One week in

It has been a week since my arrival in Baama and I am starting to settle in to both team life and work life. Fortunately, this isn’t an urgent emergency response type of mission so we work at the pace of the local people, which is slow and casual. It is hot, as I mentioned before, so there really is no other way to be.

I am getting a better understanding of my role here now that I have visited some of the clinics we are overseeing. The context and background for this project are as follows:

The maternal and under-5 mortality in Sierra Leone are ranked as the highest in the world. MSF has chosen to give extra attention to a very rural and neglected area in the east of the country where the infrastructure is poor. The health facilities are decayed and the roads are in general, rough roads where only 4 WD trucks and motorcycles have access.

Sierra Leone’s dubious distinction is not just its supposedly record-breaking rate of maternal death. A World Bank line graph plotting the World Health Organisation’s estimated maternal mortality rates for low-income countries over the past 25 years, shows war zones such as South Sudan and the Central African Republic closely bunched together. But Sierra Leone’s line, while decreasing gradually from a high during its own 1990’s war, is extraordinary. It floats high above the rest. This estimated ratio is almost three times higher than the average for sub-Saharan Africa. The statistics are a mark of continuing infamy for the country.

Gorama Mende and Wandor are two chiefdoms in Kenema district, the district where we are focused. The population in total is approximately 64 000 inhabitants residing in small towns (villages) spread around in the jungle forest. The most populated towns have Peripheral Health Units (PHU) to provide health care. These centers are all a part of the primary health care service and are served by staff from Ministry of Health and Sanitation (MOHS) and volunteers.

There are 10 PHU’s that I am responsible for visiting in order to gather data, consult on complicated cases, make referrals and ascertain what training the staff needs. I then coordinate the training and work with the outreach teams to accomplish the training goals. While this all sounds fairly simple, logistically it is extremely difficult because the PHUs are scattered over a large area with the aforementioned roads our only access. During the rainy season, the roads are worse and there are PHU’s that literally take 3 or more hours to reach after which time we can only stay about an hour or so before we have to return back to base! So 6 hours in a vehicle on horrible, bumpy roads and work for 1 hour. You see the challenge.

To give you a frame of reference, on Saturday we visited 3 of the PHU’s so I could be introduced and so we could check on some renovations that MSF had help facilitate. We were away for 6 hours total. We managed to visit all 3 PHU’s with short stops of about 15-20 minutes at each place. So less than 1 hour was spent outside the vehicle total. The urge to vomit was continuous and I managed to overcome it with the help of tic-tacs and mind-power!

The government here has made healthcare free for pregnant women and children under 5, in order that they might make a dent in their maternal/infant and child mortality and morbidity. It remains to be seen if free care will bring more people into the health centers and help lower those rates.

Homebirth has also been outlawed, bringing with it very steep (by Sierra Leone terms) fines to the mother, any attendant, the homeowner and the father. I do not yet know if these penalties are being carried out because as soon as you drive something underground, like homebirth, there is an air of secrecy surrounding it. We know they still happen because women come to clinics to register their babies. Whether anyone is actively reporting them, I doubt.

Although care is free in the PHU’s, the providers – who are very basically trained – do not have much themselves and so they often charge patients. These health units cannot manage critically ill women, and those must be referred to the nearest hospital (sometimes hours away) by ambulance. So it is very easy to see why the mortality rate is so incredibly high here. Poor infrastructure, poor nutrition, lack of access to care, delay in treatment in emergencies, under-skilled staff – it is the perfect storm.

We are heading into a holiday weekend. We are off Good Friday and the Monday following Easter, so it is 4 days off for us. I plan to do some hiking, cooking, bird watching and a lot of reading and relaxing.