The Lutheran Church—Missouri Synod (LCMS) sends short-term Mercy Medical Teams (MMT) to underserved regions around the globe to deliver healing through medicine and the Gospel. The main goals are to provide primary medical care, connect people with their local church and health care providers and share the Gospel.

MMTs have been on hiatus since the COVID-19 pandemic began in 2020. This first MMT to Sierra Leone was a trial to see if this type of mission service can be successfully resumed. Sierra Leone was chosen as the location due to the great need in the country and the amazing local team in country. Sierra Leone experienced a civil war for twelve years that caused great destruction and despair in the country. Soon thereafter, the country was one of the hardest hit by the Ebola outbreak, which took over 12,000 lives, including those of many medical personnel who were caring for the sick. As a result, there is only one physician for every 30,000 people in Sierra Leone. The need for medical care is great. In addition, this is the third MMT to Sierra Leone. There are very strong church and medical partners in country that help make the trip run smoothly and successfully.

We arrived in Lungi, Sierra Leone, on May 6 after a long trip via Washington D.C. and Brussels, Belgium. Surprisingly, the process was very smooth to enter Sierra Leone with the visa process and COVID precautions. We spent the night at a hotel near the airport that provided two surprises: air conditioning and hot water! We enjoyed a local meal of fried rice, chicken and a local Star beer. The next morning, we had a local breakfast of eggs, a small hot dog, a roll and fried sweet pancakes. We then loaded the van and began the journey to Bo.

There are two main, paved roads in Sierra Leone; one goes east–west and the other north–south. Thankfully we were able to travel on paved roads all the way to Bo. The journey took about four hours in a very hot van. Whoever designed the van neglected to add windows that open in the back. So, the only relief was when the van was moving, and the driver's and passenger's windows were open to create a nice breeze.

We arrived at the Galliness Paradise Hotel in Bo that afternoon, which is quite fancy for an African hotel, though the workmanship is of much different quality than what we are used to in the United States. We each had our own room. There was air conditioning in the rooms, however, those of us on the second floor learned it could be quite finicky. Some days there was a light breeze and others an artic freeze from the room air conditioner, depending on if the generator was running in addition to the city power. Running water was available but not always reliable. There were buckets in each shower that we kept full of water, just in case. The water pressure was non-existent, so we were grateful for the scoops in the showers that supplemented the buckets. Cold bucket-scoop showers were actually quite welcome with the very hot weather. The rains came through that night, which greatly helped with the air temperature but increased the humidity and bugs for sure!

Sunday began slowly. Sierra Leone is a hot climate culture, which is relationship based. This means people are not as time oriented. Experiencing the moment and creating relationships is more important than being on time. The rains from Sunday night delayed church as people needed increased time to get to church. I am still unclear how anyone knows what time to arrive places, as there can be several hour delays. Church was supposed to start at 10:00 AM. We finally left the hotel at 10:00 and headed to Jembe, where Christ Evangelical Lutheran Church of Sierra Leone has a seminary at St. Peter's Lutheran Church. The Sunday service included the installation ceremony of the national executive body for the seminary. The church service and installation finally started around 11:45 and continued for three hours. Christ Evangelical Lutheran Church of Sierra Leone is a partner church of the LCMS. Church followed a familiar order of service and used the LSB hymnal. Parts of the service were in English. Other parts were in the local language, Krio, which is a Creole language based on English, so you can follow a little. Following the service, we were fed rice and peanut soup, which was quite tasty. Since the local church invited people to come, they shared that they had to feed them. In this culture, men eat first, then women, then children.

We were able to tour the seminary grounds—library, dormitory, kitchen and classrooms. In Sierra Leone, there are 125 Lutheran churches supported by twelve pastors. There are currently thirteen students at the seminary from Sierra Leone, Guinea and Liberia. The original land for the seminary had been occupied by rebels during the civil war. The land was donated for the church and seminary because it was believed there were bad spirits on the land, and no one wanted to live on it. So, a missionary accepted the land for the seminary. Additional land has been purchased since to expand the impact.

