Friends of Nixon           Charity no. 1145455     www.friendsofnixon.org.uk
                         						            
FOURTH ANNUAL REPORT 			November 2015
				
This year has seen the Trust continue to support the Nixon Memorial Hospital in Segbwema, Sierra Leone and aid its recovery from the consequences of the West African Ebola epidemic that stretched into 2015. The Trust aims to help stabilize the hospital after this difficult period and assist in its development moving forward. The epidemic had both a devastating impact on the hospital, with the loss of 5 staff members, and highlighted wider deficits in healthcare provision in Sierra Leone. 
 
We have held five meetings throughout the year and welcomed three new trustees to the Trust; Mrs Elizabeth Musa, Dr Sarah Lever and Dr Janet Barter. Trustees continue to demonstrate dedication in assisting the hospital with its ongoing development, evidenced through enthusiastic engagement at, and between meetings. This is despite the multiple and persistent challenges the hospital faces including staffing and economic deficits in a context of endemic poverty. 

We have been fortunate to receive a boost in donations over the last financial year, most likely due to people responding sympathetically to the widely publicised Ebola crisis. Support has come from the generosity of individuals, charitable trusts (notably The Morel Trust and The Gibbs Trust), and churches (notably Stamford and Evesham Methodist Churches). We are keen to ensure that these additional funds are spent responsibly and in a way that has a sustainable impact upon the hospital.   

The Ebola crisis restricted mobility, services and disrupted healthcare provision, resulting in a slowing of progress with some of the projects the Trust supports. In particular, for a period the nursing school, together with all educational establishments in Sierra Leone, was closed and clinical activity at the hospital became limited. This was in part due to community misunderstandings regarding the nature of Ebola and a loss of faith in healthcare institutions. These events had major financial implications on the hospital due to the loss of its two main local revenue streams: nursing student fees and nominal patient fees. In addition, safety concerns meant in impracticable to continue to travel to surrounding villages for community work. However, since April 2015 the nursing school has re-opened, community health work has re-started and patient numbers accessing services at the hospital are improving.  

The Trust continues to support the hospital in both a strategic and practical manner.

In early 2015, a subgroup of medical professionals met at the request of the Trust and with the approval of the head of the Methodist Church in Sierra Leone, Bishop Albert Beah (who has overall responsibility for the hospital), to discuss and develop a strategy for the future of the hospital. Key priorities were highlighted including the need for a closer working relationship with the Government of Sierra Leone, to prioritise core Maternity and Child Health services, improve links with Non Governmental Organisations, embed on-going training for all employees and most centrally, the need for committed and effective visionary leadership, possibly in the form of a senior business manager. There has been advancement with several of the key conclusions of this group including progress towards a commitment of financial support from the Government of Sierra Leone, a working relationship with Marie Stopes International to facilitate free healthcare at the point of use for a proportion of pregnant women attending the hospital, continuing higher education training for 3 staff and progress with the appointment of a business manager which the Trust is keen to facilitate.

Practically, the Trust has provided ongoing financial support for key areas of community health, training, infrastructure and medicine provision. 

During the Ebola epidemic, the Trust provided emergency grants to help with provision of Personal Protective Equipment and to provide support to hospital staff through this difficult period. In order for the nursing school to re-open, the Trust funded a 2 day workshop in April 2015 for all staff and students on infection prevention and control. This was delivered by staff from the Lassa Fever Team at Kenema Hospital, a WHO (World health Organisation) representative and community health care workers. It included sessions on viral haemorrhagic fevers(the group of disease that Ebola belongs to), as well as practical approaches to infection control including the use of chlorine, hand washing, disinfection and waste disposal. The Trust continues to fund three hospital staff through Midwifery and Community Health Office training. Although their studies were interrupted due to the Ebola epidemic, all three are now in the second year of their training and will return to the hospital on completion of their courses to improve staffing capacity. In addition the Trust contributed to West African College of Nursing’s annual conference to facilitate links with a body in that could in the future help support hospital staff.

Progress with the community Latrine Project, which the Trust funds, restarted once it was safe to travel. Phase 1 of the project involving construction of latrines in 4 villages was completed prior to the Ebola epidemic. The community health team is now working with an additional 4 villages in Phase 2 of the project which involves construction of a further 22 latrines. The Trust provides funds for materials and the individual communities invest their labour and time into the project ensuring a shared partnership. The Trustees believe that these improvements in effective sanitation can make a significant contribution to community health. 

The Trust has approved funding for the construction of a new water well and hand pump on the hospital site to ensure consistent availability of safe drinking water for patients, staff and nursing students. Construction is due to commence in early 2016.

Trustees acknowledge that currently the hospital cannot operate and provide its core healthcare services without external financial support. Therefore the Trust has agreed a conditional 4 year plan to fund the provision of essential medicines for use at the hospital. Subject to review, grants will be made every 4 months to help ensure that the hospital's pharmacy has a consistent stock of key medicines. It is anticipated that this will bring a level of financial stability to this core service and facilitate round the clock sustainable basic medical care. 

The hospital has seen a level of progress in its post Ebola recovery but many challenges remain in ensuring it continues on a pathway of sustainable development. The actions of its stakeholders including the Methodist Church of Sierra Leone, the local community and the Government of Sierra Leone, as well as its partnerships with local non-governmental organizations and its overseas supporters including the Methodist Church in the UK, will be central in determining both its longevity and its effectiveness. Through its ongoing commitment to training, community health, infrastructure and medicine provision “Friends of Nixon” looks forward to working alongside its partner organisations in enabling the hospital to meet the health care needs of the population it serves. 

Dr Robert Burnie

Chairman