During my time in Sierra Leone from 2005-2009 I often visited the Children’s Hospital in Freetown. At the time I was working in a pediatric outpatient clinic and frequently saw patients who needed to be referred for in-patient care. I had two options at the time: Emergency Surgical Centre and Ola During Children’s Hospital.
To be honest, I opted for the first choice when possible. The main reasons were because treatment was free, resources were available, staff was dedicated and it was only thirty minutes away. It was an NGO run hospital. At Ola During Children’s Hospital the user fees were high, there were few medications and consumables available, staff was not being paid and therefore either not showing up for work or showing up but not carrying out their duties and it could take up to ninety minutes to reach the hospital due to traffic. As you can imagine, the wards at Ola During were quite empty and the mortality rate was around 15%.
The situation was dire. It all seemed so wrong yet I could not point a finger. The doctors needed to collect user fees to subsidize their meager salaries, the blood bank simply did not have blood bags available to give them away and the nurses needed to make some extra money due to poor salaries and so they 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 do that with their low salaries.
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’s Hospital. This always concerned me. I was never sure if the patients could afford treatment and if the medication needed would be available. Also there was no oxygen. Patients needing urgent blood transfusions were stressful because it was often hard to get relatives to donate blood and the families often did not have money for blood bags, giving sets, etc. I helped where I could but it was always a dilemma to figure out which patients needed assistance and how much money they would actually need.
Fortunately, on my return to Sierra Leone, and more specifically since I am now based at the Children’s Hospital, I can say that Ola During Children’s Hospital has improved significantly. Yes, there is still a long way to go and many improvements can still be made, but I can assure you that significant changes have taken place in the Children’s Hospital.
First of all, during my last year in Freetown, the hospital had oxygen.
Secondly, the Welbodi Partnership introduced a triage system and opened an Emergency Room in November of 2009. This project has proved to be a great success and although the E.R. may seem basic when compared to a Western Emergency Room, 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 twenty-four 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’s 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 nurse-to-patient ratio.
Thirdly, on April 27, 2010, the Free Health Care Initiative was launched by the President of Sierra Leone, meaning that all children under five years old, pregnant women and lactating mothers are to receive free health care. As you can imagine, there are many challenges in the implementation of such a large-scale project but it is a big step forward. Currently children under five (which makes up >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%. Needless to say, the staff has had to work very hard and it has been stressful for them. It does look like people realize Free Care is here to stay and numbers in outpatients have come down a bit. In short, free care is definitely a step in the right direction, but there are definitely challenges as well. The biggest challenge is probably the supply of medication and consumables.
Finally, prior to Free Health Care the 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 eleven-day strike was successful in the end for the healthcare staff and the government agreed to increase their salaries contributing to higher staff attendance and more dedication to work.
When I arrived in the beginning of June I have to say 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 neonates, doctors present at the hospital twenty-four 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.
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