By Sallieu T. Kamara
There is nothing more hurting and agonising than to helplessly watch a close relative bleeding to death with no medical staff to help save them. Moreso, when this happens in a community health centre that is run and fully supported from tax payers’ money. It’s unacceptably annoying! This was the unfortunate situation the relatives of young Fatmata Kamara, 27, were subjected to in the early hours of Thursday 27 November 2014. Thos, as she was fondly called, left home very healthy, happily looking forward to giving birth to her second child. Unfortunately, she did not get the assistance she had gone to seek at the community health centre. She died of severe bleeding, a situation that would have been easily prevented.
Fatmata lived in a small community at Kagbanthama village in Kasseh, Port Loko district. The village has been seriously hit by the deaths of over 60 people in the past three months. And for her to die especially the way she did – because of the thoughtlessness and callous disregard for human life by staff of the centre – is heartbreaking, to say the least.
When Fatmata went into labour, she was immediately taken to the recently-established Ebola interim care centre (Community Care Centre/Holding Centre) in the village where her situation was assessed before being referred to the community health centre for medical attention. At the community health centre, there was nobody to provide Fatmata the medical assistance she needed. The staff at the centre, including the Community Health Officer and the nurses, had all gone to Port Loko where they were supposedly participating in a workshop. This is completely absurd and there is no excuse for this improper behaviour.
The question many people are asking how any reasonable professional caregiver can move away all the staff of a medical centre without putting concrete mechanisms in place to address emergencies like that of Fatmata’s. This is how hundreds of thousands of women across the country have died (or been killed?) of causes related to pregnancy and childbirth, which can be prevented with a little bit of effort and compassionate caring.
Less than 24 hours after the death of Fatmata, another woman from a nearby village also died under similar circumstances in the same centre. Nthuma Bangura, 30, of Romarong village was in her early stage of pregnancy and went to the community health centre for treatment. Unlike Fatmata, Nthuma was put on a drip by the community health officer, Peter, but the drip petered out, no pun intended, with no one to attend to her. Peter also went to Port Loko leaving the poor woman with only her nervous wrecking mother to look after her. She too later died.
The fact that the community health officer repeated this callous act within a space of 24 hours resulting in premature deaths that would have been avoided is indicative of the level of hopelessness of the health situation in the community. We saw this happen yesterday. We are seeing it happening today. Do we want to see it happen again tomorrow? No. Certainly not!
Meanwhile, many people are still wondering how the Kagbanthama Community Health Centre, which used to be highly acclaimed by communities near and far for its effective and good quality healthcare service delivery, has been easily chipped away. Memories of the invaluable contributions the centre made towards the successful prosecution of the 11-year rebel war are still fresh on the minds of many. Despite the rising intensity of insecurity in Port Loko district during the war, the health centre was not only always stocked with essential drugs and other medical supplies, but also staff of the centre were at all times ready and prepared to risk everything to give the people the very best that they deserved. Kagbanthama was the epicentre of the Gbethis, one of the local armed militia groups established to complement the efforts of the Sierra Leone Army in fighting the rebel war. Casualties of all sorts were treated in the centre thereby saving the lives of many people, including civilians.
Like most others across the country, the centre then always responded promptly to the preventive and curative needs and aspirations of the communities it served. It assisted in normal deliveries and handled complications that they had the wherewithal to handle, while referring those they could not handle to the Port Loko Government Hospital, as well as carrying out other essential healthcare duties such as ante and pr-natal care, treating childhood illnesses, malaria and many more. These were the times when infant and maternal deaths were rare in these communities. This incredible feat was achieved through the unwavering support and commitment of the then Director General of Medical Services in the Ministry of Health and Sanitation, Dr Sheku Tejan Kamara, and the dedication and devotion to duty of the then community health officer, Sheku Koroma who did not see himself as just another public servant. Rather he considered himself as part of the community and the people he was serving. And he always related with them as such.
It is this compassionate caring, dedication and devotion to duty that is now sadly absent in the health centre in Kagbanthama. Even before the outbreak of Ebola the quality of services delivered at the centre had become appalling. Many a time people came to the centre with their sick children and relatives, only for them to meet an empty place with nobody to treat them. So, the absence of staff at the centre, which eventually led to the deaths of Fatmata and Nthuma in less than 24 hours, is not uncommon in Kagbanthama health centre. The practice of staff of the centre abandoning their duties and engaging in their own vocations has become a culture that is deeply ingrained in their psyche. The problem of the centre in not more about the absence of drugs and other medical supplies, but it is more about poor management, lack of proper and effective monitoring and supervision, and the inhumane way staff behave towards the people who go there for service.
It is sad to note that in the midst of all of this, the community leadership continues to respond to such a worrying situation with the highest degree of insular complacency. This doesn’t only not bode well for the health and safety of the people it also portends disaster. If anything, how else can the community leadership explain their failure to take action on all the professional negligence of staff of the centre over the years, which would have forestalled the repulsive incidents that we are witnessing today? What about their inaction over the deaths of 64 people in such a very small community. A stitch in time would have saved nine.
A resident of the village recently shared his own unpleasant encounter with the community health officer. He said: he took his two children to him for circumcision after he had provided all that the CHO had asked for. He circumcised the kids and promised to be visiting them to provide post-circumcision care and treatment until the cuts healed up. But to his greatest disappointment, the CHO never came back to them, nor was he available even at the centre. This almost led to serious complications for the children. The father had no alternative but to request the porter to treat his children after the payment of another fee.
This is a complete reversal of the government’s efforts to strengthen the healthcare system in the country for which it introduced the Free Healthcare Policy in April 2010. The policy aims at increasing citizens’ access, particularly the poor and vulnerable, to good quality healthcare services by abolishing user fees in all public hospitals and clinics for children under five, pregnant women and lactating mothers. There is no doubt the policy was well thought-out. But it is yet to fully achieve its intended objectives. This is, in part, because some of the health workers tasked with the responsibility to implement the policy, particularly those working in remote communities like Kagbanthama, are not working in the interest of the people. They take advantage of the people’s vulnerability to further cause them more suffering.
It is no denying the fact that the Ebola outbreak has caused the near-collapse of the country’s healthcare system. It is also very clear that everyone’s focus now is on containing the Ebola virus disease. But in the midst of doing so, we must not lose sight of the fact that Ebola is not the only disease in the country that is killing our people. Hundreds of people have died of diseases that are not even remotely Ebola-related since the outbreak of the disease in the country. And it is also a fact that there are some healthcare workers including doctors, nurses and community health officers who are using the dreaded Ebola disease to criminally renege on their official duties thereby causing both psychological trauma and physical pain and suffering for many people. This must stop. Or else the country risks facing one health crisis after another even after the Ebola would have been contained. The sad stories of Fatmata and Nthuma are just a microcosm of the larger Sierra Leonean society. Every life matters!
© Politico 11/12/14
