Health Hope In Kono District.

Health & Hope After the Conflict in Koidu Town,Kono District.

Amina Issa Mohamud, a member of the health unit at the International Rescue Committee (IRC), arrives at a small village in Kono district in Eastern Sierra Leone, in the course of a daily field visit. The village of Bendu is one of nearly 300 villages supported by the IRC Child Survival Program. Amina conducts a door-to-door search for sick children with the approval of the village chief. She finds a child named Sasco who has a fever, most likely from malaria. Amina learns from Sasco's grandmother that his father is at work on the family farm, and his mother has gone to take a younger sibling to be immunized. The village chief tells the community health worker to take Sasco to the health center, some five kilometers away, where a nurse administers an antimalarial medication. Amina returns for a follow-up visit a few days later. Malaria is a leading killer of children in Kono and without treatment, Sasco could well have died; instead, Amina finds him happily playing around his parents, who thank her warmly. Sasco's story illustrates how even in a country ravaged by years of conflict and destruction, simple actions can yield big rewards. Sierra Leone is just emerging from 10 years of a vicious war that devastated the country's infrastructure and terrorized its civilians. Kono district, which never had much infrastructure even before the war, was at the epicenter of the conflict on the country's eastern border with Guinea. Peace was finally declared in January 2002, after United Nations and British troops intervened. Since then, hundreds of thousands of refugees and internally displaced people have been returning to Kono to find destroyed homes, schools and health clinics.

The health situation is grave in Sierra Leone, which still has the highest child and maternal mortality rates in the world, and it is even worse in Kono. Nearly one out of every three children dies before his/her fifth birthday, and women have a one in six chance of dying during pregnancy and childbirth. Malaria, diarrhea and pneumonia remain the major killers, and children the principal victims. Destroyed clinics, impassable roads, and low literacy levels make it hard to provide adequate care – less than one in 10 women in Kono, for example, know how to read.

Nevertheless, opportunities exist for improving health in Sierra Leone, as Amina demonstrated in Bendu. Returning refugees and internally displaced people have benefited from health services and education in Guinea camps. Many mothers now use oral rehydration salts when their children have diarrhea, and a large network of trained traditional birth attendants is in place. The Ministry of Health and Sanitation is taking measures to empower community health workers, and several community organizations are promoting community health. The IRC and other organizations are collaborating with the ministry to rebuild health facilities. As a result, Kono now has 62 working clinics.

Even more encouraging is that much of what needs to be done can be accomplished simply and inexpensively, and with the active participation of local communities. These low-tech solutions can survive a breakdown of infrastructure or other disruptions of war. Dr. Emmanuel d'Harcourt, IRC senior technical advisor for child survival, said, "It sounds simple, but it saves lives, and these simple solutions do not break down when war strikes." The IRC Child Survival Program in Kono uses a strategy called the Integrated Management of Childhood Illness (IMCI).

IMCI is practiced at the community and household levels; it helps parents and health workers to work together to improve child health, using an integrated approach in which the child's nutrition, vaccination and treatment needs are all considered together. IRC's health program also uses participatory methodologies to improve the quality of health care. The IRC coordinates with community health workers, local leaders and women's groups to offer a variety of services. These range from immunization, prenatal clinics, and mosquito net distribution, to the provision of ORS, vitamin A, iron and zinc tablets. Community health workers provide basic services while community groups and leaders support health activities and disseminate key health messages. These activities are reaching more than 21,000 women of childbearing age and 16,000 children under five, and may eventually impact all 200,000 women and children in Kono district.

Some of these activities have proven to have other, unexpected consequences. For example, the IRC distributes long-lasting insecticide-treated mosquito nets in Kono as part of its efforts to combat malaria, which accounts for more than half of child deaths in Sierra Leone. IRC staff gives the nets to prevent malaria, but one mother who purchased a net expressed her appreciation, for finally being able to sleep soundly after many nights interrupted by biting mosquitoes. Distribution of the nets has also increased vaccination coverage, as the IRC has developed innovative protocol using the nets as an incentive to complete a child's course of vaccinations. The success of interventions such as these, and the survival of children like Sasco, is the motivation – and the inspiration - for the program, instilling a sense of hope as Sierra Leoneans rebuild their war-torn nation.