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.

Makeni night life

I had quite an exciting weekend here in Makeni and had the opportunity to sample some of the night life, which was fun. We went out both Friday and Saturday nights though, so I’m a little sleepy today. That, and the lack of coffee. Heidi and KK are still in the process of setting up their kitchen as they just moved into their house, so until Saturday there was no way to cook or heat anything. Saturday we got some coal for the coal pot, so on Sunday I attempted to use the coal pot to boil water. This, apparently, is harder than it sounds, because I was unsuccessful. I don’t know what I was doing wrong, maybe not enough coal or not lighting it properly, but the water never boiled, although it did get hot. I couldn’t get enough heat going to boil it I guess. Because it was well water I didn’t want to drink it without having boiled it for a few minutes, so I just gave up on the coffee. I’ll need to get a proper lesson in how to light the coal pot some time. Anyways, I’m looking forward to getting back to having my morning java back in Mapaki, even if it is instant :-)

On Saturday Heidi and KK and their friends threw a big party for another friend, Rabia, who was leaving Sierra Leone the next day after spending a year here as a VSO volunteer. We borrowed a barbeque (not a gas bbq, just a big barrel cut in half and filled with coal) and spent the day preparing food. The main event for the meal was a goat. The goat was bought that morning and tied up in the corner of the yard for a while before he was turned into supper. I think that’s probably the closest I’ve ever been to meat that was alive before I ate it :-) It was tasty though! There was a ton of food at the party, lots of different things, which was great. About 20 or so people came and everyone brought something. We ate a lot, but there were a lot of leftovers as well. Unfortunately because there is no way to preserve things (i.e. no fridge) a lot of the leftovers were wasted.

During the party we had quite an audience. The party was out in the front yard of the house. The gate to the compound is just bars rather than a solid gate, so you can see into the yard if you are standing outside the gate. We are often visited by children coming over to stare at and to talk to us. The night of the party there were at least 10 or 12 kids standing around outside looking in. It’s a bit disconcerting. Every time someone would tell them to get lost, they would leave but then come back after a few minutes. Eventually it got late and they went home, but we had an audience for most of the night. We would have liked to give them some of the leftover food, but didn’t for several reasons: first of all, it just perpetuates the stereotype that white people have food (or money, or other things) and they will give it to you if you hang around them enough. Also, because there were so many children, with more near by, giving out food to some would most likely have caused a bit of a ruckus and there may not have been enough food for everyone.

Once the BBQ portion of the evening was over, we went out dancing. There are two “clubs” in Makeni, Apex and Flamingos. Apex is bigger and nicer and is part of the Wussum hotel (the one with the pool) and Flamingos is a more local kind of a place. On Friday night we went to Flamingos, and Saturday to Apex. The dancing was a lot of fun! The music was pop, but they played mostly Sierra Leonean and Nigerian music (same at Flamingos). I am getting to know some of the most popular songs now and am going to try to track some down to bring home with me. The bars felt similar to clubs at home, except for a few things. The group I was with were the only white people there of course. Also, many people dance by themselves (less common to see this in Canada), and people of the same sex dance together. Girls dancing together is common in Canada as well of course, but you’d never see guys dancing together in the same way that you do here. You also often see men holding hands here. This is not considered a sign that they are gay or romantically involved in any way. Perhaps this is because homosexuality is so totally hidden and taboo here. Anyways, the dancing was a lot of fun. We stayed out very late though, so Sunday was spent mostly lying around being lazy. I am still a little tired today (Monday), but not sure if that is related to the lack of caffeine or actually being tired, since I slept pretty well last night.

Two more Krio lessons today and tomorrow and then I’m heading back to Mapaki on Tuesday. One of the things that I have enjoyed about being in Makeni is becoming more comfortable doing things on my own. There has been more opportunity here for me to go to shops, the office, out to eat, etc. by myself, and I feel quite comfortable doing that now. Makes me feel more at home in the country, which is good. I’m sure I’ll be down in Makeni for the occasional weekend, but for now I’m looking forward to going back to my quiet village life in Mapaki tomorrow. I will be taking some food treats from Makeni back with me though – crackers, laughing cow cheese, hot chocolate powder and soya sauce (for those days I don’t feel like eating the plasa (sauce) that is available). The cheese especially will be a nice treat – there is very little dairy here because of the lack of refrigeration.

