Today March 8th is celebrated as International Women’s Day all around the world. This year’s theme is “women in leadership – achieving an equal future in a covid-19 world.” There is no equal future where a woman’s life will be cut short due to childbirth and other maternal health issues. Someone who gives life does not deserve to die in the process. Today on women’s day let us talk about maternal health in Sierra Leone. So we go by the general theme this year which is “choose to challenge” we challenge you all that no woman should die due to childbirth. We strongly believe that maternal health is something that should be championed by every gender. Women have carried the continued existence of the world for far too long. If the future depends on female reproduction then all hands must be on deck.
This is a topic I have been avoiding for so long because it touches the deepest part of my heart. In 2011, I lost a dear friend and colleague to maternal mortality at the Princess Christian Maternal Hospital and that experience scarred me for life. Her death was preventable, the placental did not follow immediately after delivery, we don’t know what they did to salvage that situation. She eventually died at 23 years of age. I will remember it for the rest of my life. This year we will be celebrating her tenth death anniversary, ten years just like that.
Therefore to celebrate women’s day this year we went to PCMH to interview a gynaecologist on the state of affairs.
Interviewers: Tell our readers about self
DVJC: I am Dr Valerie John-Cole, obstetrician and gynaecologists at the Princess Christian Maternity Hospital (PCMH) popularly known as Cottage Hospital. I work there in the capacity of a specialist obstetrician and gynaecologist. I have worked for five years as a specialist but a total of eleven years as a doctor in the maternity hospital.
IV: What are the common health issue among women in Sierra Leone?
DVJC: The common complaints are numerous but as a gynea, I’ll say; infertility issue is the most common, then fibroid that is otherwise known as uterine myoma is also becoming prevalent among women of childbearing age; menstrual irregularities caused by Polycystic Ovarian Syndrome (PCOS); cancer is also on the rise affecting women of all ages, women who have reached menopause sometimes wake up to bleeding and when the test is done it will be discovered that the bleeding was due to cancer; there is also the issue of sexually transmitted diseases (STD) and Urinary tract infections (UTI).
IV: What is the most effective form of birth control?
DVJC: Birth Control is also known as contraception or anti-conception. It is a method or device used to prevent pregnancy. The most effective form of birth control is abstinence. This is so because each form of birth control has a failure rate, we have had incidences of patients who are on birth control but end up getting pregnant. Another problem here also is that most people do not do consultations to know which birth control works best for them. Before birth control is prescribed for a patient, past medical history and present medical information must be reviewed to know which one works best. Some people do well with the pill, some with condoms, others with implants, some are better off with depo etc. Therefore, a proper examination should be conducted before any prescription. But what is common in Sierra Leone is that most people follow the advice of their peers, and do get these birth control methods over the counter without a prescription. The most effective depends on the patient’s clinical history.
IV: Do birth control have side effects?
DVJC: yes, of course, each one of them has its side effects, take for instance Intrauterine Device(IUD) what we commonly call coil; if it is not properly fixed it can lead to bleeding, infections, blocked tubes and or ectopic pregnancies. Other side effects of birth control methods are; nausea, bloating, withdrawal symptoms (small amount of blood or spotting), menstrual irregularities, mood change caused by hormonal imbalances, etc. Each of these methods has a side effect.
Iv: Have you ever had a patient who has reached menopause but experiencing bleeding?
DVJC: Yes! We call it post-menopausal bleeding. In most cases, it is due to cancer( cervical cancer, endometrial cancer) but there are other causes. Let me use this medium to tell each and everyone out there with parents who have reached menopause, to see a gynea immediately they start seeing blood. It is also important to note that any form of smelly discharge should also be a cause for concern and to visit a gynaecologist immediately. Because in most cases it starts with smelly discharges and they stay home until it gets to the point of bleeding. Other times post-menopausal bleeding can be caused by polyps. Polyps are ball-like structures that grow on the inner lining of the uterus. Polyps can sometimes be malignant growth that can be cancerous. Menopausal bleeding usually happens rarely with older women.
IV: Can you tell us what fibroids and ovarian cyst are and if they are the same thing?
DVJC: No! They are not the same, even though they have some similarities they are different.
Fibroids are unusual growths that develop in or on a woman’s uterus. Sometimes these tumours become quite large and cause severe pain and heavy periods. This growth can be benign but non-cancerous. Sometimes, it can be corrected through a surgical procedure.
Ovarian Cyst- are fluid-filled sacs or pockets in an ovary or on its surface due to ovulation. Many women have ovarian cysts at some point. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatments. However, ovarian cysts especially those that ruptured – can cause serious symptoms.
