“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.