Sierra Leone is a small country of 5 million inhabitants on the west coast of Africa. It is in the process of recovering from 10 years of a brutal civil war which ended in 2002. This war was about diamonds and the recent Hollywood film Blood Diamond gives an insight—albeit over-dramatised—of events at the time.

I am fortunate to have had the opportunity of working in Sierra Leone before the war started, and to continue working there during the mayhem before finally leaving in 1997. Since the cessation of hostilities I have visited regularly, up to twice a year. I am therefore in a unique position to assess changes in healthcare, with particular reference to neurology, brought about by the civil war.

PRE-WAR NEUROLOGY

Neurology was not practised as a specialty until the mid 1980s. At that time, as a UK trained Sierra Leonean neurologist, I had the opportunity of starting a service. Our initial facilities included EEG and EMG. There was no CT scanner but a radioisotope scanner was available with its severe limitations. The service was located in the capital, Freetown, but a referral system ensured that cases from the provinces were also seen. There was no specialised neuropathology, however personal contacts with centres in the UK helped with difficult investigations including muscle biopsies, and CSF oligoclonal bands. Special neurology clinics were run in the main Connaught …