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Health and Safety
Guide
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Introduction
Most visits to Sierra Leone are safe and without problems, but life in Africa is very different from
home and there are risks volunteers should be aware of. Volunteers have primary responsibility
for their own health & safety during your trip. However, our in country director will endeavour to
provide support on all issues.
The Collective is in constant contact with the British High Commission to ensure we are up todate on events in-country.
The following document provides a comprehensive guide for volunteers covering procedures and
contacts for various scenarios.
In case of emergency volunteers should follow the suggested procedures and ring Charlie
Habershon at the earliest possible opportunity.
Contact Name
Charlie Habershon
British High Commission
Holy Spirit Hospital – Makeni
Makama Hospital – Makeni Dr. Bundu
Tim (CBF)
Pete (CBF)
Mohammed (CBF)
Sallie (Regional Manager in Makeni)
Alex (Team Manager in Makeni)
Medivac
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Contact Number
076807101 or 078624667
Monday-Friday 9-5: 076912606
Out of Office: 076780713
076603252
076640898
088888555
078276000
076562073
076731725
076965505
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Health
You have made the decision to volunteer in Sierra Leone. Being healthy is of prime importance
for living in a country such as this one. Medical facilities and services are basic. Roads are not
what you are used to and ambulances are rare. You must be self sufficient. Before departure,
visit your physician for a thorough medical exam. If you are in need of medications, bring a
supply sufficient to last for the period of time you intend to be in Sierra Leone. Some medication
is available locally at recommended pharmacies but do not depend on it. This includes Malaria
prophylaxis.
1) Causes for seeking Health Care in Sierra Leone
The most common causes of illness and mortality for people living in Sierra Leone are malaria,
car accidents, vomiting and diarrhoea whether you are an adult or child.
a) Malaria
Malaria presents one of the greatest health risks to people living in Sierra Leone. Falciparum
malaria, the most lethal form of malaria is common in this country as is Chloroquine resistance.
It is vitally important that you do not underestimate the threat of malaria and that you follow all
precautions necessary to protect against the disease. If you suspect
malaria you must follow quick action guide 1
Precautions:
Take malaria prophylaxis as prescribed by your physician or travel clinic. A list is not given in
this document as the information constantly changes. It is your responsibility to get this
information from your health care provider prior to leaving your country of origin preferably or
from a local physician you trust.
The side effects of antimalarials often dissuade individuals from long-term use. If you choose
not to take malaria prophylaxis, it is important to be aware that this does come with a risk. Also,
drug prophylaxis against malaria is not absolute, and infection can occur even in individuals
taking antimalarial drugs. Prevention against bites is therefore essential, and recommended
measures include:
Sleeping under an insecticide treated net
Wearing long sleeves and trousers between dusk and dawn
Applying insect repellent containing 20-50% DEET to exposed skin
b) Accidents
Accidents are one of the leading causes of mortality for expatriates in Developing Countries
and Sierra Leone is no exception. The condition of the roads, the condition of the vehicles, the
attitude of drivers, the use of alcohol and drugs by the drivers can all lead to road traffic
accidents and tragedies.
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You can lower your risks by avoiding public transport if at all possible. Taxis and motorcycles in
the city are in deplorable working condition. For long journey we recommend visiting better
known hotels who will recommend a car and driver for hire. Motorcycles, known locally as
okadas are not a good choice even if they get you somewhere quickly in traffic jams. Most
drivers do not wear helmets and have no helmets for their passengers. Furthermore, they
respect no laws of the road. We recommend that you do not travel by motorcycle under any
circumstance. The yellow and red taxis are also in poor mechanical condition, overcrowded and
drivers impaired. The mini-buses known as poda-podas are in no better shape than the taxis.
Wear comfortable footwear as there is no flat surface in Sierra Leone. Sidewalks are broken up
and mostly non- existent and the soil is mostly loose red gravel...small stones which cause you
to slip and slide in both dry and wet season.
Water accidents are another probability. The beaches on the Peninsula are the most inviting. The
Atlantic Ocean can be rough and a considerable undertow can be felt at certain times,
especially at outgoing tide.
The Quick Action Guide 2 for Road Traffic Accidents will help you make a decision.
c) Diarrhoea and vomiting
Living in a new environment, with a hot tropical climate and eating different foods may lead to
some gastro intestinal discomforts. Most of them will be benign. It is a way for our body to adapt.
The Quick action guide 3 for diarrhoea and vomiting, will help you deal with this.
Here are a few precautions which could help you prevent diarrhoea and vomiting.
Watch what you eat
The general rule of thumb is this: If you can’t oil it, cook it, peel it, forget it. Unfortunately, most
travelers don't stick to these guidelines 100 percent of the time. Remember these tips:
Don't buy food from street vendors.
Avoid unpasteurized milk and dairy products, including ice cream sold on the street.
Avoid raw or undercooked meat, fish and shellfish.
Steer clear of moist food at room temperature, such as sauces and buffet offerings.
Eat foods that are well cooked and served hot.
Munch on dry foods — like breads — and high-sugar-content foods, such as jellies and
syrups.
Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and
avocados. Stay away from salads and unpeelable fruits, such as grapes and berries.
Don't drink the water
