Maternity ward of the Kambia govt hospital where even bed linen is a luxury
By Umaru Fofana
About one dozen people – mostly women – scramble over a notice board at the Kambia Government Hospital. Some tip on their toes to look for their names. On display is the result of the entrance exams to the 2-year programme to train to become a Maternal and Child Health Aide (MCHA). 139 sat to the exams. 74 have made the grade. Only 50 are wanted. Far more are needed. There is a deluge of work to be done here in this district.
One of those who failed the exams is Isatu Bangura. She seems in her late 30s or early 40s. Obviously a family woman. She is at present a volunteer at the hospital and so knows what she is clamouring to get herself into. Eroded health facilities and a corrosive system that would leave even the best and most sufficient of nurses and doctors go without sound results. Let alone!
But Isatu wants to give her best “to save humanity”. She looks and sounds gritty. Anyone would be happy to have her as a majordomo. That affable and dogged demeanour of hers prompts my friend and colleague, Isaac Massaquoi, to remark thus: “Never in my entire life have I seen a therapy to deal with failure so impressive”.
Isatu is full of life and is anything but broken despite her latest set back, for now at least, to achieve her life long ambition. “This is my second
attempt, still unsuccessful, but I am hopeful I will make it some day” she says. After all some have had to try four to five times before succeeding, she says as if to console herself. She smiles and walks away, determinedly. She will later tell me about her determination to become a nurse. That is badly needed. By her, yes, but also by a community so lacking in health care and personnel.
But Isatu's determination and the dedication and dutifulness and diligence of the less than ten trained and qualified nurses at the district referral hospital are nothing compared to the bigger and more daunting challenges facing them and Kambia.
Kambia is crucial for more reasons than one, and in more ways than one. It is situated in the north of the country, an area suffering from long years of unbridled, backward traditional practice and neglect which have relegated women to the back burner and girls getting sucked into the same. It calls for celebration therefore that women, including Isatu, are gunning for higher education and better skills.
The district headquarters itself is just five miles away from Guinea. Because the other side of the border is run down, it is not impossible for
Guineans to cross over to piggyback on the clay-legged health care system the Kambia Government Hospital provides. Just because I am on
diet does not mean I cannot look at the menu. The hospital compound itself is impressive. Elegantly-standing structures whose walls have a close affinity with the paint on them. Nice yellow and green. The corrugated iron zinc, not asbestos, is neatly intact. The trees in the compound provide a cool green scenery which should provide natural oxygen.
But oxygen is lacking inside the hospital for patients. There is only one oxygen tube for the entire hospital, I am told. Even that hardly works owing to the lack of electricity. On Saturday night, Deputy Minister of Health, Mahmoud Tarawallie was welcomed to the hospital by a dead
baby and a dying one. His arrival saved the dying one though. 19-month-old Adikali Bangura was battling with death because the hospital has been without electricity for over one month. The only oxygen tube available could not be utilised. Through his intervention a private generator was hired to put the tube on to save his life. Adikali is now recovering. I meet him recovering very positively. He has just escaped death. He is suffering from 60-degree burns. His mother bends over to be able to breast-feed him in a very unorthodox way.
Inside the children's ward I see malnourished children. I see tarpaulins doing what they ought not to be doing. The entire nursing staff is THREE. Ten children died in the month of August alone. That was blamed largely on the unavailability of electricity. But insufficient staff
cannot be ruled out.
Things as basic as prescription forms are not available. I see pages of exercise books being used to send to the cost recovery unit when it is open. This means anybody can prepare prescriptions and send them to the unit to buy the drugs and sell them in pharmacies and drug stores elsewhere. At the maternity ward, women go into labour under a flash light. The nurses say there is no functional toilet inside the ward. I will later see one which they say they have just been given access to because the authorities heard that the deputy health minister was coming. But in the absence of water it is hard to imagine how that can be used. A heavily pregnant woman has to be goaded outside to ease herself.
