The plight of mothers in Sierra Leone graced the cover of yesterday’s Washington Post. Sierra Leone is home to the world’s highest maternal mortality rate: mothers face a 1 in 8 chance of dying in childbirth. This is compared to 1 in 4,800 in the United States and 1 in 20 in the rest of sub-Saharan Africa.
The story of Saio Marah highlights some of the factors behind these high mortality rates. Marah arrived at the hospital by motorbike, the predominant mode of transport in the rural Sierra Leone. She is examined by Dr. Konteh (an ophthalmologist by training), who informs that her that she had waited too long to come to the hospital: the baby’s heart rate is too fast and she needs an emergency caesarian section. But all of the surgical nurses had gone home and the operation will have to wait until the team can track its way back to the hospital.
It was a Monday evening, and her husband, Mohamed Barrie, said she had gone into labor on Saturday. Both of them were worried about the expense of going to the hospital, he said, and were sure she could deliver easily enough without assistance from hospital doctors. So they had gone to a neighborhood clinic where a nurse examined her and sent her home. Now she was three centimeters dilated, her water had broken and she had finally come to the only hospital in Koinadugu, a sprawling and rural expanse in the far northeastern corner of this West African nation.
“This is our problem — all the delays,” said Samuel Kargbo, the British-trained director of the hospital and the only other physician in the country’s largest and poorest district.
The region’s largely illiterate population lives in villages scattered over a mountainous area about the size of Connecticut. The few rutted roads are often washed-out and impassable.
Even Kabala, the largest town, has no electricity or running water. Outlying villages are little more than a few thatched-roof huts. Families grow rice and vegetables, but this month, in the height of the rainy season there is less to harvest, less to eat.
Kargbo said many women delay seeking medical care for their pregnancies. He said many don’t fully understand the risks, and are daunted by the costs and distances they need to travel for care. So they tend to rely on poorly trained local midwives. When problems develop, they end up walking, or being carried in makeshift hammocks, for hours or even days to reach the hospital.
Saio’s story sheds light on the “three delays” of maternal health that are usually responsible for mothers’ deaths in childbirth: delays in not recognizing that complications are serious enough to require help, delays in getting to an appropriately equipped treatment center, and delays encountered in starting treatment at a facility because of a lack of health care personnel, equipment or drugs.
You can read Saio’s full story here. Also be sure to check out the photo and video galleries. The story is part of a feature series by the Washington Post called “A Woman’s World”, an in-depth look at women’s struggle for equality in countries across the world.
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