Cradle to grave
Minette Walters discovers the traumatic truth about childbirth in Sierra Leone
Giving birth in Sierra Leone is a life-threatening gamble. Hospitals are overcrowded, there is little antenatal care, and most families can't afford emergency transport.
It's 11pm and I'm in a Médecins sans Frontières (MSF) operating theatre in Kambia, a remote town in northwest Sierra Leone. I'm using my weight to hold a pregnant 17-year-old girl to a table. She lies in the crucifix position with each hand anchored to a wooden board, but her unfettered legs keep jerking and sliding towards the floor.
A Dutch doctor and an Irish nurse are scrubbing up in another room, while two Sierra Leonean nurses hurriedly assemble the anaesthetic and equipment for an emergency caesarean section.
The closest I’ve been to childbirth was my own pleasantly painless labours, courtesy of epidurals, while my husband put on a brave face. I try to look intelligent when Dr Anne-Marie explains that the patient’s suffering from eclampsia, but the only eclampsia I know is pre-eclampsia. Heads would roll in England if a consultant saw a 17-year-old in this state. Her seizures have caused her to bite through her tongue, and it’s so swollen that it’s protruding from her mouth. The nurses have jammed a stick between her teeth but, coupled with the crucifix position, it looks like a grotesque form of torture.
Her name is Wara, and her husband brought her here half an hour ago. One of the nurses asked him why he waited so long but she knew the answer already. It took him 12 hours to borrow the money to make the six-mile drive from their village. Sierra Leone is the third poorest country in the world and, with no public transport, vehicle owners exploit the needy. The closer a patient is to death, the higher the price.
Wara will die unless her baby is removed. The good news is it’s still alive: Anne-Marie has picked up a heartbeat. The bad news is she knows nothing about this patient except that it’s a first pregnancy. Wara has never been to a clinic, nor had her blood pressure checked or treated, and her husband’s unsure when the seizures started because, in this society, men do not attend births. He can only repeat what Wara’s traditional birth attendant (TBA) told him, and that information is unreliable.
TBAs have worked in Sierra Leone for centuries. They have herbs that can stimulate contractions, but most use them indiscriminately. The results of misuse can be horrific (excessive bleeding, ruptured placentas, retained placentas, obstructed labour, untreated eclampsia) – which may explain why women in Sierra Leone have a 1-in-50 chance of dying every time they get pregnant, and why one in five babies is stillborn.
This operating theatre bears no resemblance to anything I’ve seen on Casualty. It’s a room in a house, and the table is so narrow that Wara’s body covers it entirely. I notice blocks of wood under the legs to raise it to working height, and I worry that each new convulsion will topple us over. Ancient wooden cupboards stocked with swabs and sutures stand in the corners, and dim light is provided by an outside generator. The smell from the latrines is so pervasive that I’m grateful for the surgical mask that filters some of the odour. I feel as if I’m in a Victorian novel.
Kambia hospital was destroyed during Sierra Leone’s 11-year civil war. The war was declared over in 2002 after deployment of a large UN peacekeeping force and British troops – a military intervention that, for the moment, Tony Blair can count as a success.
With no hospital, MSF rented the largest available house and turned it into a 68-bed inpatients’ department by building an extension and erecting a tent in the garden. There’s no running water and intermittent electricity. Every bed is full and each patient has one or more caretakers to cook and clean for them.
Some days there are upwards of 200 people in a house that was once used as a family home, and the heat can be unbearable. Even at 11pm my gown is sticking to my back, and I wonder how Dr Anne-Marie and Nurse Marion cope in the middle of the day, when the temperature outside exceeds 30C.
A new hospital, funded by the European Union, is under construction nearby, although Gerry, MSF’s English project co-ordinator for Kambia, faces months of negotiation with the Ministry of Health to secure a dedicated maternity and paediatric unit. MSF focuses on mother/child health, with special emphasis on antenatal care and safe delivery.