Health Care Delivery in Sierra Leone: Pandora’s jar unveiled

9 December 2008 at 23:02 | 929 views

By Roland Bankole-Marke, USA.

Health Care delivery in Sierra Leone is dangerously diseased: if we should go by the scores of appalling and nightmarish reports, dogging this war recovering West African nation. Its population is about 6 million people, whose lives the morose of poverty with unemployment bites with a sting. And it is labeled the poorest nation in the world, according to the United Nation’s evaluation index: having the highest childbirth mortality rate in the world. Recent statistics revealed that about 1 in 8 women are at risk of dying during the ordeal of childbirth, compared to approximately 1 in 29,800 in Sweden: while in United States the probability is 1 in 4,800 [UN report, 2008].

At the Princess Christian Maternity Hospital (Cottage) in the capital city Freetown, hospital records show that 144 patients died this year alone. SL has the worst infant mortality rate in the world - 28% of all children (about 1 in 4) die before they turn 5 years old: often from preventable causes like dehydration, malaria or malnutrition [UNICEF data]. This ailing nation has about 80 registered medical doctors: with only one psychiatric doctor. Providing efficient medical services is as daunting as it is challenging. Rationally, the need to seek off-shore help, considering SL’s overburdened and outmoded facilities is critically necessary.

Although conflicting reports claim that SL is slowly trending away from rock bottom ranking, in the poverty index. The reality at home regarding the Health and Sanitation sector is asymmetric to the sealed contents of Pandora’s Jar. Like other sectors of the economy, corruption apparently is a constant. It’s a disease that’s as endemic as it is systemic, seemingly acceptable as a way of life. Probably, the invention of a vaccine would help cure this enigma. Despite the creation of the Anti-Corruption Commission to help curb corruption, health care delivery is still deficient in meeting the threshold of a reliability and dependability smell test. The enduring malady in this ministry often goes undetected by the commission’s savvy radar surveillance antennae. Public health services are more of a nightmare than a workable and efficient service rendered to the populace. Particularly for poor and destitute folk who cannot afford the prohibitive cost of medical treatment. UNICEF, Bill and Melinda Gates Foundation, the British government and Philanthropists abroad, including several chapters of Sierra Leonean Nurses Association in the US, have all donated generously to help alleviate the situation in this war weary and struggling nation.

My ailing 83-year-old mother, living in Freetown, knows too well that children and women are the Cinderella: and the most vulnerable population, caught up between a rock and a hard place in SL’s health care delivery system. She’s diabetic, and forced to seek treatment in the private sector, aided by funds from abroad. Money talks here, and has electricity to move doctors like other health care professionals, who are relatively cash-strapped. Mama spends a chunk of money each month for care, too often thwarted by the runaway cost. What about the underemployed, unemployed or unfortunate and aged folk? They constitute the largest segment of the dependent population. And have no access to regular care. The inability to pay disqualifies them from receiving services both within the public and private sectors.

A tired tune like sticky groove on a record attributes the folly to “global credit crunch” prevalent around the world. Salaries here are pitiably low and unlivable, especially in the government sector, where most civil servants earn between $ 20- 50 a month. Government employees repeatedly receive their salaries 2-3 months in arrears. To survive, they resort to dubious and unethical methods, trying to make ends meet. While law makers are asking for over 300% increase in their salaries and a $ 45,000 soft loan to buy vehicles; 70% of the loan would be borne by government and 30% by the borrower. However, salaries in the civil service remain stagnant, despite the cost of living and inflationary challenges. Who is looking out for the poor government workers? Are the people serving their elected officials or the officials serving the people?

Demanding payments before service from patients who can ill-afford them, or selling donated drugs and medical supplies are not uncommon practices. But the poor lack the megaphone to expose corruption for fear of a backlash. A life threatening emergency may warrant the urgent attention of nurses and doctors like a ticking time bomb. The rule of thumb is “A cow grazes where it is tethered.” Any employment is potential fertile grassland to graze on, according to the dictates of ‘dog eats dog world mindset.’

