Sierra Leone

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  • TERAPROOF:User:karenfunnellDate:15/05/2011Time:17:17:19Edition:16/05/2011ExaminerLiveXX1605Page: 10Zone:XX1

    10 Irish ExaminerMonday 16.05.2011NEWSXX1 - V1

    11NEWSIrish ExaminerMonday 16.05.2011XX1 - V1




    TEN DAYS IN SIERRA LEONE... for more photos see

    Ishmeall, 17, a patient at SierraLeones only psychiatric hospital inFreetown, and, below, a patient ischained to a pillar. Pictures: Clare Keogh

    Patients feel hopeless and abandoned in hospital from hellISHMEALL is 17. Three daysago, he was brought to SierraLeones only psychiatric hospital.He will be kept here for at leastthree months, chained to a dirtymattress in an open plan ward ifit could be called that with about10 men.A ward consists of soiled mattress-

    es on dirty floors, with a supply ofwater by each bed and a basin toslop out.A tour of the facility is highly dis-

    turbing. The building itself, datingfrom the 1800s, appears decent,however, its facade, hides a grimtruth. Once inside the horror is asreal and visceral as the pungentsmell of urine.The patients women and men

    peer up with dead eyes. Somesay hello, most are too despondentto be able to engage.The men are chained up because

    absconsion rates are high and theyspent their days like this, with nostimulation, no exercise, no daylight.There is a real sense of hopeless-

    ness, and patients are extremely vul-nerable, especially the women whohave no privacy or protection, noteven a light by night to providesome form of comfort.Any sane mind would find this

    place a huge challenge, never minda fragile one in need of care.According to head psychiatric

    nurse Mohamed Juldeh Kanu, whilepatients are only supposed to be ad-mitted for three months, they oftenend up staying much longer.Their families cant cope or do

    not want them. They are abandonedand some end up staying years.Locked up and forgotten.Of those who do leave, many re-

    lapse and end up returning.To say patients at the Freetown

    hospital are treated inhumanely is a

    strong statement, but one the gov-ernment has to acknowledge giventhat patients have no electricity, norunning water, and no therapy.Indeed, visiting the hospital last

    year the deputy minister of healthcalled conditions at the facility de-plorable and expressed seriousconcern over hygiene standards andthe small food rations given to pa-tients.While the dearth of services for

    such vulnerable people have beenrecognised by the government andthe World Health Organisation,tangible change is a long way off.Meanwhile, people are forced toexist inside this hospi-tal-come-prison, with no hope ofrecovery in such conditions.According to the WHO, there are

    400,000 mental health patients inSierra Leone as a result of the brutal

    conflict which dogged the countrymore than ten years ago.A whole generation was lost in

    the war, 50,000 were killed butmany more were maimed or re-cruited, lost friends and family orfled, there was no escaping it and itseffects are still rippling through avery damaged society.Although the WHO has named

    Sierra Leone as one of six countriesparticularly in need of support inthe field of mental health, the factremains only 2% of the mentallyill are treated by professional doctorswhile the remaining 98% are treatedby traditional doctors.Though he is semi-retired, the

    countrys only psychiatrist Dr Ed-ward Nahim still controls how careis administered. Increasingly, dissent-ing voices are beginning to criticisehis traditional methods.Hope has arrived, however, in the

    form of Nurse Kanu. The SierraLeone native returned home under

    a diaspora scheme and has since setup a campaigning group theMental Health Association tohelp get recognition for people withmental health difficulties.My aim is to fight against drug

    abuse, to educate the people in theghettos and set up youth centres sothey will have something to steerthem away from drugs and alcohol.Nurse Kanu maintains the war is

    the primary reason why the patientshere are so traumatised. Most ofthem were probably involved in thewar he says.Walking around the mens wards,

    the majority of them are young in their late 20s early 30s probably.Drugs and alcohol are very big

    issues for us. During the war it wasall given to these young men forfree, now they need to be coun-selled. We are talking about 12% ofthe whole population.But how much one man can do

    in the face of apathy, corruption and

    a country with so many other prob-lems is questionable.With a lack of funding and re-

    sources, the state hospital is barelyrunning.Food is not sufficient, medica-

    tions are not sufficient. There isspace for 300 people here feedingthe 100 that we have at the momentis a problem, we cant keep them.Families often have to bring food

