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In which John discusses the $6,500,000 donation he, Katherine, Sarah, and Hank are making to Partners in Health Sierra Leone, why the health care workers there need our support to address the maternal mortality crisis, and the long-term plan Partners in Health has developed to strengthen every facet of the healthcare system in Sierra Leone's Kono District. You can join us now by making a gift at and right now all your donations will be matched by people in nerdfighteria who came together to create a matching fund!

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Good morning Hank. It's Tuesday.

So over the next five years, our families are donating six-and-a-half million dollars to Partners In Health Sierra Leone. Also, we need your help, but more on that in a moment.

When I was in Sierra Leone earlier this year, I spent a day with a community health worker named Ruth, who works for Partners In Health making house calls to people living with serious illnesses like tuberculosis or HIV. Ruth makes sure her patients are able to take their medications and refers them to a clinic if they need further care and also she can help identify high-risk pregnancies, which is critical in Sierra Leone because it has the highest maternal mortality rate in the world.

One in seventeen women in Sierra Leone will die in pregnancy or childbirth. One in seventeen. Like many people, Ruth's education was interrupted by the Sierra Leonean Civil War, which lasted from 1991 to 2002. During those years, she also contracted HIV, and she nearly died before access to anti retroviral therapy allowed her to recover her health and in turn to find a job with PIH where she can care for her family and serve her community.

Today, Ruth is paid a living wage by Sierra Leonean standards, but she is far from well off. And at one point, Sarah and I were walking away to visit some other PIH employees when I happened to glance back and see Ruth slip the equivalent of $2 to one of her patients, a mother who was struggling to feed her kids a second meal that day. The family was also being enrolled in a nutritional support program run by PIH, but Ruth wanted to make sure that they could eat THAT day. And I want to be clear about this. It required far more sacrifice and compassion for Ruth to make that donation than it does for our family to make this one.

But we're talking about our gift publicly today in the hopes of bringing attention to the many healthcare workers like Ruth who need to be supported by more robust systems in order to address the maternal and child mortality crises in Sierra Leone. And I do mean crises. This is an emergency.

Ten percent of Sierra Leonean children do not live to see their fifth birthday, and 3000 women in Sierra Leone will die in pregnancy or childbirth this year. They will die of hemorrhaging, that any well-stocked hospital could easily address. They die because there is no electricity to keep the lights on during nighttime deliveries or to keep blood for transfusions refrigerated. Or they die because there is no running water, which makes it difficult to sanitize tools and prevent infection. They die for want of medications or for want of surgical gloves. Or they will die because they need a C-section, and in Sierra Leone needing a Caesarean section is often a life-threatening emergency. A woman delivering at home or at a local clinic who needs a C-section will usually find that there is no ambulance to take her to the hospital, and so her best chance will be a long ride, dying on the back of a motorbike.

This an emergency. But because it is an emergency that has unfolded over many years, it doesn't receive much attention. Also, the solution isn't simple? Like it isn't ambulances, or clean water, or electricity, or more healthcare workers. It's ambulances AND clean water AND electricity AND more healthcare workers AND much else. Systemic, long-term problems demand systemic, long-term solutions.

And that's what Partners In Health is really good at⁠. Working with them over the last 10 years, our community has seen their success at helping to build healthcare systems in impoverished communities from Haiti to Rwanda. And now in partnership with the Sierra Leonean Ministry of Health, they are crafting a plan to strengthen every facet of the healthcare system, beginning in the Kono District.

That means hiring far more community health workers like Ruth, who can make house calls to people with high-risk pregnancies and those living with chronic illnesses. It means strengthening primary care centers so that they can become safe places to deliver babies and receive basic care. And it also means the building and support of a Maternal Center of Excellence at Koidu Government Hospital, which will have a NICU and more operating rooms for C-sections and also serve as a teaching hospital that can train the next generation of Sierra Leonean healthcare workers. Ninety-six percent of PIH Sierra Leone's employees are Sierra Leonean, and I have seen what they've been able to accomplish through their commitment to their patients, even with extremely limited resources.

Hank and I are not experts, but we have spent the last several years learning from lots of experts. And in that process, we've come to understand that lasting change happens best through deep, ongoing, lasting partnerships. Which is why we're making a long-term commitment to PIH Sierra Leone, not just with our money but also with our attention. We're committed to following the successes and challenges of this project over the next five years and hopefully beyond through video and photo and audio updates, and also through interviews with Sierra Leonean healthcare workers.

Okay, so before we get to the money part of this, there's one more thing I want to discuss. I'm often asked, "Why Sierra Leone?" And to me, there are many answers to that question. The Ministry of Health in Sierra Leone is committed to making systemic change, and PIH's deep connections in Kono allow it to help make that change. But also by locating this project in the world's epicenter of maternal death, Partners In Health hopes to show that radically reducing maternal mortality in poor communities is not like some pipe dream. It's a global imperative. And just as PIH has led the charge to expand access to treatment for HIV and multidrug-resistant tuberculosis, with this project, they aim to show the world that strengthening healthcare systems in impoverished communities isn't just possible. It's necessary and can be replicated around the world.

Alright, the money. So to staff, support, and supply the Maternal Center of Excellence, primary care centers, and a broader network of community health workers in Kono over the next five years, we need to raise about 25 million dollars in total. The good news is that we are already over halfway there. In addition to our 6.5 million dollars, Partners In Health has secured several big donations. But we still need to raise a little over a million dollars per year, which I realize is a lot of money. Generous folks from within Nerdfighteria have already come together to build a matching fund of $120,000 per year. So every dollar you donate will be matched up to that amount. Thank you so much to our matching donors.

If you can donate $5 a month or $10 a month or even more, it will make a HUGE difference. You can donate right now at Partners In Health is known for its efficiency and effectiveness, and I have seen how much a few dollars can mean in Kono. Ruth's donation showed me that. Also, your donation now can have a lasting impact because when moms don't die in childbirth, their kids are more likely to go to school, less likely to be malnourished, and more likely to live a healthy life into adulthood.

In the months since I've returned from Sierra Leone, I have often thought of Ruth and what might have happened if she hadn't gotten access to anti retroviral therapy. Not just the children who would've been robbed of a mother, but also the community that would've been robbed of a generous and deeply committed advocate. It is unacceptable that thousands of women will die in childbirth in Sierra Leone this year and that thousands more people will die of illnesses we know are treatable, from typhoid to tuberculosis. That is unacceptable, and we don't have to accept it. So I really hope you will consider joining us in donating at

And finally, having asked you for money, I need to ask you for something else as well: your attention, the most valuable commodity of all. Even if you can't donate, please know that paying attention to the big, structural challenges of poverty really matters because we only address the injustices we see. So thank you for being here and for your attention. Again, the link to donate is

Hank, I’ll see you on Friday.

P.S. So many people over the last year-and-a-half have helped us get to this moment, and I am grateful to all of them, but I especially want to thank Andrew, John, Ruth, and Dr. Barry at PIH and also Nicki Hua and Rosianna Halse Rojas on our side of things. Also, huge thanks to the Life's Library community and our extraordinarily generous matching donors. If you are in a position to donate $2,000 or more to this project and would like to learn more about joining the matching team, you can email me at sparksflyup (at) gmail (dot) com.

I will be in comments to answer your questions. Thank you. Or also works.