Answering the Call: Nurse Offers Compassionate Counseling at Clinic for Teens

Phebian Sondufu-Sowa’s shift at Koidu Government Hospital (KGH)—the only hospital in Kono District, Sierra Leone—technically ends at five o’clock. But on any given day, at any given time, she’s on call, ready for her phone to ring with a patient on the line.

“Sometimes, I’m here until eight or nine at night,” Sondufu-Sowa said. “Then, sometimes as soon as I reach home, a patient will call me, saying ‘Ma, I’m not feeling bright.’ And I have to rush back.”

Sondufu-Sowa occupies a singular role at the Partners In Health-supported hospital. As the nurse managing its adolescent and youth-friendly services (AYFS) clinic, she is often the only person young adult patients truly trust—not only at KGH, but in their lives as a whole. Usually, the phoning patient isn’t facing a physical crisis that any clinician could handle; more often, they’re in need of a sounding board, or a shoulder to cry on.

Since PIH and hospital staff established the clinic in May 2020, Sondufu-Sowa has spent her days providing medical care for 10- to 24-year-old patients’ most intimate health needs, and emotional support through their most pressing challenges—around relationships, school, poverty, and planning for the future.

Sierra Leone has one of the highest maternal mortality rates in the world—women face a 1 in 20 lifetime risk of dying in pregnancy or childbirth—and, relatedly, some of the world’s highest rates of teenage pregnancy, HIV, school dropout, and sexual- and gender-based violence. Specialized, comprehensive care for reproductive health and psychosocial wellbeing is essential—especially in Kono, one of the poorest regions of the country.

AYFS services are wide-ranging—from family planning, prenatal care, and care for sexually transmitted infections, to nutrition education, career planning, and counseling around healthy relationships. The clinic also serves as an access point for young people who need other hospital services, such as the mental health unit or PIH’s social support program.

Many patients—the vast majority of them young women—arrive at the clinic hesitantly, without much practice vocalizing their experiences around seemingly taboo, and unjustly gendered, topics such as sexual health, birth control, and intimate partner abuse. Nor do they want to be seen by any older relatives or neighbors.

The clinic—a small room attached to KGH’s maternity ward—was constructed with a separate entrance and waiting area to promote patient privacy. But patients’ comfort truly relies on Sondufu-Sowa.

Her overarching tactic is meeting patients where they are—even when that entails a late night phone call and clinic visit.

“Some are really, really nervous when they come in. I want to take nerves away, so I counsel them, encourage them, ask how they are doing. I’ll be at home, they will call me and say, ‘I’m coming to the clinic,’ and then we sit here and talk, talk, talk,” Sondufu-Sowa said. “And then, they are free. They’ve opened up.”

A Purpose to Fulfill

During those conversations, Sondufu-Sowa isn’t afraid to challenge her patients—to expand their ideas of what is possible for themselves and their futures. She advocates for family planning; encourages every patient to remain in school and strive to attend university; and consistently tells her female patients to bring their male partners on their next visit, in order to expand the clinic’s reach and in the spirit of normalizing sexual health as a shared responsibility.

“You have a purpose to fulfill,” is her common refrain with patients. “You have good things to offer to fulfill the world. Don’t stop here. Go further.”

Her advice is considered radical by many patients, and is sometimes hard to embrace when living in a patriarchal context in which parents or elder relatives commonly forbid family planning; limited money to pay school fees is often reserved for sons; and many women’s only feasible pathway to basic survival is—somewhat ironically, given the persistent dangers of giving birth within a weak heath system—through pregnancy and marriage. Ultimately, Sondufu-Sowa’s goal is to let her patients be in charge of their own health and life decisions—by withholding judgment, and keeping them talking and visiting the clinic.

“I recently had a 15-year-old come in for family planning, and then a few months later, she called me to meet at the clinic at night to tell me, ‘I want to remove my implant. I want to get pregnant because I don’t want my boyfriend to get married to another.’ I talked to her, prepared food for her, tried to explain her other options,” Sondufu-Sowa recalled.

But the patient’s decision was final; and Sondufu-Sowa respected her wishes.

“So,” she continued, “the next week we removed the implant. And I told her that if she got pregnant, she should come to AYFS. And she was happy.”

Offering this kind of nonjudgmental care comes naturally to Sondufu-Sowa, who decided on nursing as a career during her own adolescence.

“For my mother, when I was growing up, even providing our daily bread was a big issue,” Sondufu-Sowa said. “At one time, she got sick, and we rushed her to the hospital. Everything was money—for the doctor to see my mother, for treatment. She was admitted for two days. We couldn’t even think about paying hospital bills. I’m the elder daughter, and was asking God, ‘What can I do?’ But there was a particular nurse who cared for my mother. I told her, ‘Auntie, we don’t have money now.’ And she said, ‘Okay.’ She was a mentor, she stood by us, she provided everything for us. She was practicing real nursing.”

