Our great trip to SIerra Leone:  sometimes a bit bumpy, but a real joy! 
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A New Office, A New Class, and A Jamboree

The Winter 2014 trip showed us an important truth:  In spite of setbacks and struggles, MOMS is making significant progress and has incredible opportunities - and we need to figure out how to rise to the next level in order to meet them. 

One of the neatest things is that the District's Head Nurse was so impressed with the Traditional Birth Attendants that she wants us to start teaching at the District's school for Maternal/Child Healthcare Aides!

- But I'm getting ahead of myself....

Our traveling team consisted of Elizabeth (Buffy) Price from Atascadero, CA, making her second trip, Chris McManus, MOMS' President, and me, Trish Ross.  Jitta Rogers Seisay, as usual, served as our translator. 

We trained 33 women to be MOMS’ TBAs, who are now working for their communities, committed to making a difference in the lives of women and girls.  We also attended the MOMS’ TBA Jamboree, where we celebrated the results that our previous groups have shown over the years.

Making the transition

Arriving at the airport in Sierra Leone, we hit our first snag – no Jitta, no vehicle.  After borrowing a cell phone, we found that the vehicle’s owner had missed the last ferry from Freetown to the airport, and he and Jitta were driving the long way around the harbor.  (Imagine driving from Oakland to San Francisco via San Jose, in rush hour traffic.)  Two hours later, they arrived, and we piled into the vehicle and took off directly for Bo.

A new office!

Four hours later, we discovered our new headquarters, a gracious house with an office and four bedrooms.  This will make a great home base for us.  Jitta and Junior will be able to work well there.  The well is deep and the water is quite clear.  It includes a large storeroom for our teaching supplies.  We’ll have comfortable space to house our teams for staging to and from our training sites.

The next morning, we discovered that we'd had a major miscommunication with Junior, our CFO.  We'd sent money in preparation for the trip, but he thought it was to furnish the office!  So we didn't have the money we needed to rent the vehicle and feed ourselves. 

Fortunately, Buffy knew about some money she'd raised that hadn't yet been delivered.  She contacted her husband, who was able to wire us the money by the end of the week.  Project saved!  (Many thanks to St Luke's Episcopal Church in Atascadero for their generosity and flexibility!)
Below you see the front door of our new office in Bo.  It will provide us a relaxing place to prepare for our trips upcountry and unwind afterwards. 


Our new class

The journey to Gbalahun, our teaching site, was long, in spite of paved roads for much of the way.  The last 30 or so miles took about three hours.  Chris wrestled the car through ruts and over rocks, and we arrived intact. 

Getting started

After a day of rest, we started in.  This session was different in some important ways, which led to a rocky start.  This was the first time that the District Health Team selected the site and learners and managed communication.  We’ll do it differently next winter!  

By Wednesday, we had our final group of 33 women, from five villages, speaking two languages (Mende and Kissy).  They understood the ground rules and were ready to commit. 

The women pulled together as a group, making sure the Kissy-speakers fully understood the teaching.  They started creating skits and songs to review and reprise what they learned.  After class and on weekends, they went to their clinics and practiced what we taught.

Results begin rolling in

Each morning, we always ask, “What did you learn yesterday?”  In addition to reviewing the lessons, the women reported their experiences at the clinics.  They were so thrilled to report labors that went more smoothly and resulted in happier and healthier mothers and babies.

They said,
  • You told us that forcing out the babies by pushing on the uterus can be dangerous.  We stopped doing that.  We saw that the women didn’t bleed as much, and the babies breathed on their own. 
  • You told us that labor is work, and women need food and water during this work.  We offered laboring women water and small amounts of food.  We saw that the labors went faster and the women push better and weren’t so tired. 
  • You told us that women who move around during labor and stay off their backs often have smoother labors.  We suggested to the women that they try laboring and birthing in different positions.  We saw that moving around helped babies improve their position and that the mothers had easier labors. 
While we were delighted with these reports, we worried because several of the women just didn’t seem to be retaining the material very well.  We redoubled our efforts to review the material.

On the day of our grand review, our hearts sank.  About six or seven of the 33 women did very poorly.  On exam day, we were really nervous – what would we do if so many women failed the test? 

And the test....

The first student tested got an “A” and the second scored 100%.  Then the next five students all passed the test with flying colors.  Then the next five.  In total, five students earned a perfect score, more than any other group we’ve trained! 

We did have one woman who did not pass the exam.  With her supervisor, who was also in the class, and the head woman of the group, we decided that she had earned our special award for her commitment and effort:  The Spirit of the TBA Award.  Her supervisor would be the one to tell her of the exam results, after the celebration. 

The celebration, attended by many in the area, was wonderful.  Several women participated in skits and taught the audience about key concepts.  The people seemed a little surprised at the women’s confidence and knowledge; we were delighted at how well they did.


I got it, in spite of taking prophylaxis to prevent it.  I hated it - painful chills, fever, vomiting.  Chris and Jitta took me 45 minutes over a terrible road to see the District Medical Officer.  He gave me $100 worth of medicine and told me to go home and sleep.  Unfortunately, I had nightmares whenever I'd doze off, so rest was hard to come by.  But I got well. 

Malaria is completely curable if you have the money for medicine or a generous friend who will give it to you,  Sadly, many people aren't able to walk miles to a good clinic, or can't afford treatment.  Some of our friends have died as a result.
Here you see the women in our classroom - an empty classroom in the village school.  The small chairs might have been uncomfortable, but the women were so excited to learn that they never complained even though they didn't have food for lunch. 

