Tell God Tenke

First few days of work have been great - I came here with the intention of interviewing at least 50 women and I’ve already interviewed 30. A typical day starts at 7am when we wake up, bathe, eat whatever we can and leave by 8:30. Depending on traffic and the location of the hospital, we usually arrive at the hospital between 9:30am and 11:00am. At the first hospital, we had to wait forever to see the Medical Superintendent before being told that we would have to travel to the Ministry of Health in order to get authorization to carry out the questionnaires.

The way I collect data is by travelling to maternal facilities in Sierra Leone and reporting on the medicines, staff, equipment, and utilities available at each of the facilities. In addition to this, I interview women who are at the facility and who have given birth to find out what their experience was like, their socioeconomic information, their living conditions and I record an extensive history of previous pregnancies. This information creates a map that can be used to note trends and changes since the free maternal healthcare policy was passed by the Sierra Leonean Ministry of Health.

Frankly, believe that the Sierra Leonean government is actually holding the people back. Going to the office, we waited 15 minutes to see the Deputy Minister of Health. After explaining why I was here and what I wanted to accomplish, he gave permission for the letter to be written (a letter that was quite similar to the letter of consent I typed and would read to each patient). However, from the time that he left and told the secretary to type the letter (the letter couldn’t have been more than 1 paragraph), to the time that I actually received the letter, was about an hour and a half. During this time, I waited and waited and waited and watched as Ministers came into his office to talk about their day, as secretaries stood around drinking tea and talking and as people who needed to see all these people waited outside in the heat. There was no urgency, no sympathy for us, and if I asked what was taking so long I was considered rude and sent back outside. It seems as though the people in the high offices do little more than what is required of them to help those that are struggling in the streets of Salone. Nonetheless, that day I managed to interview 7 women at Kingharman Government Hospital. I love interviewing the women because each one has their own story to tell. My Krio isn’t up to speed yet so I have Mohammed translate for me, as many of the women don’t speak English. One time, I tried to administer the survey on my own; the woman I was interviewing could barely answer the questions due to how hard she was laughing at my Krio.

The sample is an interesting one however; many did not go to school and many more live in poverty. Most don’t own a toilet that flushes and don’t know that they shouldn’t cook outside in the vicinity of the pit latrine. When talking to the pharmacists they are so passionate about the work they do, but discouraged because they do not have the help they need. When working without constant light (no one says electricity in Salone), they cannot do their jobs adequately and when there is no air conditioning they fear that the drugs will denature and be rendered useless. There is also a lack of space in most of the hospitals – a couple has converted neonatal wards into delivery rooms that also serve as storage rooms for the medicines. From what I’ve seen though, the Free Maternal Healthcare policy is doing a great job at convincing women who would normally give birth at home to give birth at a proper clinic or hospital. The challenge remains twofold: (1) to regain the trust of those who continue to visit Traditional Birth Attendants (TBAs) despite having access to free care, and (2) to help support the hospitals so that they are able to provide for the increase in patients without losing quality service. This of course requires money that Sierra Leone does not have, or if it does, has not allocated for this purpose.

So far I’ve only been in the city of Freetown, but next week I’ll be travelling to Bo, Kenema, and Makeni to interview women in the rural regions and to gather data on the facilities out there. Those are the frontlines of the maternal mortality war as accessibility to advanced healthcare facilities is extremely hard. The roads make it nearly impossible to transport women from villages to the nearest emergency hospital and before the Free Healthcare policy was passed, women were discouraged due to the cost of transportation and the fee per service. Hopefully though things have changed in those regions, either way I’ll find out sooner or later.

ALSO,

On our way to Princess Christian Maternity Hospital we travelled through some rough parts of Freetown. The first obstacle was the cab driver who recognized that we were foreigners and attempted to charge us double the fare even though we had travelled half the distance compared to the other passengers. Mohammed blew up over this. We backed up traffic as Mohammed told us not to pay him the extra money and called, excuse me- shouted, that the cab driver was a criminal. If Jordan hadn’t put the money into the cab driver’s hands then there would have been a brawl (I’m sure Mohammed would’ve whipped his legs though). Anyway, passing through to get another cab we noticed a mob forming on the other side of the street. Apparently a thief had tried to steal somebody’s bag and didn’t make it away fast enough so the people were exacting justice on him. Sierra Leone Police officers are few and far between and the crowd clearly knew this as they were going to work on this kid. In the middle of the crossfire, a stone hit a car and the driver got out and got involved in the brawl. I saw at least 3 sucker punches as other teens who weren’t even involved wanted to fight as well. We tried to move away but the mob literally picked up the thief so that he couldn’t move and continued to whip him down the entire street. About 10 minutes into the fight and 30 yards down the street we saw A SINGLE POLICE OFFICER attempt to break up the 20 man mob. Obviously this failed. We lost track of the mob as we got into a cab but I’m sure if the cop hadn’t come they would’ve killed the boy. From the minute I got to Sierra Leone people have been telling me to watch out for thieves and to make sure I always wear my bag in front of me and to make sure I don’t take out anything nice in public and to, essentially, put all my money between my buttcheeks. Poverty drives people into crime, and in Sierra Leone there is an abundance of both.