Salone's frustrations...

This week has been rather frustrating in the medical world of Sierra Leone; frustrating to the point that I have wondered if healthcare here will ever improve. But surely it has to improve. How much worse can it get? The country is already at the bottom of the list with the highest maternal and child mortality rates in the world. There are so many changes needed; big and little. Change for the good, because believe me things are changing but not necessarily in a good way. Don’t get me wrong- of course I always have positive stories too and I still love my work here BUT sometimes it’s discouraging. I wonder if the Ministry of Health needs to open their eyes to what is really going on. Maybe everyone knows what goes on and no one knows where to start. How do you start to change a system that has crumbled to pieces? Which pieces do you put together first? I don’t have answers, but let me share with you what has frustrated me this week…

An adult patient (one of our staff in her early 20’s) with a respiratory rate in the 50s and saturations less than 80% (!) needed to drive around the city to find a hospital with a bed, oxygen and x-ray facility. The MAIN TERTIARY government hospital had an ICU with Oxygen but no bed and another ICU with a bed but NO oxygen. They offered her a temporary bed while waiting for space in the ICU with oxygen, but when you can hardly breathe, that’s just not an option. She ended up in a small private hospital, with oxygen, but the cost of admission is more than a month’s salary! And she still had to go elsewhere for an x-ray

Prices for x-rays are sky rocketing; from one day to the next the price increased from Le 30,000 to Le 50,000 (Le 3,000=$1). Most people couldn’t even afford them at the initial cost due to high unemployment and an average daily wage of $3-5 per day

Patients I refer to the Children’s hospital are charged Le 30,000 for a doctor’s consultation instead of the official fee of Le 15,000

Standing at the gate at 8am having to send away 15-30 patients because the clinic is already full, not knowing if the kids will find decent healthcare elsewhere that's affordable.

Treating a child with Burkitt’s Lymphoma in a government facility is almost impossible due to lack of needed drugs for chemotherapy and high costs and unfortunately the NGO run program has to stop as of this week

One of my kids died; a 6 year old, sick at home for too long, partially treated for malaria by some nurse (given wrong dose of malaria meds), showed up in the clinic on Monday, looked terrible, referred by me to the hospital (no space in the NGO one, so went to government one) but unfortunately died only 5 hours later

One of my referred kids discharged from the hospital on Monday was sent home with drugs that should NOT be taken as an outpatient: a vial of Lasix, a vial of quinine, a vial of powder without a label, an already used 2-day old vial of chloramphenicol. The granny was told to ‘find a nurse near her house and have her give the drugs’. Praise God the child was better, and thank God the granny did not give these potentially dangerous drugs. We threw them in the trash and prescribed the 2 medications he needed in tablet form.

That was just a glimpse of the frustrations & challenges of my work here in Sierra Leone! By God’s GRACE I carry on, and thankfully there are many bright sides to life here as well.