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Direct Relief staff attended the commissioning of a new solar installation project at Bo Government Hospital in Sierra Leone in August 2024. The installation will cover 70 percent of the hospitals energy needs, with plans to expand to 100 percent. Direct Relief supported the project, as well as oxygen delivery projects in the Gambia and Liberia with a $5.5 million grant, in coordination with the Society of Critical Care Medicine, or SCCM. SCCM partnered with the Institute of Global Perioperative Care (IGPC) and Johns Hopkins University Global Alliance of Perioperative Professionals (JHU-GAPP), who are subawardees on the project. (Courtesy photo)
Editor’s note: This story is the first of three profiles documenting new energy and medical projects in three West African countries: Sierra Leone, the Gambia, and Liberia.
Over decades of work with medical partners in West Africa, Dr. John Sampson had seen the infrastructure issues many times: Talented, dedicated doctors and nurses lighting up surgeries with headlamps or cell phones after the power went out, or patients dying because oxygen wasn’t available. One 2016 training at Bo Government Hospital in Sierra Leone stands out distinctly in his mind.
Dr. Sampson, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, had been tasked with training nurse anesthetists from across Sierra Leone to use a Universal Anesthesia Machine, or UAM. Sierra Leone’s government had purchased 41 UAMs, specialized devices that manufacture an oxygen supply for surgeries using a power source, and that maintain a flow of oxygen even during power failures, for use at 22 hospitals.
Because UAMs are designed to provide oxygen from a reserve tank if the power shuts off during surgery, Dr. Sampson needed to simulate power failures so that nurse anesthetists could practice deploying the reserve oxygen supply. However, during training at Bo Government Hospital, in the country’s Southern Province, he encountered a problem: a power failure at the training site that continued for over two weeks.
“We had to simulate a power failure while having no power,” Dr. Sampson recalled.
This August, Bo Government Hospital unveiled a new solar power installation that will provide reliable electricity to all of the major clinical areas of the hospital, including its operating theater, 24 hours a day. The installation will also support a medical-grade oxygen plant, which Sierra Leone’s Ministry of Health plans to build.
Medical providers and staff, who serve a population of more than 660,000 people, have reported successfully conducting surgeries at night, fewer interruptions to medical care, reliable storage of cold-chain medications that the hospital uses in specialty treatment, and higher morale.
“It’s been a big relief,” said Dr. Osman Kakay, the hospital’s medical superintendent. Now that staff are no longer confronting late-night outages, or completing surgeries via cell phone light when there’s no funding for backup generator diesel fuel, he joked, “I’ve been having very peaceful sleep.”
For Dr. Kakay, the project addresses an essential — and often overlooked — need. Bo Government Hospital, the second-largest facility in Sierra Leone, is a teaching hospital offering a wide array of specialty services, from ophthalmology to fistula surgery. The issues that concern him most aren’t medical staffing or training — it’s the difficulty that the hospital’s providers encounter with infrastructure like oxygen and power, or accessing medical supplies.
“Electricity in the U.S. is still taken for granted,” he said.
The new solar installation is part of the larger Africa Infrastructure Relief and Support, or AIRS, project – a Society of Critical Care Medicine collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals and the Institute of Global Perioperative Care. (Dr. Sampson founded the last two organizations, and is the Global Alliance of Perioperative Professionals’ executive director.) Through AIRS, Direct Relief is funding reliable power and medical oxygen projects in Sierra Leone, the Gambia, and Liberia, with a $5.5 million grant. The project will also include biomedical training for skilled workers operating these projects, to ensure they are successfully maintained over time.
Dr. Sampson worked closely with regional experts, national authorities from each health ministry, and partners across West Africa to choose the three projects. Energy and oxygen challenges aren’t just deadly, dangerous, and unjust, he said: They also hurt the providers working to deliver medical care in unreliable circumstances.
“It makes doctors and nurses who have trained for years to hone their knowledge base and skills frustrated, and wondering if they’re actually making a difference,” he said.
Hospital nurses present during the commissioning of a new solar installation project at Bo Government Hospital in Sierra Leone in August 2024. (Courtesy photo)
Americans and Europeans often underestimate the skill that healthcare providers in West Africa are capable of providing, Dr. Sampson explained. Like medical providers everywhere, doctors and nurses in Sierra Leone and other West African countries need access to medical infrastructure. Health systems need the funds to build and maintain it.
He said short-term medical missions, often led by American or European doctors, can provide valuable patient care, but leave the health systems with the same infrastructure problems that hinder consistent quality of care to begin with. Media outlets hail the missionary providers as heroes, compounding the mistaken idea that West African medical care relies on international missions.
With reliable medical infrastructure, West African doctors and nurses may see more reason to devote their skills to their home country rather than leave for a Western country, Dr. Sampson said. Local providers can offer high-quality, reliable medical care, and patients can fully experience what their public health system has to offer.
“No one is addressing the core infrastructure issues that prevent the healthcare providers who were born, who were trained, who live, who teach, and who care for their people” from doing everything they’re capable of doing, he said. When it comes to power and oxygen, “the situation in those countries is worse than in a country that may be undergoing active warfare.”
Even when international groups focus on infrastructure, Dr. Sampson observed that they may not prioritize partnership and regional expertise, which means that projects are less likely to be a good fit for a hospital’s needs. For example, employing and training technicians to maintain a solar or oxygen project — a major emphasis of the AIRS project — is often overlooked. This has led to broken-down oxygen plants in a number of global regions, and hospitals reporting difficulty in receiving skilled support to repair them.
“It’s important to work closely with people who live and have a stake in the environment where they work,” he said.
Sierra Leone’s Ministry of Health selected Bo Government Hospital as a site for the AIRS project, but Dr. Sampson was delighted by the sense that things had come full circle. “That was the first hospital that someone referred me to when I came into the country,” he said.
Watching hospital nurses put on a skit to celebrate the launch of the solar installation — showing first an unsuccessful attempt to resuscitate a newborn with no electricity, then a lifesaving revival supported by reliable energy — was a touching moment.
“This is their chronic situation every single day,” he said.
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