Sierra Leone has experienced its share of health challenges in the past decade. In 2014, it was at the epicenter of the West African Ebola epidemic. The country lost roughly 4000 people to the deadly disease over two years. Partners In Health was integral to the country’s response efforts, and vital to their strategy was the training of community health workers (CHWs). The government of Sierra Leone officially declared the country disease-free in 2016, becoming an example of the efforts needed by governments and partners to defeat a deadly disease like Ebola.

Having seen firsthand the devastating potential of disease outbreaks, when the threat of coronavirus grew to pandemic levels, like many countries in world Sierra Leone acted fast, not willing to risk another mass outbreak inside its borders. Often the first and only representative of health care that patient see, Community Health Workers were instrumental in the Ebola response, and are therefore critical within the success of COVID-19’s response. 

Leah Blezard, a 2019 graduate of UGHE’s Master of Science in Global Health Delivery program, is on the frontlines of this strategy. Blezard has spent the last five years working in international development across the continent of Africa. She began her career working on a community development initiative in Zambia before learning about UGHE and moving to Rwanda to pursue her graduate studies. After graduating in August of this past year, Blezard joined Partners In Health – Sierra Leone as their Community-Based Programs Associate. Now, she finds herself an integral part of her organization’s efforts to train and prepare community health workers to respond to the COVID-19 pandemic. 

We spoke to Blezard from her home in Kono District of Sierra Leone to hear her insights about the response in Sierra Leone and the importance of CHWs in responding to pandemics like COVID-19.

Tell us a little about the day-to-day of your role/ latest projects?

Currently, I’m an Associate on the Community-Based Programs team for Partners In Health, here in Sierra Leone. I support the Management Team with various community health efforts. We manage around 150 Community Health Workers (CHWs) and other community-based frontline staff within our district. Before the pandemic hit, I was working a lot on improving the quality of our mobile data which is collected by CHWs during their home visits with patients. Now that the pandemic has hit,  I have been working exclusively on our COVID response over the past few weeks. 

We just finished our general COVID training for CHWs a couple of weeks ago, and I’m still working on some things before it officially launches in the communities. This training was to adapt some new COVID protocols into the CHWs’ scope of work and make sure that they are practicing their home visits in a super safe manner – safety is our priority. During the training, they learned how to screen people for COVID symptoms and do COVID health promotion before their regular patient reviews. Home visits can put frontline workers in vulnerable situations when there is an outbreak like this, so we want to make sure the CHWs are safe and have the education and equipment they need to feel as such. The training was a big job, I feel like at the moment everything is happening so quickly – you’re trying to pump out materials and protocol a lot faster than in normal circumstances. 

Our team helped evolve these training materials with the context of Sierra Leone specifically in mind and aligned the messaging with Sierra Leone’s Ministry of Health supported guidelines. From a community perspective, there are a lot of myths propagated that cause panic and fear- you need to know which ones are relevant to your setting. It’s unprecedented in terms of how quickly the information is changing. I’m looking back at the training and feeling already that changes have to be made. This makes it super interesting — how dynamic it is. It’s been a hugely valuable career experience so far.  

Right now, our community-based programs team is developing job aids for CHW’s. When they are in the field and going house to house we want them to have a COVID information handbook as well as a visual guide for their audience to follow along while they are delivering health promotion messages. We are also about to launch a COVID screening and contact tracing program in the next couple of weeks, so I’m busy working on the Community-Based Program’s action plan for that — mapping out our district into catchment areas, identifying how many personnel we’re going to need, stuff like that.  

What are some of the challenges that you’ve encountered in your work around COVID-19?  

I think it’s largely the lack of resources, which I know is an issue for the entire world right now. It’s especially stark here as Sierra Leone has always had a lack of resources, especially in regards to maternal health care. When something like this happens, it really highlights these resource limitations. 

One thing I’ve struggled with is how to address the issue of personal protective equipment (PPE). We want to send our CHWs out into the field with masks and hand sanitizer, but with resource limitations and border closures, making sure we have enough PPE has been tough.  We’ve made adaptations when possible, and are also ensuring that strict social distancing and no-touch protocols are implemented for further safety. Keeping everyone safe is paramount.  

