In Sierra Leone, medicine looks and feels different in ways that are difficult to fully grasp until you stand in the center of it. After three days of travel and a handful of small but inevitable delays, our team arrived and immediately stepped into work that was both familiar and completely foreign. The familiarity comes from the human body, illness, anatomy, physiology—the universal pieces. The unfamiliarity comes from everything else: the constraints, the urgency, the heat, the lack of diagnostic certainty, and the reality that here, clinical judgment is often the only tool available. Each member of the team began contributing in deeply meaningful ways. Raine and Lun spent the day with a local midwife, learning new techniques, assisting with patient care, and confronting the realities of maternal health in a region where outcomes depend far more on timing and geography than anything found in a medical textbook. Cassie met with community members still navigating the aftermath of a recent mining accident, hearing firsthand the cascading challenges that ripple far beyond the initial trauma, and her conversations will help shape how Jericho Road and our partners can offer sustainable support in the weeks ahead.
This morning, Natalie and Tim observed an inguinal hernia repair—an ordinary procedure in the United States, yet here it unfolds in a setting that demands resilience from both patient and provider. Natalie assisted until the heat inside the OR suit became overwhelming, forcing her to step away before she fainted. It wasn’t the surgery that got to her, but the humidity, the temperature, and the suffocating layers of protective gear. It was a reminder that even seasoned clinicians can be undone by the environment alone—and that the work continues regardless. Tim spent the rest of the day supporting care for patients with typhoid and malaria, where the margin for error is razor thin, diagnostics are limited, and rapid clinical judgment becomes a lifesaving skill rather than a professional preference. Later, Natalie evaluated patients whose symptoms required quick, intuitive reasoning. There is no CT scan to rule out appendicitis, no broad panel of labs to confirm suspicions. Here, fever, vomiting, anorexia, and a positive McBurney’s point are enough to act. Appendicitis is assumed until proven otherwise—and proving otherwise isn’t something anyone waits for. The surgeon is called, the abdomen is opened, and if the appendix isn’t the culprit, it is still removed to prevent future risk. Another patient arrived having battled fever and abdominal pain for a week, and she was immediately started on intravenous ciprofloxacin for typhoid. If the test returns positive, treatment continues. If negative, it stops—even while knowing the broader implications for antibiotic resistance. But those are distant-world concerns. Here, the only question that matters is whether the patient survives until tomorrow.
Practicing medicine in this context forces confrontation with the stark contrast between how care is delivered in the United States and how it unfolds in much of the world. Natalie has experienced this before, yet it continues to astonish her each time. In the U.S., diagnostics, imaging, protocols, and evidence-based algorithms guide much of the decision-making. In Sierra Leone, the stakes are immediate, and clinical instinct becomes the most reliable instrument. Tomorrow is never guaranteed, and care is rooted in the urgency of the present moment. For Natalie, today distilled a truth that is easy to forget when surrounded by the abundance of American healthcare: when resources are limited, a clinician’s skill becomes the laboratory, the imaging suite, and the diagnostic software. Eyes, hands, intuition, and experience are what determine outcomes. It is humbling to remember that much of the world practices medicine this way—immediate, high-stakes, and anchored completely in the needs of the current moment. Here, you do not think about tomorrow unless the patient survives today. That perspective reshapes you. It recalibrates assumptions. It reveals how much of modern medicine depends on tools, not talent—and how much talent remains essential when the tools are gone. It also highlights the resilience of the human spirit—patient and provider alike. People here survive illnesses that would be treated early elsewhere, clinicians here carry workloads that would overwhelm most practitioners in high-resource settings, and still, hope persists.
In our faith tradition, we hold to a belief that one day the world will be restored—where suffering and early death will cease, and where wholeness will prevail. But until that day, we each have a role to play in working toward healing—in Buffalo, in Sierra Leone, and in every place where access determines survival. Natalie’s experience is a reminder that global neighbors are still neighbors, that urgency is still shared humanity, and that compassion remains a universal language.
A reflection by Natalie Asbach, PA-C, Physician Assistant at Jericho Road.
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