By Mabinty M. Kamara
Skepticism, even fear gripped me as hospital workers carefully wheeled me to the labour ward to deliver my child at about 11:30 am on a normal Friday. Thinking of the many women who had been in a similar situation but couldn’t make it alive, my labour experience was indeed less of a pain and more of fear that I may die in the process. At that point all I could do was to seek the face of God Almighty and it could have been my last prayer on this beautiful planet.
Along the way I also saw other women and girls suppressing the expression of fear and pain that was written all over their faces as they sought divine intervention while waiting for the will of God to be done. Not even the busy scenery of the nurses and other hospital workers to attend to the many cases at hand could distract me from the seriousness of my situation.
Minutes later, the sound of a baby boy was heard from my room and I overheard my husband asking “and my wife, is she safe?” and the nurses jokingly replied “give us something for a reply” such is how giving birth in Sierra Leone has over the years been a journey filled with uncertainty.
Through the intervention of God and the professionalism of the midwives, I safely walked out of the country’s main maternity hospital with my child.
Depending on the time and situation, pregnancy is viewed by many women especially in African as a fulfillment of the promise of womanhood and marital success. It brings discomfort such as changes in diet, sleep patterns and other rare conditions to some women but all of these have been counted as the joy of motherhood many women desire to experience at some point in their lives.
However, that blessing has over the years become a journey of no return for many women in Sierra Leone and many other parts of the world. A recent report by the Guardian newspaper of UK described Sierra Leone as one of the riskiest places in the world to be pregnant. This is just one of such damming reports about this land that we love.
Several other such reports have indicated increasing number of maternal and infant mortality incidents in the country.
Data for 2021 captured by the Ministry of Health and Sanitation (MoHS) through its Maternal Death Surveillance and Response (MDSR) indicate that the cumulative maternal deaths recorded in all districts across the country were 506, with the Western Area topping the chart with 86.
According to Dr. Tom Sesay, Director of Reproductive, Neonatal, and Child Health at the Ministry, the data represented what was captured by the response, noting that there could be more that were not reported by the communities.
Presenting the report in Freetown during a consultative engagement on the proposed Safe Motherhood and Reproductive Health Bill, Dr. Sesay said that abortion accounted for 6% of the figure recorded, with hemorrhage (bleeding) and hypertension being the leading cause of the deaths.
A report on the causes of maternal deaths in the African sub-region also indicates that one out of every 2 to 3 women who die during pregnancy, die from two major preventable pregnancy complications - Hypertension and Hemorrhage - which account for 19% and 31%, respectively.
Other causes include Sepsis, accounting for 10%; Dystocia, 9%; and indirect causes generally accounting for 25%. That same report notes that maternal health complications account for 23 % of deaths among women of age 15-49, with adolescents contributing 20%.
How I came to terms with the figures
As a journalist with a passion for reporting human interest stories, I have reported on many of the realities represented in this terrible data but I have never had to come face to face with things until recently.
In the last two years, I have lost more than ten relatives - friends, and neighbours inclusive, all to childbirth complications. Last May marked the second anniversary of the death of a very close neighbor, gone to the great beyond, leaving behind four children, including the one she died giving birth to. Not long after that, I heard sad news about a friend’s mother. The other day, it was my cousin in the provinces.
One morning in May this year, I woke up to the shocking news of the sudden demise of a former university course mate, a lady I had last seen just a week earlier. Not being convinced about the news of her death, I started calling those close to her, only for me to learn that she died minutes after giving birth to her child. Being an employee of State House, her death to me was a wake-up call for President Julius Maada Bio who happened to be her employer. But did it make a difference? That is a question we will return to later on.
In addition to all the terrible news of maternal deaths, in mid-2021, I got another major shock of my life when I came across the story of 27 -year-old Zainab Kamara, mother of two who had for seven years lived with a pair of scissors in her abdomen. The lady had gone through a Caesarian Session in 2014, during which she lost the baby. She suffered marginalization, discrimination, and rejection at the hands of her peers and even the man who impregnated her – basically been condemned to death while still alive. Zainab died a year ago, on December 7th after months of fruitless appeals for another surgery to remove the scissors and bring to book those whose professional ineptitude would eventually cause her death.
