Monday 17 February 2020

Risks


“If u feel fo born, come na di big hospital fast-fast, na Lion Heart. U have risk fo bleed!”

Every Wednesday during our antenatal care screening, I repeat this sentence several times. We tell pregnant women that have already given birth more than four times to come give birth for free at our hospital. We know that they have an increased risk to bleed heavily during their delivery, and hope that the free treatment (including sterilization, if they want) can persuade them to deliver with us. But if it went well four times at home or in a small health center, why would you suddenly come to a hospital for the 5th or even 7th baby?

Risk is a tricky concept. We often hear it: if you do this or that you have a high risk to get problems. But risks always seem far away until it is you that gets the problem. Until the risk is suddenly your reality.

In Sierra Leone statistics get a face very quickly. Sierra Leone has one of the highest rates of women dying during or after child birth. It has one of the highest rates of children dying during their first years of live. It has low education rates, high unemployment and all sorts of infectious diseases flourishing freely.

During my first weeks working here, it was mostly the under 5 mortality that became harsh reality for me. Every week several children less than 5 years old died, most from complicated malaria. They were carried in by their parents looking weak, pale and barely alive. Parents bring their children so late, that often while we are trying to give the emergency treatment, the children die under our hands. Malaria can be treated very well, but if left untreated, the parasite can destroy almost all of a child’s blood within days. By the time these children come to our hospital, even the time it takes to crossmatch for a blood transfusion can be too long. But for all the children we lose, there are several we can save. We try to educate the mothers about malaria, about the importance to come early with a sick child. We look again at our protocols, we practice and drill our checklists another time, and we try again.

During the past months, it was a different kind of risk turning into reality that shook me to my core. A fellow tropical doctor, working in a hospital not very far from us, died from an infection he got while trying to save a life of a pregnant woman. The chance of getting the virus he got is very, very small where we work. It is understandable that he did not think of it, and the choices he made were choices I would have also made in the situation he was in. As tropical doctors, we are a small community with similar values and dreams, we choose to take small and sometimes big risks while working towards the fulfillment of the right to health care for all. But when one of us who so enthusiastically fought for that which we all believe in dies, it is like a bad nightmare becoming reality.

But we know, I know, it was not for nothing. We don’t save lives with every move we make. We are not always fighting death. We are fighting a shortage of health care personnel, a shortage of health care knowledge and training. By trying to fill some of the enormous shortage of doctors in Sierra Leone, but even more so by teaching the staff on all levels. And even the smallest thing that is taught, the effect might echo further than even I myself might realize. The work is so essential, so necessary, and in Sierra Leone unfortunately still very urgent.