Another challenge is that this situation is evolving daily. Our CHW’s are incredibly responsive to this; they always have a ton of questions, which keeps me on my toes. Rapidly changing circumstances demand a lot of research to make sure as a team that we are driving home relevant health messages, sharing up-to-date prevention information, and new developments on basic protocol around washing hands, covering your face, and social distancing.  We need to empower our CHWs to drive home these messages at the household and community level — they need to be well-versed in COVID information in order to pass it on effectively to their community members

How do you feel that this pandemic has shone a spotlight on the unsung heroes and heroines of our global health systems? 

In global health, we are already aware of the value that CHWs add to the health system but hopefully, the COVID pandemic will highlight the value of these healthcare practitioners in a broader way. I love community health, and I think it’s amazing to see how much can be done even if you have super limited resources, just because of how well people — CHWs — know their community.  That was the greatest asset that the Ebola response had – and I  think we will see this again during COVID-19. 

Can you imagine if you had a person living in your neighborhood in Canada or the United States who you could go to for basic health advice, for help with picking up your medications, for advocacy and support? Especially for aging adults or groups marginalized by the formal healthcare system — how valuable would this be?!  I think the healthcare systems of high-income countries can learn a lot from CHW programs from low- and middle-income countries.  

What drove you to consider furthering your health education at UGHE?  

My decision to apply to UGHE came about through my admiration for the work of Partners in Health (PIH); I’d followed the organization for some time. I learned about Dr. Paul Farmer (Chief Strategist and Co-Founder of PIH) at university and felt my views and outlook on global health very closely aligned to PIH’s philosophy. 

I was living and working in Zambia at the time UGHE launched (as an initiative of PIH) in Rwanda. I strongly believed in their approach to health education as I’d always held the belief that to learn about health systems strengthening, you need to do so in the right context. It is, put simply, more valuable to learn about Rwanda’s health system while also living in Rwanda, rather than attending a US or Canadian university and trying to understand the situation from afar.

How did your MGHD Masters Degree at UGHE prepare you for the work you’re doing now?

One of the great things about UGHE is that you learn that the soft skills are equally as important as the hard, “research” skills. For example, we did so many presentations at UGHE – almost every day. You learn how to get your point across succinctly and clearly and these skills have been critical in my current role – presenting has been a big part of my job as of late, which has been unexpected but I have felt pretty well-prepared for it because of UGHE. It’s a reflection of the fact that my UGHE education was very multi-faceted  – it gave us an overview of a lot of leadership and management skills that have been crucial in this field so far. 

UGHE also has a foundation based in community health and it recognizes the importance of addressing social and environmental determinants of health, which are not always super apparent in a clinical or hospital setting. The teaching is really grounded in that philosophy. We learn about expanding our thinking beyond just looking at the clinical presentation in front of you. I do this every day now – consider the community context specifically and therefore how this pandemic can be handled best given the contextual circumstances of the community  — where people live and work, what they eat, their education levels, etc. UGHE prepared me to think about things in a systemic manner and consider the social context. 

Tell us a little about how PIH is involved in curbing the spread of COVID-19 in Sierra Leone?

The situation in Sierra Leone is interesting, as COVID-19 arrived here later in the grand scheme of things. So if there is any form of a silver lining, it’s that we are learning and adapting our COVID-19 response from the successes and failures of other country responses, with a little more time to prepare than some of the unfortunate countries who suffered it’s full force first. 

There are also a lot of comparisons to be drawn between the current situation, and that of the 2014 Ebola epidemic, within which PIH was also involved in the response. As this country had experience in dealing with a widespread health crisis like this in the recent past, it was able to act quickly, including closing the air borders early, before the first case was confirmed. 

So far, we have had 231 confirmed cases and fourteen deaths, and most of the cases are clustered within the Freetown region, where the population density is higher and can, therefore, have a greater risk of transmission. Perhaps the biggest initiative PIH in Sierra Leone is taking on in the COVID fight is the training and management of the national contact tracing effort. The government has asked us to train a cadre of community contact tracers and become an integral part of the wider country initiative. In Kono, the eastern-most district of the country where most of PIH’s operations are located, our CHWs are going to be doing house-to-house screening to identify suspected COVID cases across the entire district. They will also be promoting key COVID health messages across the district, such as the importance of hand hygiene, etc. We are linking up with the district surveillance team and contact tracers to complete the care continuum. Sierra Leone and PIH learned so much from Ebola, and given everything we know now and all that these CHWs have been though, I know we will get through this too.