Anna Macauley has worked for MSI Sierra Leone since 2000. The team has endured many challenges, going from strength to strength to become the nation’s leading reproductive healthcare organisation – a safe, reliable place for women to find support in Sierra Leone.
I remember my first client well. Even though it was 26 years ago! She was called Fatou and was overwhelmed with her six children, and desperately thin, living in a rural, unfinished house. I talked to her about family planning. Well, she’d never heard about such a thing in her whole life.
She decided to try a contraceptive implant. When I met her again months later – looking so healthy and happy I might add – she and her husband went around the village shouting, ‘Our nurse has come!’ so more people could benefit from this magic. She became a local advocate for using family planning.
Back then, Sierra Leone was known as the deadliest place in the world to get pregnant. I’m 62 now so yes, I remember it well. We didn’t have enough reproductive health or maternal health services or midwives, or any real medical support for births. Most women would deliver babies at home with unskilled attendants. As a pregnant woman, you’d feel lucky if both yourself and your baby survived the birth.
We’ve been through a lot in this country. When I joined MSI, we were right at the end of a decade-long civil war and we were one of the only places where women could get reproductive healthcare. Women would whisper to each other about our services and line up down the street for them.
When Ebola struck us in 2015, it felt like its own war. People were dying and scared. We thought we were going to shut down, but we carefully considered the information we had, put safety measures in place, and decided we could remain open. We trained staff on preventing contact, invested in infection prevention gear, employed extra people.
It was not easy. Imagine you have your own family to protect, yet you’re travelling to areas that are loaded with Ebola cases. We started small with precaution, and kept building up from there, over time feeling safer and more confident. And we never had a single team member infected! In fact, the government even asked us to support public health teams with our protocols and training.
It meant that when COVID-19 hit, it was not as much of a shock. We put barriers and safety measures in place, and we carried on. Because women and girls need us in these times of hardship – we can’t sit comfortably while they suffer silently. We refuse to.
If I think about why we’ve been able to persevere through these big hurdles, I’d say it’s our people. MSI attracts tenacity in human form. We have positive, flexible attitudes, are willing to work under strain, to embrace whatever change comes – because underneath it all, we care about the women of Sierra Leone. That includes our donors, whose support continues and flexes with us. People have kept our programme going.
Our systems and approaches have changed too – but the right people with the right ideas are the true backbone of these evolutions. I’ve seen our programme grow from one mobile health team and two clinics to become the biggest reproductive health organisation in Sierra Leone with a presence felt in all districts and throughout the public health system too. We are doing a whole lot. We have increased our services to focus on everything a woman needs across her reproductive life.
MSI Sierra Leone is known around here as ‘de mammy fo welbodi’, the mother of health. Isn’t that beautiful? To me, it means people feel looked after by us, that we’re reliably there for them. For decades we’ve been here, supporting women and girls in our communities, and they recognise that.
Nowadays my role is training government health workers. My most recent ‘client’ is a public health worker who I trained in reproductive care, and helped set up family planning systems and services at her facility. Now she’s a family planning mentor in her district, sharing her knowledge with others. It reminds me of my first client Fatou who went on to inspire others too.
That’s how this works. What I sow today, will be carried on by others. This impact ripples out forever.
Scroll for photos from our Sierra Leone programme >
50 years of MSI Reproductive Choices
Read more about MSI’s five decades of delivering reproductive choice.
Reflections from MSI co-founder Jean Black
Jean is sharing how MSI began, taking us for a trip down memory lane.