    for the patients, medication oftenruns out and families have to buysupplies.Indeed lack of trained staff may

    also lead to abuses. In the local presslast year it was reported that pa-tients food was being taken bycooks and their relatives leavingthem hungry. They were also repri-manded for drinking alcohol whileat work.According to Nurse Kanu, staff

    training would go a long way tosolving these problems.There is no training, and so no

    recognition for the work peopledo, he said.We need help to train people

    properly, not people from outsidethe country but our own people.And they need to be paid properly.Currently, they are getting abouthalf of what they should be paid.These are people who have 20 or30 years experience but it is not ac-knowledged and their knowledgewill be lost.Unfortunately, although there is a

    great need for workers in the fieldof mental health, the stigma aroundit means it is difficult even to recruitstudents into psychiatry. Until this isaddressed, men and woman willcontinue to be chained up in themental hospital, not because theypose a threat, but because the skillsand resources to deal with them arenot in place.

    Clockwise from top: Esther Koroma, 24, recovers after her child was stillborn at the PrincessChristian Maternity Hospital, Freetown; teenage mother Kadiatu Kamara wonders how she willcope after giving birth to twin boys in the Labour Ward, the Government Hospital Makeni;Zainab Banqura recovers after giving birth to her baby in the labour ward of the GovernmentHospital, Makeni. Pictures: Clare Keogh

    CONDEMNED TO LIFE OF POVERTY AND STRUGGLEIn the slums of SierraLeone, progress is slowas young women facemultiple pregnancies,poor sanitation and alack of hope that theirlives will improve, writesJennifer Hough

    In the hospitalsspecial care unit, a

    young couple wait tobe admitted. Their

    infant looks to be onthe brink of death,but there is no rush

    to assist them

    IT IS eerily quiet in thegloomy wards of the PrincessChristian maternity hospitalin the heart of Sierra Leonescapital, Freetown.There are no crying babies or

    proud new mothers, and far frombeing a vibrant bustling place,there is a melancholy air.Long empty corridors lead to

    basic and unsanitary deliverysuites and wards where worriedwomen lie in wait.Christina Kiakia is waiting. The

    20-year-olds child-like featuresmakes her fear all the more acute.Alone and afraid, she has beenhere, just lying in the dank bareward, for one week, waiting forher baby to arrive. She came, shesays, because she was afraid of thepains in her belly.Christina, like most women in

    the tiny west African nation,knows the statistics.Here, about one in eight women

    risk dying during pregnancy orchildbirth, one of the highestmaternal death rates in the world.About 80% of women in Sierra

    Leone give birth at home withoutconsulting a doctor or midwife.The biggest cause of death iswomen simply bleeding out aftergiving birth. Others suffer hoursor days of obstructed labour.Fewer than half of deliveries are

    attended by a skilled birthattendant and fewer than one infive are carried out in healthfacilities. If and when the womendo arrive at a hospital, often it istoo late.Esther Koroma, 24, has just

    arrived in from the country. Herprevious child died and now shehas had a stillbirth. With the babystill inside her, nurses give herfluids to rehydrate her. Butit maybe too late for Esther.She only lives 30 miles from the

    hospital but on unpaved roads andwith Freetown traffic it could takea half a day to get there.As is the norm in rural areas,

    she was first taken to a traditionalbirth attendant, again delayingproper medical intervention.This is the reality facing women

    in a country where so manychoose to give birth at home withthe help of such attendants,

    people who are thought toactually be contributing to thematernal mortality rate due totheir lack of training.With the government now

    under pressure to reduce the ratesof maternal mortalities, it isunclear what the role oftraditional birth attendants will be,but there is evidence to suggestthey are not prepared to give uptheir way of life and income.Hospital notes seen by the Irish

    Examiner reveals they are nowbeginning to present at labourwards with expectant women.These are people with a lack of

    professional medical training, ithas been proven time and againthey are not a solution to reducingmaternal mortality but acontributing factor to its increase,one doctor noted, saying heconsidered their presence in thehospital illegal.They have caused havoc in

    local communities, they shouldnot be encouraged to work in thishospital as they will cause moredisaster because the moment yougive them a yard, they ask for amile. They are trained from anunknown source, he said.To combat mother and child

    deaths, the government last Aprilannounced a programme of freehealth care for