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Healthcare in Sierra Leone

Nine women joined ONE last week on a listening and learning tour through Ghana and Sierra Leone. Nancy Brady reports back:
Our final day of the trip proved to be a challenging and emotional day for our delegation as we examined Sierra Leone’s devastated healthcare system and confronted numerous obstacles for providers and patients alike. A consistent theme throughout our journey has been the association between healthcare and development. A strong healthcare system balances prevention and intervention strategies, provides healthcare education for citizens maintains an active workforce of healthcare providers and affords sufficient resources to confront illness and/or disease. In turn, a robust healthcare system can promote and maintain a sustainable workforce. Since the end of Sierra Leone’s civil war in 2002, the country has struggled to rebuild its healthcare infrastructure. Furthermore we examined some of the country’s most affected and most marginalized groups, mothers and children; and how to keep them both healthy and alive.

One immediate concern is the sheer lack of healthcare workers for the approximate 6.5 million people living in Sierra Leone. One obvious reason is that during its eleven year conflict most nurses and doctors fled the country in pursuit of security and prosperity. Today, doctors and nurses continue to leave Sierra Leone as salaries remain uniformly low while workloads continue to escalate. Despite the internal plea for healthcare workers to return home or remain in country, the country struggles to maintain its qualified workforce. One gross example includes the fact that there is one lone Pediatrician for the entire country. Another important healthcare indicator is maternal and infant mortality rates. Sierra Leone ranks among the highest (or worst) in the world. While the average woman carries six children, she also has a one in eight chance of dying during childbirth. The results are devastating.

For women of Sierra Leone, additional healthcare concerns center around access to care and lack of healthcare information. Many women residing in isolated and/or rural areas are unaware of the benefits of birthing in a hospital. Thus, they prefer home deliveries. However should a problem arise during childbirth, there may be grave consequences. Sometimes a woman may be located far from a suitable healthcare facility or left without transport. Should she secure those things and she arrive in time, fees in order to access life saving services may be prohibitive. In a similar fashion, some parents avoid or delay bringing sick children to the hospital because they fear costs, sometimes resulting in infant mortality. Children needlessly die from treatable, preventable illnesses such as malaria, pneumonia and diarrhea.

Over the past two days we visited organizations that are addressing the healthcare crisis with a particular focus on maternal and child health in Sierra Leone. Our first visit was to the Aberdeen Fistula Clinic. The clinic is one of few places in Africa that repairs obstetric fistula, a condition that arises usually as a result of prolonged and obstructed labor (usually lasting between 2-5 days) when emergency care is unavailable. It almost always results in stillbirth. Fistula is described as a hole or opening between the birth canal and one or more of a woman’s internal organs which results in a constant leakage of urine. Without surgical repair she will be unable to bear children. Many women suffer nerve damage and have difficulty walking after delivery. In addition to its physical effects, a woman may often face social ostracism by her community, abandonment by her husband and family, impoverishment, or depression and suicide. An estimated 2 million African women are affected each year. The Aberdeen Clinic is run by Mercy Ships in partnership with Engender Health, with support from USAID. We had the opportunity to meet with Terri Bilton, manager of the clinic and her staff who discussed the progress as well as the challenges ahead. In total, the clinic has carried out a total of 1558 obstetric surgeries and repaired many more lives. You can read more about the program here.

Here’s a video of Terri discussing Mercy Ships in greater detail:

The following day, we evaluated the challenges of maternal and child health with a visit to the Sierra Leone Institute for Child Health and Princess Christian Maternity Hospital. At the Institute for Child Health, we applauded the efforts of the staff which saw a reduction in children’s mortality rates from nearly 15% to 5% during the previous year. Hospital staff equates these findings in large degree to patient education and parents bringing their sick children to the hospital earlier. Hospital costs were also reduced and medicine and surgical procedures have become more affordable to patients.

We also visited the hospital’s maternity ward. Despite all efforts to encourage women to arrive sooner and avoid complications, the hospital still sees a significant maternal mortality rates. Just this week, the hospital saw a staggering five deaths alone. Overall while the hospital is making some improvements, it continues to face ongoing challenges including a lack of basic supplies like plastic gloves, medicine, and an inadequate blood supply to provide transfusions for mothers who suffer from hemorrhage or anemia.

Finally, we completed the day with a visit to a midwives’ training facility, located next to the hospital. The training facility aims is to build healthcare capacity Midwives undergo training for a period of 18 months. Following training and certification, midwives are dispatched by the Ministry of Health to various posts throughout the country. In order for Sierra Leone to address its debilitating healthcare infrastructure, training programs geared towards health workers are critical. Maternal and child health will be greatly affected by the reach and skills of its providers. In order to retain these trained professionals Sierra Leone will also need to systematically address salary and medical supply limitations in order to achieve the Minister of Health’s goal of dropping user fees for pregnant women and children beginning in April, 2010.

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