It's Tuesday.

Sarah and I spent last week in Sierra Leone warning about the health care system there, and along the way we visited Keesee Psychiatric Hospital, a 199 year old facility that is the only mental health hospital in the country.

This was of some personal interest to me because I have been, at one level or another, a psychiatric patient for most of my life.

The hospital is led by Dr Abdul Jolla, one of the only psychiatrists in Sierra Leone, a nation of over seven million people.

He explained that as recently as a year ago, life in the hospital was extremely dire for both staff and patients.

You know what no city Almost everything was, was a Dr J.

Lo keeps a picture in his office to remind him of what the hospital looked like.

Recently.

It was truly horrific.

Perhaps most disturbingly, many patients were chained to their beds for much of the day and night.

As we walked around, a staff member showed me a poster about chaining that had been sent to the hospital years ago.

The poster was really frustrating to the staff because everyone wanted to end chaining, but without medication or any functioning infrastructure, they couldn't find another way to keep aggressive patients from harming themselves or others.

They didn't need posters.

They needed support.

The staff walked me through one ward where the tile had been broken up to prepare for renovations, but otherwise it looked as it had for decades.

We visited what was until recently the hospital's pharmacy, and I was told that these shelves had long been nearly empty.

I mean, imagine it no water for showers or to flush toilets.

No medication to treat the immensity of psychic pain, very few clinicians to offer cognitive therapy and no electricity.

There were generators to huge ones donated years ago by a charity, but they turned out to be much too powerful for the hospital's electrical grid and shorted everything out.

Had the charity asked, the staff would have explained what kind of generator they needed, but no one asked, at least not until partners in health began working with Sierra Leone's Ministry of Health, along with Dr Jell O, his staff and the patient population.

To improve the hospital, they brought in the right generator and now the hospital's wards have lights and functioning fans.

They also work to increase staffing at the hospital and brought medications in hundreds of medications actually stored in a climate controlled room.

The beds and mattresses were replaced and running water was restored so that toilets and sinks and showers would work again.

And because medications and other treatments are now available, many patients have been able to move out of the hospital and live at home.

As one nurse explained to me and offices so much these daisies.

Just a year ago, almost everyone who received care from kissy stayed at the hospital.

Now, most of their patients are able to live at home, and critically, the practice of chaining has ended.

Patients now walk freely about their care area, and when patients do become a threat to themselves or others, humane restraints are used.

But even that is now rare.

Several patients took the time to talk with me, and one long term patient spoke of how life has changed it kissy in the past two years.

Theo, of course, no one wants to be a patient at a psychiatric hospital.

Chronic mental illness is extremely difficult to live with, even in the best of circumstances.

And there's still a long way to go at Casey Maur areas to be renovated and opened, including this room, which will become a lecture hall to train the next generation of Sierra Leonean clinicians and a soon to be opened ward that will serve as the country's first dedicated drug addiction rehabilitation center.

And a Sierra Leoneans begin to trust that the mental health care system can offer effective treatment.

The demand for service is will continue to rise, which will lead to new challenges.

But the transformation so far is truly profound, and it has immeasurably improved the lives of the patient population here.

I feel a kinship with them because I owe my life to effective mental health treatment, the kind of treatment that these patients are at last beginning to receive.

We saw again and again in Sierra Leone that individual interventions of poster campaign, a donated generator, often failed to be transformative, in part because it's not one thing or another that needs to change its the system.

The problem is an infrastructure or chaining or staffing or medicines or running water or electricity.

All of this must change together, isolated investments often yield isolated results.

But if you invest in systems, you can get systemic results.

And by investment, I don't just mean money.

I also mean investing the time and attention toe.

Listen carefully rather than just barging in with preconceived solutions.

That's what our community has learned from working with partners and health for the last decade.

PH is successful because it build systems and because it listens to the people it seeks to serve.

It's no coincidence that 96% of Ph.

Sierra Leone's employees are Sierra Leonean.

In the coming months and years, Hank and I will be focusing more on providing ongoing long term support to strengthen the health care system in Sierra Leone.

And that will be the biggest project we've ever undertaken on this channel by far, which is intimidating.

But the need is immediate and it is critical.

And when I look at what the staff and patients at Kissy Psychiatric Hospital have accomplished in the last two years, I know that really change is possible.

We'll be talking much more about this in the coming months, but in the meantime, I really hope you'll sign up for our new newsletter about the Sierra Leone project toe.

Learn more.

There is a link in the Doobie Doo below.

I will also be in comments to answer your questions.

Lastly, a huge thanks to everyone at P h n Kissy Psychiatric Hospital for sharing their time, experiences and expertise with us.

Hank, I will see you on Friday.