A large part of my job is supporting the 10 peripheral health units (PHU’s) in the 2 chiefdoms we cover for this project. One of them is right next to the office here in Baama. The remaining 9 vary between 15 minutes and almost 2 hours away depending on whether you are in a vehicle or on a motorbike. During the rainy season, the furthest one can be over 3 hours away because we take a different route and can no longer cross the river at the easy access point.
I usually set my activities for a week at a time and visit the 9 PHU’s on a rotating basis but the most that could be visited on a given day is 2 given distance and even then I cannot spend much quality time given the time restraints we have for our working hours. So at the end of the week I choose 3 days to be in the field the following week, working around meetings and other things on my agenda. I set my locations and file a movement plan with logistics. They then make a schedule with all the movement plans and either assign me to a vehicle with the outreach department going to that PHU or they assign me a motorbike and a rider if no one else is going that direction. It is all carefully planned.
Being the only midwife on staff, I am busy fielding all the calls from the PHU’s when they have complicated cases or if they need to refer. The staff in the PHU’s are not trained as midwives, rather they have health aides and nurses staffing the PHU’s due to shortages of midwives here. So while the staff do all antenatal care and conduct the births, they are doing midwife duties but are not considered midwives by Sierra Leone Ministry of Health because they are not trained as such.
The PHU’s are extremely basic in the care they can provide. They have protocols to follow and are supposed to refer anything higher risk to a higher level of care, which is here in Baama where there is the one trained midwife for both chiefdoms. Even here in Baama, “higher level of care” does not mean much. The nearest hospital is 3 to 4 hours away on a good day in good weather and requires our ambulance to meet a national ambulance at the ‘kiss’ point across the river. It is a whole production and not a fast one.
This past Wednesday, I planned to go to Ngeigboiya (pronounced ge-boy-ya). It is far and the road is treacherous to say the least. We went by motorbike and believe me when I tell you I was not a passive passenger. There are some very steep and rocky points. The entire way is gravel – there are no paved roads out here. We have to cross tiny foot bridges not really made for vehicles so their stability is always in question. But the landscape is spectacular and it is like going onto a movie set as we pass small villages and young children wave and shout.
Prior to my departure that day, I was informed about a women who had died the day prior leaving behind 4 month old twins. The outreach department asked that I check on them and find out what they needed and how they were being fed. All babies here are breastfed, there is no other option. So there is always a concern when a mother dies as to how the baby will survive. I said that I would check on these two as they were in a village just 4 miles from the clinic.
When I arrived in the village, we were escorted to the house where the babies were. Both were very small for 4 months and clearly lagging behind in developmental milestones. I figured they were probably premature when they were born but I would have no way of knowing any history on them now with the mother dead. I learned that the father too, had died no long before. There were 2 other children, 2 and 4. All were now orphans. The mother died from complications of malaria. The 2 year old was currently hospitalized for complicated malaria but appeared to be getting better.
The caregiver explained that for the last day, the babies had been getting biscuits soaked in water and then boiled. The biscuits had run out and they were now hungry. There was no one in the village willing to nurse the babies because it is a commonly held belief that if you nurse the baby of another woman that your own baby would die. These beliefs are so strongly held, there would be no convincing them otherwise and I did not even try.
The village we were in does not have a well, therefore, when it is outside the rainy season, it is difficult for them to get water, let alone clean water. They fetch water from streams and wherever they can find it. There is no market in this village and they have to walk long distances for food as well, hence when the biscuits ran out, that was it.
I was able to put in an emergency order for formula when I got back to the office that day. It was really going to be the only thing giving these two a chance at survival. The next day a health promoter went with a rider to the village and brought the formula. They taught the caregiver how to prepare it properly. Most people in the villages are illiterate and they would not be able to follow instructions on the can so we always send a health promoter to give instructions. In the coming week, I plan to check on them again.
With both parents being dead, the survival rate for these babies is not good. I do not know enough about the village structure and what sort of support the extended family will have to be able to care for these 4 children. They are all at risk. We will be following them and do what we can within our scope but it will not be an easy road for them.
Days here are full of unforeseen challenges. The work is not easy. I expect the coming months will bring with them a myriad of things I could not have imagined I would encounter. For now, taking it a day at a time.