Mariama paying careful attention

Off to the Jamboree

After the training, we headed to Ngolahun for the Jamboree.   About 75 women made it - and were thrilled at meeting their "MOMS Sisters." 

On Saturday, we had some continuing education and shared stories.  Then on Sunday, we had the grand celebration with honored guests and a chance for the women to show off what they know.  It was all marvelous!


We asked the women to share stories about their work.  Woman after woman stood and told fascinating success stories.  They told stories like these:
  • Nancy Alpha:  I was in Liberia, and you know that TBAs are like soldiers and we serve wherever we are.  I heard a woman crying in the clinic, and went to offer my services.  I explained that I was a MOMS TBA.  They welcomed me and updated me on the case.  I explained what you had taught us about labor.   They took my advice, and the baby was born safely, but the woman started to hemorrhage.  I rubbed on the acupressure point above her ankle and used nipple stimulation.  She stopped bleeding right away, and she and the baby are just fine.  The clinic staff were really excited to learn these techniques, and I taught them other things, too.  Their clinic is doing much better now.
  • Lucy Kamara:  I was teaching the women of my village to do breast self-exams for cancer.  One of the women came to me and said she found a lump.  I checked her, and she does have a lump.  I brought her here for you to see, too.  Thankfully, none of the other women had lumps, but they have all promised to check themselves every month. 
We were delighted to hear these stories, but also wanted to hear about the problems they faced.  We want to plan continuing education and help with problem solving. 

They looked at each other.  Then one of the women stood. 
  • Since you trained us, we refer and transport women who have issues that we can’t handle.  Since then, we have had very few problems, and you taught us how to solve them.
Another woman stood. 
  • Remember back in 2009?  We called you to come and get a woman in premature labor who was bleeding – she died in your vehicle as you tried to get her to the hospital.  (We remembered, too well.)  Well, that was the last real problem we had.
These poor women were trying to find a problem to tell us about, but just couldn't think of one!  What could be better than that?
Left to right, below:  Mamie Brima of Jokibu, Mamie Lamin of Pellie, Jeneba Battie or Ngolahun, and Mamie Sandy of Daru.  These are the Head TBAs of our previous classes; they form the MOMS Advisory Council.  They're learning about planning and problem solving.  The District Medical Health Team also includes them in their regular meetings - a national first!


Each group of women presented a skit to the gathered community.  The elders and chiefs laughed uproariously at the costumes and plot lines.  They sobered, though, as the messages penetrated. 

One group demonstrated how they teach breast self-examinations.  They were complete and careful.  Our special guest, the District Head Nurse, was impressed.  “I didn’t know that a woman could examine her own breasts.  I want to teach this information in the  Maternal Child Healthcare Aide school.  This is just great!”

Another group told the tale of two families:  one used family planning and the other didn’t.  The family who spaced their children had the money to educate them – the “son” became a doctor and was the District Medical Officer of the Kailahun District, and the “daughter” was the chief engineer in charge of building roads.  The “father” proudly commented that girls can grow up to do anything they want, provided they get an education.  During the skit, the “mother” fussed over her children, dusting them carefully! 

The family who didn’t use family planning was dealing with sick children, one of whom was pregnant along with the mother also being pregnant.  The harried father complained about being broke and tired.  The women in the audience applauded while the men looked at each other a little uneasily.
Below you see the women handling models showing fetal development.  They are fascinated by the topic, and it helps them understand why prenatal care is so important and what they may see when helping women having miscarriages.

Examining the fetal models

And the future? 

The District Head Nurse asked us to start teaching at the MCH Aide school.  The District Medical Officer told us that 800 more TBAs work in the Kailahun District, and he wants us to train them all as soon as possible.  We’re thrilled with the possibilities, and have to find a way to make these things happen well!

For August, 2014, we are set to train a new group and a few trainers in a village named Tikonko, in the Bo District.  We’ll be working with the Rural Health Care Initiative, our first collaboration like this and our first class outside the Kailahun District.

Next winter, in February, 2015, we want to field two teams to teach in nearby areas in the Kailahun District.  Also, we hope to teach at least a few days in the MCH Aide school.

In August, 2015, we’ve penciled in the village of Gbendembu, among the Loko people, where MOMS Volunteer Mary Jane Lavin served while in the Peace Corps.  This would be our first training with a group other than the Mende.

And in the winter of 2016, we again want to have at least two teams working near each other in the Kailahun District and do more teaching at the MCH Aide school. 

Further, we’re in conversations with other agencies working in Sierra Leone.  Dr Darius Maggi runs a fistula center in Bo – and is interested in ways to train maternity care providers to prevent this debilitating condition.  Dr Paula Dhanda is exploring the opportunities to work with him, and to teach, and we may have great partners in them.

Bai-kah-kah (thank you very much)

We rejoice in this success, and are delighted with the prospects.  If you want to know more, just ask! 

Now it is time to work – raising money, writing more detailed lesson plans and trainer guides, planning our next steps. 

You, obviously, are critical to our success.  You make it happen.  You made it possible for Nancy and Mamie and all the others to make these changes. 

We ask your continued support.  Please be generous.  Please volunteer. 

Thank you, thank you. 

Trish Ross and Chris McManus
Copyright © 2014 Midwives on Missions of Service, All rights reserved.

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