Harm with goodwill


FY2 Dr Mikey Bryant is in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where one in five children don’t live to see their 5th birthday. In this regular column he gives us an update on his experience.


Thankfully, I manage to hold my tongue until the end of the meeting, and again some of the conversations about expanding the tuberculosis program in the country sound much more promising. I manage to network enough to get hold of some more firm promises that we will soon have our own proper supply of anti- TB drugs, and it feels as though the DOTS programme is suddenly taking shape.



I make it back to the hospital in time to catch the end of the day’s clinic and to see the last few children. As usual, there are no children who are at the healthy weight they would be, and the last one makes me particularly sad, even a little angry. A tiny-looking three year old (called Asiatu) is brought in by her exhausted Mum. She clearly has Down’s syndrome, but that doesn’t explain the protruding ribs and gasping breaths.

As the story unfolds, I realise that she has been coughing for the last few weeks and she has been breathing frighteningly quickly over the last three days. Her head is bouncing up and down like a basketball and Mum’s weary eyes tell me that they have tried all sorts of things to cure the child before finally turning up here.

We persuade her to let us take care of Asiatu here overnight and try to help her breathing, and thankfully she stabilises a little on oxygen and becomes a lot more alert as the night goes on. Mum lets me look through the bag of medicines she has bought, and sure enough, a bottle of magnesium sulphate is sitting in the bag attached to a giving set. Exactly how or why the mother was expected to give this to her child, I can’t fathom.

Our Sierra Leonean lead nurse has a long chat with Mum about where best to find medicine and help for her child, and once again I question the value of some of the work being done by international organisations.

I reflect when I get home on how easy it is to do a great deal of harm with a lot of goodwill and a few handy international development buzzwords. I think of all the well-meaning projects supported by generous philanthropic folk back in the UK, supported by people who really believe they are making a difference.

I think about all the children and pregnant mothers who are going to be injected with inappropriate doses of drugs over the next few months, and I realise that the only way to decide what to support and who to put time and energy into is by looking past the glossy photos and grandiose mission statements and working out what is actually happening.

Something that is near impossible to do without having been there and seen it. Something that, unfortunately, far too few international decision-makers and funding bodies understand.

I feel like a lost patient in a foreign hospital. I try to focus and ask, “How do these partnerships benefit the local Sierra Leoneans?” The woman still resembles a Duracell bunny as she replies, “It involves local partners in resilient micro-financing initiatives!”

I give up trying to break through the gobble-de-gook and decide to pick up one of the lady’s many leaflets. On reading what is going on, my confusion slowly turns to horror. The leaflet describes, in nauseating detail, her organisation’s mission statement.

The plan is to get hold of as much magnesium sulphate and misoprostol as possible from whatever benevolent health boards in the UK are willing to donate, and then give it to whoever in Sierra Leone wants it. There seems to be no audit trail mentioned, nor is there any record of which health centres are getting the drugs. Instead, there are lots of photos of smiling mothers with cute babies in well-knitted woolly hats.

The “micro-financing” seems to involve drugs and money being given at random to a collection of dubious people who are accountable only to themselves. I had wondered why the black market had been so full of magnesium sulphate last weekend, and now I know.