Alicia, a 20-year-old patient from Freetown, suffered an intrauterine death (her 2nd pregnancy) and was unaware for some time that her baby had died. This is the story that Susan Schulman watched as it unfolded.
“She has already lost the baby and is unable to push. She’s not having anycontractions”, the nurse explains. “The relatives came, brought her in; the doctor saw the patient but the relatives bought only the medicine she needed and one pint of blood and then deserted her abandoned at the hospital, leaving her like this.”
“She needs surgery urgently to save her life and there is no one there to assist,” (ie relatives) the doctor states.
“Dr Thorlie is doing his best,” says the nurse, “to see how to get blood for the operation but at the hospital we only have a limited amount of blood that doesn’t cover the operation. The baby is dead. It is a very large baby. The labour has been obstructed. We suspect a ruptured uterus. This is what we suspected yesterday when she first arrived. The father of the baby has promised to come but he has abandoned her.”
Alicia protests: he is coming.
“The doctor has been waiting all morning for the relatives to come with the drugs but there is no one around. She is bleeding internally, she is very anaemic. She has been in labour for four days. She might have an infection. She needs antibiotics, IV infusion and blood.”
Dr Thorlie (Chief Medical Director, Princess Christian Maternity Hospital, Freetown): “I will see what I can do to save her. Almost everyday, I stay here until 10pm, after operating on a patient, there will be no bed. It is always like this. People don’t come here in time. The TBAs (Traditional Birth Attendants) keep them too long. I am trying to be a bridge and get all women to come to government hospitals not to just use them like emergency rooms but it is a Herculean task.”
“The ADB (African Development Bank) funded the regeneration of the hospital but the job they did both in design and in equipping was very unsatisfactory. There are not enough instruments; there is not enough ventilation. It becomes insufferably hot in here. They built a lift which is effectively useless for us as we have no power. This is a very serious issue. The generators they installed consume about 10 gallons an hour which makes them pretty useless indeed. So, we have power here only for the operating theatres and we can’t use a lot of life saving equipment due to a lack of power and lack of generators."
"The blood bank, the Red Cross, takes blood without paying people for it but few people want to donate blood under any circumstances. There is an irrational fear of giving blood here in this society. People out of ignorance are afraid to do it. And due to the lack of power, our storage capacity is limited: we can’t keep blood long. One of the main causes of infant and maternal death is the lack of blood. Mothers should come here in good time as referrals but instead it is like an emergency ward. They only come in emergencies."
"A lot of doctors and nurses go abroad. But not everyone can go and stay abroad. I trained in Kiev in 1984 and then went to Guinea briefly after the war, but my mother was ill and I wanted to do something for my country so I returned to work here. We have to sacrifice something for our country. Things were much better in 1984."
Dr Thorlie states that he would not kick a patient out for lack of funds (we know from the woman at Rokupa Wharf that she was kicked out into the streets by the nursing staff for exactly not having enough money).
“I have ordered that the abandoned woman (Alicia) be given drugs free of charge but there are simply no drugs available in the dispensary to give her. There simply aren’t any. I have told my staff to break into the gift package from Libya to see if there are any in there to give to her.”
Dr Thorlie, the nurses and I are all stood next to Alicia. Her situation is life threatening. It is distressing to helplessly watch someone die.
Dr Thorlie has explained that the way he runs his blood bank is that the relatives need to replace blood used from the blood bank with their own donations of blood. As such, he says that Alicia’s problem is that given the relatives have deserted her without donating blood, she has no blood. When I pointed out the fact that her relatives might not have the blood type she needed, it became apparent that in fact they were indeed withholding the blood from her. The supply was there.
Although I was acutely conscious that the problems they had outlined were not issues of money but issues of supply, I asked if money might help. They muttered. Clearly, yes. I gave what I had $10 plus about 40,000 leones and remained in the hospital, following her care to ensure she was treated. She was, eventually, taken up and operated on.
Alicia’s baby was removed by c-section. She went into the operation unaware that the baby was dead. It was a boy. A big, healthy baby.
“He died of prolonged labour. He died of poverty,” the nurse said.
Darkness was falling and were are no lights in the hospital. A woman who had given birth at home seemingly unproblematically earlier in the day was brought in the arms of her husband and laid onto the examining table, bleeding. The staff worked by flashlight.
“We work under perpetual darkness. We have had no lights for a month. The government says everything is in good condition but this is the reality.”
A nurse earns 267,000 leones in two years. The doctor says he earns at the top level, which Dr Thorlie is US $400 a month. The fees that he collects from his patients go straight into his pocket. He estimates that this brings his salary level up to $1000/month. The average wage, for those few lucky enough to have a job, is 100,000-120,000 leones a month.
Dr Thorlie states that he puts a lot of care into sewing up the seemingly many ruptured uteruses as he sees as it is a cultural necessity to have many children.
“Children are their insurance when they are old. They are an asset, as they are obliged to look after their parents. And as they can never be sure the children they have will survive, they keep trying to have more and more.”