Visit to Government Hospital Makeni

Yesterday I visited Government Hospital in Makeni. I have made friends with two VSO volunteer nurses who are working there (Vicki and Susie) and they showed me around. Seeing the health care system here definitely makes me appreciate our health system in Canada.

The Government Hospital in Makeni is the main government-supported hospital for Bombali District (the district Mapaki is in). There is another government hospital that is actually closer to Mapaki, in Magboroka, but that is in Tonkolili District. I am hoping to visit the Magboroka hospital as well.

There are 4 wards at the hospital in Makeni: male, female, children and maternal, and a total of 86 beds. If you’ve ever read about, been to, or seen photos of a hospital in a poor country, you probably have an idea of what it looked like. If not, I will try to describe it for you. The facilities are very basic. There are about 20 beds on each ward, and most of the beds had patients in them. The beds are close together - no such thing as a private room here. Often family members surrounded the beds as well. Some people appeared very ill, and others not, but it’s difficult to tell from appearances. The equipment and beds generally seemed old. Each bed has a mosquito net hanging above it. Each ward has at least one nurse’s aide and sometimes several staffing it. Patients are fed a few times a day, but the food is pretty minimal – tea and bread for breakfast, an egg and some bread midday, and then rice with sauce in the evening. A patient's family usually supplements the food provided by the hospital.

Currently there are 2 doctors on staff at the hospital, both Sierra Leoneans, one of whom is a specialist surgeon in orthopaedics. There are 8 nurses and about 120 nursing aides. The nursing aides are the ones who really run the day-to-day activities of the hospital. Apparently here they do many of the same things that an RN in Canada would do. Some have many years of experience and are very competent. Others have almost no training – they do a 2 week training course when they first start at the hospital and that’s it. A matron (head nurse) might earn around Le 300,000 per month, and a regular nurse about Le 200,000. Nurses aides earn even less. Qualified nurses often work 2 jobs (either at another hospital, a private clinic, or they run their own work on the side) to make ends meet.

There is no running water and the electricity for the hospital is from a generator, which I understand is not always totally reliable. There is one operating theatre. I was told that they often don’t actually use the generator during surgeries, for fear of it going off part way through. They just do them when the room is very bright with daylight.

In terms of fees, from what I understand, fees are really set individually at each hospital or clinic – this seems to be basically at the discretion of the doctors that are in charge. In many cases, fees are charged that aren’t “official” fees in terms of being mandated and/or approved by government. As an example of fees, a c-section at the hospital would cost about Le 150,000, and an X-ray Le 40,000.

While we were on the tour, when we stopped in the women’s ward, the mother of one of the patients came to tell us that her daughter’s dressing (she’d had surgery I gather) had not been changed in two days. The nurse’s aide who was on the ward said she had informed the people who were responsible for this, but that they still had not come to change the dressing. Unfortunately, my impression is that this standard of care is more the norm than the exception.

Now that I have ethics clearance for my thesis research, I will most likely be writing more about health care here as I start my interviews and continue to do observational visits like this one to government hospital. Hope you find it as interesting as I do.