In this latest guest blog, Dr Mabli Wyn Davies, Critical Care Clinical Fellow at Warrington and Halton Teaching Hospitals, writes about her experiences working on the Street Child Marathon in Sierra Leone.
‘Fancy a trip to Sierra Leone in June to provide medical cover for StreetChild’s marathon?’
A sentence that was uttered to me towards the end of a polar expedition in March 2022. A sentence that my impending post expedition blues clung onto. As a full time, critical care fellow in the North West, the ‘can I fit this in?’ question creeped into mind.
Another question I asked myself - who are StreetChild and what do they do? As I witnessed first-hand, they are an international children’s charity that aims to see all children safe, in school and learning. An objective with which I concur. The runners were raising money for this wonderful charity and had the opportunity to visit some of their Sierra Leonean projects whilst in country. These included rural schools that street child had built and community projects such as farming landscapes.
Fast forward to June 2022 and I have just returned from an incredible 10 days in a beautiful country, filled with heart wrenching history & wonderful people.
In 2002, the country saw the end of its 11 yearlong civil war where over 50,000 people were killed. A decade later, the country was troubled with the Ebola epidemic.
The trip started by collecting the medical kit from TrailMed’s base with my colleague and friend, Jack. Filled with excitement, and somewhat naivety, we headed for Heathrow where we met with Tom the following morning, a GP and one of the co-leaders of the trip. We managed to bypass the recent airport security drama and things seemed to be going smoothly until we landed in Lungi, Sierra Leone.
We glanced at each other nervously as the baggage carousel came to a halt with no sign of our luggage or the 46kg of medical kit.
Firstly, how were we going to provide medical cover for a marathon in Sierra Leone without the medical kit? Secondly, how are we going to camp in Sierra Leone without our own kit?
We spent the night at a hotel in Lungi where we met our 2 other team members Dave and Leonora, envious that their luggage had arrived safely along with Dave’s own medical kit. We brainstormed some ideas with StreetChild staff and started to put a plan in place to source medical kit in country.
The next 48 hours were filled with apprehension about the medical kit, but also a lot of excitement and enthusiasm as we met the international runners and StreetChild staff both from the UK and Sierra Leone. We had travelled out to Makeni City, where we fortunately were not expected to sleep out with the and had accommodation arranged for us. We had the opportunity to visit rural schools that had been built by StreetChild, local hospitals and wander around the market.
We were able to breathe easily as news had arrived that our bags, including the medical kit had arrived safely in Lungi and in time for race day. Familiarising ourselves with the kit, we ran some dry simulations of common heat related scenarios we may face the next day.
Finally, we were able to confidently run our evening clinics with the runners knowing that we had a full supply of medication. Fortunately, other than a few stat doses of azithromycin for upset stomachs, we didn’t have to delve too much into it.
We were invited to observe the Sierra Leone Red Cross’s training and refresher session ahead of the marathon the following day. Meeting the team and having a mutual understanding of each other’s skill set and roles was important ahead of the race. There were over 30 local Red Cross volunteers who were invaluable to our team of 5 medics as they were our eyes and ears out on the course.
5th June 2022: Race Day
The day started with a 03:30 alarm. Feeling tired and a little peaky after our second night of humid camping, disturbed by my dramatic screams as a cockroach made its way inside my mosquito net, we headed for Wussum Stadium with the medical kit to set up. We were allocated a nicely air-conditioned room with a mattress, some chairs and a space for us to set up emergency equipment.
We split ourselves into teams according to our skillset- Tom would act as a base with communication at the start/finish line. Jack, an ambulance technician and student paramedic and myself, a senior house officer would work alongside Tom but had a vehicle on standby should we need to move out onto the course. Dave, our second leader, a vascular surgeon and BASICs doctor would be circulating the course with Leonora who is a paramedic in Gibraltar. With a breadth of skills, experienced leaders, many Red Cross volunteers and finally a medical kit(!), we were ready for the day ahead.
As a keen runner myself, I was in awe of the local runners as they zoomed around the course, unfazed by the 30-odd degree heat and humidity.
I was inspired by the international runners, many of whom had suffered with upset stomachs, long travel journeys and were only just getting used to the heat who completed the course and crossed the finish lines with huge smiles on their face. Their determination and motivation were admirable.
There was a huge sigh of relief amongst us as a team of medics, StreetChild staff and local volunteers when all runners crossed the finish line largely unscathed. Jack and I had stayed at the finish line, cheering runners and distributing oral rehydration sachets with water as if they were smarties.
We returned with the runners to the StreetChild clubhouse where we hosted the final clinic of the week, luckily our quietest clinic due to a successful race day. There was the odd blister care and hydration advice given, but largely was a medically uneventful day!
So, what have I learnt from this trip?
Missing luggage is NOT a myth. How can we be prepared for this in future? Is it wise to split the kit up into multiple bags & take what we can on as hand luggage? Do we make contacts in country prior to departure in case luggage does not arrive?
Always pack your antimalarials and any personal medication in your hand luggage
Sierra Leone is an incredible country filled with wonderful people and impressive thunderstorms!
StreetChild have done, and continue to build hundreds of schools to serve rural communities – please check out their social media @streetchilduk or https://street-child.org/
Azithromycin 1g should be considered a critical medication for expedition medics who may be faced with an abundance of travellers’ diarrhoea!! Antibiotics should be considered if an individual has one or more of the following: loose stools for >72h, blood in their stools, pyrexia, profuse watery stool or are at high risk (NICE, 2019).
I have the running bug and would love to return to Makeni to run the marathon!
I feel extremely fortunate to have been able to share this experience with a phenomenal team of medics, StreetChild staff and runners. There were certainly some worrying moments with regards to the medical kit but surround yourself with positive and likeminded people and problems are solved rather than dwelled on. After all, the drama is part of the adventure!
Reference:
NICE (2019) Diarrhoea – Prevention and Advice for Travellers. Available at: https://cks.nice.org.uk/topics/diarrhoea-prevention-advice-for-travellers/management/diarrhoea-prevention-advice-for-travellers/
Dr Mabli Davies is a junior doctor, about to start anaesthetics training. She is an expedition and wilderness medicine MSc student at The University of South Wales, a keen sportswoman and lover of the outdoors.
She is keen to share her passions with others whilst simultaneously creating a safe environment for others to explore and achieve their own personal goals.