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During my time in Sierra Leone from 2005-2009, I often visited the Children\u2019s 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\u2019s Hospital.<\/p>\n
I opted for the first choice when possible. Mainly because treatment was free, resources were available, the staff was dedicated, and it was only\u00a030 minutes away. It is a hospital run by a non governmental organisation (NGO). At Ola During Children\u2019s Hospital the user fees were high, there was a shortage of medications and consumables, and the staff were unpaid. Therefore they either didn\u2019t show up for work or they showed up but did not carry out their duties. Also it could take up to\u00a090 minutes to reach the hospital\u00a0because of\u00a0the\u00a0traffic. As you can imagine, the wards at Ola During were quite empty, and the\u00a0death rate was around 15%.<\/p>\n
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.<\/p>\n
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\u2019s 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.<\/p>\n
Fortunately, on my return to Sierra Leone, and more specifically since I\u00a0have been\u00a0based at the Children\u2019s Hospital, I can see that Ola During Children\u2019s Hospital has improved significantly. It has even had oxygen since last year.<\/p>\n
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\u00a024 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\u2019s 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.<\/p>\n
On 27 April 2010, the free health care initiative was launched by the president of Sierra Leone, meaning that all children under\u00a05 years old, pregnant women, and lactating mothers are to receive free health care. The implementation of such a large-scale project entails many challenges,\u00a0but it is a big step forward. Currently children under\u00a05 ( >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\u00a0as if\u00a0people realise their free care is here to stay, and numbers in outpatients have\u00a0fallen 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.\u00a0<\/p>\n
Finally,\u00a0before 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\u00a0greater dedication to work.<\/p>\n
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\u00a0newborn babies\u00a0doctors 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.<\/p>\n