When visiting high-risk countries; keep the following tips in mind:
Avoid unsterilized water — from tap, well or stream. If you need to consume local water,
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boil it for five to 10 minutes.
Avoid ice cubes or fruit juices made with tap water.
Beware of sliced fruit that may have been washed in contaminated water.
Don't swim in water that may be contaminated.
Keep your mouth closed while showering.
Feel free to drink canned or bottled drinks in their original containers — including water,
carbonated beverages, beer or wine — as long as you break the seals on the containers
yourself. Wipe off any can or bottle before drinking or pouring.
Use bottled water to brush your teeth.
Use bottled or boiled water to mix baby formula.
Order hot beverages, such as coffee or tea, and make sure they're steaming hot.
Follow additional tips
Here are other ways to reduce your risk of traveler's diarrhoea:
Make sure dishes and utensils are clean and dry before using them.
Wash your hands often and always before eating.
Seek out food items that require little handling in preparation.
Keep children from putting things — including their dirty hands — in their mouths. If
possible, keep infants from crawling on dirty floors.
Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush
your teeth with — tap water.
Other preventive measures
Public health experts generally don't recommend taking antibiotics to prevent traveler's
diarrhoea, because doing so can contribute to the development of antibiotic-resistant bacteria.
Besides, antibiotics provide no protection against viruses and parasites, but they can give
travelers a false sense of security about the risks of consuming local foods and beverages.
They can also cause unpleasant side effects, such as skin rashes, skin reactions to the sun,
vaginal yeast infections and, rarely, blood disorders.
As a preventive measure, some doctors suggest taking bismuth subsalicylate (Pepto-Bismol),
which has been shown to decrease the likelihood of diarrhoea. However, don't take this
medication for longer than three weeks, and don't take it at all if you're allergic to aspirin,
pregnant or taking certain medications, such as anticoagulants. Common harmless side effects
include a black-colour tongue and dark stools. In some cases it can cause constipation, nausea
and, rarely, ringing in your ears (tinnitus)
2) Medical Services
a) Surgical Emergencies
Even with a thorough medical examination, a surgical emergency such as appendicitis could
occur at anytime. The only means of fully assessing a surgical emergency is by clinical
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assessment from an experienced practitioner, a surgeon. Holy Spirit Hospital in Makeni has
surgeons.
It is important to find someone to stay with you while in hospital. Food is usually available but
someone may have to get it as well a good drinking water. Nursing care is not what you would
expect back home. It is also good to ask questions about the treatment you are being asked to
follow.
Spend as little time as possible in hospital. Cleanliness and hygiene standards are quite
different than the ones we are accustomed to. Hospital-borne infections are easy to acquire
when your immune system is affected by illness. Outpatient departments exist in the main
hospitals. If the necessary surgery can be done there, have it there and go home to recuperate
even if you have to come back on a daily basis for dressing changes etc.
b) Bites from Dogs, Cats and Bats
The large numbers of stray dogs means that the risk of dog bite is relatively high. The risk of
being bitten by a cat or a bat is considerably lower. Any animal bite or scratch should be
thoroughly cleansed with plenty of soap and water. Once the wound is clean, individuals should
go straight to hospital for further treatment.
All volunteers should have had a tetanus vaccine within the past ten years. However,
individuals whose most recent immunisation was more than 5 years ago (or who were not
immunised at all) may require a booster dose of the tetanus vaccine.
c) Rabies
The risk of contracting rabies from an animal bite in is low, but it exists nonetheless.
The rabies vaccine does not provide protection from rabies – it simply buys additional time in
which to administer rabies post-exposure prophylaxis (ideally a human anti rabies immune
globulin).
** There is currently no guaranteed supply of post-exposure prophylaxis for rabies in
Sierra Leone.
d) Snakes
The risk of snake bite is relatively low in Makeni, but much higher in rural areas.
If you are bitten by a snake:
• Go straight to Emergency Hospital
• Do not pick up the snake or try to trap it, as this may put you or someone else at risk
for a bite.
• Do not apply a tourniquet.
• Do not slash the wound with a knife.
• Do not suck out the venom.
• Do not apply ice or immerse the wound in water.
• Do not drink alcohol as a pain killer.
The doctors at Emergency Hospital will assess the wound and give advice about treatment,
including the need for snake anti-venom.
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At the time of writing, snake anti-venom is available at Choithram Hospital Freetown and at Holy
Spirit Hospital in Makeni.
3) HIV/AIDS
Human immunodeficiency virus (HIV) attacks the body's immune system and weakens it,
resulting in chronic, progressive illness. The advanced stage of the illness is called the acquired
immunodeficiency syndrome, or AIDS. HIV makes infected individuals vulnerable to other
infections and cancers that would not ordinarily be a threat. It is these "opportunistic diseases"
that can be fatal.
a) How Can I Get HIV/AIDS?
HIV is spread through the exchange of infected body fluids: blood, semen, vaginal fluids and
breast milk. If HIV-infected blood is present in saliva, there may be a risk of transmission. It can
also be transmitted through contaminated blood or contaminated blood products, such as
through a blood transfusion or organ donation.
HIV is not transmitted through everyday social contact, air, food or water. For instance, shaking
hands, touching and swimming are safe. Furthermore, no risk of infection comes from sharing
transportation with people living with HIV/AIDS.
b) How Can I Avoid HIV/AIDS?

