By Dr Augustine Kamara MD MPH. Freetown Sierra Leone.

Its been nearly two months since I arrived in mama Salone, and I am glad it is possible for me to observe the health situation of the country. Visiting around various hospitals, and other health institutions, I feel disappointed that Sierra Leone is yet to move the health institution, and health workforce forward to an appreciable and acceptable standard.

If people are to survive with the least trivial of health problems, then it is a must that the health system be revamped as soon as possible. I visited several times the Connaught hospital the main government and referral hospital in the capital Freetown, I am appalled to see an Emergency Room (ER) that is lacking with the basic diagnostic tools let alone the personnel as one would expect to see in an ER. There is hardly any physician to be seen around the ER, and if one is present, it would be occasionally and briefly leaving the rest to be taken care of by few nurses. This is the reason why most patients would avoid this hospital, for other private hospitals like the Choithram hospital at hill station, Abanita hospital off kingerman road.

The very few that can afford it, would fly out of the country to India, neighboring Ghana, or Europe. The Chinese hospital at Jui the east end of Freetown, is a standard hospital with a robust medical staff, but again not many patients can afford to visit this hospital when they fall sick.

I visited a private hospital at mile 13 along the Freetown peninsula -Goderich axis, this is one example of a clinic created by diasporas that could change the face of the health condition in Sierra Leone; This is a small clinic that has some diagnostic material that caters for the catchment area around Goderich even though it is struggling for enough medical staffs. I have not been upcountry to see how things are done, but, one can easily conclude that things would not be better off than the capital city Freetown. At this juncture, I would advocate to fellow Sierra Leoneans with medical background to take the challenge as a few have done to come back and give service to their country.

I know it would not be easy to do that when one thinks about the hurdles one must overcome. The government of the new direction must help in this matter by encouraging health personnel from the diaspora to come back home. Diaspora must be ready to form partnership and build alliances like our Ghanaian counterparts have done in Ghana to alleviate the sufferings of not only Sierra Leoneans, but regionally. As part of the fight against corruption, let the idea of “2 sim” ideology segregation be abolished.

The idea of colleagues’ or senior officials in the medical profession, that tend to discourage medical professionals return from abroad, by discouraging their recruitment must be investigated into. I see no reason why medical personnel from other continents, and countries that have similar qualifications as Sierra Leoneans to be good salaries; but refuse to give the same salaries opportunities to Sierra Leonean doctors or nurses. I have gone around and can testify to this malpractice within the medical profession by senior officials. I guess we will not easily fill the gap of medical personnel without foreign help, but slowly we can bridge the gap of medical personnel shortage if we encourage “2 sims” to come home with good incentives, the same way the Ghanaians did. The brain drainage by our medical personnel will also be curtailed. It is high time we build strong medical institutions with meaningful faculties in our new form medical college.

Community medicine or Public Health must be put into good practice effect, by strong health education, and outreach activities. Our poor environmental sanitation, including food handling by peddlers, and daily practices of hygiene including hand washing is awful. These are the main sources of public health where intervention, and prevention must be done. We must have learnt why the Ebola Virus Disease “EVD” quickly disseminated within our communities was due to poor hygiene, health education, and lack of personal protective effects (PPE). After the last episode of the EVD in 2014 in West Africa, one would expect serious awareness preparedness for future unprecedented natural or artificial calamities should be going on. There must be drills of different public health awareness of the communities, organized at local, urban, and national levels. The different cultural and religious bodies must be involved as well as mass media; Schools, and colleges should be encouraged to partake as volunteers in serving their communities. Outreach activities should be double paced to educate the different populations.

Waterborne diseases including mosquitoes seem to be responsible for most of our common ailments, one can quickly say about 70% of our ailments are waterborne diseases. Recent years have expressed serious flooding along our coastal lines that affected low social economic status dwellers not only by displacing them from their poor habitats, but also impinged on them serious gastrointestinal diseases such as cholera outbreaks or typhoid. The soup created from unsanitary latrines during flooding would infect underground water, exposing the entire population to diseases such as typhoid, weils disease, and cholera. Stagnant water around the city in crevices, open tins and abandoned open containers, or disposed lorry or car tyres and abandoned water-pipes are good breeding grounds for mosquitoes; poor refuse disposals, and mines of dustbins are good breeding grounds for mosquitoes, rodents, cockroaches, stray dogs. The eradication by recycling of these dumping grounds, would greatly reduce illnesses such as Lassa fever another hemorrhagic disease caused by rats.

Over population is a major problem in Freetown, that creates a social menace. Apart from unemployment, there is high incidence of prostitution the scary cause of HIV infection upsurge that has engulfed the population according to reports from the media. Drug addiction and crime is on the rise among the youths, a partial creation by political parties who used the innocent unsuspecting youths to carry out violent campaigns during elections but left jobless after election periods.
The common man and some of our “pepe” doctors or quack doctors are quick to diagnose everyone as having typhoid, or malaria with non-laboratory/radiology diagnoses. The innocent population is tortured with frequent malarial medications, and saline infusions, that can easily be reached.
Constitutional or systemic diseases like Diabetes, Hypertension, Urinary Tract Infections etcetera, are often missed out or misdiagnosed or delayed due to lack of diagnostic tools. It is disheartening to think of a simple interpretation of an electrocardiogram (ECG/EKG) is done by few as two physicians in the entire nation. There are instances an EKG result must wait for it to be interpreted in Europe, or America until then nothing would be done to attempt a cure. This is just some of the simple things that are lacking.

However, there is an olive branch to be extended to all the brave Sierra Leoneans that withstood the test of times, and challenges; despite the shortcomings in the health system, they have been there to rescue as much as they could whether at Connaught or elsewhere. I must pause here for a minute of silence to recognize our fallen heroes during the EVD; this goes from Dr. Khan and all other medical personnel both nationals, and international players including volunteers that lost their lives in combating the deadly bug. As we move with the new direction of president Maada Bio, I humbly request the full participation of all Sierra Leoneans to drop all animosity or grudges we may Abor for one another and help propel the country forward.

When one considers the country’s potential wealth, Sierra Leone should be counted as one of the most progressive nations in the continent of Africa, and the world, but this will come only if we Sierra Leoneans think as one family, and embrace ourselves as brothers and sisters, and put the interest of the country first. Meanwhile I am humbly asking our government and all officials of the country to also be honest in running the country and to do due diligence in promoting the development of the country. PAOPA SALONE FOR BETTEH.

Cocorioko 5th September 2018

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