Sunday evening we met the local team we were working with and completed a team orientation outside on the hotel patio. The directness and openness of the discussions were impressive considering we were in a hot-climate culture. The leader of the Leoneans told us clearly to all be on time in the morning, and none of us planned to be late ever! We were a team of fifteen, seven from the U.S. and eight from Sierra Leone. Our U.S. pastor and team chaplain, a missionary to west and central Africa and the husband of our MMT leader and organizer, would have been the sixteenth team member. Unfortunately, he was unable to make it to Sierra Leone due to his passport going missing at the airport in Congo on his way to Sierra Leone. Such a disappointment for him and all of us!

After the discussion on timeliness the night before, Monday started off delayed. The clutch on the van needed to be repaired, so the loading of supplies could not occur at 7:00 AM as planned. The part for the van could not be purchased until after 8:00, so we all waited. Eventually, the leaders spoke to the hotel to see if they had a vehicle we could use. They had a Range Rover, and the local Lutheran Bible Translator, Amy, was able to transport most of the supplies in one trip in her pickup. Half the team went with the supplies around 10:00 to the clinic site. By the time the vehicles were back to take the second group to the clinic site, the van had been fixed. So, we loaded up and headed out. The first group onsite did much of the clinic setup. It was probably 11:30 or 12:00 before we officially began the clinic work after we all arrived and were set up to begin.

The local church partners choose the location of the clinic with two guidelines: there is a Lutheran church, and the location is five to ten miles from medical care. This MMT was held in Bo, Sierra Leone, which was a more metropolitan location than we are used to and closer to local medical care than ideal. However, it worked well for the first trip post-pandemic. And while medical care is available nearby, we found there was great need for health education. There is a Lutheran primary school on site where church is held inside of a classroom each Sunday. Several school classes were let out for the week so we could host the clinic in their space. There is electricity available in the building, so each day we paid for one tank of gas to run the generator in the afternoon, which allowed the ceiling fans to run. While it was super noisy, the air movement was completely worth it! The temperature was in the nineties with 100% humidity, so it's hot!

The MMT was set up with the standard process and flow. First, there is a gathering area where patients register with the local church pastors. Each morning, the local pastors held an opening devotion with the waiting crowd in a shaded area. During this time, our MMT met for our devotions, which included singing from the Leonean team. What a great way to begin the day!

From registration, the patients proceed to vitals, where team members obtain the patient's weight, blood pressure, heart rate, temperature and oxygen saturation. The patients then proceed to triage where a nurse obtains the patient's chief complaint and performs a focused assessment. We had three or four nurses working in this role. The local pastors and church leaders translated for the U.S. nurses. From here the patients go see one of two local clinical health officers (CHO), which is similar to a physician's assistant or nurse practitioner in the U.S. Two ancillary rooms were available as needed. The laboratory offered basic tests, such as malaria, hemoglobin, and blood sugar testing. A treatment room, staffed by a local CHO and nurse, was available for wound care and medication injections. Once finished with the clinical process, the patients proceed to the pharmacy where they receive medications paid for through the trip fees and amazing health education from the pharmacist. Finally, before leaving, a local pastor prays with the patient.

Several people worked in traffic control to ensure patients were proceeding to the proper location. And the local church workers helped with crowd control. Obtaining a registration paper is like winning a golden ticket, so there can be much ruckus, and since the Leoneans naturally speak loudly and over each other, it can be quite the affair to watch the process. Stephen, the Leonean team leader who is a CHO and pastor, spent each day working to obtain additional supplies for the team. First, he was on a hunt for malaria tests because they did not come as planned in the original pharmacy order. He also would shop for medications we were running low on. Stephen made sure we were set up for success. He is well respected by his team and great at what he does.

Through the five days of the clinic, we were able to care for just under 600 patients. We saw fifty patients the first day and 163 patients on our most efficient day. Since the MMT clinic location is near to local available healthcare in Bo, many patients knew their diagnosis upon arrival but were seeking alternate treatment options. We discovered that our largest opportunity was providing health education related to diagnoses and medications. The CHOs took great care in communicating and explaining to patients. Charles, the pharmacist, took time to ensure each patient understood each medication, how and when to take it, and what signs to watch for. He really prides himself in providing quality and safe care. Much of the focus from the local Leonean team was to ensure we are providing high quality care, which was so great to see and hear. While we saw a wide range of diagnoses, several common ailments were high blood pressure, stomach ulcers, acid reflux, wounds, osteomyelitis (bone infections), malaria, fungal infections, urinary tract infections, hernias and seizures.

