During my time in Sierra Leone from 2005-2009, I often visited the Children’s Hospital in Freetown. At the time I was working in a paediatric outpatient clinic and frequently saw patients who needed to be referred for in-patient care. I had two options at the time: either the emergency surgical centre or Ola During Children’s Hospital.
I opted for the first choice when possible. Mainly because treatment was free, resources were available, the staff was dedicated, and it was only 30 minutes away. It is a hospital run by a non governmental organisation (NGO). At Ola During Children’s Hospital the user fees were high, there was a shortage of medications and consumables, and the staff were unpaid. Therefore they either didn’t show up for work or they showed up but did not carry out their duties. Also it could take up to 90 minutes to reach the hospital because of the traffic. As you can imagine, the wards at Ola During were quite empty, and the death rate was around 15%.
The situation was dire. It all seemed so wrong, yet I could not point a finger at anyone. The doctors needed to collect user fees to subsidise their meagre salaries, the blood bank simply did not have enough blood bags available and the nurses needed to make some extra money to subsidise their salaries, and would sell medications to the patients on the wards at a higher price to make some profit. These people all had families to feed, and they could not manage with such low salaries.
There were of course times when the pediatric ward at the emergency surgical centre was full, and I would have to refer patients to the children’s hospital. This always worried me. I was never sure if the patients could afford treatment and if the medication needed would be available, and there was no oxygen.
Fortunately, on my return to Sierra Leone, and more specifically since I have been based at the Children’s Hospital, I can see that Ola During Children’s Hospital has improved significantly. It has even had oxygen since last year.
The Welbodi Partnership introduced a triage system and opened an emergency room in November 2009. This project has proved to be a great success and although the ER may seem basic, it has definitely increased the standard of care. An emergency case arriving at Ola During is now sent directly to the emergency room, staffed by a doctor and a team of nurses 24 hours a day and supplied with emergency drugs, consumables, and equipment. The equipment, consisting of digital thermometers, a pulse oximeter, and two oxygen concentrators is basic and limited but a huge step forward in delivering quality care. There are also two oxygen concentrators in the intensive care unit. The ICU at children’s hospital is not a unit with a lot of equipment, monitors, and alarms, but more like a ward with the sickest patients and a slightly higher ratio of nurses to patients.
On 27 April 2010, the free health care initiative was launched by the president of Sierra Leone, meaning that all children under 5 years old, pregnant women, and lactating mothers are to receive free health care. The implementation of such a large-scale project entails many challenges, but it is a big step forward. Currently children under 5 ( >95% of the in patient population) are receiving free health care, which includes free consultations, medication, consumables, laboratory tests, x-rays (at another facility), and blood transfusions. Outpatient consultations have doubled, and in patient admissions have increased by 25%. The staff has had to work very hard and it has been stressful for them. But it does look as if people realise their free care is here to stay, and numbers in outpatients have fallen a bit. Free care is a step in the right direction, but there are challenges too. The biggest probably being the supply of medication and consumables.
Finally, before free health care, healthcare workers went on strike, demanding a higher salary. I think doctors were being paid $100 a month and nurses $50 per month. They knew their work would become even more demanding and wanted to get paid for work done. The 11 day strike was successful in the end for the healthcare staff, and the government agreed to increase salaries contributing to higher staff attendance and greater dedication to work.
When I arrived in the beginning of June I was impressed to see the once empty wards now bustling with patients, the emergency room up and running, four oxygen concentrators providing children with oxygen, a neonatal unit full of newborn babies doctors present at the hospital 24 hours a day, and patients with proper charts. In my eyes, the situation, has greatly improved since June 2009, but of course, we still have a long way to go.
Sandra Lako is a doctor from the Netherlands who previously spent 4 ½ years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK-based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.