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Sierra Leone
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Pregnant Woman driven on wheelbarrow to hospital

January 30, 2015   By Mahmud Sheriff Ismail

Early yesterday morning, the BBC correspondent in Freetown, Umaru Fofana shared the following on his Facebook page:

“This morning at Mabella slum in Freetown, ‪Sierra Leone, a pregnant woman was brought to the community health post convulsing. Health workers scared to touch her because they don’t know her ‪Ebola status. 117 wouldn’t respond to numerous calls. Taxis wouldn’t take her. A wheelbarrow had to be utilized by the community people.”

I was moved by this sad story and set out to get a better understanding of what was happening in that slum community. But let me first state that in the absence of any help, community people and family would do whatever it takes to support their own. In many cases, this was the reason why the Ebola virus spread so fast and so widely across Sierra Leone. The country’s health infrastructure was very weak before the outbreak and when the epidemic broke out, the sector’s capacity to respond practically crumpled under its weight. Communication between peripheral health facilities and the referral hospital was negligible while transport to effect such referrals nearly non-existent – only a few ambulances for the whole country.

This type of incidences occurred over and over again during this outbreak across the country. But when it happens in central Freetown – just few hundred meters away from the two main referral hospitals, Connaught and Princess Christian Maternity Hospital (PCMH) – it speaks volumes of what many underprivileged Sierra Leoneans in those hard-to-reach communities have had to grapple with. If this suffering pregnant woman turned out to be positive of the Ebola virus you can only imagine how many more people would have been infected.

I was expecting that a community health facility in such an overcrowded slum in the business district within the capital would have been supplied with the relevant protective clothing and should be prepared to provide service. I am aware that several households within the Mabella slum have had cases of Ebola infections, so it sounds absurd that this patient was turned away because the facility wasn’t prepared in all these months? I therefore took the liberty to go and ascertain my assumption.

“They did not offer any help,” said Councillor Abu Assief Khanu. “They were recently supplied with PPEs, they have everything here but they are not supportive at all.” He added: “We are only waiting for this epidemic to be over and we would ask for the removal of this batch of staff.”

Abubakrr Kamara, who was introduced to me as the Chair of the Mabella community, said that the patient, Isatu Kamara, was actually from Susan’s Bay, another sprawling slum nearby.

“They also have a community health center (CHC) but ours is closer to her house,” he told me. Abdul Kamara, 35, who witnessed the incident yesterday morning, confirmed that the patient did not receive any help from the staff at the CHC but Kadiatu Sesay, a volunteer community health worker explained that according to one of the nurses at the CHC, the patient’s condition was already above them and there was nothing they could do – the reason why they immediately referred her to Princess Christian Maternity Hospital.

The snag was, the pregnant woman laid on the street groaning with pain and had to be taken on a wheelbarrow instead of being attended to within the center until an ambulance would come and pick her up.

Brima Mansaray, who described himself as the Commander of the Community Ebola Taskforce, said the CHO – David Vanney Nyumah – attached to their facility has been absent for more than two weeks. “Although there is a Community Health Assistant and about six other staff, we feel that these staff are usually afraid to attend to our people because of the Ebola virus,” Mansaray said, adding that as of 28th January, 2015, his community has recorded 68 confirmed cases of the Ebola virus with 34 deaths.

As he spoke to me two truckloads from Plan International and UK AID arrived with food and non-food supplies for the quarantined homes.

Meanwhile, I went inside the facility to get a feedback from the staff on the allegations but there was no one inside. I saw that the lights were on, fans running but all the staff had abandoned the facility.

So I moved on to PCMH to check on the status of the pregnant woman. I found Isatu Kamara in the Eclamptic Ward (2) stable and responding to treatment. “She is coming around,” a very polite Sister-in-Charge, Josephine Samba told me. “She was brought in unconscious and was immediately put on treatment.”

Dora Sesay, (Isatu’s mother) who was at her bedside, confirmed that her daughter was in a bad shape and that they indeed used the wheelbarrow because that was the only transport available to take Isatu out to an accessible place. But Dora further explained that they eventually found a taxi that conveyed her daughter to PCMH. I deliberately asked Dora what response she got when she called the 117 emergency telephone line. “No I didn’t call 117 because I was afraid that they would take my daughter to an Ebola treatment center,” she said.

However, Abdul (the eyewitness) said “several people tried to call but we didn’t see any ambulance”.

The Mabella community is an extremely congested environment that makes movement even for pedestrians very difficult and for an emergency like Isatu’s, it is even more challenging for any form of vehicle to get in. Isatu could have lost her live because of this and the lack of care at the health center.

But according to Sister Josephine, Isatu has already taken two doses of seven injections she would have to complete in 24 hours. A treatment, she said, could only be provided at a hospital like the PCMH. The nursing sister further explained that “the convulsion Isatu suffered could lead to serious complications that may result in loss of the pregnancy”. In some cases, “the doctors would have to resort to ‘induced’ labour”, she added.

Thankfully, as at 3:45 in the afternoon, although she looked weak, Isatu had even eaten and was able to talk. How are you feeling now? I asked. “I am feeling much better,” she mumbled.

Isatu may have been lucky because her community is actually only hundred meters from PCMH but once again, her case reinforces the all-too-familiar many weaknesses in Sierra Leone’s health sector.

Only last week, the Ministry of Health and Sanitation held a stakeholders’ conference on the sector’s post Ebola recovery strategy.

In his presentation, the newly appointed Director of Health System Planning, Policy and Information in the Ministry of Health, Dr. SAS Kargbo, spoke on what he called the “key health system deficits” and mentioned the following: (not in the order they were presented):

* Ineffective referral system

* Poor institutionalization of quality assurance programmes

* Weak coordination

* Lack of community ownership in health service delivery

* Weak infection prevention & control practices at all levels

* Weak integrated disease surveillance & response (IDSR) system including and emergency preparedness plan

* Inadequate health technologies (medicines, supplies, laboratory) & weak supply chain management (quality & quantity)

* Inadequate human resources (quantity & quality) and misdistribution

This is certainly a tall order so the ministry would need substantial support to adequately address all of the deficits.

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