Don't have sex (vaginal, oral or anal) with strangers or commercial sex workers, and
avoid casual sexual contacts.

If you are going to have sex with a new partner, use latex (or if allergic, use
polyurethane) condoms consistently and correctly for every sexual contact. Before
departure, pack your own supply of high-quality latex condoms.

Don't share needles or syringes.

Don't share razors, toothbrushes or shavers.

Don't receive tattooing, body-piercing, acupuncture or other skin-piercing procedures.

Don't receive injections or transfusions unless it is an emergency. If you must receive
blood while travelling, try to ensure the donated blood has been tested for HIV. If you
cannot ensure the blood has been screened, and you do not require emergency care,
return home for treatment.

Pack a supply of syringes, needles and blood products to cover the length of your trip if
you require any of those for regular treatment. Also carry a medical certificate explaining
the supply.

Consider packing a suture kit containing sterile needles, syringes and suture material
c) Voluntary Counselling and Testing
Voluntary counselling and testing services are ubiquitous and are available in most
hospitals, clinics and health centres. All of these facilities use a rapid antibody test for HIV1
(using a test strip that looks similar to a pregnancy test). Results from this test are available
within minutes. Positive tests would then need to be confirmed using a PCR test which may take
up to a few days to process. Counselling, testing and the subsequent referral to HIV treatment
services if necessary should all be carried out confidentially in order to respect the individual’s
right to privacy and nondisclosure.
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Concerns about confidentiality may lead some to opt for services at facilities less often utilized
by other expatriates. Connaught Hospital (Section 4) is a good option – the Voluntary
Counselling and Testing (VCT) site there is on the ground floor to the left of the main wards, and
provides free counselling and testing for HIV.
d)
Ongoing Treatment
HIV positive staff should attend a primary care physician or HIV specialist for their regular
ongoing care. CD4 count and viral load testing are available at the main hospital laboratories
and at Ramsy Laboratories, but these will be coordinated by the primary care doctor.
A limited selection of antiretroviral drugs are available free of charge through the National AIDS
Secretariat – these are dispensed through HIV treatment sites in government facilities, and by a
few private physicians. Choithram Hospital can also provide these.
e) Post-exposure prophylaxis
If you suspect you may have been exposed to HIV, it is recommended that you consider
beginning a course of antiretroviral medications as soon as possible (ideally 1-2 hours) of
exposure. Your physician can direct you to location for this treatment.
Consult the Quick Action Guide 4 for Possible HIV Exposure
4) Mental Health
Mental health services in Sierra Leone are extremely limited. Individuals with a history of serious
and potentially relapsing psychiatric illness should be aware that there is very little in-country
support available for acute mental illness, and are encouraged to reconsider whether this is an
appropriate posting for them. Individuals with stable but long term psychiatric problems should
visit their mental health care provider outside of Sierra Leone prior to arrival, and arrange for
ongoing follow-up back at home.
Staff who experience or witness a traumatic event should be offered mental health support as
soon as possible after the event. In some instances, it may be necessary to access services
from overseas – either by Medivac or by bringing in mental health specialists from within the
region.
5) Blood transfusions
The only hospitals with a Blood Bank are Connaught amd Marie Stopes Hospitals in Freetown
and St John of God Hospital in Lunsar. Other hospitals can do a Typing and X-Match, screen for
blood borne pathogens. They may ask the Blood Bank if the blood is available. However, there
is a shortage of blood in the blood bank.
You or whomever is accompanying you should have the following information available when
they speak to the Health Advisor – ask the doctor who has prescribed the blood transfusion to
provide you with these details:
• Your blood group and type
• Your haemoglobin (Hb) level
• Underlying diagnosis / reason for anaemia
• Proposed amount of blood to be transfused
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• Proposed plan for follow-up and further treatment
You and the health advisor should be aware that standard protocol in Sierra Leone is for blood
to be screened for HIV, Hepatitis C and Hepatitis B antibodies and Syphilis (VDRL) prior to
transfusion.
This is very important to note, as it means that there is still a risk of contracting these viruses
