and accompanying women to the district hospital in emergencies
Most of the CHWs who focus on maternal and child health formerly worked as indigenous birth attendants, and they are familiar, trusted members of their communities. Their work has enabled Wellbody to establish an effective referral system that links women and their children to rural health outposts, the Wellbody clinic and the district hospital to ensure that life-saving medical care is never out of reach. Completion of all four antenatal care has significantly improved for women in our program, in-facility delivery rates increased and not a single woman has died in labor since our program began.
With support from the World Health Organization's TB Reach initiative, in 2013 we initiated our largest CHW program yet: a District wide TB case-detection and treatment program. In the most remote villages throughout Kono District, healthworkers have been trained to conduct house-to-house screening for the disease and collect sputum samples of potential TB patients. Wellbody coordinates testing and case management through local public clinics, and can arrange for advanced PCR-diagnostics through its GeneXpert device at the Wellbody Clinic. Patients who are found to have TB are immediately enrolled in a daily, home-based care program, in which the healthworker delivers medication daily and provides support and counseling on the importance of completing the course of treatment.
Amputees and War-Wounded Civilians
During Sierra Leone’s decade-long civil war, thousands of civilians were systematically maimed and amputated by rebel combatants. Many of those who survived were provided with housing and material aid in “amputee resettlement camps”. In Kono District, the location of the country’s biggest diamond mines and the epicenter of the civil war, around two hundred amputees live in twelve camps scattered around the region’s capital. In the years after the war, the international relief effort has waned and most material aid to the resettlement camps has ceased. Unemployment and food insecurity are pervasive, both for the wounded and for their families and dependents.
Wellbody provides medical interventions targeted to the needs of people living in the resettlement camps. CHWs from the camps have been trained to monitor pain levels and adherence to medication, promote health literacy, and provide targeted physiotherapy and prosthetics services to amputees. Free care is available to amputees and their dependents at the Wellbody clinic, and a “mobile clinic” is sent to the more rural camps once a month.
Residents of the amputee camps identify not only chronic pain and illness but also poverty, hunger, and instability as major determinants of their health. We believe that we must address these factors in addition to providing medical care in order to improve the health and quality of life of our patients. Wellbody has worked with the communities to implement income-generating projects in several of the camps. Read more about Wellbody’s poverty-reduction initatives.