Extreme world: Dying

Sierra Leone hospice Only one hospice, in Freetown, serves the needs of Sierra Leone's dying

On the edge of a small village just outside Sierra Leone's capital, Freetown, there is a line of four or five mud-brick rooms.

Most of the 20 or so residents there - men, women and children - are in real danger of dying from untreated tuberculosis (TB).

But in a hospital in Freetown, just a couple of hours drive away, women are giving birth safely in a country that has been notorious for being one of the most dangerous places in the world to have a baby.

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Sierra Leone is a country that is trying hard to change its image of being a hopeless "basket case".

But it is a country where the challenges are still huge.

It certainly has some terrible statistics. Among those I dug up before my trip here were: an average lifespan of about 40 years compared with between 70 and 80 in rich countries; one of the highest pregnant mother, and infant, death rates in the world; and extreme shortages of health facilities in rural areas.

But every health worker I met on my trip to Sierra Leone, from junior nurses to experienced doctors and managers, said matters were slowly improving.

'So much pain'

In the village outside Freetown, a 17-year-old boy sits on a broken plastic chair.

Saidu Sankoh has advanced TB. Because it was not treated properly, the wasting disease has spread from his lungs to his bones.

Worlds Apart

Graphic

Saidu is now virtually immobile.

He is a bright, articulate boy who learnt to speak good English when he could still go to school.

"The pain is so much," he says. "It makes my bones ache. I sometimes lie here crying softly to myself."

But Saidu feels another sort of pain, too. His mother is blind, yet he cannot help her.

The other pain Saidu feels is shame.

"Look at me," he says, "I am 17, a big boy. I should be able to help my mother. But instead I am sick and I sleep in the same room as her. My little brother of six has to do all the chores."

A few doors along in the row of village rooms, a young woman, Emma Kamara, can barely move.

She has a cough which convulses her thin frame.

John Conteh, a social worker from a nearby clinic who accompanied me to the village, suspects that Emma also has TB.

Tuberculosis is an airborne disease. So Emma's baby, who sits beside her, is in danger of catching it.

And Emma's mother, who was also there, sitting on the rough floor, looks weak - and is already coughing.

If something is not done to isolate and treat these cases, the whole community is in danger of early death.

Drive for improvement

A couple of hours drive away, in the capital Freetown, there is a very different scene.

In a modest hospital maternity ward, Mariama Mansarray is sitting in the sunlight that is streaming through an open window

Mariama and her baby Mariama Mansarray would have died in childbirth had she not had access to medical care

She's pinning a nappy on her baby, Sarah.

"My baby was sideways inside me," says Mariama, "and wouldn't come out."

"I tried the traditional healers in my village but that didn't work. Then someone told me I could come here without paying money. So when they sent an ambulance, I came and had my baby. Here she is."

Dr Michael Koroma, the senior medical officer at the Princess Christian Maternity Hospital, stands next to the bed.

I ask him what would have happened if Mariama had stayed in her village.

"She would have died," he says.

"In many cases in this country, women deliver their babies but then develop complications which cause extreme bleeding. If this is not treated properly, they die," he adds.

Hospice care

A policy of free healthcare for pregnant women was introduced in Sierra Leone two years ago.

The government - with help from foreign governments and aid agencies - introduced the measure as a way of targeting the biggest killer in the country, which, ironically, is birth.

Start Quote

We see the patients every day. They are our friends. Then someone tells you your friend has died”

End Quote Hannah Ngobeh Hospice nurse

In the harsh conditions of Sierra Leone, giving birth is a dangerous business for mother and baby.

So, is it making a difference?

"Yes, I think it is," said Gabriel Madiye, an experienced health administrator. "We have evidence that in recent years the average lifespan has increased from about 40 to around 42 years."

This would nudge Sierra Leone above several other African and Asian nations in the UN league tables for life expectancy.

Mr Madiye runs the Shepherd's Hospice on the edge of Freetown.

It is not a hospice in the Western sense - a place where people can stay and get permanent end-of-life care - but is more like a pain relief centre.

It is a modest place, and relies on financial help from abroad.

And it is the only health facility in Sierra Leone that has a licence to administer morphine - a drug that is crucial for relieving pain in cases of terminal cancer.

It is not an easy place to work in.

"The patients here become our friends," says Hannah Ngobeh, the senior nurse in the hospice.

She's a big woman, a bustling, efficient presence. But she is also gentle and re-assuring towards her patients.

"We see the patients every day," she says. "We go to their houses and get to know their families. They are our friends."

Hannah pauses.

"Then someone tells you your friend has died."

Tender touch

This is certainly an extremely poor country that suffered decades of misrule and military conflict after independence.

Now, by contrast, it has an elected government that is trying, albeit ever-so-slowly, to change things for the better.

Saidu, left, and his mother, right Saidu, left, is too ill to help care for his blind mother

In the maternity hospital I met women with healthy, newborn babies.

Many were rural women dressed in the simplest of clothes. They looked as if they were surprised, and in awe, that they were here in this modern place.

The hospital is modest by international standards. But here the rural women were seeing, many of them for the first time, doctors with stethoscopes around their necks.

The new mothers were listening to nurses in crisp uniforms who were teaching them how best to breastfeed.

And in the hospice I saw Hannah Ngobeh gently hold the hand of a terminal cancer patient. She then expertly administered some painkillers.

If I were dying, I think I would like someone like Hannah Ngobeh to hold my hand.

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