through a blood transfusion if the blood donor has recently acquired the infection themselves –
ie. within the past six weeks to three months.
Wherever possible, it is advisable to receive a blood transfusion from a donor known to you,
who is aware of their HIV and Hepatitis status and unlikely to have engaged in high-risk
behaviours within the recent past.
6) X-rays
Choithram Hospital and Emergency Hospital have x-ray and ultrasound equipment with staff
oncall 24 hours a day:. These would be the first port of call in an emergency situation or for
patients who are admitted to hospital.
X-rays are carried out by radiographers or radiography technicians (non-doctors), who will
position the patient for the x-ray and produce a film which must then be shown to a doctor to
review. A radiologist later confirms results. There is only one radiologist in the country, Dr.
Gordon-Harris.
Most other health facilities in Freetown will refer to Dr. Gordon-Harris’ radiology suite on
Bathurst Street for x-rays. He will then report on the film before he sends it back to the referring
doctor.
You must also ask to keep a copy of your x-ray for your own personal medical records – it may
also be useful for follow-up and if you seek further care elsewhere.
If you are pregnant or think you might be pregnant, it is imperative that you notify the doctor
and/or radiography technician before you go for the x-ray.
7) Ultrasound Scans
Ultrasound scans should be carried out by a doctor. For non-emergency cases, it is
recommended that you attend Dr. Gordon-Harris’ radiology suite; Dr. Gordon-Harris also
performs ultrasounds at Choithram’s Hospital on request.
Pregnancy scans are carried out routinely as part of antenatal care for pregnant women.
Ultrasound scans do not use radiation and are perfectly safe during pregnancy.
Echocardiograms (ultrasound scans of the heart) are more difficult to come by. There is a
cardiologist, Dr. Russell, who can carry out this investigation; however, if you have or suspect
you have a chronic heart condition, it is recommended that you seek assessment and care from
your regular healthcare provider outside Sierra Leone.
8) Pharmacies
Recent concerns over the quality and authenticity of drugs in Sierra Leone warrant increased
vigilance to ensure that drugs meet international quality control standards. Although there are
infinite numbers of pharmacies in Freetown and many in Makeni, staff should aim as far as
possible to only buy drugs from the pharmacies recommended in the list of Pharmacies, or from
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the in-house pharmacies at any of the recommended hospitals. The following general guidelines
should apply to any medications you use:
Check the expiration date. Refuse expired date medication.
If the seal has been broken or the packaging been tampered with, discard the
medication and do not use it.
Tablets that are crumbled, discoloured or misshapen should also be discarded.
Notify your doctor of any pre-existing conditions, known allergies, and the names of
other medications you are taking when being prescribed medications.
It is your responsibility to carefully read the instructions that accompany any medication you
take.
9) Hospitals and clinics
There are many hospitals and clinics in the country. There are government hospitals and clinics,
private clinics and hospitals and clinics run by individual physicians and nurses and missionary
hospitals usually operated by Western missions.
a) Connaught Hospital
This is the main government hospital in the country. It is the teaching hospital for the School of
Medicine and often have consultants from Europe or the Americas visiting sharing their skills
and knowledge. The services are adequate considering the constant lack of resources. The staff
is courteous and professional. Local staff could use this facility but expatriate staff may not feel
comfortable as the facilities are below European standards.
b) Choithram Hospital
It is a large private hospital. The hospital is staffed 24 hours a day by in-house Medical
consultants, laboratory, radiology and pharmacy staff. Most of this staff is from India. The
premises are clean and the staff professional and courteous. Expatriate staff can be comfortable
using this facility for themselves and their families as there is a 24-hour paediatrician and a 7
bed paediatric ward supervised by paediatric nurses. There is also a Helipad for Medevac
purposes. There are different fee schedules for Sierra Leoneans and expatriates.
c) Emergency Surgical and Paediatric Centre
This hospital provides a high standard of care for victims of serious road traffic accidents,
surgical emergencies, and burns. It also provides high standard of care for children needing
treatment for malaria, anaemia and respiratory infections. Always call this facility before going.
