In January, when I began my work at the health centre in the small town of Mile 91, we saw only ten to fifteen children a day. Today, in April, it is quite different: my colleagues and I are visited in the morning by many mothers, some with seriously ill children. Many are grateful that MSF now supports the health centre, run by the Ministry of Health, in its work. The information spreads quickly in the many small villages.
Our health centre in Mile 91. © MSF
In addition to minor ailments we also see, unfortunately, a lot of severely ill children. They suffer from malaria, pneumonia or diarrhea, with serious complications. Every day I'm convinced again of the importance of my work here. Meanwhile 30 to 50 sick children come daily.
All around us are a total of 28 other small health centres. It is planned that we will begin to support five of these facilities. I have already started training staff in order to improve the quality of the treatments. But the road is still long. Often there is a lack of technical resources or the small health posts run out of medicines before replenishment arrives.
Another big problem: children often arrive at the hospital when they are already very sick, rather than being brought sooner. That’s why we are working together with the decentralised, small health posts, to shorten the distances their mothers have to travel to get the right care. To understand why they often come late, it is important to look at the women’s hard everyday life: in the morning they have to leave for their work on the field, on the market or other heavy work. Their children are left with older siblings or relatives who also have to do household work and can hardly take care of the infants. If the kids - we're talking about babies and children up to five years old - are sick, their sisters / aunts / grandmothers don’t have the resources to adequately care for the fevered little girls and boys.
Often then the children’s conditions can become life-threatening: they get dehydrated and have severe hypoglycemia, (low hemoglobin, which transports the oxygen in the blood). If this happens with a malaria infection, for example, such a development can quickly cost the child’s life. But in the health centre we can usually stabilize the children swiftly. We can give them glucose (sugar) and liquids, but a blood transfusion is not available for us here. Often, however, a blood transfusion is the only chance to save their lives. For this we need to bring the young patients in our hospital in Magburaka. And that is not so easy.
My colleague Carolin (right) and I with the twins Alusine and Hassanatu. © MSF
For the children here in Sierra Leone, an ambulance is generally unavailable. The routes are long and there are no good roads. Only a brown dirt road with many unpleasant potholes leads to Magburaka. Depending on weather conditions the route may take two hours, sometimes longer. The rainy season has started now, bringing heavy rains, and so the streets look like muddy runways.
Another obstacle to rapid transportation to the hospital is the financial situation of the parents, who often cannot afford a taxi or motorbike transport. MSF thankfully takes on the cost if we have to bring a child to the hospital. Nevertheless, it happens again and again that the child arrives with us too late for the help we can offer - that one of these obstacles "wins", and we lose the child. I've learned to deal with it, but still I don’t want to accept it.
But there are also beautiful moments. There are, for example, my twins: Alusine and Hassanatu. Their mother died shortly after birth, and the family has six sons, who have to be fed. The father, a farmer, initially decided not take the babies with him and left them in the hospital in Magburaka.
It touched us all how the father had to fight with this hard decision, but it was about the existence of the whole family for him.
Later on a psychologist of our team and a public contact person spoke empathetically with the father. They made it clear that he loses all rights to his children if he did not want to take them with him. He did not want that, and so he finally brought them home.
The father and grandmother of the twins at a consultation in Mile 91. © MSF
A couple of weeks we have been asking ourselves, how our twins are getting on. And one day, while working in Mile 91, I saw them again. The desperate father and the grandmother told us during the consultation that they cannot afford milk, so the kids had vastly lost weight. They also suffered from skin problems and infection. But they'd come in time. The diseases we could treat with medication, and I was able to take the twins into our nutritional program. Now they come every two weeks and they are developing very well. I am grateful that I can support this and other families through MSF.
The infant mortality rate in Sierra Leone is very high - especially in the first weeks and months of life. MSF can make an important contribution to improving the situation. I am grateful that I can work with my team. From my Sierra Leonean colleagues especially I'm learning a lot about the people here and their lives. I feel lucky that I still have a while left in the project here.