Mar 2 2009 Western Mail
Angela Gorman, recently in Sierra Leone, reports on how the charity she founded, Hope for Grace Kodindo, plans to help turn things around for the country that suffers some of the worst risks for mothers and their babies in the world
SIERRA LEONE, a country of five million people on the west coast of Africa, is recovering from a brutal civil war.
The country has the potential for vast wealth, with gold and reputedly the highest quality diamonds in the world. Sadly, the civil war and extensive mining has sent the country to the bottom of all the health indices.
Most significantly Sierra Leone is now identified as the most dangerous place on earth to be pregnant.
Poverty is at the root of all the health issues in this most friendly, welcoming, in parts beautiful and yet desperate country.
Our Wales-based charity Hope for Grace Kodindo received a request from the United Nation Population Fund, UNFPA, two years ago to support the maternity service by supplying magnesium sulphate to treat eclampsia, and misoprostol in Chad, Somaliland and Liberia. These drugs help to reduce the risk of postpartum haemorrhage. Eclampsia and postpartum haemorrhage are two of the main causes of maternal death in the developing world.
During our time in Sierra Leone we carried out a needs assessment, identified people who would be prepared to take responsibility for the resources the charity sends them and, most importantly, ensure that the women and families are not asked to pay for the medicines we supply free of charge.
A tour of the Princess Christian Maternity Hospital in the capital, Freetown, revealed an extremely resource-poor environment, including a lack of basic equipment. There was no autoclave – instruments were soaking in sterilising fluid on the wards to be dried and re-used.
On our arrival in the labour ward, we were told that a mother and her baby had died that day.
We noticed a group of staff standing around a cot and when we looked, a baby was laying, lightly wrapped, and not breathing. We were told that he had cried at birth and then collapsed, followed by an attempt at resuscitation. I listened to the baby with a stethoscope, but clearly the infant was dead, adding one more death to the total for that day.
We saw a very sick-looking mother who had given birth to healthy twins. The mother appeared anaemic, prompting the matron to remind the staff to get the family members cross-matched when they visited.
One of the consultants in the reproductive health programme told us that last year, of 2,000 deliveries 121 women had died. In 2007, 141 women had died with four deaths in one day. There was no evidence of how many babies had died.
He told us that the hospital occasionally received magnesium sulphate from the UNFPA but that provision was patchy and there were long periods without the drug. He showed us the path outside his office where he said: “The mortuary trolley is rolled past my window. When I hear that trolley, my heart sinks.”
We also spent a day with student midwives, exchanging experiences and knowledge. In Sierra Leone the midwives have already spent years as qualified nurses before undertaking the 18-month midwifery course.
The tutor told us that every one of the 40-plus students wanted to leave the country when they qualified and work in the UK. A newly qualified midwife earns about £40 a month in Sierra Leone. There was a distinct lack of text books, with most of the lectures being given verbally and accompanied by frantic note taking and there is no internet access.
I had the opportunity to address the class, explaining what Hope for Grace Kodindo hopes to do. I was received with cries of relief when I mentioned providing the medicines to help to reduce the numbers of women dying in pregnancy and childbirth.
Despite being only five months into their training, they recognised the significance of these two drugs.
We also had an opportunity to visit the Marie Stopes private hospital, where a care package costs about $75.
The country director, Martyn Smith, said that in 2008 of 1,000 deliveries they had seven deaths. In two of them the traffic in Freetown had been a contributory factor – a fact that I could understand as I was stuck several times during my short visit.
The private hospital with its oxygen cylinders and an autoclave was a world away from the government establishments.
Sierra Leone is clearly struggling to reduce the rate at which women are dying unnecessarily during pregnancy and childbirth. Poverty is at the heart of the majority of this country’s health-related problems.
In the UK pregnancy and birth are anticipated with joy and positivity. In Freetown, as in Chad and Liberia, I found myself looking at pregnant women wondering whether they would survive the gestation period and at groups of schoolgirls, wondering how many of them would be victims of maternal mortality.
The prospect of any one of these precious individuals and their babies dying for the want of medicines which we, in Hope for Grace Kodindo, can provide leads me to recommend that we initiate the provision of the two main drugs as soon as possible.
Angela Gorman is a neonatal nurse from Cardiff. For more information visit www.hopeforgracekodindo.org
 

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