Give the patient’s age, sex, medical history and the kind of injury or illness they have sustained.
The Medical Coordinator will advise you about whether they will be able to attend to the patient.
Do not bring adults for treatment unless it is a surgical emergency! All services are free of
charge and is funded by private donations. Ask for details.
d) Davidson-Nicol Memorial Hospital and Blueshields Hospital.
These are two local private hospitals/clinics who also see expatriate staff. They are small
facilities with approximately 10-15 beds each. They are adequate for very basic primary care.
The owners are well respected physicians. The laboratories are very small and cluttered. One
has an X-Ray department...very small room, very cluttered and equipment in questionable state.
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Running water is not always available as the electricity is often non existent and generators are
only run sporadically, for example during surgical procedures.
e) Holy Spirit Hospital and St. John of God Hospital
Two facilities worth noting are about 2-3 hours from Freetown. Both are Missionary Hospitals
and offer a high level of care and most services required. These would be good options if you
are travelling or working up country up. Holy Spirit Hospital in Makeni is self sufficient for
electricity with 24 hour generators. It also has its own source of water through 3 boreholes. It
has the only Reconstructive Surgery facility in the country teams of expatriate consultants
coming every February to do approximately 200 surgeries (burn grafts, repairs of cleft lips etc.)..
f)
St. John of God Hospital in Lunsar is a very active hospital with 150 beds including a
30 bed
paediatric unit and an active Outpatient department. It has one of the best laboratories in the
country doing most investigations and are also well equipped for a blood storage. Both facilities
have ambulances for road transport to Freetown and nearby football fields to use as Helipads
for Medivac purposes.
g) Marie Stopes Clinic
This is the best option for emergency obstetric care in Freetown. It provides emergency and
routine obstetric care with doctors on call 24 hours a day. The clinic has facilities for caesarean
sections including oxygen and emergency drugs. It also operates a blood bank.
h) Medevac
There are serious limitations in the quality of health facilities available in Sierra Leone for
complicated illness and emergency care. It is therefore advisable to consider Medivac in any
serious illness that does not seem to be improving, and/or in major trauma.
Deciding when to initiate Medivac is a challenging issue. Ideally this process should begin as
soon as it becomes apparent that the necessary level of care is unavailable in Sierra Leone.
However, the following guidelines may be useful in helping to make this assessment:
• Any trauma (eg road traffic accident or diving accident) that results in known or
suspected head, neck or spine injury will almost certainly require Medivac;
• 2nd and 3rd degree burns may require Medivac, although this depends on the area of
skin involved;
• Illness in children and pregnant women should be taken very seriously and Medivac
considered early;
The support of a trusted physician in Sierra Leone will be invaluable in helping to facilitate a
timely Medivac. Organisation and individual staff members should invest in building good
relationships with local doctors and health facilities.
In order to facilitate the MEDIVAC, the following information will be required:
1. NAME OF CALLER and return call contact details. (mobile, sat phone, Thuraya)
2. PATIENT’S DETAILS (name, age, date of birth, blood group, details of medical
attention given)
3. SYMPTOMS (nature of accident, or when the complaint started)
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4. DIAGNOSES AND NAME OF DOCTOR and his contact information
5. LOCAL SURROUNDINGS AT PATIENTS LOCATION (airstrips or football fields in
Close proximity)
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Safety Tips:
In giving this safety advice, we want to promote a good attitude and preparation without scaring
you or spoiling your trip.
Most people visiting Sierra Leone do so safely, but you should be aware of the dangers of crime
when travelling to unfamiliar places
Petty theft is rare but is probably the most common crime you are likely to come across. As a
visitor with cameras and cash, you just have to be careful. Violent muggings are rare but you
should be careful in big cities.
Basic Safety Tips
Regardless of your budget, when you travel in Sierra Leone you must remember you are much
richer than most locals. Most people are honest but the sight of a tourist with cash to spare and
cameras dangling is too tempting for some. To avoid being fodder for petty thieves and
opportunists keep the following tips in mind:

