Emily Spry on nursing in Sierra Leone

Pikin HospitalThe nurse steps forward into the circle, putting her hands together.  She prays aloud, “in Jesus’ name,” asking that our four day workshop at the Children’s Hospital be blessed, “so that we might put everything that we have learnt into practice.”  After a rousing Christian song, we proceed directly to the Muslim prayer.  Nearly every nurse who clapped, sang and loudly proclaimed “Amen” now turns her palms to the ceiling and intones in Arabic.  Quietly atheist, I vaguely join in with the gestures; luckily no one expects me to know the words.

Such religious tolerance is the norm in Sierra Leone, though I do wonder if my faithlessness would be as well accepted, if I were more open about it.  Either way, I’m sure that this society has much to teach, as well as to learn.  Someone told me that life is so hard here that the wise hedge their bets; mosque on Friday and church on Sunday.  A nurse whose birthday it was told me that she would spend her special day praying that she will see another one next year.  With average life expectancy in the 40s, it is perhaps unsurprising that people in their 30s are nervous.

The last day of our Emergency Assessment and Treatment workshop for the nurses this week coincided with pay day.  The junior nurses receive 120,000 Leones (around 20 GBP) per month from the government for working a six day week.  It’s not enough even to buy rice for an average family for the month, though many nurses are the only breadwinner.  At the Children’s hospital, a charity provides a monthly top-up of a further 50,000 Leones (around 8 GBP), still little more than the average monthly spend on getting public transport to work.

Nurses’ neglecting to come to work at all is a major problem at the Children’s Hospital, particularly at night.  To make ends meet, staff often take part- or even full-time jobs in private healthcare facilities, on top of their government jobs.  The Ministry of Health and Sanitation has central control of staffing, making it hard for the Children’s Hospital to replace those who do not attend.

But, as I consider the small pile of tatty bank notes that the nurses are taking home for the month, I wonder about things the other way around.  While some do not attend, most are there, many working longer than their hours rostered.  Why do they come to work at all?  The Children’s Hospital is trying hard but is chronically under-resourced and treating a poor and sick population; around 1 in 10 children who are admitted die.

As I see it, these nurses are no different to healthcare professionals elsewhere.  Yes, they want to be paid; they need to eat and they have families to support.  But that’s not the only reason they work here.  They are here because of the respect that they get from their community for their skills, even if that means being woken in the night by a neighbour with a sick child.  They are here because of the gratitude of parents when a child recovers.  They are here because they enjoy the camaraderie with colleagues who have also seen life and death and everything in between. 

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.