Do you know the statistics for maternal and child mortality where you live?
“Maternal mortality” refers to women who die from causes related to pregnancy and childbirth. If you look the statistics up online, chances are you will find they are much lower in your country compared to Sierra Leone, which has one of the highest rates in the world.
This is the reason why Médecins Sans Frontières / Doctors without Borders (MSF) runs a paediatric hospital for children under the age of five in Kenema district, in the east of the country. To add to the 98 beds we currently have for children in need of emergency care, last month we began building a maternity and neonatal unit to help address maternal mortality.
Now, what do you do if you or one of your family members are sick?
For many of us, it is simple, we may wait a few days with the hope of getting better, then we go and seek medical attention. For many people in Sierra Leone, it’s not that simple, especially if they live in a remote village where there is no health facility at all.
In places without health facilities, one or two people are selected by the community to provide volunteer health services for the whole village. They are called community health workers and are trained by the Sierra Leonean Ministry of Health and Sanitation so they can provide rapid tests for malaria, as well as treatment for people who have malaria, pneumonia and diarrhoea.
Hills, broken bridges and rocks
But sometimes people need more care than the community health workers can give. These patients with more severe symptoms have to be referred to medical clinics, which can be 10 km away or even more.
One could argue that 10 km is not a long distance to go and seek medical attention, but if the sick person or their caretaker lacks the means or money for transportation, they will have to travel by foot. If you’re very unwell, and you have to walk, then 10 km is a lot! Add to that the road conditions, with hills, broken bridges and rocks and it’s clear why people can be delayed or put off from seeking healthcare.
Memories of Ebola
In Sierra Leone, people had a tough time with the civil war, then the Ebola outbreak that started in 2014 claimed thousands of lives, including many health care workers. Now when things are finally improving, the COVID-19 pandemic happens!!
As the number of COVID infections in the country is slowly rising in Sierra Leone, the devastating experience of Ebola has led to a mix of fear and anxiety.
Right from the beginning of COVID, we could feel the tense atmosphere in Kenema. The streets are quieter than usual, and hospital had fewer admissions as people feared going to a health facility. Some people would hide their sick children during our mobile clinic, for fear that we would want to take them to a hospital.
Rumours began to spread, with many people fearing that they would not survive the weekend, or that COVID is worse than Ebola and everybody is going to die from it.
As a health promoter, all this is a big challenge for my team! It takes a lot of discussion and meeting with the community for them to understand our purposes of treating the sick children and the fact that hiding them will led more damage to their health, especially if they have malaria.
Road to the mobile clinic
A “mobile clinic” is just what it sounds like: instead of waiting for people to come to us, we get in the car and go to the people!
This gets more difficult when there is a heavy downpour of rain and the road conditions get worse. The car wheels can sink into the mud and sometimes we have to get out and walk. And when we reach a narrow path with cars and motorbikes coming from opposite directions, it becomes a tough game. Sooner or later, someone may end up tumbling over the side of the road into some poor farmer’s field. It takes patience and perseverance to pass through this kind of road.
Sometimes the roads are blocked by fallen trees after strong wind and rain the night before. Some roads are filled with different sizes of rocks to the point that the vehicle becomes very jumpy and the driver asks us to “hold tight”.
Thanks to the powerful engines of the Land Cruisers and highly trained and skilled drivers, we always arrive safely at our destination. But then, I would not forget the countless times I’ve said “Oh my God! Our car is flying!” both in English and Burmese during the whole bumpy ride.
Playful and healthy
One of the challenges as a health promoter is to see many children struggling at an early age. On one of our mobile clinic visits to a remote village, I met a family with a two-month-old baby who was severely malnourished, and finding it hard to breathe.
For this child, things could get worse at any moment. We knew he’d need to be treated in the MSF hospital – his symptoms were severe and he needed more care than we could give in the community. As we travelled back to the MSF hospital in the car, it hurt me seeing the child breathing so heavily; his ribs going up and down.
The sight made me think of my two nieces and nephew of two, three and five years old who are very energetic, playful and healthy. I thought about how much my brother and sister hate to clean up the mess they make, but also suddenly become worried if they stop playing and get sick.
Although I am not a parent, I can understand how devastating and exhausting it must be to watch your usually happy and energetic child getting sick.
Two weeks later, this two-month-old was discharged, and I saw how much his condition had improved. The smile on his mother’s face gave me a hope that he will grow up to be as playful and as healthy as any other child.
I suspect it is the hope and the dream of all parents across the world to see their child growing up healthy and successful. The rough road will never stop us fulfilling the hope of the parents in Kenema, and perhaps we could say our mobile clinic is “Hope on wheels”.