She asked for 150 buckets, but I only sent 15. The idea that someone needed 150 buckets at a COVID-19 facility for mild and asymptomatic patients seemed ludicrous to me. It wasn't until I actually went to see the Fouray Bay College COVID-19 Community Care Center - that I realized that it was ridiculous to send just 15.

There are 150 rooms at this student hostel that has been converted into a "community care center" not to be confused with treatment and isolation centers. Each room holds two patients. The center gets its water supply from a dam through a pump that runs on a generator. The generator needs to pump two times a day. If there is no fuel for the generator, there is no water. Buckets in each room mean that patients can take their bath and store water in-between. 

As I stacked the 135 buckets for delivery to FBC to complete their initial request, I realized that lack of trust will delay Sierra Leone's national COVID-19 emergency response. We live in a low trust environment characterized by citizens mistrust of government institutions; and intra-government mistrust.

When a frontline health worker requests 150 buckets or 11 million leones ($1100) to repair a generator in a low trust environment like Sierra Leone, the need may not be met when it is needed.

Frontline leads at COVID facilities report their needs to the Case Management Pillar at the National Emergency Operation Center. The Case Management Pillar lead then sends the request up the chain to the Logistics Pillar and or to the EOC's Finance Department. 

When a request makes its way up the chain, those beyond the Case Management unfamiliar with facilities reduce the urgency of their requests or dismiss them altogether due to mistrust. 

The healthcare system in Sierra Leone (before Ebola, during ebola, after ebola, and in the immediate pre-COVID-19 period) is weak. In December 2018, doctors went on strike to protest poor wages and the lack of "proper tools to provide sufficient medical care." While the strike eventually ended with the government committing to improved salaries, based on the current state of hospitals during this pandemic, the medical tools never came. 

As we continue our drive to support frontline healthcare workers at COVID-19 isolation units and treatment centers, the effects of longstanding medical needs are apparent.

For example, we asked one hospital for their emergency needs for COVID-19 for the next 30 days. In their response, they included 20,000 gloves. Do they need that much for a 20-bed COVID-19 treatment facility? Probably not! Is that what they regularly need their 100-bed hospital? Most Likely. 

Understanding and mitigating the longstanding unmet public health care needs in Sierra Leone's low trust environment during the COVID-19 crisis is crucial to the management of the pandemic.

Every week since April 24 C19 Dignity Project have been visiting COVID-19 treatment facilities to deliver medicine, medical tools and hygiene supplies. C19 Dignity is a citizen-led community mobilization project to ensure that frontline health workers in Sierra Leone have what they need to provide quality of care. Click here to send medical supplies and tools to frontline health workers during the COVID-19 Pandemic in Sierra Leone