Good morning, Hank, it's Tuesday.  So almost exactly one year ago, we announced a new project to support Partners in Health and the government of Sierra Leone in their efforts to radically reduce maternal mortality.  This initiative, which seeks to raise $25 million over five years will strengthen the healthcare system in Sierra Leone's Kono district at every level, from hiring and training community health workers to building, staffing, and supplying a new Maternal Center of Excellence at Koidu Government Hospital, which will have all the clinical spaces and services that mothers and their children need to stay healthy.  That's everything from a child health clinic to a neonatal intensive care unit to family planning clinics to labor and delivery to operating rooms.

This Maternal Center of Excellence will dramatically change the quality of healthcare available to women and children in Kono and we hope it can provide a blueprint to reducing maternal and child mortality elsewhere in the world, or at least, that's what I said a year ago.  It has been a very long year and today I would like to give you an update on where we are.

First of all, I want to recommend the documentary "Bending the Arc", which is currently available on Netflix and which explores how, when the global health community believed that treating multi-drug resistant tuberculosis in impoverished countries was impossible, Partners in Health helped prove otherwise, because I think it's helpful background and understanding why Partners in Health is now working to show that maternal and child mortality can be radically reduced starting in a place with one of the world's highest rates of these unnecessary deaths.

One out of every 20 women in Sierra Leone can expect to die in pregnancy or childbirth and almost all of those deaths would be preventable with a strong healthcare system.  Every day, women die for want of a safe emergency c-section or for want of a blood transfusion or for want of blood pressure medication, basic services and medicines that most of us living in rich countries take for granted, and we know this is not like, inevitable or natural, in part because as the Sierra Leonian healthcare system has begun to strengthen over the last few years, there have been big reductions in child and maternal mortality.

Like at the hugely successful Wellbody Clinic that PIH runs, there hasn't been a single maternal death in years.  The change is happening, we just believe it needs to be accelerated by a high quality teaching hospital that makes pregnancy and childbirth safer for both mother and child.

So, where are we?  Well, the original plan was to break ground on the maternal center of excellence in April of 2021, but with COVID and everything, the plan is still to break ground in April of 2021, which is a wonderful credit to both Partners in Health and the government of Sierra Leone, and some system strengthening is already happening.  More community outreach, more training for nurses and midwives, social support programs for pregnant women and new moms and other maternal health initiatives, but recently, when I spoke to Isata Dumbuya, the nurse who Koidu government hospital's maternal and child health teams, she said the next big step for the community is the Maternal Center of Excellence.

Isata: Our special care baby unit, we have a new unit, a new space that we've just moved the babies to.  The results already in three months are phenomenal, but yesterday, I went in there and it was full, which is why the Maternal Center of Excellence cannot come soon enough.  This is a space and place where women in Sierra Leone would know for the first time that they are worthy of having the same level of care, the same treatments, the same access to equipment as anybody else in any part of the world.

John: The design for the Maternal Center of Excellence, created in partnership and consultation with the staff at the hospital and the community it serves, is really wonderful.  It features lots of locally sourced materials.  Like, the community is especially enthusiastic about the use of stones cast off from the nearby diamond mine to help build the hospital.  That mine has become a symbol of destruction and despair for many in Kono, but now, stones from that mine can become a symbol of hope, and of course, it'll have all the stuff a hospital needs: 24-hour electricity, safe and sanitary operating rooms, an extensive blood bank, incubators for the NICU, and so on, all resources the Koidu government hospital never had, even just a few years ago.

It's hard to overstate how big the change will be.  Like, the MCoE will almost triple the number of maternal hospital beds in the region.  They expect to see over 4,000 deliveries a year, a fivefold increase in the number of family planning visits, and critically, the MCoE will dramatically increase the number of medically necessary c-sections that can be performed, and because it's a teaching hospital, the MCoE will help train the next generation of Sierra Leonian healthcare workers, from doctors to nurses to community health workers.

Right, so the overall five year cost of this project is $25 million, but in order to break ground, we need to raise $20 million.  This is because both PIH and the government of Sierra Leone want to prevent a building getting like, halfway built and then abandoned or fully built but never adequately staffed or supplied, which is a huge problem in impoverished countries.  

Too often, people or institutions make big promises that they fail to keep or make short term investments that are quickly abandoned, and none of that strengthens the system in the long run and so that's why we have to raise $20 million before breaking ground.

Because thousands of you have become monthly donors to this project at PIH.org/hankandjohn and because incredibly generous matching donors from within Nerdfighteria have banded together to match every monthly donation, at the current rates of donation, over five years, we will have raised over $15 million.  Another $3.5 million has come from large donors to PIH, thank you.

If you want a fuller, more detailed breakdown of the fundraising so far, there is a link to a video in the doobly-doo and the comments below, but yeah, all together, we have raised over $18.5 million.  In the last 13 years, Nerdfighteria has accomplished some amazing things, but that has to be the most amazing, and I know how grateful all of our PIH friends in Sierra Leone are to you all, but there is still a funding gap.

Like, one way of looking at this is that we have raised 93% of the money we need to break ground, and another way of looking at it is that we still have a million and a half dollars left to raise, which is a lot of money.  I expected that because of the pandemic and the tremendous stresses it has caused, that donations might go down, but in fact, they have gone up every month and I find that so encouraging, and of course, we understand that many of you are not in a position to donate right now, and that is okay, but if you are able to become a monthly donor at PIH.org/hankandjohn, it can make a huge difference.

I have seen how critical the need is for better child and maternal health care in Kono.  It is an emergency.  It's just one that doesn't make headlines.  Also, in order to get to the $20 million mark, we are gonna need some larger donations, so if you happen to be in a position to donate say, $5,000 or more to this project, there is a separate link in the doobly-doo below, or you can e-mail me at sparksflyup@gmail.com to learn more.

I want to emphasize one thing, though. The MCoE will be, like all of Koidu Government Hospital, owned by the people of Sierra Leone through their government, and it will be staffed almost entirely by Sierra Leonian healthcare workers and supported and funded to a large degree by the government of Sierra Leone.  The heroes of this story are the people like Isata, who sacrifice so much to help vulnerable women deliver safely.

Hank, I said earlier that 1 in 20 women in Sierra Leone can expect to die in pregnancy or childbirth.  Not long ago, that statistic was 1 in 17 women, and so, maternal death is declining and the progress is real.  It's just not fast enough.  Every health care worker I've spoken to in Sierra Leone has gut-wrenching stories about the pain of knowing what needs to be done to save the life of a mother or a child but being unable to do so because there is no working ambulance or there is no blood bank or there is no safe operating room.  As one PIHer told me, "We know how to save women's' lives, we just need the tools," and that is our challenge and our opportunity to help provide the tools to this community so that they can radically reduce maternal and child mortality.

So again, if you can join us in donating, the link is PIH.org/hankandjohn.  To the thousands of you who are already monthly donors, thank you.  We are 93% of the way there, and if you can't donate, thank you for your attention.  It matters.  If the world was paying attention to this crisis, more would be done to stop it.  So thank you and Hank, I will see you on Friday.