Some foreign doctors at Massanga Hospital in Tonkolili later performed the surgery and had the scissors removed but it was too late. She died a month later, due to complications, before she could be discharged.
In my last interview with the Medical and Dental Council President, a regulatory agency for medics in Sierra Leone, he expressed shock at the news and requested that a formal complaint from either a family member or any member of the public on the issue be made to the council for appropriate action. A Civil Society Organisation based in Kambia did as requested. A copy of the letter was emailed to me. I printed it out and delivered a copy each to the Secretary at the office of the Medical Council President and the Registrar, as advised. Six months since I dropped those letters, the organization neither got a reply nor was any action taken against those who sent Zainab to her early grave.
What is most frustrating is that on the disciplinary committee, sits a vibrant Civil Society Activist, who happens to be the leader of the Health for All Coalition and is well informed and aware of late Zainab’s story, even before her death.
Zainab’s elder brother, Ishmail Kamara, flew all the way from Canada to see how he could get justice for his deceased sister, but he couldn’t do much.
The problem
Successive governments have made several commitments, including to eradicate or reduce the maternal mortality rate to 500/1000 by 2023, and 300/1000 by 2024; improve maternal health through the introduction of the Free Health Care program for pregnant and lactating mothers; increase budgetary allocation to the health sector; increase the number of health centres; introduce the sexual model court to try cases of sexual offence against children and women; introduce family planning methods to prevent teenage and early pregnancy that leads to most complications, among others. Yet the figures remain alarming.
In my last discussion with the current Minister of Health and Sanitation, Dr. Austin Demby, at the Sierra Leone People’s Party Convention in Bo last year, he emphasized his quest for effective service delivery and most importantly patient care in all health facilities across Sierra Leone, which he acknowledged could be a way to addressing some of the challenges encountered by women in health facilities.
In my experience as a journalist and a woman of childbearing age, I love testing waters and I can assure you that I have seen it all when it comes to service delivery in government health facilities, Non-governmental, as well as Private-owned facilities. And my experiences at each of these facilities vary.
Health facilities where you get the most care are the private hospitals, yet they do not cater for the majority of Sierra Leoneans due to the high costs involved. At these facilities, you get treated to show that indeed your life matters and it is their utmost priority.
The Aberdeen Women’s Centre happens to be one of few non-governmental health facilities in Sierra Leone that have over the years been complementing the efforts of the government in maternal and child health care, as well as survivors of sexual and gender-based violence. All the services there for pregnant women and survivors of rape and fistula patients are completely free of charge. The hospital is doing a fantastic job.
However, like government facilities, patient care remains a huge challenge at the Center too. As a charity, those who go there are usually vulnerable women who can barely even a decent attire for antenatal visits. Some nurses there are more often than not judgmental of teenage patients, with their actions amounting to psychological torture.
With all due respect to some highly diligent and professional staff in our government facilities, their effort is overshadowed by extortion and sometimes blatant disregard for patient care.
I was amazed when a pharmacist, who is supposed to supply me with free health care drugs as a pregnant woman, asked me for a token even when not all the medicines prescribed was available, according to him. This is what you go through during every antenatal care session, at every table you visit for attention. They also do not respect patients’ time. They tell you to be there for a scan at 7 am, only for the doctor to turn up after 11 am.
It amazes that in all the three situations mentioned earlier, the private, government, and non-governmental run facilities, mostly the same nurses and doctors are found doing the job but they have different attitudes, depending on where you meet them.
The Milestone
The government and other partners continue to work to ensure that women’s health improves in the country. One such move is the government championing the safe motherhood bill, a legal initiative which according to ministry of health officials, is to ensure that women receive high-quality care in order to achieve the optimum level of health for the mother and child.
The bill is also to promote the development of the school health policy along with the radical inclusion policy of the Ministry of Basic and Senior Secondary Education (MBSSE) for school health services and comprehensive sexuality education in schools.
The safe motherhood bill was first introduced in parliament as a private member’s bill. It passed through parliament but could not get the required presidential assent due to pressure from pro-life campaigners.
Overall patient care in our hospitals will remain an issue of grave concern in 2023.
Copyright © 2022 Politico (19/12/22)
