Combating Cholera in Sierra Leone

Having granted 3 million yen in financial aid, the Japanese Red Cross Society sent Dr Satoko Otsu to the Republic of Sierra Leone on 31 August to help stem the cholera epidemic that had broken out in July. Together with a team from the Finnish Red Cross Society she engaged in medical activities for two weeks in a country suffering from a chronic shortage of doctors.

Lack of local doctors

According to UN statistics, Sierra Leone is considered to be one of the world’s poorest countries. The average male life expectancy is 47.5 years, while that of women is 49.4 years. Although public health systems are in place, the infrastructure to support them was devastated by a civil war that lasted more than a decade. There are also serious shortages of safe water and toilets. One of the reasons cited for the cholera epidemic is that wet season floods had caused sewage to overflow and contaminate the well water used for drinking.

Looking back at her activities, Dr Otsu said, “The shortage of doctors was a serious problem. There were no local doctors in the cholera ward of the Makeni Regional Hospital, where I carried out medical duties this time. In a situation where nurses are responsible for providing all day-to-day medical care, for the duration of my time there I examined the patients with two Finnish Red Cross Society doctors.”

A total of 165 patients were admitted to the cholera ward while Dr Otsu was seconded there. The definition of cholera in Sierra Leone is actually very wide; patients were being rushed to the hospital one after another in the belief that those with cholera-like symptoms, such as vomiting or diarrhea, were infected. These included many patients suffering from malaria or tuberculosis. Having carried out all the medical examinations, Dr Otsu pointed out that a fundamental part of the problem lay in the management of patient information. “As the keeping of medical data is not standard practice, we had difficulties in obtaining accurate patient data. Without analyzable data we were unable to make objective recommendations. Urgent improvements are needed,” she said.

In Sierra Leone, children under five years of age are exempt from medical fees. Dr Otsu reported on the state of the poorly equipped medical system, saying, “Even if I prescribed medicines, some patients would discharge themselves from hospital for financial reasons, saying that they would take traditional medicine.”

High public awareness, environmental improvements highly desired

In contrast, Dr Otsu did find local villages where attention was being given to health and hygiene education. “I visited a woman who had been admitted to Makeni Regional Hospital with cholera. Having already recovered from the illness, she was putting into practice what she had learned in hospital, namely the importance of hygiene, by placing a bucket for washing hands in her home’s toilet,” said Dr Otsu, referring to a change to a heightened sense of awareness among residents. In the meantime, she accepts the inferiority of the sanitary conditions, in which unsanitary toilets and wells used for daily water needs are adjacent to each other. “Long-term support focusing on protection against infectious diseases will be needed in the health field,” she urged.

Japanese Red Cross Society sends another medical staff member for six months

As a result of this cholera epidemic, the International Federation of Red Cross and Red Crescent Societies is continuing its medium- to long-term relief efforts in Sierra Leone aimed at preventing cholera outbreaks in the years to come. On 26 September, the Japanese Red Cross Society thus sent a nurse named Chiyuki Yoshida to the country for about half a year. The Japanese Red Cross Society will maintain a focus on preventing the spread of the Sierra Leone cholera epidemic.