Proposal for a Sustainable Community Medical Clinic at Koindu, Kailahun District in Eastern Sierra Leo

June 9, 2016Usman F Daramy – Facilitator

1377 Keppen Blvd.Lincoln Park, Mi. 48146

313-923-7261540-414-1112

usman.daramy@gmail.com

Kollan Kissi Rural Development Agency (KKRDA) is a development oriented Non-Governmental

Organization registered in Sierra Leone and the United States whose mission is the development and

implementation of self-sustaining systems and community development platforms. KKRDA has

established a strategic collaborative partnership with globally willing individuals and institutions such as

the Henry Ford Health System Global Health Initiative in Detroit, Michigan, USA.

Our project focuses on the establishment of a sustainable model community clinic to serve one the most

marginalized rural areas in the World. In Sierra Leone, one region of great need is found at the border of

Guinea, Sierra Leone, and Liberia. This region has been dramatically affected by one of the worst civil

conflicts of the past century as well as the largest Ebola epidemic ever recorded. In fact, the 2014--2015

Ebola epidemic started in Guechedou, Guinea (a district adjacent to Koindu, Sierra Leone) and quickly

spread through the porous borders into the neighboring countries. Despite control of the Ebola epidemic

KOINDU MKRU CLINIC

in Sierra Leone and other countries, devastation to the community in Koindu has been severe and

continues even to this day.

Based on a community health needs assessment performed in Koindu, we have determined the need for a

clinic is very critical. Yet, at the same time, we fully believe as do local residents, that this clinic must be

integrated with other community sustaining projects. For this reason, we propose the establishment of a

multi-disciplinary community clinic to serve as the nucleus of the community development platform.

Key initial components of this platform will include a self-sustaining clinic and agricultural food

processing activity. Once these activities are established, additional programs will be integrated and

established in a phased manner to ensure appropriate staffing and sustainability plans are in place.

The clinic, a central pillar of the platform, would address immediate and basic health needs of the

community. The clinic will have an outpatient primary care facility, laboratory, mini-research center,

pharmacy, and accommodations for visiting health care providers. The clinic facilities will also have

training facilities to promote community education, environmental and occupational health as well as

wellness and nutrition.

BACKGROUND

From 1991 to 2002, the people of eastern Sierra Leone were caught in a bitter and brutal civil war

(subject of movie THE BLOOD DIAMONDS) started in Liberia and then moved to Sierra Leone

affecting Koindu in the Kailahun district. Sierra Leone and the Charles Taylor’s Liberia rebel group

survived throughout this conflict by preying on the livestock, cash crops, and by kidnapping an estimated

100,000 children and forcing them to become war soldiers. They committed some of the most outrageous

atrocities known in human warfare – cutting of hands and arms of innocent civilians, rapes, and the total

destruction of property. At its height, this bloody civil war displaced nearly 90% of the region’s

population (2.0 million people). It became one of the world’s worst humanitarian hot spots with the

deployment of a large UN peace-keeping contingent. The war ended in 2002, but the process of

rebuilding eastern Sierra Leone has been a slow and an arduous one. Kailahun district remains one of the

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poorest districts in Sierra Leone. In March 2014, the region was again invaded this time by the Ebola

virus.

Prior to the Ebola epidemic, the under-five mortality rate for Sub-Sahara Africa in 2007 was 148 per 1000

live births resulting in 4.5 million children dying before the age of five. In Sierra Leone the under

mortality rate was 270 per 1000. In addition, due to years of disinvestment and out-migration, Sierra

Leone had just 0.5 health workers per 1000 residents and the government spent 8% of GDP on health.

Before the Ebola epidemic, Sierra Leone recorded a total of 71,000 under five deaths. 1 Unfortunately,

billions of dollars of the global goodwill funds that poured into the countries have had a minuscule impact

on the front line communities and people.

RATIONALE:

Koindu is now a typical sub-Saharan African rural village located in eastern Sierra Leone with little

health or community-based infrastructure. With neighboring sister villages in Liberia and Guinea located

just a few kilometers over the border, many residents migrate to

visit Koindu for the purposes of trade. At present, the 50000

residents of Koindu, and its environs lack access to basic medical

services. In fact, the closest Regional Hospital is in Kailahun

approximately 75 km from Koindu with residents required to

travel by foot or motorbike along challenging roads. Due to

limited health-care access, residents in this region suffer daily,

and in some cases, die needlessly because they do not have

access to routine primary health care or emergency health

services. 

