A world apart

17.53, 18 March 2010
 
It has been a busy month here in Sierra Leone and also at home – the charity that I’m working for have this month changed their name to Health Poverty Action, as this more accurately describes what they do than ‘Health Unlimited’.
 
I been travelling a lot since I wrote my first blog a month ago, working in Kamakwie, Makeni, Freetown and Bo. Travelling around the country, there are visible signs of development during the year that I have been away, from the beautifully smooth new tarmac road between Freetown and Bo to the power lines snaking across the country bringing electricity to Freetown from the hydro-electric dam at Bumbuna, which has been under construction for three decades and began providing power at the end of last year. When I was last in Sierra Leone, pylons without wires stood useless and Freetown (the capital city) had an extremely intermittent electricity supply, which is now much improved. However, outside the three largest cities, there is no mains power and apart from a few people with generators, most people live without electricity. I am in Kamakwie and my computer and phone batteries are dead, so I am quite literally writing this blog on an old exercise book. I am keeping my fingers crossed that the generator will be switched on in the hospital, which normally happens for two hours each morning, so I can charge my computer to type and send this blog. There has been a fuel shortage throughout the country over the last week, which means that the hospital generator has been used only for emergency surgery and not switched on routinely. In Makeni last week, getting a motorbike taxi to work was difficult and the price doubled overnight. For me this was an inconvenience, for a pregnant woman with complications during pregnancy or labour, this adds an additional delay to an often already challenging journey to reach a healthcare facility.   
 
I am spending an initial short period observing both the hospital and the rural health posts to explore areas for development and identify training needs. My week in the hospital was mainly very positive with the birth of three healthy babies on the ward, but also sadly the tragedy of the death of a young pregnant woman due to severe pneumonia, which highlights the need to address the delays in women seeking or reaching appropriate health facilities.
 
Following work at the hospital, I spent four days in Bo as one of a team of both local and expatriate facilitators providing a training course on emergency obstetric and newborn care designed by the Liverpool School of Tropical Medicine and implemented in collaboration with the Ministry of Health and Sanitation of Sierra Leone. It is designed for qualified midwives and doctors in low resource settings in order to equip them with the skills to improve outcomes for women and babies. On this course, we were training mostly maternal and child health aides (MCHAs), who have less training and a smaller scope of practice than midwives. This raises the question of ‘who should be trained?’ In the context of Sierra Leone with its huge human resource constraints, the reality is that MCHAs and traditional birth attendants are providing the vast majority of care for women giving birth. Currently, the MCHAs are often the only trained health workers in rural areas with limited support, drugs and equipment – they should refer women to hospital if they present with or develop complications. Even when referral to a hospital is timely, there can be delays due to poor road networks and limited transport. My ongoing work in Sierra Leone will be around training both midwives and MCHAs. I believe that in conjunction with training more midwives and creating an enabling environment for health workers through provision of essential drugs and equipment, equipping these frontline health workers with the skills to provide life-saving emergency care for women and babies is important to begin tackling the high maternal and infant mortality rates.

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