St. John of God Clinic, Port Loko (December 13, 2022)

We visited a clinic built by the Brothers of St. John of God mission in Lungi and spoke with Brother Frances Kabia. He has been in Lungi about three months, received his RN degree in Ghana and did post-graduate studies in mental health and psychiatric disorders in Malawi. In addition to overseeing the clinic, he teaches psychology and mental health courses at the St. John of God Nursing School in Lunsar one day each week. Brother Kabia welcomed us into his office and spoke with us extensively about the clinic and public health challenges in Sierra Leone.

The clinic was built in 2007. The facilities are well constructed with large reception area, exam rooms, in-patient wards for men and women, labor and delivery rooms, pharmacy, laboratory, and ultrasound room. We met very few patients at the clinic, but staff indicated that Thursday and Friday are much busier due to childhood vaccination and well-child checks on Thursdays and expectant mother clinicals on Fridays. They offer low fees for health services and appear to be well staffed with a State Registered Nurse (SRN), Community Health Nurse, and a Nursing Aid. In addition, the clinic is a post for four government healthcare staff, including a Chief Health Officer. Due to lack of salary payments from the government to their staff, only one of those posted here, a Maternal Child Health Aid (MCHA) who performs ultrasound exams, sees patients on a regular basis.

Due to the low number of patients we observed, I asked Mr. Kabia his thoughts. He discussed several obstacles for healthcare delivery:

1. Traditional beliefs – many in Sierra Leone prefer to visit a local traditional healer. These individuals use local herbs/homemade medicines to treat patients.

2. Time and cost – these were discussed together. Most of the population work in agriculture or as petty traders. If they don’t work, they don’t earn money for the day and cannot feed their families. Going to a clinic for themselves or a child may take many hours. In addition to the cost of treatment, time is money as well.

3. Transportation – most Sierra Leoneans do not own their own vehicle. They us taxis or motorcycle taxis, where passengers ride up to three per seat, to get from place to place. The cost of transportation is an obstacle.

4. Medicine Supply – many medications are in short supply and cost of medications are also an issue. Most clinics charge patients for medications, if not covered by a government program, such as malaria treatment. Clinics then replace medicines with the payment they receive. If medications expire before they are prescribed and paid for by patients, the clinic has no funding stream to replace them.

The St. John of God Clinic also offers occasional dental services. There is a dental chair donated by a dentist from the Netherlands. Dentists who volunteer services are announced in advance of their arrival at local churches and mosques. In recent times, services were limited to extractions.