Sunday, September 20th:
I arrive in Sierra Leone Sunday at 3:30 p.m. From the airport there are two ways to get to Freetown, the capital: by boat or by helicopter. We take the ferry along the Atlantic Ocean, which takes about 35 minutes, and we arrive in Freetown. Freetown seems to have grown around itself. Its infrastructure barely seems to be able to handle the demands of the city and its people. We travel by car to the hotel and I’ve never seen as many potholes (craters really) in my life. After I left India, where I was born, I never thought I would say this about another place.
Once at the hotel, we are asked to go to the Princess Christian Maternity Hospital (PCMH), in the center of town, right away. We need to get there before dark because lighting at the hospital is bad and also because travel after sunset is not safe. We arrive at the hospital and after some negotiations the head nurse agrees to let us to visit two of the wards in the hospital.
The first ward we visit is Labor Ward 3, which is for women who have had pre-natal complications that have resulted in c-sections. The hospital is not a happy place. The families of the patients sit on the stairs leading up to the hospital’s entrance. Their faces convey the anxiety and fear that we see more explicitly on the faces of the women in the ward itself. At the entrance to the hospital there is a huge sign that lists the prices of the services provided. We see the signs inside the hospital as well even though the government has said they guarantee free service for those in need.
The inside is dark and seems more like an abandoned building than a hospital. It’s lit with florescent lights but only in some sections. The hallways and lobby area remain dark to conserve light. The nurses look exhausted and resigned to the conditions that surround them. We enter the “ward”, just a section of space separated by curtains from the hallway. It has two rows of about a dozen beds. At one end of the ward there is an old television. It is on and it seems to provide some form of diversion for women who’ve lost their babies or who are in severe pain from giving birth. A mosquito net hangs over each bed, and a small basket or crib sits next to it.
I meet Ester, who had complications during labor and has lost her baby. She’s 35 years old and has no other kids. She’s visibly, and understandably, sad. Her eyes convey her internal struggle to make sense of what has happened as well as to make peace with it. She was brought to the hospital after having a difficult labor. As is the case with most of the women here, Ester came to the hospital as a last resort. One, because it’s expensive and very few have the means to pay for it and two, because the community does not seem to trust the quality of service provided. Women are brought here only if something has gone terribly wrong and there is no other option.
We hear of the fees the women are asked to pay before any services are provided. These fees are even higher than the signs inside and outside of the hospital indicate. The health care providers seem to charge based on their assessment of the patients’ ability to pay. One of their aims is apparently to recover costs of medicine and equipment that they pay for themselves, upfront, and then recoup from patients. This leaves women and their families left to negotiate prices for medical care at one of the most vulnerable times in their lives.
Across from Ester is another woman who is holding her newborn. As I approach her, she lifts her baby towards me and quickly puts him in my arms. I was surprised, not expecting to hold a newborn. After all, if I was in a U.S. labor ward, I’d be peering at the little one behind a solid glass wall to ensure that the baby wouldn’t catch any germs. The baby boy, who is wrapped in a little blue jumper and a matching cap that make him look like he’s got bunny ears, is named David. David has a face that is perfectly formed, unlike most newborns, whose faces look like those of little old men. David has a perfect nose and full lips. His eyes are closed and he sleeps peacefully in my arms. I talk with his mom and she speaks of her difficult delivery. She won’t talk about details of what brought her here to the hospital. She only says she’s waiting for her milk to come in so she can feed David. She’s clearly been through a great deal in the labor and is visibly weak.
Before I leave the ward, another woman asks to speak to me. Her name is Saffitu. She was pregnant with twins. As she went into labor it became clear that she needed to get to the hospital. Most “normal” births in Sierra Leone are performed by traditional birthing assistants (TBAs) who are either elderly women in the community or the first wife of the husband. TBAs are not trained and do not receive any government aid or supplies. They are left to their own devices and their own practices in helping the vast majority of women in Sierra Leone give birth.
Saffitu tells me both her babies died during birth. One of the twins was breached and the other baby was stuck behind it. She says her heart is in pain because she’s grown attached to them. She says “You see, I could feel them move inside me. I knew and loved them. They are not here.” I struggle to find words to console her. I have none. I can only think to ask if she has other children. She says yes. She has a 5 year old boy at home. She’s been in the hospital for 17 days and she is missing him. I tell her (and her husband outside) that she needs to take care of herself so she can be there for him. She holds my hand and squeezes tight. She’s heard about why we’ve come to talk to the women in the ward. Her squeeze affirms she wants her story told so someone else can avoid living it.
PCMH is considered the best hospital in the country. It’s one of a handful of hospitals in the country that has a maternity ward. This is what the women of Sierra Leone have to count on. In Sierra Leone, one in eight women dies during child birth or pregnancy. That’s one of the highest rates of maternal mortality in the world.
On Tuesday, September 22, Amnesty will launch a report on maternal mortality in Sierra Leone that documents the struggle of mothers who are dying. Together with this report, we’re launching a five-year campaign to pressure the government and donor countries to make maternal mortality a priority.
In a way, the women I met at PCMH are lucky. They at least are alive.