Sierra Leone, a smallish coastal nation of 7 million in the West African tropics interlaced by savannah and forest and grassland, was well on its recovery path from a hard bout with Ebola from 2014-2016 when the Covid-19 pandemic arrived.

Medical care in the country is still hard to access in large parts of the country. While Sierra Leone was one of the first western African nations to receive COVID-19 vaccines—beginning its vaccine rollout in March 2021—by March 2022, Sierra Leone had only 14 percent of its population vaccinated. That was up from five percent two months previous.

On the strength (12 mass vaccination campaigns in 2022 and three in 2021) and strenuous efforts to reach remote parts and populations of the country, a year on—as of March 2023—Sierra Leone had administered 7.8 million doses of COVID-19 vaccines.

37.9% of Sierra Leone’s total population has now been vaccinated against COVID-19 and in December 2022 Sierra Leone reached the target of vaccinating 70% of their adult population.

These photos, shot near the end of 2022 among isolated villages and dense forest in the northern district of the country, illustrate essential scenes in what is an extraordinary collective effort.

The community nurses and mobilizers in the Northern Province district of Bombali, as in other parts of the country, strive hard to reach what are very remote communities and villages. Nurses Kai and Koroma from the Masselleh Community Health Post, some 20 kilometers by rugged dirt road from the regional city of Makeni.

Nurse Kai (right) and Nurse Koroma (left) are heading out from Masselleh Community Health Post to conduct mobile vaccination clinics on 8 December 2022. Nurse Koroma is Nurse In-Charge; she has been a nurse for 28 years, with the last six years being posted at this facility.

“The biggest challenge that we have is accessing the patients in the remote villages. Many of the communities can only be reached by bike or on foot, which becomes very difficult in the rainy season,” she says.

Masselleh Community Health Post (CHP) in Safroko Chiefdom, Sierra Leone, on 8 December 2022.

The health facility is approximately 20 kilometres of dirt road from the nearest city, Makeni, and serves approximately 3400 people in its catchment area – mostly farmers in hard-to-reach communities.

Masselleh Community Health Post serves approximately 3400 people in its catchment area – mostly farmers in hard-to-reach communities. Nurse Kai bundles her vaccines via local motorbike taxi to access hard-to-reach communities as part of the mobile COVID-19 vaccination team in Sierra Leone on 8 December 2022.

Bombali District in Sierra Leone features lowlands between two long rivers, the Rokel and Mobole; Nurse Kai, accompanied by community mobiliser Jeremiah, sometimes need to use dugout canoes to village patients.

Mamanso and Mansunthu villages are located next to one another in Karene District, Sierra Leone, approximately 65 kilometers from the nearest major city, Makeni.

The nearest health facility serving the villages is five kilometers away on small dirt roads often only accessible by motorbike or on foot. The two villages are separated by a one-kilometer track which requires crossing a locally made bamboo bridge during months when the river level is high. Many of Mansunthu’s 50 residents are elderly and unable to make the river crossing.

So nurses and community mobilisers do the walking. Here they walk to reach Mansunthu while conducting a mobile COVID-19 vaccine clinic on 7 December 2022.

Nurse Isha crosses a bamboo bridge to reach the remote village of Mansunthu to conduct a mobile COVID-19 vaccine clinic on 7 December 2022.

An aerial view of the village of Makontakay, Sierra Leone, on 8 December 2022.

Makontakay, a farming community, is home to 290 people and served by Masselleh Community Health Post. But to reach the post residents travel seven kilometers along small dirt tracks either by foot or motorcycle, with numerous water crossings. A narrow dirt track joins Makontakay with another village, Kamoi, most of whose farming residents do not have the resources to journey to the health post.

Mobile outreach campaigns are the only way that most community members are able to get vaccinated against COVID-19.

Residents of the village of Makontakay, Sierra Leone, meet under a mango tree to be vaccinated against COVID-19 from a mobile health team on 8 December 2022.

Community mobilizers such as Jeremiah, pictured here, work with partner organization GOAL Ireland and speak local languages such as Temne and Limba. Born and raised in Makontakay, Jeremiah knows the area and the communities well, and is trusted: he loves working in the health sector, and dreams of becoming a doctor.

“I feel really good to be able to help my people. I can see their health improving and I know I am contributing that that,” he says. In speaking with residents about COVID-19 Jeremiah is also able to engage people about drinking clean water, hygiene, malaria prevention and general health.

“As a mobiliser we are role models, so it’s important that people see us doing the right thing like taking the COVID-19 vaccine. When others saw that I took the vaccine, it gave them courage to take it themselves.”

Here Jeremiah (right) walks with Kamoi resident Amara (left) to a mobile COVID-19 vaccination clinic on 8 December 2022.

Amara suffers from partial blindness and limited mobility due to his age; after speaking with Jeremiah, Amara is getting  first dose of COVID-19 vaccine. Due to vision and mobility issues he does not leave the village. This is the only way Amara will get his shot.

Amara receives his first dose of COVID-19 vaccine from Nurse Kai Koroma in Kamoi, Sierra Leone, on 8 December 2022.

Amara holds his vaccination card after receiving a first dose of COVID-19 vaccine from a mobile health team visiting Kamoi, Sierra Leone, on 8 December 2022. Sheka, a resident of Mamanso village, Sierra Leone, had earlier refused the vaccine. After seeing a friend take it he decided he would get his first dose after all.

“I was afraid before – I thought I would die if I had it,” he said. “But when I saw my friend take it, I thought it must be fine. I’m really happy now because I don’t want to be the only one without it! When they come back for the booster I will get that too.”

Here Sheka is shown on 7 December 2022 after receiving his first dose.

Chief Almamy (centre) the chief of the village of Makontakay, Sierra Leone, comes for his second dose of COVID-19 vaccine from a mobile health team on 8 December 2022.

“I’m really happy that they brought the vaccine to our community,” he said. “It is really important that they come here with the vaccine because most people in this community are farmers and can’t afford to get to the town. If not for these teams most people here wouldn’t have been vaccinated.”

“Before the mobilisers came, we were all very afraid to take the vaccine. No one wanted to take it because they thought it would kill them. But when they came and talked to us about the virus and the vaccine most of us changed our minds. Many people here