Real Help is greater than Loss

Article by Pim Nolet, originally published in the March/April issue of the magazine ‘The Optimist’

By Pim Nolet

Meaning

Sometimes I think back to the conversations we had together, long before he left for Sierra Leone in 2017. Conversations between father and son, about making choices, about ideals and about how to find your place in the world. Wouter wanted to become a doctor and he was still looking for the form in which that was right for him. The well-organized Dutch healthcare system offered a lot of quality and security, yet he kept wondering whether he would come into his own there.

During his medical internships, he traveled a lot. He talked about what struck him: the big differences between rich and poor and the limited resources with which medical care in developing countries has to survive. There is such a great inequality between people in terms of access to medical care. That made a big impression on him and made him think about what healthcare in these kinds of countries means for a doctor.

Choice

Wouter could have led a comfortable life as a doctor in the Netherlands, but his ideals and his desire for adventure took him to places in the world where he could shape his profession in a different way. The follow-up training as a Doctor of International Health and Tropical Medicine at KIT in Amsterdam was actually a logical choice. It offered him the opportunity to delve further into surgery and obstetrics, specializations that are most needed in developing countries. After that, it came fast and naturally: an internship in Yele and later an appointment at the Masanga hospital (both in Sierra Leone), where he worked as a doctor and coordinator of the Surgery course at CapaCare.

Sierra Leone is a country where healthcare faces major challenges. There is only one doctor per 23,000 inhabitants, maternal mortality is high, with 443 women dying per 100,000 live births and many children do not reach the age of five. By comparison, in the Netherlands, four women die per 100,000 deliveries and infant mortality is much lower.

In Masanga, Wouter worked under often difficult circumstances. I can still see him in front of me, in the sober operating room, focused and calm, explaining to students around him what they had to pay attention to during the operation. He visibly enjoyed the freedom and opportunities that this work offered him. He loved the people of Sierra Leone, their determination and their motivation to learn.

Loss

Six years ago, in November 2019, that valuable work came to an abrupt and unexpected end. Wouter became infected with a dangerous infectious disease during emergency surgery and resuscitation of a pregnant woman. After a short illness, he died in the Netherlands at the age of 32 from the effects of Lassa fever.

When his death dawned on me, my world collapsed. It had never occurred to me that we could lose Wouter to the passion that drove him. Why did this have to happen? Wouter did such a wonderful job, didn't he? It felt so unjust. Soon I discovered that asking the "why" question makes no sense. You won't get an answer to that anyway. Moving on and doing something positive with his death, that was a better way of processing this great loss. His dedication deserved a sequel. Continuing his work was the only correct answer to the question: "What would Wouter have done now?"

Real Help

From there, the Wouter Nolet Foundation was created in 2021. The philosophy was clear: "to educate and provide work". By training and guiding doctors in their work, their knowledge and skills can become of great, lasting value to local healthcare. Doctors who know their own country, speak the language and are willing to dedicate themselves to their country - that was exactly in line with Wouter's vision of how the healthcare system can be improved.

Meanwhile, the Foundation offers medical students in various fields of study - surgery, obstetrics, pediatrics and internal medicine - a scholarship. This allows them to fully concentrate on their studies and no longer have to work in the evenings. 79 students are now using our program.

We started small, but soon the financial support from the Netherlands became so great that more became possible. In September 2022, we started the Maternal Outreach Project that matched the great need for pregnancy care in remote, rural areas. With ambulances, we visit small communities and offer ultrasounds scanning on location. High-Risk Pregnant women are identified early and referred to the nearest hospital. The women also receive information on family planning and contraception. At the same time, the interventions provide an opportunity for our sponsored students to gain work experience as certified scanners in the field.

In 2025, we performed 8,170 scans and 755 women were referred to the hospital for a safe delivery. This year we have expanded the project to include care for children: prevention of malnutrition, malaria prevention, hygiene and vaccination. More than 85 malnourished children have been taken care of in the hospital and the parents have received 'healthy parenting' training.

Beacon of Hope

Now, four years later, the Foundation has become a beacon of hope in the region, with a local team of thirty dedicated employees. There is intensive contact between the Netherlands and Sierra Leone and last year I visited the remote area again. We are currently investigating how we can make our presence sustainable by handing over as much responsibility as possible to the local management.

Recently, we experienced a memorable moment: the hospital's naming of the new Wouter Nolet Memorial Skills Lab. A Skills Lab is a learning and training environment where healthcare professionals can develop medical-technical and surgical skills in a simulated environment. It was Wouter's passion to convert theoretical knowledge into practical skills.

Looking Ahead

Sierra Leone is a country of extremes. The resilience of the population is admirable, but the medical challenges remain enormous. Wouter gave his life for healthcare in this country. As a father, I feel the loss every day. Through the work of the Foundation, I also see the positive developments that have come out of it. I see how our local employees are working every day to help people and strengthen the healthcare system. It gives me direction and strength and helps me to move on, despite this intense loss.