1 www.wvafrica.org

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Figure 1 A TYPICAL BORDER CROSSING POST

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GOAL OF THE PROJECT

The goal of this project is to establish a sustainable clinic and help ensure the availability of preventive

health services for all residents living in the Makona River Union (MKRU) areas. Such a facility will

benefit residents in Koindu, Kailahun district. At the same time, the established clinic will be a center for

health-care service innovation by providing rapid, portable and affordable diagnostic services to residents

such as screening for eye diseases using a pocket-sized ophthalmoscope costing just US$8.00. This

simple, field-tested device offers a low-cost tool to improve medical care and provides a novel tool for

training of health professionals in developing countries.

Figure 4 Manual Cassava tuber preparation for bending to produce flour.

Figure 5. Potential dehydration feed stock products food powder production

before packaging.

Figure 6. Food produced from cor. Figure 7. Proposed packaging container

for mixture of edible gari, and corn meal.

OBJECTIVESThe overall objective of the project is to design and build a community development platform with a clinic as the nucleus. This program is expected to help ensure the provision of basic quality health services, preventive health education, and to identify appropriate technologies, renewable energy for the establishment of mini agricultural industries, and to plants the seeds for research – including record keeping. Specific objectives:

1. Establish procedures for ongoing assessments of health threats to the population in and around Koindu particularly women and children’s vulnerability to malaria, water borne diseases, including the Ebola or any endemic. Promote the Koindu clinic, as a model of the first integrated regional health program.

2. Develop a training program in partnership with the Centre for Affordable Water and Sanitation Technology (CAWAST) a non-profit organization that provides training and consulting to organizations working directly with people in developing countries who lack access to clean water and basic sanitation. The community would be educated to

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Figure 2 Cardio-pad

Figure 3 Pocket Ophthalmoscope

KOINDU MKRU CLINIC

understand that there are many factors that can affect health including exercise, diet, environment, and heredity.

3. Establish a basic research program that would stimulate intellectual thoughts, and job satisfaction – hence, enhance youth retention. Develop proactive measures for the handling of the next Ebola, or any other epidemic.

4. Exploit available local resources, including the region’s strategic location for establishing a modern food production, and processing for the domestic, regional, and the international market. Advance the mini agricultural initiative to an integrated regional economic development program, by evenly dividing the mini processes between the three countries.

Budget Tables

Item Year 1 Year 2 Year 3Clinic $381,420Cassava Flour BakeryDehydration $Corn/Gari meal Packaging

Appendix 1 Project Timeline

Activity

Year 1 Year 2

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

THE PROJECT PROGRESS AND GOALS TIMELINE.Project Timeline for Activities

Budget & Components activity

Responsible (Party)

Cost Milestones Deliverables Completed date

Sensitization Programs

Converging a 1 or 2 day regional meeting at Koindu signing of project support letter.

International partner rep.

U. Daramy & Medical expert

$10,013 9/15/2016 Receive written

endorsement of the

project from all the

relevant authorities.

9/30/2016

Clinic Proposal & total 3/1/2016 In progress

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costComplete business plan for associated agricultural industry

4/18/2016 In progress

Identify funding sources

Submit Funding applicationAdministrative Costs

Total Project Costs

PROJECT OUTCOMES:

The Koindu clinic would be staffed by one doctor, assisted by two nurses, two employees, a medical assistant, and a receptionist. Ongoing training, and support for these employees will be provided by national Governments throughout the first and second year. The promotional events, all aimed at residents living within a 40 mile radius. With only one hospital within that radius, we project a gradual increase in patient load over the first two years as we find our place in the community. As patient volume increases, we will begin supporting our expenses from revenues. At the end of the second year, the subsidies will cease, and the resident doctors, including supports staff’s will become the clinic’s expenses. We expect to incur operating losses in the first and second year, but have planned for a strong cash flow to keep the business running. We will begin a small profit at the start of the third year. We will promote community pride, and clinic ownership to facilitate affordable monthly premium payments – with free health services for the most vulnerable community members.

PROJECT’S LASTING AND SUSTAINED IMPACT IN SIERRA LEONE:

The Koindu clinic has been designed strategically to disassociate it from the infamous white elephant projects of the past. It is an integral of a total community development platform that encompasses income generation, and employment. As part of the ongoing efforts to improve access to health care in rural areas, several local Governments and international agencies are subsidizing the start-up and first year of operations of a new family medicine practice, such as the Koindu Clinic. Throughout the first year, the Koindu clinic will work closely with advisers from local and international medical experts to get the clinic on a sound financial and operational footing, using this medical clinic business plan as a guiding management tool. These strategies in addition to the anticipated increased community income earnings would positively impact a lasting sustainability of the clinic, the community, Sierra Leone, and the region.

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