Commonwealth Nurses Federation – West Africa, 1981

Freetown & Sierra Leone – Written by Helen Mussallem.  

Until 1981, Sierra Leone was, to me, just a name on the map of West Africa. I had met the country’s senior nursing officer and her assistant in nursing education many times at ICN Congresses. The latter person was afflicted with sickle cell anaemia –the first case I had ever encountered. I soon learned that this hereditary condition was common in many families in West Africa.

My hotel at Manny Lo was luxurious but far out of Freetown. I should note here that Freetown is reached by a ferry which runs on an erratic schedule from the airport. While travelling on the ferry and enjoying the warm sea breeze, I was delighted to note that the matron and the two accompanying nurses were in full uniform. Despite the winds and surf, they somehow managed to stay starchily stiff.

The hospital and the school of nursing were unlike those of other developing countries. The school was rather bare, with a minimum of teaching tools. Likewise, the hospital was barely furnished –but clean. Wards consisted of rows of beds in a large, open room and the “utility rooms” and equipment was in rather poor shape. I could sense from conversations with the Matron and her assistant, however, that the “caring” for patients was paramount even though the curriculum was disease oriented. In essence, it followed the U.K. pattern for the preparation of nurses.

As planned, I delivered three speeches on “primary health care” to the nursing staff, to the entire hospital staff and one which was open to the “general public”. Everyone listened politely, laughed at the appropriate times and applauded enthusiastically. I shall never know if my enthusiasm for the WHO goal of “Health for all by the year 2000” was understood by any member of the audience. I often heard those words repeated but I was never sure if they really understood the concept and how it might be implemented in their own country. Would the students see the vision of this new approach to health care and internalize it? Not likely if the rigid curriculum, as I viewed it, was followed.

The chief nurse recognized my enthusiasm for primary health care and arranged for me to see a primary health setting several kilometres inland. We set out on a hot, hot day. I was in the front of the car with the driver and the matron and her assistant –again in full uniform –sat in the back. About one hour out of Freetown, we heard and saw a loud explosion of steam from the radiator. The car stopped suddenly. For a while, the driver just sat but eventually, he opened the hood –still spurting steam. Having driven a car since the age of 10 and having been loaned a second hand car during my student days, I had some, scant knowledge of auto mechanics. I had even had a similar experience with a burst radiator hose in a huge Essex. This seemed similar but, unwilling to interfere, I sat quietly with my companions until the driver announced we were stuck as he had absolutely no equipment for repairs. Ready for action, I got out of the car and asked to see the problem –a broken radiator hose alright and all the water was gone.

Looking around, I spotted a small stream way down in a gully and asked the driver to fetch some water. He refused saying he had no container. We did have our water rations for the day but how was I to fix the burst hose with no tape of any kind. I had an idea. While the matron kept the driver from following me, I went to the back of the car and removed my pantyhose. Triumphantly, I returned to the front where the hood stood open and instructed the driver on how he was to repair the burst hose. His eyes got bigger and bigger. He simply could not understand what I was talking about but, together, we wrapped the burst hose with the pantyhose. I then used all our precious water –about three to four litres –for the radiator. Thankfully, the car started and we managed to drive the five or six miles to the next village. There, a temporary patch was applied and my handiwork discussed to the amusement of the villagers.

Prior to reaching our destination, we stopped to pick up the public health nurse for the region. When we finally arrived, I emerged from the car to the sound of many women singing around large pots. The pots, to my amusement, reminded me of the ones in Sunday school books that showed the natives boiling the missionaries. The public health nurse explained that these women were midwives whom she was teaching to sterilize the blades, knives and cord, etc. used for deliveries. I asked what they were singing and was told that it was a song of thanks “to my mother for having brought this wonderful woman into the world” (me). I was especially touched as it was 14 March (1981) –my mother’s birthday.

Glancing to one corner of the clearing, I saw the elders seated around a rustic table discussing plans for health care. Nearby a group of young men was being taught by a “trained health teacher”. He was teaching them how to carry vaccines, packed in dry ice, and administer them to villagers in the remote areas of the country. The teacher asked me to address the group and he would translate. I started off by telling them about the WHO goal of health for all and noted that my home was far away and that it was covered with snow and ice. The translator stopped and, when I asked if there was a problem, answered, “Yes, we don’t have words for ice and snow”. Ever inventive, I suggested he tell them that the temperature in my country was cold like the dry ice in their vaccination kits. They all laughed hysterically. I was then asked to come and see their new project — a compost heap with boards on four sides! This was a new and exciting venture in this part of Sierra Leone.

