Giving birth in Sierra Leone
AS GOOD AS IT GETS
“Push… PUSH the baby!” Mamie Mattia alternately squeals and whimpers, her left hand wrapped tightly around the window bars, as midwife Christiana cajoles the 22 year old through the final stages of labor. “There is poor maternal effort,” Christiana comments in a stern voice, though she acknowledges Mamie is probably weak from lack of food.
The room is small and the facilities are few — no pain relief, no stirrups, no hot or running water — but this is pretty much as good as it gets in much of rural Sierra Leone. The health post, at Sembehun in Bo District, is clean and dry and the staff are trained. And that’s a big step up from the alternative.
Twenty miles away in the village of Tikonko, Mamie Morray shelters from the rain and patiently shells a small mountain of groundnuts. Her age is unclear (although she estimates she’s around 90) and she has nine children.
Morray’s description of childbirth in years gone by is nothing short of horrific. When the local traditional birth attendant decided a girl was ready, she would be taken into the bush by all of the women in the village. “They would force you to deliver — even if it was not your time. They would hold you down and press on you. We lost many babies and sometimes mothers.”
THE WHAT AND THE WHY
The actual medical causes of death amongst Sierra Leone’s pregnant women and young children are not much different than in most sub-Saharan countries. But explaining why so many women and babies die in Sierra Leone is much more complicated… and not so easy to wrap up in a social-media-friendly package. Cultural tradition, high rates of teenage pregnancy, lack of education, distrust of an overburdened health system, and extreme poverty make a very potent mix. The legacy of a ferocious Ebola outbreak in 2014 doesn’t make it any easier.
The idea of a silver bullet is an attractive one, but few complicated problems have a simple solution. Strengthening the health system and encouraging more women to use it are obvious answers. High in the densely populated hills of Freetown, tireless community worker Abu Touray leads an army of volunteers who go door to door persuading women and their families to use the local health facilities. “Sometimes people put it down to God’s will. I tell them it is not God — this child is not supposed to die.”
But there may be other, low-cost ways to move the needle. Emily Cummings of Concern Worldwide suggests the simple act of sharing key information with community influencers might have an outsize impact. “We’ve been carrying out hundreds of interviews called ‘verbal autopsies’ with parents in some of the urban communities here in Freetown. These interviews find out about the events leading up to the death of children and we use this to determine what the child most likely died from”.
She says the results so far have been quite powerful. “Often the leaders within a community didn’t realize the extent of the problem… and they really stand up and pay attention. I think this may one of the most powerful and efficient ways to make change.”
A GOOD START
Meanwhile, back in Bo, midwife Christina calmly says the words, “cord around the neck.” Newly trained community volunteer (and former traditional birth attendant) Zainab Sandy hands her a forceps and then scissors. Deftly the midwife unwraps the umbilical cord and, with one final heave from Mom, Sierra Leone’s newest little citizen emerges — alive and well. Mamie was visited during her pregnancy by a volunteer, who encouraged her to attend the ante-natal clinic and come to the health post when her child was due. As yet unnamed, this little boy will face a lot of challenges to his future survival, but one simple decision by his Mom has at least given him a fighting chance.