## Charity no. 1145455 Friends of Nixon ## www.friendsofnixon.org ## **TENTH ANNUAL REPORT** November 2021 ## Introduction As we mark 10 years as a UK registered charity we can reflect on the very real and positive impact our work has had within the Nixon Methodist Memorial Hospital in Segbwema, Sierra Leone, and the material difference our collaborative approach has made to the lives of those individuals in need within its wider community. We both celebrate our joint successes across training, improvements in patient care, hospital infrastructure and community health, but also acknowledge the pervasive challenges that remain in the hospital’s path of ongoing development. We recognise that the rate of progress in overcoming the human resource and socio-economic barriers required to improve health care provision in this setting mean that our Trust’s commitment to the hospital will be required for the foreseeable future. However, our approach of supporting locally initiated projects and activity has enabled ownership and sustainability of grass-root development, whilst at the same time using the expertise of our dedicated trustees to guide activities ensuring they are effective and evidence based, with an appropriate level of governance. Our independence and clear unequivocal focus on patient care and population health through direct and indirect means has resulted in credibility with our partners and has enabled us to craft effective working relationship with the hospital’s stakeholders. Particular progress has been made towards the Trust’s goals of strengthening child and maternal care provision, as first concluded as a priority by a clinical working group early in the Trusts existence. Trustees continue to show dedication, enthusiasm and pragmatism in assessing, developing and overseeing project work both at, and between, virtual meetings within the UK and Sierra Leone. ## Hospital Context The hospital continues to provide emergency, planned and preventative healthcare in Kailahun District through its inpatient and outpatient services. Notably, a Memorandum of Understanding between the Christian Health Association of Sierra Leone (CHASL), of which the hospital is a member, and the Ministry of Health & Sanitation, was signed in early 2021, formalising partnership arrangements between the Government of Sierra Leone and Christian faith-based institutions. Greater stability in staffing for the benefit of patients is welcome, as is effective working with Kailahun District Medical Health Team. Efforts to re-open the Nursing School are continuing. There has been progress regarding provision of necessary training equipment and classroom rehabilitation funded by the Trust. However, the resolution of some local in-country issues remains outstanding and have necessitated a delay in the commencement of the new nursing course. ## Fundraising Despite the circumstances of the Covid-19 pandemic, we have gratefully received continued support from long standing partners and individuals, allowing us to maintain a stable financial position. We remain particularly appreciative of those individuals who have faithfully chosen to support our work via standing orders, some of which have been in place since the Trust’s inception. We also remain hugely indebted to the Missions Project of the Stamford Methodist Church whose continued commitment is invaluable and whose additional targeted support was pivotal in the establishment of the pilot Community Wells Project this year. We also owe a huge thanks to the Gibbs Trust whose very generous support has been sustained throughout the last decade. Fundraising efforts from the Emmanuel Church Redditch, Trinity Methodist Church and Pontillfraith Methodist Church are also very thankfully received. We hope that our approach to the hospital’s development, together with appropriate governance and administration of such generosity justifies the kind support we have received. Charitable Activity ## _Training_ This year the trust had been able to support and deliver workshop training on site at the hospital, provide clinical supervision and continue support for individual hospital staff undertaking Higher Education Courses as part of their Continuing Professional Development. Following a needs assessment of current provision and supplying missing equipment, a 2-day multidisciplinary training workshop on post-natal family planning was delivered to hospital staff and their colleagues working in community settings in July. By addressing this unmet need for family planning and tailoring training to the specific local challenges, it is hoped a wider impact on both maternal and child health can be achieved . Early data and follow up reassuringly shows the initiation of an effective post-natal family planning service at the hospital. In January, a workshop introducing new VSA Blood Pressure devices to the hospital was conducted for clinical staff at Nixon. Although primarily aimed at improving the detection of blood pressure problems in pregnant women, the benefits of both the training and new devices directly translate to the wider adult population and can