Sondufu-Sowa’s mother recovered—and instantly heard about her daughter’s determination to become a nurse.

“I said to her, ‘The disadvantage is too much. There needs to be somebody in the hospital who can interact with people,’” Sondufu-Sowa said.

Support, Counseling, Encouragement

Sondufu-Sowa now is serving as the nurse she long hoped and endeavored to be: not just a medical provider, but also a friend, confidant, and advocate for some of the most at-risk, marginalized patients a hospital sees. The AYFS clinic is promoted in classrooms and afterschool clubs throughout Kono District, with KGH staff presenting on the services available and engaging students. But it’s Sondufu-Sowa’s approach to caregiving that has steadily grown the young clinic, with 737 patients visiting for care in the first three months of 2021—up from 377 in the three months previous. In total, the clinic has thus far served 1,427 young adults in Kono.

One of those patients is Isatu Mondeh, 20, who is due to deliver her first child in May. She already is spreading news about the services.

“I tell my friends who are pregnant to come to the hospital, and I tell every teenager around that there are family planning services here,” Mondeh said.

Mondeh first visited KGH for prenatal care when she discovered she was pregnant—and at her first appointment, also discovered she was living with HIV. Given her age, clinicians referred her to the AYFS clinic.

“When I met Isatu, she was wasting away, and she was emotionally down and avoiding her friends,” Sondufu-Sowa recalled. “I encouraged her, saying, ‘All is not lost. We have seen many people living long lives with this illness. It only depends on you taking your medication every day.’”

She supported Mondeh through the process of enrolling in free antiretroviral therapy, and enrolled her in social support programming: for nutrition, to ensure she could tolerate her new daily medication regimen and regain her health, especially as a pregnant woman; and for transportation, to ensure distance from the clinic or the cost of a motorbike would not prevent her from attending her prenatal appointments.

“The food packages have helped me a lot,” Mondeh said. “I have enough to eat with my medication, and have money left over to spend on other things.”

“I hope for a healthy baby—and I would prefer to have a girl,” she continued, smiling. “I’m nervous, but excited.”

During Mondeh’s regular visits to the clinic, Sondufu-Sowa is an outlet for these feelings.

“I’ve been talking to her and encouraging her since the day I met her,” Sondufu-Sowa said. “Support, counseling, encouragement...that is what young people need from this place.”

A Three-Generation Bond

This level of bond is commonplace at the clinic. For 20-year-old Zainab Sesay, all hope had been lost after she gave birth to her second child prematurely—at 24 weeks, her daughter weighed less than two pounds. Sesay then struggled to care for her at home, living in extreme poverty. Though her daughter had received care at KGH’s special care baby unit and been discharged healthy, Sesay avoided naming her.

“I did not think she would survive,” Sesay said. “It was scary.”

The turning point came, she said, “when I met Phebian.”

Knowing the dire circumstances to which Sesay would return home—kicked out by her family, receiving no support from her children’s father, food insecure, and on the brink of eviction—a community health officer at KGH recommended Sondufu-Sowa reach out to the young mother.

Sesay readily accepted Sondufu-Sowa’s invitation to the clinic and, on behalf of her and her baby’s health, confided in the nurse.

“She told me she didn’t have enough food and wasn’t producing breast milk,” Sondufu-Sowa recalled. “She was giving her baby water.”

So began a partnership between the two women. Sondufu-Sowa immediately enrolled Sesay in social support similar to Mondeh, with PIH providing her food packages and transportation stipends, as well as cash assistance and a postnatal package consisting of items like reusable diapers, soap, and lotion.

That tangible support was supplemented, of course, by what Sondufu-Sowa refers to as “passionate care”—a listening ear and constant encouragement.

“She was really emotionally down,” Sondufu-Sowa said. “She needed someone she could talk to.”

Sesay visited the clinic multiple times a week to spend time with Sondufu-Sowa, as her and her baby’s physical health gradually improved. She soon decided on a name for her daughter: Phebian.

Today, with young Phebian now seven months old, the trio still see each other several times a week. Sondufu-Sowa continues to monitor their health, including family planning; Sesay opted for an implant. And Sondufu-Sowa is serving as an advocate for Sesay as the two prepare to speak with her family to let her return home.

The hours, it sometimes seems, are never-ending. But for Sondufu-Sowa, there’s no choice but to answer her calling.

“The other nurses at the hospital say, ‘Ah, Phebian, I pity you,’” she said. “I say, ‘Sister, this is my job. I have to stand by my patients.’”