Each day we drove to clinic in the van. There were not quite enough seats for everyone, so three to four team members stood in the back to fit us all in one trip. The drive took about twenty minutes and traversed on dirt roads through Bo. We passed by markets, goats, houses and industrial areas. Toward the end of the week, Bo and the hotel became very busy for the military games that were being held at the large soccer stadium in Bo. The Army Chief of Staff stayed at our hotel, so there was a large military presence. It was enjoyable to see Bo each day on the drive to and from clinic. One of the most interesting comments I heard during the week was regarding the mangoes on the trees. It's a good sign that people are not picking the mangoes off the trees before they are ripe, as it means the tree owner is not concerned about them being stolen. This is a sign that there is stable food security in the area.

Our meals were local cuisine all week. Breakfast was a buffet at the hotel consisting of eggs, mini hot dogs, fried bread flavored with bananas, fried yams, fried plantains, a pasta of some sort left over from the night before and coffee or tea. Lunch was prepared and served on site at the clinic by the local church women. Each day we had rice or yams with a spicy sauce with chicken or fish pieces mixed in. The meat is served bone-in, which adds adventure and crunch to the meal. The locals say you have not eaten yet if you have not had rice! We at dinner at the hotel each night, which was served buffet style. We had either fried or coconut rice, couscous, a half chicken (wing, thigh, breast) and some sort of pasta salad or spaghetti with a light sauce. On the last night fish was a choice (whole or fried) and small meat pies were added to the menu. The local team quickly realized that we enjoyed fruit, so each day someone got us a pineapple, mangoes or avocadoes (pears) for dessert. Thursday night Amy, the local Lutheran Bible Translator, invited us out to dinner at a local restaurant, where were able to order foods more similar to our American cuisine. It was a great treat! Each night before dinner we completed a team debrief from the day to discuss what went well, opportunities, and any adjustments for the next day. After dinner we completed team devotions together.

On Friday afternoon, we ended clinic a bit early for the end of the week closing ceremony. Much gratitude was shared from all sides. Our MMT leader presented certificates to the local team members, which they really appreciated. The local church presented our two missionaries with handmade, tailored dresses. The custom is to honor the guests by dressing them in local attire. Our MMT also spent time discussing if there were surgical or other cases we wanted to support financially to receive further care. Our team is supporting several patients to receive continued, necessary care. Friday night we enjoyed a fancier dinner at the hotel as we finished up the week and said goodbye to our Leonean healthcare team partners.

Saturday morning our U.S. team departed Bo early to head for Tokeh Beach. It took us four to five hours to trek from Bo. We did stop along the way at a Chinese hospital to obtain our COVID tests for the trip back home. The pandemic is pretty much over in Sierra Leone, so much so that most testing sites have closed. Thankfully Stephen was able to use his contacts to find us this hospital testing site. We had to pack our patience as we each completed paperwork and were swabbed. We also had to pay extra to have the test results expedited. In Sierra Leone, it seems that you're paying for a negative COVID test. Even if you're positive, they will likely provide you with a negative result. Quite the ordeal!

Tokeh Beach is absolutely wonderful and a perfect place to decompress. We stayed in small huts along the beach where you can hear the crashing waves all night. We enjoyed swimming in the warm water and walking the white sand beaches. Truly breathtaking. The seafood was delicious and matched our American cuisine preferences. There were many European guests staying at the resort, and the finale of Eurovision was happening that night. It was wonderful to see their pure joy and enthusiasm for the event.

We enjoyed a relaxing Sunday morning on the beach with an extended devotion for Sunday worship. Midday we began the four-hour trek back to Lungi and the airport. We all made it safely out of Sierra Leone. We transited through Brussels and Newark. There were no flight delays until we were back in the U.S. and were dealing with storms on the east coast.

We all made it safely home and are grateful for new friendships and the success of the MMT. We shared the Gospel and love of God, provided medical care and education, and connected the local pastors and medical providers with their community. Thanks be to God!

“Hesed” is a Hebrew word that means “kindness,” “mercy,” “loyalty,” “loving-kindness” or “steadfastness.” It’s the way God intends us to live together—a “love your neighbor as yourself,” active, selfless, sacrificial, caring-for-one-another brand of living contradictory to our fallen natures. The “Heseders” are continually looking to work together to share some small measure of God’s extraordinary love. Won’t you join us?