be used as part of initiatives required to address the increasing burden of non-communicable disease such as stroke within Sierra Leone. The community nurse we have supported through scholarship continues in her final year of her higher nursing qualification in Kenema and will soon return to the hospital. We have also agreed funding to support another staff member in their request to pursue Community Health Officer training to complement existing clinical staff. The hospital’s management also have additional candidates for further training to enhance the available expertise on the hospital site. This includes plans to seek funding to train a nurse anaesthetist. However, they, and we, are aware such upskilling needs to be achieved gradually in order not to compromise the existing limited workforce at the hospital. ## _Community heath_ The extension of our community health work has, this year, resulted in the successful completion of a pilot project to build two community water wells in Ngodama and Waiima, both villages within the catchment of the hospital. The villages were identified as most in need by the hospital’s Public Health team based on limited access to very poor existing water sources. Labour was provided by the healthy occupants of the villages, overseen by a contractor in liaison with the Sierra Leone Water Company. This pilot work did reveal issues regarding the most appropriate time to start digging to ensure it coincides when the water table is at its lowest, managing significant inflation of material costs within budget and, for Ngodoma village, having to change the planned site of the well after hitting an unpassable rock layer (incidentally, this first redundant very deep hole was resourcefully converted into an additional double latrine). Despite these difficulties and as a result of significant collaborative efforts, many more families now have access to clean, safe water, significantly reducing their risk of infection with water borne disease. Keen to apply lessons learnt from the pilot project and refine the construction process further, the hospital team is now identifying a further two villages as suitable candidates to be supported by Friends of Nixon for new wells. ## _Electricity and Infrastructure_ We have commenced the second stage of our work developing the hospital’s electrical infrastructure as per recommendations of an independent review commissioned at the end of 2019. This work, which is due completion by the end of the year, involved the extension of the solar field by a further 24 panels, repair and maintenance of existing solar components and effective training of the onsite electricians. This project is critical to safeguarding the hospital future electrical supply and enabling the use of core medical and surgical equipment needed to care for patients. We are liaising with in-country contractors to ensure regular maintenance agreements are enacted to ensure this work remains sustainably operational. In addition to the electrical infrastructure, the Trust also supported a significant grant to refurbish the outpatient department and consultation rooms together with new tiling of these areas. This work also included necessary repairs to damaged windows on the hospital wards. Ensuring a safe and appropriate working environment amenable to appropriate infection control measures and cleaning was seen as important to the hospital’s functioning. ## _Laboratory Support_ Local in-country issues regarding the availability and cost of reagents and disposables for point of care tests had impacted upon the ability for the laboratory team at the hospital to consistently provide basic testing, included blood glucose testing. Friends of Nixon has therefore funded both a regular supply of compatible glucose test strips and has set up a small annual fund to ensure consistent provision of laboratory reagents and consumables. These tests are critical for blood grouping to enable safe blood transfusions and for the diagnosis of typhoid and monitoring and diagnosis of diabetes. We have also approved funding for a new binocular Olympus microscope. This will enable the analysis of malaria thick and thin films, the gold standard diagnostic needed to guide the treatment of patients with malaria. In addition enhancing the diagnostic capability of the laboratory with regards to malaria testing, the additional microscope will also be useful for stool, urine, and sputum microscopies. ## _Ultrasound service_ As part of our focus on maternal health, our work introducing a basic obstetric ultrasound service to the hospital continued through 2021 with training of staff and development of appropriate protocols for maternity patients. This training subsequently continued remotely and at a follow up visit later in the year staff continued to demonstrate competent practice. The service enables maternity outcomes to be improved through establishing 6 features of the pregnancy including the gestation age, viability, presence of multiple pregnancy and presentation. Feedback from both patients and staff has been very positive. ## _Essential Medicine Provision_ We have