Good morning Hank, it's Tuesday. Greetings from Sierra Leone and the Maternal Center of Excellence. So Hank, this is the 48,000 square foot maternal and infant care center currently being built in Sierra Leone, these are a few of the women building it, and this is my crying and sweaty face as it sinks in how many lives are being helped by our little online community. But let me back up.

Eight years ago when Partners In Health began working with Sierra Leone's Ministry of Health to strengthen the healthcare system in the Kono District, the maternity ward at Koidu Government Hospital did not look like this, overflowing with new moms receiving excellent care with a functioning operating room and blood bank and medical residents training to be the next generation of Sierra Leonean physicians. No, eight years ago, it looked like this. Dirt floors devoid of patients due to a long history of impoverishment, a horrific civil war, and the collapse of the already fragile healthcare system during the Ebola epidemic. 

What's been accomplished since is remarkable. Kono was the epicenter of the world's maternal mortality crisis with 1 in 17 women dying in childbirth or pregnancy. But that's changed. Both maternal and child mortality have declined dramatically. Still the healthcare system in Kono remains inadequate. There are only 41 maternal beds to serve a population of over 500,000 people, so the maternity ward is perpetually overfull. And mothers and children in Kono are still dying every day for want of emergency C-sections, ambulance services, and drugs to combat postpartum hemorrhage. It's simply not acceptable, and also we don't have to accept it.

That's where the Maternal Center of Excellence comes in. With help from the nearly 40 million dollars raised by Nerdfighteria and PIH over the last three and a half years, this will be the world-class healthcare center moms and kids deserve in Kono. Hank, it's impossible to communicate the scale of this place with a camera, but footers are being poured, tresses are being welded, plumbing and wiring is going in, and the first wards will hopefully open next year. Isata Dumbuya, the nurse midwife who leads maternal health at the hospital, is working closely with Build Health International engineer John Chew and his team to make sure that everything is right where it should be. John, by the way, has a phenomenal Sharpie hat.

At the Maternal Center of Excellence, there will not only be excellent maternal care, there will also be two neonatal intensive care units. One for babies born in the hospital, another for babies born outside and brought to the hospital. As well as enough operating theaters and supplies to perform up to 10 emergency C-sections every day. And the MCOE will also be a teaching hospital, so a new generation of midwives, nurses, and doctors will train there. We also got to visit the site where the dormitories and staff housing will be, and met some kids engaging in the time-honored cross-cultural tradition of young boys watching big machines. 

But it's not only healthcare workers who are learning and being trained via the MCOE. As John Chew explained to us, almost all the people working on the construction site have been trained in new skills, partly via classes and partly via, get this, educational YouTube videos.

John Chew: We go to YouTube University on the TV.

65% of the construction workers on this site are women, and I got to chat with three of them including Hawa, who was selling corn on the street in Koidu before getting this job and who now has become an expert in reading blueprints and trains new workers on how to use tools. 

Hawa: So I know the skills I’m learning are not only for today; it’s for tomorrow.

She told me about how profoundly her life has changed, but also about how she feels differently about herself.

Hawa: I am proud as a woman now. Anywhere I go, people will be proud of me, because [Yeah] they’ve never seen construction women before.

Marie has also been able to learn a highly-skilled trade.

Marie: They teach us to cut, to weld, and now I am a welder.

And Success, after working as a mason on the site, is now a steel binder. She has a theory on why so many women are working at the MCOE.

Success: We know that one day we will give birth in this hospital. Our children will be coming here. So that's why we try all effort to build this hospital.

But to be clear. Isata and her team aren't waiting on buildings to improve maternal and child health. More nurses and doctors are already training at the existing facilities, more community health workers are being hired to identify high-risk pregnancies via house call, and most astonishingly a special care baby unit at the hospital has already dramatically reduced child mortality. 

“The idea is that they should always have access to their babies and be able to to feed on-demand as needed.”

Before we visited the unit, I saw it explained to us that as recently as two years ago, the vast majority of these babies would’ve died. The unit is full. So full that at times the team has to make unspeakably difficult decisions about who they can admit, but the babies here receive excellent care, world-class care, the kind of care that every baby deserves. There are many such special care baby units at hospitals around Sierra Leone, but very few of them are functioning because it's not just about the building and supplying incubators, it's also about the staff, the training, the ongoing supplies needed to run such a unit, maintenance, and so much more. 

Because Isata and her team have not just the building and the incubators, but also the support they need to succeed, this unit is thriving. And so to the thousands of you who donate monthly at pih.org/hankandjohn and the thousands more who've made one-time gifts to the people who've brought attention by sharing this project with friends and family, this is the change you're making. Two years ago, the parents of almost all of these kids, would’ve gone home heartbroken. But the kind of dignified high-quality healthcare that everyone deserves is coming to Kono. And with it, generational change.

To properly support the MCOE and the larger strengthening of Kono's healthcare system over the next few years, we still need to raise the paltry sum of, uh, just over 10 million dollars, so we have a long way to go. If you can join the monthly donors or make a one-time gift, check out pih.org/hankandjohn. And if you're considering making a large gift, we've had donations from two thousand dollars to five hundred thousand dollars please give via the special link below or email me with questions. And if you can't afford to donate, that's ok. Thank you for your attention. It matters. 

If I've learned anything from the first three and a half years of this project, it is this: Collectively we are much more likely to solve the problems that we pay attention to. When we were in the special care baby unit Partners In Health co-founder Ophelia Dahl asked a nurse if one especially frail baby on a CPAP machine was likely to live. “All these babies are going to live,” the nurse responded. "This is the good news room." I'm so proud that Koidu government hospital now has a good news room, and with the work of Marie, Hawa, Success, and so many others on the Maternal Center of Excellence, there is much more good news to come.

Hank, look at what humans can do when we come together. I'll see you on Friday.