I've been thinking a lot recently about a research trip that I took to Sierra Leone. [MUSIC] [NOISE] Hi, class. Today, we are in Sierra Leone. Sierra Leone is in West Africa, Sub Saharan Africa, obviously. And, it is one of the poorest countries on earth. It is also one of the countries with some of the poorest health outcomes. If you are a child under five years old, there is a, actually great one in ten chance that you will die before the age of five. The greatest determinants of, of disease here are still things like anemia, protein energy malnutrition. In fact, if you look at the top causes of years of lives lost, you will see that you don't even get to a cause being a noncommunicable disease. Until you're well below seven, eight, nine, ten in the list. Neonatal mortality is high. Maternal mortality ratio is still one of the highest in the world. While Sierra Leone's made great strides in a variety of issues, there is healthcare now free for children under five. There is free malaria treatment. Treatment for everyone, if you're close to a health center. People here on average still get malaria four times a year. It's still one of the greatest causes of morbidity and mortality. The country is developing the health system, struggling. I think there's a bright future for Sierra Leone, but in terms of the health sector, there's still a lot of work to be done. Dr. David, I have interviewed many people about the Ebola out in Sierra Leone. My friend Fatmata said, I had heard about Ebola, but I had never seen an Ebola patient, but the way people are talking about the virus, I am very afraid now. We have never experienced such illness in this country. We are all panicking now, and especially, when the government has restricted the movement of people. Economically, this has affected our business. Has us selling in the local market most commodities are coming from provinces. And, people are not allowed to move far. I am really scared. My child's examinations have also been postponed. A teacher said, the Ebola out virus is a very deadly virus, although I have never come across the disease. But, the government is about doing their best to control the virus. This Ebola has affected me emotionally, economically, and socially. I am not happy as a Sierra Leonean. I am teaching an extra class for more money for, for those that are preparing for their final high school examinations. But, my number has dropped because government is campaigning for us to stop public gatherings. And, I have my family to take care of. I talk with a young boy, age 15. He hasn't, he is an orphan. He has lost his parents through Ebola. He say one problem that is paining him now is who next will take care of him. Especially, about my school fees, he says. No one to help me. All say, go away, you Ebola boy. I drop to school, I will starve to death. I went to mosque to talk with my Imam. He said, Imam's now telling people not to eat bush meat that has died by themselves. We must stop shake hands and always, we should wash our hands with soap or chlorine. But, people don't listen to religious leaders. He pray that Allah will solve this problem because this is killing our culture and economy. Dr. David, the situation in this country is really sorrowful. Th government did not have enough equipment to treat the people. And, lack of health, health education has caused death. So, many business has closed or dropping staff, no investors coming, and few have flew back, because of the virus. Many Sierra Leonean are contributing financially, waiting for the international body to bring help. Congratulations to the MSF, they are doing a great job. But, many nurses have died out of the virus. So, most nurses are afraid to go for work. They are afraid of the stigma. Some people call them Ebola nurse. >> I shot that video in 2014, right before the Ebola break, breakout. And, as you all know at this point, with the spread of Ebola throughout West Africa, this is an example of what happens when countries have health systems that are not strong or well developed. In fact, that is one of the themes that I'm going to talk about in our module that's, that's coming next. And, that really is not only about health systems and why health systems are so important, but exactly who are global health actors? How did these actors work in this landscape of global health? And, how do we go about with those actors improving health outcomes for everyone around the world?