“Could I go out to the little huts I could see from the compound,” I asked. They discouraged me as there were “biting snakes” in the area and I would have to wear high leather boots. I went! Along the path, mothers held their children out in front of them. When they saw me, they pinched their children’s cheeks and said something — always the same-sounding phrase. Curious, I asked for a translation but my guides were reluctant to interpret saying it was a bad word. “What bad word,” I asked. “White woman, white woman”. That was a bad word! That was me!

At work in Africa


Arrival at the airport in Ghana was almost as spectacular as arriving in Nigeria. After the strenuous lectureship in Nigeria, covering cities and villages, I returned to the Government House residence for VIPs with a serious flu-like condition with fever and a hacking cough. The “government nurse”, who came at my request, confirmed that I was ill and should not travel the next day. I had to travel, however, so tight was the schedule for visits to the seven countries –Nigeria, Ghana, Liberia (not Commonwealth but squeezed in by the Secretariat), Sierra Leone, The Gambia, Malta and Cyprus.

I was transported to the airport in great style but the trip took hours through the city’s congested traffic –possibly the world’s worst. Peddlers approached our car continuously hawking all types of wares. The most amusing were young girls with radio/stereo/recorders on their heads –the music going full blast. I coughed continuously. At the airport, I left the first class lounge and boarded the Royal Dutch Airlines jet, again first class. I leaned back ready to soak in the calm of this luxurious style of travel. The aircraft was cool and clean and special gifts of Dutch chocolates and mementos were offered. En route, we stopped only at Abuja(?). It was an all too short hour of luxury.

When we landed I peered from the plane and saw dozens of immaculately dressed nurses in starched aprons, bibs and frill caps. The other first class passengers were asking the hostess what was going on but I said nothing. As I disembarked, the 30-nurse guard of honour stood with military precision. What a thrill! Then I was presented with the customary bouquet. I felt like royalty! Unfortunately, my beautiful bouquet was full of ants which crawled all over my front as I posed for pictures.

The route to my lodgings was interesting. We passed through many guarded gates and finally reached my luxurious quarters –built for use by President Nkrumah. He was a large man so the bed was double, double size. At night when I coughed constantly the whole, massive bed shook.

After completing my lectures on “Continuing Education, An Essential to Nursing Strategy and Networks in Primary Health Care” in Lagon, I was scheduled for appearances in various cities and villages in Ghana. To my delight, I found I was to travel by private, government plane with Capt. Reynolds as pilot and accompanied by the chief nursing officer. For each trip, my companion and I boarded the plane and were settled into our special seats. Only then were the other Ghanaian passengers allowed on with all their goods and chattels. Before takeoff, Capt. Reynolds would come back to ensure that we were comfortable and to give us instructions about seat belts, etc. I was very impressed with his decorum and his concern for us.

At one stop in Northern Ghana, I gave my lecture in a large school packed with students, villagers, etc. I had difficulty being heard as the large yard was filled with innumerable guinea hens, which made such a loud racket that I had to shout to be heard. I was told the hens came only once a year and brought good luck. After shouting for about 30 minutes, I thought I would lose my voice. I did take time out for coughing.

When we returned to the airport, we could see that here was a problem. A young man had taken photos with his camera and immediately the military police pounced on him and seized his camera. Neither the young man, nor we two, had realized that we were in a restricted zone. The young man pleaded for his camera –without success. We boarded the plane and I asked my companion to seek Captain Reynolds’ help. When she refused, I boldly walked up to Captain Reynolds when he boarded the plane and relayed the whole story. He sprinted from the plane, talked with the military police and returned with the camera, giving it to the young man. Only the film was removed. My reward was the boy’s most appreciative ear-to-ear grin.

The day after our return to Lagon was a national holiday and we, and other dignitaries, had special seats for the festivities. I was fascinated by the huge umbrellas carried by aides and used to shield the tribal chiefs from the hot sun. The parade started and who was the smart, slim, air force officer leading the entire parade? Our Captain Reynolds.

Later, after my return to Canada, I heard that he had been elected President, an office which he has held to the present day.