IV: What are some of the challenges you face in the health care systems in general and how does that affect women’s health and maternal mortality?
DVJC: Hmmm, the challenges are many, some of them affect the health systems generally, and some are peculiar to our facility.
I am sure you may have read a tweet in recent weeks about the lack of water in our hospital. Yes, we do have a regular supply of water now from Guma since the tweet went viral, but even that is not sustainable. Somedays the water finishes at night and we go the whole night without it until we have a supply in the morning. In instances where we have to perform overnight surgery, what do we do? That is a major challenge.
Another I’ll say is the lack of human resources. When we talk to our colleagues overseas, we find out that they have teams made up of over thirty personnel. Here we have a team of five people to work the whole. What if you have to perform ten caesarean sessions? By the time you get to the fourth or fifth, you are tired and when you are tired you cannot work as effectively as you should. The most important thing is that these operations cannot be deferred because most of them are emergencies.
Logistics and supply is another challenge. For us who work at the free health care section, the supply of resources is not commensurate to the influx of people. Supply is never enough sometimes we have to put our private resources into the job.
A conducive working environment again is another factor. No sustainable electricity, medical supply not available, no proper coordination, e.g even our blood banks do not have a single drop of blood. Before now we used to have a policy that each pregnant women should donate blood, but due to some legislation, that policy was scrapped. If you go to places like Aberdeen women centre they religiously follow that policy and they always have blood for patients who need it. These are some of the reason why Sierra Leoneans abroad do not want to come back to work in the medical sector.
Limited space is another issue. The fact that our facility is small, and we are now catering to more than the number of people it was built for is a problem. It was called a cottage because it was built for a small number of people. Now with the free health care, there is a large influx of patients. It should no longer be a cottage. Another reason is that some other health clinics are not equipped to handle all the health issues, thereby causing the influx of patient at our facility and we can’t efficiently cater to everybody
Demotivation: The staff are demotivated, the salary is nothing to write home about. In other countries doctors have on-call allowances, here we don’t have perks like that and this is contributing to brain drain. Medical personnel are diverting to public health and avoiding the clinical aspect of the job. Others are leaving for greener pastures abroad and even other private facilities within the country.
Finally, the lack of public health education by most people, especially, pregnant women. A large number of them do not show up to the hospitals until they are in their second trimesters.
All of the aforementioned are challenges that affect maternal health directly or indirectly. Each of them weakens maternal health care in the country.
Interviewers: would you say the health care situation in the country is improving or deteriorating?
DVJC: This is difficult to tell because in some areas there are progress but the deterioration in other areas will derail and override all the efforts or progress that has been made in some. Until we stop recording the death of pregnant women in high digits or incidents of child mortality, we cannot claim any progress. For now, PCMH is being highly supported by an NGO and if that NGO decides to pull out there will be serious implications. This place will be left completely naked and exposed.
IV: So what are your expectations, recommendations, and advice?
DVJC: We look forward to days when we will have a proper hospital setting, where both patients and doctors will be satisfied working or using the facility. If Patients know that when they go to the hospital they will get efficient and effective service delivery they will be excited about their visits. Doctors and nurses are motivated to work, money is important but it is not all we need. The working environment should be conducive, medical supplies must be always available and enough. We hope to have a twenty-four-hour functional lab for investigation and diagnosis. For instance, if a patient needs a CT Scan we will have to refer such a patient to private institutions like Ramsey and Ecomed. Since these services are not available in government hospitals, and the cost can be a burden to some patients, considering the economic situation in the country. We need twenty-four hours running water( pipe-borne), twenty-four hours electricity (it is high time hospitals have special electricity line). We should have a rich blood bank, blood is essential when a patient needs blood nothing can substitute that. You will be surprised to know that emergency hospital gets medical supplies from government, but we either don’t get the same supply or we just have a broken hospital system here. All of us have to do more, government, health workers, and even you people blogging. We should all do more in raising and creating awareness and education for more people.
IV: Thank you so much for your time, Doctor Valerie.
Conclusion: Sierra Leone has one of the highest (if not the highest) maternal mortality rate in the world. A UNICEF report of 2019 indicated that 1360 mothers die in every 100000 live births. The mortality rates of neonates, infants and children under five are also amongst the highest globally at 34, 82, and 111 deaths per 1000 live births, respectively. These staggering figures represent the real and pervasive challenges women and children face in Sierra Leone with poor healthcare practices and sub-standard and ill-equipped health care facilities.
Dasalonetiti Rahima and Juliana Sesay