![\"Pikin](\"http:\/\/www.bmj.com\/columns\/icons\/pikin_hospital.jpg\")
Despite my best efforts, I seem to have ended up with four sick babies and a mother with an infected Caesarian wound, all of us stranded in an unused wing of the fanciest hospital in Freetown.<\/p>\nDespite my best efforts, I seem to have ended up with four sick babies and a mother with an infected Caesarian wound, all of us stranded in an unused wing of the fanciest hospital in Freetown.<\/p>\n
It all started on Wednesday when the doctors and nurses went on strike across the capital.\u00a0 As I have noted before, doctors here are paid around $100 per month and nurses around $50 per month, not enough to live on in Freetown.\u00a0 After the strike was called, there was a flurry of phone calls and between myself, two German NGO nurses, the VSO doctor and an experienced neonatal nurse, who also volunteers almost full-time with me for the Welbodi Partnership.<\/p>\n
The gut reaction was for us to step into the breach at the Hospital. At least to review those who were too sick to be discharged and field the Emergency cases. To be heroes.<\/p>\n
But there were lots of questions.\u00a0Safety for one; VSO ordered its volunteers to stay away from the Hospitals, as there could be risks in a situation with angry staff and patients.\u00a0In fact, no trouble
\nmaterialised, but it wasn\u2019t an outlandish concern.<\/p>\n
Secondly, and more complicated, the question of whether we should interfere with the healthcare workers\u2019 decision to shut the Hospital down.\u00a0Who were we to go against their decision? The healthcare workers know the implications of what they are doing; patients will die.\u00a0 But they feel strongly enough that the upcoming abolition of user fees (the President\u2019s Free Healthcare Initiative) cannot and will not work if their conditions of service are not improved to fill the
\ngap left by user fees.\u00a0 They feel that this is their only chance to force the Government to meet their demands.<\/p>\n
This also leads on to what our role should be here.\u00a0The Welbodi Partnership\u2019s approach is to form a long-term relationship with the Hospital that will bring slow but, hopefully, sustainable improvement. \u00a0Breaking a strike is a strategy that could seriously damage important relationships and raise questions about our role.<\/p>\n
After long discussions and advice from my boss, all of this led to me staying away on Wednesday and I had a prior engagement speaking at a conference on Thursday.\u00a0But by Friday, I felt that it was time to go and have a look at what was going on.<\/p>\n
In retrospect, it seems that the best way to deal with an insoluble ethical dilemma is to stay as far away from it as possible.\u00a0 As soon as I got into the Hospital, I was sucked right back in.<\/p>\n
When the strike was called on Tuesday evening, the staff had discharged most of the children, with only the sickest remaining.\u00a0 By Wednesday, there were less than 30 patients left, gathered in the ICU. \u00a0Somehow, the German nurses and another volunteer ended up caring for these patients between them, with an occasional doctor review. The Military sent a nurse to relieve them on Thursday night.\u00a0 The Head of the Hospital forbade further admissions (not that the skeleton team
\ncould have handled it) and all patients were turned away at the gate.<\/p>\n
By the time I arrived on Friday morning, they were exhausted. Some senior nurses were also murmuring about why the Hospital was still open three days after the strike started. So, with the Prof\u2019s help, we swung into action, reviewing, discharging and ringing around to try to find Hospitals that would take some of them.<\/p>\n
The Military Hospital generously accepted some patients and we discharged several more. But we were left with four sick babies, all on IV drugs, two of whom were dependant on oxygen. The manager of a private hospital offered us a room with some beds, but had no extra staff; he had already taken around 15 surgical patients from the main Hospital in town.\u00a0 There was talk of a\u00a0 general strike at the Children\u2019s Hospital, so the security and porters would be gone by Monday.<\/p>\n
Late on Friday night, we ended up cramming four cots, an oxygen concentrator, boxes of drugs and equipment, four babies, mums, aunts and grandmas and all their stuff into two cars. A friendly local policeman agreed to lead our strange convoy through town on his police motorbike, haring down the middle of the traffic, flashing and beeping (we have no oxygen cylinder, so we needed a quick transfer for the babies dependent on oxygen).\u00a0 I have never crossed traffic-clogged Freetown at such a pace.<\/p>\n
I also never quite imagined myself in this situation, especially in my non-clinical role with the Welbodi Partnership.\u00a0I tentatively think that we have done the right thing.\u00a0We made sure that the children already admitted to the Hospital were cared for appropriately, though we didn\u2019t accept any new cases.<\/p>\n
There is no doubt that sick children will die because of this strike. But I am not here to break the strike of the Sierra Leonean doctors and nurses whose duty it is to care for those children.\u00a0 I believe that I am here to try to help them build a system whereby all children have a better chance at life-saving healthcare.\u00a0 And paying doctors and nurses properly is a must for that to happen.<\/p>\n
But it\u2019s a bit of a minefield, to say the least.\u00a0As I write this, I do wonder if it will sound insane or just plain wrong from another perspective.\u00a0Do please let me know.<\/p>\n