Building Care with Stuff: The 5 S’s of the MCOE

Editor's Note: The Paul E. Farmer Maternal Center of Excellence (MCOE), a Partners In Health (PIH)-supported facility, opened to patients in February 2026 on the campus of Koidu Government Hospital (KGH) in Kono District, Sierra Leone.

Built in partnership with Build Health International and the Sierra Leone Ministry of Health, the state-of-the-art facility was designed to confront one of the most urgent challenges in Sierra Leone: preventable maternal death. It represents years of deliberate work to strengthen care where it has long been weakest, part of a two-decade effort across Sierra Leone that has reduced the country's maternal mortality rate by 78% since 2000.

This series explores the MCOE through what PIH calls the "five S's": staff, stuff, space, systems, and social support, the essential elements of a strong health care system. In this article, we focus on stuff: the critical tools and resources that staff rely on to deliver safe and effective care.

On Feb. 14, 2026, shortly after the MCOE opened its doors to patients, 17-year-old Fanta Jimmy arrived at the facility's triage area.

She was quickly shown to one of the curtained beds, and a team of nurses, midwives, and doctors carried out an in-depth clinical assessment. They quickly found that Jimmy was suffering from pre-eclampsia with severe features and that her baby was in distress. An emergency C-section was needed.

For Jimmy, the situation was urgent, and every decision made by the clinical team depended on what they could see and measure.

Once she was moved through to the operating theater soon after, Jimmy gave birth to the first-ever baby born at the MCOE. Her newborn was then immediately placed in an incubator to maintain her body temperature and transported to the facility's neonatal intensive care unit (NICU)-the first NICU in Sierra Leone.

Over the following week, staff closely monitored the baby's progress.

Each step of Jimmy's care, from diagnosis using an ultrasound machine to administering support through IV fluids to the use of vital monitors and incubators, depended on access to the right equipment at the right time. All of this is what PIH considers "stuff."

Individually, none of these clinical items are unusual in a modern maternal health care facility in the United States and other high-income countries. But in Sierra Leone, they are unprecedented.

What Was Missing

Nurse Daniella Jabati feeds Fanta Jimmy's newborn in an incubator in the inborn section of the NICU at the MCOE on Feb. 17, 2026. Photo by Caitlin Kleiboer / PIH

For clinicians in Kono District, having access to the correct medical equipment and knowing the lifesaving impact is deeply personal.

Boyama Gladys Katingor began working as a midwife at Wellbody Clinic in early 2014, before PIH arrived in Sierra Leone. She remembers what it was like having limited tools to care for mothers.

"I felt that I was letting them down, that we were not providing the necessities," she says. "We lacked so many instruments and things that we needed to do our best work."

For years, many health workers faced this reality: knowing how to respond to clinical complications during pregnancy and childbirth, but not having access to the required equipment to diagnose or treat them.

In pre-eclampsia cases like Jimmy's, where complications escalate rapidly, that gap between instinct and certainty can be the difference between life and death.

This cost of operating without the right equipment became starkly visible during the Ebola epidemic-the reason PIH was invited to West Africa just over a decade ago and has remained ever since.

"Contact with blood and amniotic fluid is expected while accompanying a woman's labor," says Jonathan Lascher, former executive director of PIH Sierra Leone from 2017 to 2021. "In 2014, without proper protective equipment and treatment, it was life-threatening."

During that time, many health centers lacked basic supplies. In some cases, thermometers used to screen patients were unreliable, and protective equipment was scarce. Pregnant women often labored with minimal clinical support as health workers struggled to protect themselves from infection.

The consequences were severe. In settings where childbirth already carried enormous risk, the absence of proper equipment made routine care dangerous. It exposed mothers and newborns to delays, uncertainty, and preventable harm, while also forcing health workers to operate under fear.

Princess Sia Fatorma (left), a neonatal nurse, and Mc Geofrey Mvula, NICU nurse supervisor for PIH Sierra Leone (center), transport the first baby born at the MCOE from the operating theater to the NICU in a neonatal transport incubator on Feb. 14, 2026, alongside the baby's grandmother, Yei Senessie (right). Photo by Caitlin Kleiboer / PIH

A Turning Point

However, the situation began to change in late 2014, when PIH began supporting Wellbody Clinic, a primary health facility based in Kono District.

"Suddenly, we had what we needed," Gladys recalls. "So many things arrived. From delivery beds and postnatal beds to linens and pillows. More than this, though, was the arrival of the things we needed to do our best observations for the women."

Among the most transformative additions was ultrasound technology.

"This became a way to bring women to us," she says. "Not only to have midwives here, not only to offer our support as women, but [to have] the right equipment. Mothers could ask to see the scan of [their] babies."

For many mothers, seeing their baby on a screen for the first time became a powerful reassurance during pregnancy. It made care feel more tangible, more immediate, and perhaps more trustworthy.

Ultrasounds strengthened clinicians' ability to understand what was happening inside a woman's body, make earlier decisions, and recognize when a pregnancy might require closer monitoring or urgent referral.

What "Stuff" Makes Possible

Identification bracelets await the arrival of the first twins born at the MCOE. Finda Boyah, 26, arrived at the MCOE on Feb. 15, 2026 from the maternal waiting home at PIH-supported Wellbody Clinic for a cesarean section. She delivered twin baby girls on Feb. 15. Photo by Caitlin Kleiboer / PIH

Over the next decade, the supply of "stuff" expanded from fetal heart rate monitoring devices and protective equipment to vaccinations and medications-at Wellbody Clinic, KGH, and other PIH-supported facilities.

And with the opening of the MCOE in 2026, KGH's previous maternity and special care baby unit (SCBU) has enhanced capacity from 48 beds to 120 inpatient beds, including 39 beds in the NICU.

Princess Sia Fatorma, a neonatal nurse who moved from KGH's SCBU into the NICU at the MCOE has witnessed the change in daily patient care directly.

"Before, we would just carry a baby in a blanket from the theater to the SCBU," Fatorma said, recalling how newborns were moved before incubators became available.
Now, in the NICU, babies like Jimmy's daughter have their own incubator, also termed an infant warmer, which provides a sterile, temperature-controlled environment. Clinicians use specialized monitoring equipment to carefully observe each baby, alerting them to changes and emergencies faster than ever before.

There are also things that aren't as readily visible. The MCOE introduced a piped medical gas system, allowing oxygen and other gases to be delivered directly to patient beds, making it the first facility outside the capital, Freetown, to do so.

In emergency situations, when minutes can determine survival, reliable oxygen access can make a critical difference for both mothers and newborns, including women in respiratory distress and babies who need immediate breathing support after birth.

Technology-and the People Who Use It

Fanta Jimmy holds her newborn daughter outside of the MCOE on Feb. 20, 2026. Photo by Sean Andrew Bangura / PIH

Still, access to equipment alone is not enough.

As Isata Dumbuya, director of nursing and midwifery at the MCOE, has emphasized, training triumphs technology.

The MCOE is equipped with nearly every piece of advanced technology needed to treat pregnant women and newborns, but the presence of that equipment does not guarantee good care on its own. Staff must know how to use the tools, interpret what they show, and respond accordingly.

That is why the story of "stuff" inevitably points back to "staff." The monitors, scanners, oxygen systems, and theater equipment inside the MCOE matter not simply because they are present, but because they are placed in the hands of clinicians, technicians, and support teams who were trained to use them well.

The impact is obvious in the kind of care clinicians are now able to provide. Where once clinicians worked with too few tools and too much uncertainty, readily available equipment now enables them to respond to complications sooner.

For Jimmy and her daughter, that difference was immediate and lifesaving.