How Patients Are Healing Amid Sierra Leone’s Drug Crisis

In the United States, there's an opioid crisis. In Sierra Leone, there’s a kush (a potent mixture of substances) crisis.

The drug crisis is global. And it’s a severe public health emergency—causing an estimated 600,000 deaths around the world every year.

Treating people with substance use disorders is complex, regardless of where they live or their income. But recovery is possible. In Sierra Leone, Partners In Health (PIH) is providing comprehensive care for people with substance use disorders—and seeing promising results among patients and their families.

Treating complex wounds

Last fall, a group of 50 patients—including 42 with significant wounds covering large areas of their feet and legs—were admitted to PIH-supported Sierra Leone Psychiatric Teaching Hospital (SLPTH). It's unclear exactly what causes such wounds, but they’re increasingly appearing on people who use kush, a highly addictive mixture of opioids, sedatives, stimulants, and more.

Some of the sores were so severe, infected with maggots, leaving patients unable to walk or stand. For some, the intense pain left them pleading for amputation.  

The situation required rapid intervention.  

“It was a learning curve. This is a psychiatric institution where people were not ready to be nursing wounds,” explains PIH Sierra Leone Mental Health Program Manager Chenjezo Gonani, noting the lack of supplies and knowledge gaps. Still, he thought: “How best can we support these people? How best can we manage to make their wounds better?”

In November, nurses at SLPTH’s drug treatment and rehabilitation center participated in a two-day training co-led by Sam Kelts, PIH’s manager of grassroots strategy. Outside of PIH, Kelts works part-time as a community health nurse in Boston, primarily caring for people with substance use disorders. Many of the wounds she treats in Boston are caused by contaminants in the drug supply that led to rapid tissue damage once introduced into the bloodstream. She explained that in Sierra Leone, the wounds look very similar; however, the drug supply isn't tested in the country, so the exact cause is unknown.

Regardless, she knew treatment and recovery were possible.

A wound-certified nurse, Kelts led 10 nurses through a day of classroom learning around the science behind wound development, assessment, and proper cleaning and dressing techniques. On the second day, nurses put their learnings into practice with hands-on demonstrations and care best practices with patients in the facility.  

From November 2025 through January 2026, nurses provided around-the-clock care for patients at the SLPTH. Back in Boston, Kelts virtually provided ongoing accompaniment and support.

Upon returning to the SLPTH in January, Kelts witnessed extraordinary outcomes.

"Every patient I saw had either full or substantial healing with really healthy-looking wounds," says Kelts. "This is a direct result of the countless hours of detailed, careful wound care put in by the team of nurses. It's incredibly impressive to do wound care of that caliber with so few resources."

The wound outcomes at the SLPTH were better than she sees in Boston, explains Kelts.

“This demonstrates the power of high-quality training, clinical care, and accompaniment,” says Kelts. “It’s a huge area of work to continue to evolve.”

‘Are you sure this is my son?’

Alongside wound care, all patients received mental health care. At admission, social workers conduct a detailed psychosocial assessment to identify each patient’s needs. Based on the results, patients were connected to appropriate services, including psychotherapy, occupational therapy, and skills-building sessions.

From the beginning, the team focused on what would happen to patients after being discharged. Most patients were living in the streets and disconnected from their families and friends for years. Rebuilding those relationships required intentional, and often difficult, mediation.

The psychosocial team began by taking detailed social histories—identifying loved ones and locating them across the country. From there, they reached out directly, traveling into communities.

When families were shown photos, and told their relatives were receiving care and doing well, reactions varied. Some “believed that their loved ones died a long time ago,” says Gonani.

Others were in disbelief.

“Are you sure this is my son?” a relative asked, as the team showed them a current photo.

Each family was invited to a discharge ceremony to celebrate their loved one’s recovery. At first, not all families were immediately open to reunification. To address this, the psychosocial team facilitated conflict resolution meetings between patients and their families. They also involved community leaders, including chiefs, faith leaders, and other respected figures, to rebuild trust and encourage reunification.

These efforts successfully reunited 48 out of 50 patients with their families; and culminated in a celebratory discharge ceremony at the SLPTH.

“It was really beautiful to see families embrace their loved ones,” says Gonani.

Back home, patients continue to receive regular visits from community health workers who monitor medications and provide long-term support.

An evolving crisis

The kush crisis remains complex and evolving. But the work at the SLPTH is helping shape a model for care by integrating clinical treatment, mental health support, and community reintegration. SLPTH’s drug and rehabilitation center opened in June 2024, in response to the country’s national emergency on substance abuse. It’s staffed by a multidisciplinary team including a drug addiction specialist, one clinical psychologist, three psychiatrists, seven resident psychiatrists, and a cadre of nurses.

The team is also collaborating with PIH colleagues in Liberia, a neighboring country also facing a kush crisis, to expand and adapt approaches to substance use care across similar contexts. In rural Maryland County, Liberia, PIH provides outpatient community therapy for people with substance use disorders. In Kono District, Sierra Leone, a similar community-based approach is underway.  

“I’m so excited about what we have learned,” says Gonani. “We are ready for the next 50 patients.”