I understand the UN children's agency, UNICEF, has bought solar panels for the Primary Health Care unit of the hospital. But that is yet to be installed. Only God knows why, the staff tell me. So the vaccines inside the freezers which are supposed to be kept under a 2-5 degree Celsius
temperature are decaying under 26 degree heat. The vaccine valium monitoring white dot on them is giving way fast. I am told once that becomes dark in colour it can no longer be used. And it is getting close to getting there. The cold room is as hot as an oven. The staff say they cannot supply the vaccines to areas that badly need them, in part because of the lack of electricity to keep them potent, but also because there is no transport to distribute them to the 65 peripheral health centres in the seven chiefdoms that make up Kambia district.
In February this year, the UN population fund, UNFPA, donated a utility vehicle. The staff say it cannot be used because of lack of fuel. The District Council that is to help with the provision of fuel, I am told by various sources at the hospital, has not provided their quarterly
contribution since March.
The Chief Administrator of the Council, Victor Kallie Kamara, admits to me that they have not been able to pay their quarterly subvention since they provided for the first quarter in March. He blames it on bureaucracy in Freetown set up to ensure rampant corruption is curbed at the council. Under the Integrated Public Finance Reform, councils have to comply with certain standards before money is disbursed to them. He says it has even affected their payment of salaries for council staff.
The CA also says that they are struggling to cope. As part of the Free Health care initiative introduced in 2011 for children, pregnant women and suckling mothers, additional staff arrived in the district, he says, when his council did not budget for them.
I cannot put some of the issues crippling the health care delivery system at the Kambia hospital to a Medical Superintendent because there has been none resident there since the last one was transferred I understand some two months ago. The District Medical Officer (DMO), Dr Tom Sesay admits to me on the phone that there is no surgeon specialist at the hospital but is quick to say that there is hardly anyone anywhere outside Freetown. So he says that a relationship with a UK hospital has meant that they send doctors from time to time to train Community Health Officers to carry out surgeries – unaccompanied and unaided by a doctor. Just as I am readying myself to leave the hospital I can see some CHOs from the theatre just having carried out a surgery without a doctor. I don't know the nature of the operation because no one is willing to tell me.
But the DMO himself has come under flack. I am told he has been away for over one week. Unexplained. In an interview, he says he went to Freetown for “six days to attend an important and very relevant training” that would benefit the hospital. The security
guards say they do not receive even torch lights or rain coats even in the thick of a heavy downpour. They say they have to either
abandon their guard post or fall sick staying on.
All over the hospital there is no running water. Nurses complain that they cannot keep their hands clean as they should. Those who reside in the hospital quarters find it daunting to wash their clothes let alone drink. Cholera where are you? Even accommodation is a problem for the
medics. The two midwives have to make do with one room each. And they have their families with one of them having three children including a teenager. Both families share the same living room.
It is a wonderful decision for the midwives and nurses to live inside the hospital compound so as to be able to respond to late night emergencies, they agree. “But not at our own expense”, one of them tells me before threatening to leave if the situation does not improve.
At the maternity ward I am welcomed by three beautiful and chubby babies delivered less than an hour earlier. Among them fraternal twins. They each weigh 3.5 kg. As their mum, Isha Conteh is still on anaesthetic, following a caesarian delivery, the babies sleep. Innocently.
Naturally. Not sure what lies ahead of them. The three babies and their mothers are lucky. Two weeks ago, mum and baby died after a
complicated delivery. I will later receive a call that one died on Sunday night and another on Monday morning.
It is a miracle that the nurses here perform. Inside the labour room there is no water. And one of the beds is corroded. Some of the pregnant women lie on bare mattresses in the ward. No bed linen. No mosquito-treated bed nets. The nurses say there is no sterilisation facility in the
ward.
As I bid farewell, I see a bowl full of rice being brought in for the patients. They do not pay for it. It is provided by the state. Impressive! But when I go to the kitchen, the bowls in which the sauce is, are leaky. There is rust at the bottom of the pans with rice used to plaster the
holes. But they leak nevertheless. Perhaps ineluctably.
Despite all the tough and torrid times, or may be because of them, Isatu Bangura is determined to retake the MCHA exams again next year, hoping she will be third time lucky. She hopes conditions will have improved so the needless dying of women in labour will end and those chubby twins will be attended to as they should and become good citizens in a country where more is said than done, and less done than meant.
(c) Politico 18/09/12
