World Agenda

Last updated: 3 february, 2011 - 14:25 GMT

Fairly reflecting death in Sierra Leone

Doctors say Mariama Mansarray would have died in childbirth had she not had access to medical care

Doctors say Mariama Mansarray would have died in childbirth had she not had access to medical care

BBC International Development Correspondent Mark Doyle describes the challenge of evenly representing death in Sierra Leone by balancing human stories and raw statistics for the Extreme World season.

"Sierra Leone is the world’s worst place to die."

With that bold and rather grim assertion, I was despatched to a country I have been visiting for more than 20 years to do the 'worst' side of dying for the Extreme World season.

But I had my misgivings. Certainly the statistics were clear enough. Infant and maternal mortality rates in Sierra Leone are appalling – some research says one in seven women die in childbirth.

And the average lifespan there is horribly short. United Nations figures put it at around 40 years – about half the average for people in Japan or Australia.

And yet, could Sierra Leone truthfully be described as the world’s worst place to die? Can it be defined through statistics alone?

New ground

How would we show the human side to Sierra Leone, which I knew was not reflected in those statistics?

BBC International Development Correspondent Mark Doyle

My experience of the country meant I knew there was another side to this story – a living, human side.

I knew, for example, that despite the very real poverty and the war which raged through the 1990s, family and community meant almost everything in Sierra Leone and that people were very rarely alone.

I’d never covered the topic of dying there before, but surely this spirit should somehow be reflected in our stories.

Vital job

I found the personification of that spirit in Hannah Ngobeh, a nurse who works in a small hospice on the edge of the capital Freetown.

It’s not a hospice in the Western sense – where people stay long term until they die – it's more of a drop-in pain relief centre.

The Shepherd's Hospice is also the only health facility in Sierra Leone which can administer morphine – the crucial 'end-of-life' painkiller for cancer patients or others in extreme distress.

Nurse Ngobeh, a bustling, efficient figure with a warm smile, broke off from our interview several times to care for a terminally-ill patient who was lying on one of the two beds in the modest consulting room.

She held the lady’s hand and helped her walk to the toilet; spoke softly to her and expertly administered her drugs.

Crucial leads

BBC International Development Correspondent Mark Doyle

BBC International Development Correspondent Mark Doyle

I wasn’t in denial about the statistics. Sierra Leone is certainly near the bottom in the life expectancy tables, along with countries like Afghanistan and Niger.

But I was also sure that the main challenges in covering this story were ethical.

How would we find dying people, in a short space of time, without being offensive to relatives or crass in our portrayal of death?

And how would we show the human side to Sierra Leone, which I knew was not reflected in those statistics?

We opted for short cuts – trusted people who would serve as our bridge to the dying. People who would have a family’s trust before a BBC team crashed into the rest of their loved ones’ lives.

Nurse Ngobeh was one of those bridges. Thanks to Hannah and her colleagues we had a case study – a 17-year-old boy who had untreated tuberculosis that had spread to his bones. The boy, whose mother was blind, was dying in a shack on the edge of a small village.

Dignified deaths

Another bridge was funeral director Juliette Macauley. I approached Juliette with trepidation – what would she think of a foreign reporter wanting to meet a family in mourning?

But I also knew from my experience of Sierra Leone that death holds few taboos. It is openly discussed and sometimes, when a life has been long and full, it is even celebrated. So I was confident the funeral director would help us.

I wanted to film one of the lively funerals I had seen before in the streets of Freetown.

I wanted to reflect on film the fact that many people in Sierra Leone, despite the circumstances, have dignified deaths.

After a few quick but sensitive phone enquiries, as she sat at her enormous office desk, Juliette told me that she had found a family that was happy for us to film their father’s burial.

Balancing act

Saidu Sankoh (left), from a village outside Freetown, has advanced TB and is too ill to help care for his blind mother

Saidu Sankoh (left), from a village outside Freetown, has advanced TB and is too ill to help care for his blind mother

We visited the family in their home before the funeral the next day – because we had done this I was able to quietly, but publically, approach the family in the church pews, during the service, before cameraman James Harrod and producer Peter Emmerson began their work.

In this way, everyone in the church could see that these foreign visitors were known to the family and that we were welcome at the funeral.

Others will judge if our balancing act with statistics and humanity worked in the various TV, radio and online pieces we produced.

But my own litmus test was the reaction of cameraman James. When I briefed him in London on the job it must have sounded grim and foreboding – sequences at a hospice, funeral home and graveside.

James’s first trip to Sierra Leone must have sounded like the assignment from hell.

Reflecting the spirit

He showed a perfectly human reticence on the ground and admitted, at first, to being uncomfortable about working in the church during the funeral. He, of course, got on with the job in hand with utmost professionalism.

But as the day wore on, the West African Methodist service morphed from a solemn affair into a lively march down the streets.

Hundreds of people sashayed towards the cemetery as a brass band played – and I saw a smile on James’s face.

To me that smile meant that at least one of our film sequences would indeed reflect the spirit of Sierra Leone.

Mark’s click report is part of the BBC’s ongoing click Extreme World season

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