Three weeks in a London stroke ward: Dr Melvina Thompson visits from the King's Sierra Leone Partnership

Welcome to London, Dr Thompson! Can you firstly tell us about your role at Connaught Hospital in Sierra Leone?
I am the Senior Resident Doctor in the Department of Family Medicine at Connaught Hospital, as well as at the new Palliative Care Unit. I am also Clinical Research Assistant for the Stroke in Sierra Leone (SISLE) project, co-led by King’s. I have been involved with King’s Global Health Partnerships since 2018, working on the SISLE research project and now at the newly established stroke unit, the first in the country.

I oversee the stroke unit, which involves monitoring patients, mentoring nurses and health workers, and coordinating the weekly review of patients on the ward, to ensure good clinical outcomes for our stroke patients and to maintain a high quality of care. I also work with the families of stroke survivors to counsel them and motivate patients and their families in the recovery process.

How did the opportunity arise for you to come to the UK and what has your three-week placement at St Thomas’ stroke ward involved?
In 2020, I applied to the World Stroke Organisation’s exchange programme which sends health workers from low- and middle- income countries to an international stroke centre of high quality, to observe how they are run, and then apply some of these lessons to their own countries. I was one of five people who won the grant but because of Covid-19 travel restrictions I was unable to go. Finally, this year, and with the support of King’s and the NIHR SISLE project, I was able to undertake the observation placement at the Mark Ward at St Thomas’ Hospital, shadowing consultant physician, Ajay Bhalla.

There are 28 patients on the ward who have been transferred from eight stroke units across London for rehabilitation. They are cared for by a multidisciplinary team of doctors, nurses, physiotherapists, occupational therapists, and speech therapists who aid them in their recovery before they are discharged back to their community.

From your observations, what have been some of the main differences between stroke care in London and your experience of stroke care in Sierra Leone?
There is a vast difference in the clinical management of patients and the way investigations are done following a stroke in the UK, compared to in Sierra Leone. In the UK, investigations can happen very quickly following a stroke. In Sierra Leone, it is slower. For instance, we don’t have a walk-in CT scan at Connaught Hospital. Patients have to go privately for these and there are only three facilities in the capital, Freetown, with CT scanning equipment. Most patients don’t have health insurance so they have to raise the funds to pay for a scan which is around $100. Also, we don’t have electronic medical records, we still use paper records, so the management of patients is much slower.

Our resource capacity is also different. We don’t have enough equipment on the wards at Connaught Hospital. At St Thomas’ Hospital, if each patient needs a hoist or a wheelchair to move, they are readily available on the ward. There are also so many specialised health workers on the stroke team in London from physios to speech therapists. At Connaught Hospital we have one or two physiotherapists, otherwise care is provided by our general nursing team who might for instance, have some speech and language training.

There is arguably an advantage to this – it enables a greater breadth of knowledge amongst our clinicians. Doctors need to have a very good grounding across all specialisations. And without the availability of a broad range of diagnostic tools and technologies in Sierra Leone, doctors’ clinical skills need to be very strong to diagnose patients’ symptoms. This also means that the doctors are really hands-on with their patients in Sierra Leone and will communicate at length with their patients about their symptoms and diagnosis.

Are there any lessons you will take back to your practice at Connaught Hospital?
I have been very impressed with the multi-disciplinary provision of stroke care at St Thomas’ Hospital. There is proper coordination amongst the team - everybody is clear on what they are supposed to do, and everybody does what they are supposed to do! Morale can sometimes be low amongst health workers in Sierra Leone. At St Thomas’, everyone works as a team, including both clinical and non-clinical health workers, to do as much as they can for their stroke patients. It is this team spirit that I will bring back to the stroke ward at Connaught Hospital!

With my stroke patients, I feel so much happiness when I see them recovering, it is very rewarding. When they’ve been in this acute state and they gradually start recovering, it gives me peace of mind that I did something to help and they are now fine. I want to improve the bond amongst my team so together we can do as much as possible for our stroke patients.