28 Jul 16 06 Jul 21

Sierra Leone: A Canadian nurse in a country with one of the worst maternal mortality rates in the world

Jane Little
MSF nurse
“The obvious humanitarian needs are no longer Ebola, no longer the war, but are clearly this high, high maternal mortality rate.”

Fifteen years after her last field posting with Doctors Without Borders/Médecins Sans Frontières (MSF), Canadian nurse Jane Little returned to the organization last February to work on a maternal and child health project in Sierra Leone. Below she recounts her experiences delivering healthcare in a post-Ebola context.


By McKenzie Ross

When Jane Little received a call confirming her first overseas posting with Doctors Without Borders/ Médecins Sans Frontières (MSF), she was working in the Canadian Arctic as a nurse. It was the winter of 1993, and within a month Little found herself in the heat of the Democratic Republic of Congo. While this was her first visit to Africa, it wouldn’t be her last. Little took part in 10 more field placements across the continent with MSF until 2001, when she took a break from international humanitarian work to raise her family.

 “Before my children were born, being in the humanitarian world was very important to me and it remained important to me,” the nurse from Wiarton, Ontario, says. “Of course I missed it, but it’s okay to miss something when you become a mother because there’s nothing better.”

Fifteen years after her last mission with MSF, Little returned to the field last February for three months, this time to help fellow mothers in Sierra Leone — the country with the highest maternal mortality in the world.


Concern over Ebola ongoing

Little arrived in Magburaka, Sierra Leone, during the aftermath of the largest Ebola epidemic in history. The virus had caused nearly 4,000 deaths in the country since the the start of the outbreak in the spring of 2014. While the outbreak has since been declared over, there is still concern over ongoing transmission. To prevent new flare-ups, healthcare providers have to follow strict protocols around anyone showing possible symptoms of Ebola. This restricts the quality of care available to patients because they can’t be treated as quickly as they need to be, and close contact with medical staff is not possible when they have to be dressed in full personal protective equipment (PPE).

“You’d have a child in front of you with fever, aches and pains, and you knew that kid just had to be responded to right away. But because of the nature of Ebola, it had to be so methodical, and then sometimes that child would die in the interim,” she says.

While working in this context brought many challenges for Little’s team, Ebola wasn’t the only medical concern in the country. “The obvious humanitarian needs were no longer Ebola, no longer the war that had been over for many years, but it was clearly this high, high maternal mortality,” says Little.

Maternal mortality highest in world

In Sierra Leone, approximately 1,360 of every 100,000 live births result in the death of the mother — in Canada, this number is only seven. Delivering healthcare to these women and their children in a fractured medical system that has been further damaged by the Ebola outbreak is difficult, but it is also the area where Little believes that MSF is making the biggest impact.

She was especially impressed by the work being done in pediatrics. “I think the pediatrics unit was quite profound. In the hospital there was a unit of about 45 really sick little guys, and you know kids can turn around quite quickly even though there was a high mortality there,” she says. “There were amazing staff who tried so hard with those kids for them to be able to have a good outcome.”

Collaborating with national staff has always been the best part of MSF field work for Little, and it was no different on her latest mission in Sierra Leone. “They have worked in the war, they have worked in Lassa Fever, they have worked in Ebola,” she says of her Sierra Leonean colleagues. “They have so many skills. I think it’s a privilege to work alongside those national staff.”

These are the kinds of experiences that Little returned to humanitarian work for, and that she hopes to continue to encounter as she gets more involved in field work with MSF in the future.



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