SIERRA LEONE: Maternity hospital is “last resort”

Two babies and several gaunt women are the only patients in the gloomy wards of the Princess Christian Maternity Hospital in Freetown.

The hospital is supposed to be the main training and referrals unit for obstetrics in the country but its handful of staff were mostly found in backrooms, drinking tea with their feet resting on the surgical tables as they wile away their days in the eerily slow-moving wards.

“This hospital is a place of last resort for patients and staff,” said Sister Kanu, a nurse, who reckons conditions for mothers and hospital staff have “barely improved” since the end of Sierra Leone’s 11 year long civil war which devastated government and social infrastructure.

“By the time women get here it’s too late and the most we can do is to save the mother,” she said. “That’s why you see so few babies.”

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Medical officials in Sierra Leone estimate 80 percent of women give birth at home without ever consulting a medical official or midwife.

The majority of births in Sierra Leone are supervised by untrained “traditional birthing attendants”, miles away from even the most basic medical facilities that can intervene in case of complications, according to the UN Population Fund (UNFPA) in Sierra Leone.

The biggest cause of death is women simply bleeding to death after giving birth. Others suffer hours or days of obstructed labour.

Those who survive will join what UNFPA said is a growing number of women in Sierra Leone living with fistulas – a tearing of the tissue that develops when blood supply to the tissues of the vagina and bladder and/or rectum is cut off during prolonged obstructed labour. When the tissue dies a hole forms through which urine and faeces pass uncontrollably.

“When the formal [health] system collapsed during the war, people turned to the informal system of using traditional birthing assistants and they have not yet come back to the formal system,” said Dr Jarrie Kabba, a programme officer at UNFPA in Freetown.

Even when women do make it to the country’s rudimentary health facilities they must pay for and provide all their own drugs and even blood before they will be treated.

Sister Rugiatu Kanu, a midwife in Freetown, said just giving birth costs 50,000 leones (US$17) in a country where the minimum wage is US$14 a month and many of the 8 million population live on considerably less.

Sierra Leone now has one of the highest rates of maternal mortality in the world, perhaps losing more mothers in child birth than anywhere else in the world, according to the UN children’s fund (UNICEF).

Big push

Sierra Leone’s government says improving conditions for pregnant women and infants is a priority. On 29 February it launched a long-awaited maternal mortality “strategic plan” which focused mostly on eradicating overlaps and redundancies from the various government agencies involved in reproductive and child health, while promoting preventative activities like immunisation and women’s rights generally.

The strategy has the backing of the UK Department for International Development (DfID) which is the country’s main foreign donor.

International aid agency UNICEF has also promised to help improve care for pregnant women and infants, although the organisation has identified cultural factors such as early marriage, female genital mutilation, poor nutrition and lack of breastfeeding as the main obstacles to reducing the number of deaths among mothers and children.

Health official Dr Ibrahim Thorlie, Chief of Obstetrics at the Princess Christian Maternal Health hospital in Freetown, said he is sceptical about about the government’s new strategy as well as UNICEF’s emphasis on cultural factors.

“We need a new health system not a new strategy,” Thorlie said. “Only education combined with a health system that actually provides results can change things,” he said.

Trained staff

The main problem Sierra Leone’s mothers face is not awareness about what they should do but trained staff to give them the assistance they need, Thorlie said.
“What use is having more drugs and equipment if we don’t have people to administer them?” he asked. “Should patients start treating themselves?”

UNFPA agrees, having calculated that there are just six obstetricians for country of 5 million people: Five in Freetown and the sixth in the town of Bo, 200 km east of the capital.
“At the end of the day it’s about human resources,” said Bobo Yabi, head of the UNFPA in Sierra Leone, the UN agency supporting the government in its reforms.
“The strategy can be there, but if there is no-one to implement it, it will be just hanging in the air.”