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Read the PIH Sierra Leone's Annual Report:
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In which John talks about looking away, a video he made (actually five, not six) years ago, and the maternal and child mortality crises in Sierra Leone's Kono district.

If you're able to make a large ($2,000 or more) donation to support the Maternal Center of Excellence, join the matching fund! (If you have questions, or are considering a large gift and want more information, you can also email me at sparksflyup -at- gmail. Thanks!)

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Good morning, Hank, it's Tuesday.  This video is about looking away and you may need to look away at some point and I totally understand that, but I hope that you'll stick with me.

So when Sarah and I went to Sierra Leone, we visited the only hospital in Kono District, Koidu Government Hospital, which has come a very long way.  Like, when Partners in Health began supporting the hospital in 2014, there was no consistent electricity or running water.  The maternity ward had a dirt floor.  There was no emergency department, no blood bank, no functioning x-ray machines.  After the devastations of colonialism, Sierra Leone had never had much money to build up a healthcare system, but the system was further weakened first by the Sierra Leone Civil War and then by a horrifying Ebola outbreak.

Five years later, when I visited, KGH was a vastly different place.  Clean maternity wards, a functioning emergency department, a laboratory to diagnose illness and plentiful stocks of medication to treat it, along with many well-trained healthcare workers, and this is reflected in child and maternal health, more safe deliveries, fewer stillborn babies, and a dramatic reduction in the so-called "decision to incision" time, the amount of time between when the need for an emergency c-section is identified and when that procedure actually happens.  Because these are emergency surgeries meant to save the mother and baby's lives, the sooner the procedure can happen, the higher the likelihood of a positive outcome and just a couple years ago at KGH, the decision to incision was often over three hours.  Today, it is an average of one hour, eight minutes.

But the hospital is still woefully inadequate.  There are only 48 maternal beds to serve a population of 500,000 people and there's no NICU, no incubators or ventilators.  There's only very basic equipment to try to save sick kids, and when we were at KGH, I saw a mother with a young child in the pediatric ward and without going into details, I think the child was probably dying and I looked away.

I looked away because I didn't want to gawk and because I didn't know what I could do in that moment to help and because it was awful to  see a mother in that kind of pain and to see a child suffering, but there was also something else.  I've worked in a children's hospital.  I've held the hands of kids as they died.  I understand that children sometimes die, but most kids who die in Sierra Leone die of conditions we know how to treat or prevent and most mothers who die in childbirth die for want of an ambulance ride or a blood transfusion or an emergency c-section.  These deaths are preventable and they have been for decades.

Six years ago, I made a video from Ethiopia called "Looking Away" about the importance of listening to and supporting people living in absolute poverty.  Six years ago.  In those six years, I had done some things and given some money, but I had not made a serious commitment to listen better or to focus on the needs of the poor in an ongoing way, so I wasn't just looking at a child who was dying, I was looking at a child who very possibly wouldn't be dying if I had understood earlier the scope of the problem and devoted more of my resources to supporting the people who are solving the problem, and I think ultimately that is also part of why I looked away, again.

I had understood in the abstract that the maternal and child mortality crises in Sierra Leone were emergencies, but I hadn't been treating them like emergencies and now I was faced with the consequences of that.  The truth was, I wasn't doing nearly enough with the money and power and platform I'd lucked into to support truly vulnerable people and I'm still not doing enough, but I am trying to do more, not just with my money and with my time, but also with my attention.

On that front, Partners in Health: Sierra Leone's annual report just came out and even if you can't afford to donate to their efforts to build and support stronger healthcare systems for the poor, I really recommend reading it, because it is, in many ways, a very hopeful document.  Like, one primary health center supported by PiH, The Wellbody Clinic, saw 0 maternal deaths in 2019 for the third year in a row.  This in a country where one in 17 women will die in pregnancy or childbirth.  So the solutions are happening, just not yet across the whole region.

Access to mental healthcare in Kono
 has dramatically increased.  People with cancer or type I diabetes, which until recently were considered death sentences in Kono, are now being treated.  PiH was also able to hire more staff, now employing over 450 people, 96% of whom are Sierra Leonian.  Locally sourced nutritional supplements are decreasing malnutrition and the maternal and neonatal care team at KGH is hiring nine new nurses and four new midwives, but as PiH's John Lasher told me, Koidu Government Hospital is the only place within many hours, whether walking, driving, or motorbiking, where women can receive an emergency c-section and that puts tremendous pressure on a maternity ward that is just totally inadequate, which is why PiH and the Sierra Leonian Ministry of Health are working together to build a maternal center of excellence and a NICU at the hospital, which will more than triple the number of maternal beds and also dramatically improve child and maternal care, and it cannot wait.

That's why, while the Ministry of Health and PiH are going full speed on the planning, we are working very hard to raise the money.  In total commitments, we are now close to $13 million, which is amazing, but we still have a ways to go, so if you can make a monthly or one-time donation at, we would really appreciate it.  Also, every dollar you donate will be matched by generous people from within Nerdfighteria, and if you want to join the matching fund by making a donation of $2,000 or more, there is a link below to that as well.  

Believe me when I say that I am talking to every rich person who will take my phone calls and doing whatever I can think of to drum up money, but ultimately, I think if this is gonna work, it's gonna work because thousands of people come together to show solidarity with people in Sierra Leone.  I hope for many of you that solidarity can come in the form of donations, but it can also come in the form of listening and paying attention and reading annual reports or telling your friends and family about these efforts.

Regardless, thank you for being here.  I know that the kind of complex, systemic, long-term problems that demand complex, systemic, long-term solutions can be easy to look away from, so thank you for not looking away.  Hank, I'll see you on Friday.