When travelling, wear a money belt underneath your clothes to keep your credit cards,
passport and money safe.

Keep a copy of your passport, insurance and credit card numbers in your main luggage
so, if you lose the originals, you have the information for insurance and replacement
purposes.

Don't wear jewellery, flashy watches or cameras around your neck, you're just inviting
trouble.

Obviously you'll want to take photos when you travel; just be discreet and put your
camera away or leave it in a safe place when not using it.

Don't walk alone at night and in stick to well lit areas even if you are walking with a group.

Don't look too obviously lost even if you are. You can always walk purposefully into a
shop, bank or hotel to ask for directions or consult a map.

Watch your belongings and pockets carefully at busy bus stations, train stations and
markets.

If, in the unlikely event, you are held up with a weapon never resist. Give your money,
belongings, whatever is demanded. Most people are hurt because they do not cooperate
with demands made.

You should take precautions and avoid large crowds and demonstrations, especially in
urban areas.
If You Are a Victim of Crime
If you get robbed you will need a police report. Most insurance companies and embassies will
require a one before they replace your valuables, passports and tickets. When visiting a police
station be polite and friendly and agree to a fee if one is asked for. Contact your credit card
company directly if your credit cards are stolen. Contact the High Commission if your passport is
stolen.
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Note: If you see a thief run off with your belongings think twice before you yell "THIEF" and give
chase. Thieves are despised in Sierra Leone and they will be run down and dealt with on the
spot by locals. You don't want to witness a mob beating a young boy for the sake of your watch.
Be careful about accusing anyone of theft especially if you are not 100% sure about it.
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Quick Action Guides:
In any form of emergency it is important volunteers contact Charlie Habershon at the earliest
opportunity. It is also High Commission policy that when any UK citizen is taken to hospital they
are informed.
1) Malaria
If not already done, contact Charlie
Habershon. The next stage will be to
contact Medivac
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2) Road Accident
Notify the patients family. In the event of serious trauma, Medivac will
be inevitable. Begin arrangements as soon as possible.
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3) Diarrhea and Vomiting
Seek advice from Health Advisor
about initiating Medivac
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4) HIV
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5) Sergical Emergency
Seek advice from Health Advisor about initiating Medivac
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