Sierra Leonean award winning photo journalist, Sorious Samura, who earned stardom with his documentary “Cry Freetown,” had stormed the world stage with one of the most graphic documentary in history. It was through his reportage that the rest of the world learnt about the gruesomeness and seriousness of the Sierra Leone civil war. Recently, he braved it out to Freetown, on a fact finding mission. This BBC journalist’s powerful and respected megaphone reaches most folk around the world. He interviewed business officials and the minister of health Dr. Soccoh Kabia. The telling video on: would eventually unveil Pandora’s Jar. His application of investigative journalism is worthy of emulation by other Sierra Leonean homegrown journalists, who still fall short of measuring up to global standards. However, the United States and Canada continue to invest monetary and human resources toward the growth of journalism as a vital service in this budding democracy. To enable journalists to render effective service to the local society and humanity in general.

Samura’s investigation was as bold as it was professional; armed with his secret camera. Appearing in stores and pharmacies, he disguised himself as a potential customer desiring to buy drugs and medical supplies from money hungry business folk. He found out that drugs and other donated items by UNICEF and private agencies were sold openly in the market place bearing the UNICEF logo on them. Donations that were meant to benefit poor people, who cannot afford to buy them were stolen and sold to stores that now sell them for profit. The intended benefactors would have to go without. The culprits admitted “We’re getting the items from the government” through officials stationed at New England Ville, where medical supplies are stored. “We are not the only people involved” the businessmen added. The government sold it to us and that is not a secret one man stressed. These items are sold every where, even by petty traders in street corners. In a functional democracy, a crusading press working in consonance with an informed public can infuse the chlorophyll of attitudinal change. A dynamic press serves as a watchdog to safeguard the people’s interest, and not being a lapdog for businesses or the government’s agenda.

Samura’s next interview was with the minister of Health and Sanitation Dr. S. Kabia, a veteran medical doctor from the US with 30 years medical practice under his belt. A returnee turned politician, returning home to help his country. Kabia has held this position for less than a year. Samura demanded accountability from the minister which he said he owed to the people. Kabia confessed that government was aware that pilfering and sale of donated medical supplies had been going on, though it was yet to apprehend the miscreants, who are out to discredit the government at the expense of the suffering masses. But this is not enough to simply admit that mistakes were made in his ministry.

Heads should roll to bring the offenders to justice. Anything short of that would be political pandering. Politicians have to win elections, and often making a bold and unpopular decision could not be politically savvy, but suicidal, especially during troubling economic times. But good leadership should not be traded for cheap, immoral principles. Taking action now to fight corruption will send the right message that a complete house cleaning is in progress. Is that not why the ACC was set up in the first place? Credibility and accountability are essentials of good and open government. The previous government was swept out of power because it failed woefully to meet these sacred tenets.

But the minister has been working assiduously to effect dynamic changes in his ministry to help improve health care delivery to the people. He said recently in a press conference to journalists in Freetown, “I have spoken to different people and different organizations, who have pledged to help us upgrade our hospitals, train doctors and provide equipments to enable the doctors and other medical personnel to do their job.” Earlier, he traveled to Westchester Medical Center, and they are interested in helping to upgrade the Emergency Department. Their experts will do the assessment he said. “I’ve also asked Howard University for a sickle cell center, which we don’t have in Sierra Leone. Doctors don’t even diagnose it.

Lots of people are dying from it. Some doctors diagnose it for malaria,” he lamented. In years to come Sierra will be a different place, he assured journalists. The announcement that pregnant women will soon start receiving free medical care: including medication and free ambulance service is music to the ears, coming from the minister himself. This is prima facie evidence that investigative journalism works effectively, when professionally done. Poor Sierra Leoneans have suffered too long. It’s time we restore their dignity and humanity to optimum standard.

I cannot resist the legendary reggae artist Bob Nestor Marley’s lyrics, whose prophetic words are relevant today. His song ‘Pass it on’ resonates:

Be not selfish in your doings -pass it on

Help your brother in their needs -pass it

Live for yourself and you will live in vain

Live for others, you will live again

In the kingdom of Jah man shall reign -pass it on.

Roland Bankole Marke(photo) is a Sierra Leonean author and poet resident in Florida, USA. His publications include: Teardrops Keep Falling, Silver Rain and Blizzard and Harvest of Hate; Stories and Essays: visit his website on: