Tackling Child Mortality in Sierra Leone

Sierra Leone exemplifies the public health challenges of the world’s poorest countries. The tiny West African nation has one of the lowest doctor-to-patient ratios in the world and a corresponding lack of access to healthcare. As a result, many of Sierra Leone’s citizens, especially young children, die from treatable diseases like malaria, pneumonia, and diarrhea. In 2010, the World Health Organization reported that nearly one out of every five children born in Sierra Leone dies before age 5.

Ayman Yassa, MD, is spending several months in the Kono district of Sierra Leone as part of an overseas practicum, helping to evaluate a promising new program aimed at lowering that shocking statistic. Dr. Yassa is a physician in Columbia's International Emergency Medicine Fellowship (IEMF), a program with NewYork Presbyterian Hospital and the Mailman School's Program on Forced Migration and Health,

Before embarking on his journey to Sierra Leone, Dr. Yassa and his co-fellow Mary Choi travelled to Atlanta to work with the Centers for Disease Control and Prevention (CDC) and the International Rescue Committee (IRC) on developing a survey tool. The survey will be used to evaluate an initiative called the Community Case Management Program, which seeks to decrease preventable deaths in under-served regions by training community members to diagnose treatable illnesses, administer the necessary medications, and refer patients to health facilities when needed. The program is funded by the Canadian International Development Agency and implemented by the IRC.

Dr. Yassa, who majored in international development studies as an undergraduate before studying medicine and completing his residency in Emergency Medicine, finds the practicum is an opportunity to combine his passions for clinical work, international work, and health policy.

“Prior to studying medicine I had an interest in working in an international setting and during my residency I was able to work in various countries, which further solidified my interest,” Dr. Yassa explains. “My training in emergency medicine highlighted the discrepancies in health care both in the U.S. and overseas. Improving public health is one way to ameliorate these discrepancies.”

The Mailman School has a long-standing relationship with the IRC and the International Emergency Medicine Fellowship program has placed fellows with IRC projects overseas numerous times before. As Dr. Yassa learned more about the position, he was excited about the size of the survey, the participation of the CDC, and the innovative research design.

A pilot phase of the project involved meeting and speaking with families in Sierra Leone to better understand the types of illnesses they experience, how they are treated, barriers to treatment and local terminology relevant to the project.

“This allowed us to take feedback from the communities to find the optimum way to phrase questions or even to assess the age of an individual in a culture where birth dates are often not known,” he explains.

Dr. Yassa says he is excited about the project “because it is centered in public health rather than clinical medicine. While I enjoy both type of experiences and have no plans to stop working clinically, the opportunity to improve research and data collection skills in the field while improving the health of a population is appealing.”