completed the second year of a two-year extension to our original four-year programme of support towards the hospital’s essential medicine budget. This work has enabled both the provision of life saving medicines required for patients experiencing acute illness, as well as guaranteeing regular supplies of medications for patients with chronic conditions. The Trust recognises that certain medicines are supplied to the hospital through specific initiatives and other donor programmes but we are aware that deficits for particular medicines or patient groups remain; a gap we are happy to help fill. However, it is our ambition for the hospital to gradually take greater ownership of its pharmacy supply in the medium to long-term particularly as it integrates further with government programmes. We have therefore planned a gradual reduction in this support over the next 3 years, subject to local conditions. ## Conclusion Whilst over the last 10 years the specific projects we facilitate have evolved in response to the hospital’s development and needs, the similarities within our activities _(and by nature these annual reports)_ reflect a continuing commitment towards our core ambitions of enabling effective activity that will improve the health, and preserve the life, of individuals from Segbwema and its surrounds, regardless of age, gender or any protected characteristic. Although the beginnings of new endeavours and founding of organisations are often celebrated, it is the continuation and perseverance of quiet support on a scale appropriate to sustain and administer from which we hope meaningful development will arise. I remain excited by the possibilities and plans that ‘Friends of Nixon’ will bring to the hospital in its second decade of formally registered existence! Dr Rob Burnie Chairman FRIENDS OF NIXON MEMORIAL HOSPITAL ACCOUNTS FOR THE PERIOD ENDED 31 AUGusf 2021 srATEMENT OF FINANCIAL AcrivrriES Unrertricted Designated RestTlCted Total thls Total last Funds Fund5 Funds year year Note Incomlng Resources Donations Grants Invertment Income Total Incoming Resources 31.473 592 31.473 592 64 32.129 27.392 365 27.757 32.129 Resources ExFended Charitable Activitie5 Goveman(e Cort5 Total Resources Expended 26.424 34 26.458 26,424 34 26.458 36,246 34 36,280 Nel Movement in Funds Transfer5 befween funds Total Funds Brought Forward Total Funds Carried Forward 5.671 5.671 (8,523) {500) 500 45.646 51.317 46,146 51,817 54.669 46.146 BALANCE SHEEf AT 31 Au6usr 2021 2021 2020 Current Assets Cash at Bank and In Hand 51.888 51.888 59,360 59,360 Current Llabllltle5 Accrua15 71 71 13.124 13.214 Net A55ets of the Charlty 51.817 46.146 Funds of the Charlty Unrestricted Fund5 Designated Funds Restricted Funds Total Fund5 51.317 45,646 500 51.817 500 46.146 Signed Dr Rot*rt Burnie Chair of Twrtees Date (L/,.I loLI FRIENDS OF NIXON MEMORIAL HosprrAL INDEPENDEKf EK4MINER'5 REPORT TO THE TRusfEES OF FRIENDS OF NIXON MEMORIAL HOSPITAL I report on the accounts of Friends of Nixon Memorial Hospital for the year ended 31 Au&Jrt 2021 ReSF*dive responsibilities of trurtees and exarniner The charity'5 trustees are responsible for the preparation of the ac(ount5. The charity's trurtees Consider that an audit is not required for this year under section 144{21 of the Charities Act 2011 cfhe 2011 Act) and that an independent examination is needed. Havin8 satisfied myself that the charity 15 not subjert to audit under company law and is eligible foT independent examination. it is my responsibility to: examine the account5 under sectlon 145 of the 2011 Act follow the procedures laid down in the General Dirertions glven by the Charity Commissioners under section 145{5)(b} of the 2011 Act and.. lo rtale whether particular matters have come to my attention. Bas15 of Independent examlner's report My examlnation was carried out in accordance wlth the General Dlrections given by the Charity Commi5sioner5. An examlnatlon includes a review of the accounting records kept by the charity and a comparlson of the accounts presented wlth those records. It a150 includes conslderation of any unusual items or disc105ure5 in the accounts. and seekin8 explanatlon5 from you as trustees concerning any such mallers. The procedures undertaken do not provide all the evldence that would be required in an audit. and consequently no oplnlon is given a5 to whether the accounts present a 'lrue and fair view. and the report is limited to those matters Set out In the statement below. Independent examlner's rtatement In connertion with my examinalion. no matter has come to my attention: whlch gives me reasonable cause to believe that In any materlal respect the requirements to keep accounting records in accordance with section 130 of the 2011 Act: and to prepare accounts which accord with the accountln8 records, comply with the accounting requirernents of the 2011 Act have not been met: or (2) to which. in my opinion. attention Should be drawn in order to enable a proper understanding of the account5 to be reathed. Laura Parfitt-marr MAAT The Accounting Equation Parade Chambers. 10 Parade Street Penzance. Cornwall. TR18 4BU Date: