Settling In - The Task really starts now

Its been 2 weeks since we have been in Segbwema, and we are loving it more and more each day. We had the opportunity to go to Freetown for a few days for a meeting and were longing to go back ‘up country’. We have become comfortable with the night noises and the peace and quiet that comes with a deep rural setting, and were uneasy with the city noises of Freetown. We are well and truly converted.

So, Michael is on full speed ahead at his post as Hospital manager. There’s lots to do here, with challenges similar to regular hospitals, in addition to many other problems. We seem to have a good team to work with, though, they just need to be organised and motivated to develop and fulfill a specified goal. Knowing Michael, the greater the challenge the more exciting the job, so he’s very happy.

Joelle continues to have such a great time. The kids are numerous and we are expecting a few more in December. Our house is always full of children ready to play at all hours (after school ). We have to limit them – once it gets dark everybody needs to find their yard………..

We are still trying to work out child care – the lady we found will need help with house work ( the fetching of water is a day’s work on its own) as well as running after Little J – so Joey needs to be home until this is sorted. Even then she has started her orientation of the hospital and the nursing school. We were pleasantly surprised to find 117 students enrolled – mostly all of them living on compound in addition to some of the hospital staff and their family. So, we feel we are living in what seems like a mini- village. The land space is huge – more than 50 acres - maybe covering more than a mile or two – or more!!!! We haven’t toured it all yet. The problem is that it’s so remote that selling the land would not fetch much, so we have to think of other means – maybe farming to market or to subsidize our needs. I tell you, we are far from being lonely.

The statistics for the country makes grim reading and the midwifery course Joey is asked to coordinate will have to reflect this in its preparation of the students. Death is nearly a daily occurrence here – and one needs to get used to this fact. Delivering macerated babies or watching a mum die from obstructed labour or ruptured uterus is an experience one dreads– so it’s going to take real guts to face a case.

We understand the need to highlight the current situation ( as much as we are aware) of the country, as this will give a somewhat updated picture of the hospitals’ situation.
A networking proposal by Cordaid has described SL as:

‘….from a period of more than 10 years of civil service ..…SL is now one of the poorest in the world with over 50% of the people living in absolute poverty. Large part of the health service infrastructure was destroyed and more than 60% of the health workers stopped working. The health indicators is the worst in the world with maternal mortality 2000 per 100,000 live birth, infant mortality of 170 per 1000 per live birth and an under five mortality of 286/1000 live birth.’

As indicated in an earlier post, the maternal mortality rate feels similar in this hospital. This is not due – as far as we are told - to health professional mismanagement, but to sheer cultural practice of many women finding it easier and faster(roads to the hospital are atrocious) to go to the village Traditional birth attendant (TBA) who have very limited knowledge and resources to deal with complicated and difficult deliveries. The women are usually ‘rushed’ to the hospital at the point of death ( days in labour leading to ruptured uterus’/ post delivery bleeding). So far we have not personally experienced any of this (and pray we will not have to at all) but Joey personally witnessed a case of eclampsia – the woman was having an eclamptic fit. After helping to settle her with medication ( there is no magnesium sulphate in the hospital - she was prescribed and given diazepam), Joey was informed that this was her first baby, she had no antenatal care ( she didn’t visit the hospital for this ) and her only symptom was very bad frontal headache for a couple of days (her blood pressure was in normal range and there was no sign of odema). She was seen in the community by a MCH who referred her immediately to the hospital. She started fitting before delivery, delivered normally and then fitted again. Happily, she recovered ( however slowly) and when we visited the ward she was reported to be able to care for herself and her baby after a few days of being in an unconscious state.

The health professionals are doing their best – there is only 1 midwifery sister( she works every morning shift – except Sunday – and is on continuous call in any emergency) and student nurses who have done basic obstetrics on the maternity ward. We now have 2 doctors and they are also on call 24/7. We cannot imagine working in this kind of condition and pray the hospital management will look into employing another midwife – fast!!!!!!!!! Sister has already implied Joey takes a few morning shifts on Sat. to allow her to have a weekend off, but that is still to be decided. .

The infrastructure is dire indeed – there are hardly any drugs, one blood pressure machine and stethoscope available for the whole hospital (4 wards – male, female, children’s and maternity- and clinics), mattresses are filthy and flimsy, no running water or electricity (the generator is used on surgery days and alternate nights) and one very small operating theatre for every case.

We have started highlighting the need in emails to friends and have appealed for small groups of people to help. There is so much need here that we believe that it would take more than the public sector/ government to help with alleviating some of the problems .
Even with all this limited resources, the hospital’s catchment area covers 100 or more villages and even see people as far away as Freetown. We believe people visit hospitals mainly because of its reputation/cadre of doctors/level of care, and this somewhat explains them trekking more than 100 miles on very very bad roads to be seen here. It says much about this hospital, but we are not surprised as it was rated the second largest in Sierra Leone before the war. At its peak the hospital had 4 Medical doctors and provided both general medicine and specialized services such as eye clinic, Lassa fever research, ( linked with an institution in Atlanta, Georgia, USA) and had specialist TB and leprosy wards. The reputation of the hospital was such that it drew patients from all parts of the country and from neighbouring countries such as Guinea, Liberia and Ivory Coast. Therefore, it has the potential to regain its reputed form. This is not necessarily our goal, but it is close to what can happen in the next few years. We feel this is enough ( distressing) information for now, so we’ll leave the story of the nursing school for future posts.

Thank you for your prayers, we have felt and seen their effects as God continues to watch over us and prepares the hearts and minds of the people here for change. We are comfortable and happy and are convinced that this is the right move for everyone. Continue to pray, esp. for continued good health and strength. With all our blessing and love.
M, J, and Little J