More on Makeni - September 25

So this is now my fourth day in Makeni. Unfortunately, the internet hasn’t been working very well all week in the UN office, so I’ve had some trouble getting online. Heidi assures me that it’s not usually like this, I guess I’ve just picked a bad week to be here. Too bad, I was looking forward to a more reliable connection than I have in Mapaki, but I guess not.

The issues with communications (bad internet connections, lack of cell phone signal, my inability to send text messages to Canada) has been one of my biggest frustrations with being here so far. It’s difficult not to be able to communicate with people when you want to, especially with my friends and family back home. It also makes it difficult to get work done. Poor communications prevent you from doing work because you need to communicate in order to do it, and they also waste time because you spend time fiddling with the internet or your phone or whatever instead of working on something. Sigh. I know I will be more appreciative of our reliable telecommunications network when I get back home!

I want to describe Heidi’s house, where I am staying while in Makeni. The house is a compound, meaning it has walls around it and a gate. In addition to the main house, which has about 8 rooms plus a big living room and a bathroom, there is a second, smaller house in the back. Lecturers that work in the mental health program that KK works on stay in the back house when they are in Makeni. Everything is surrounded by the wall. The gate is always kept locked for security reasons, and there is a guard at night. All of this makes it sound like Makeni is very dangerous or something, but that isn’t really the case. I haven’t felt unsafe or worried for my security the whole time I’ve been here. It’s more to guard against theft. Especially since it would be known that white people are living in the house, there is a greater risk for theft because it is believed that there would be more to steal.

A few other stories from the past few days: Two nights ago (Wednesday night) we went to the launch of a new Amnesty International campaign to reduce maternal mortality in Sierra Leone (I mentioned this in a previous post, along with a link to some information about the campaign). This kick-off event was part of a tour Amnesty is doing around the country – the first stop was in Freetown, and they were going to a few other places in addition to Makeni as well. The launch was held outdoors at the football “stadium” (it’s not a stadium in the sense that you would normally picture it – it was just a huge dirt pitch with some goal posts where football is played). The event started about 2 hours late. This seems to be fairly typical here. The Secretary-General of Amnesty was here though, as well as the Paramount Chief in the area and a few other dignitaries. Following the speeches, there was entertainment, local Sierra Leonean dancers and singers. It was fun, pop type of stuff with some dancing as well. There was quite a crush of people there, but we managed to situate ourselves right in the front, so we had a pretty good view of the entertainment.

I think that a campaign around maternal mortality is a good thing - according to the WHO statistics, the rate in Sierra Leone is one of the highest in the world. The two main issues I think are the inability to access medical care because of cost or distance, and the poor availability of care because of staff shortages or poor training, lack of supplies, etc. For example, I visited a clinic in Makonkorie in Gbonkolenken chiefdom when I was there - they had almost nothing there. They didn't even have scissors or forceps to use during a delivery. From what I have seen from the Amnesty campaign so far, it focuses primarily on cost and transportation barriers. In my opinion, the supply side problems in health care here are equally as important.

Speaking of health and access - I got conditional approval from Carleton's research ethics committee on my research today! Yay!! I have to make a few changes and send it back, but they are minor, and it's nice knowing I'll be able to go ahead as planned. I'm hoping to start interviews within the next couple of weeks.

Oh, I also had my first taste of something called a killdriver at the Amnesty event. It’s a cookie, very similar to a shortbread cookie taste. You can buy it from sellers on the street. It’s called a killdriver apparently because it’s so good that when drivers eat it they crash and die. Funny, hey?

Last night we had a fun evening. In the late afternoon we went over to the Wussum hotel, the nicest hotel in Makeni. They have a pool, and you can swim for only 10,000 Leones (about $3). I didn’t swim, not having a bathing suit with me here in Makeni, but the others did. Then we sat around and had supper and drinks (chicken shwarma, yum!) and watched “Africa Magic” – movies from Nollywood (Nigerian Hollywood – apparently the third largest film industry after Hollywood and Bollywood). The Africa Magic films are generally terrible, or so I’m told. The one we half-watched while sitting around wasn’t much of a gem. The acting is bad and the stories are silly. But it’s still neat to see African popular film. I also very much enjoyed the tv, electricity, cold drinks and food available at Wussum. All in all, a good night!

p.s. no new photos until I am back in Mapaki as I didn’t bring the cord for my camera with me.

Krio in Makeni

On Tuesday morning I came to Makeni. I will be here for a week doing Krio language training and working in the office with Heidi (she works in an office that is available to NGOs in the UN compound here in Makeni – there is power, internet and best of all, air conditioning!!). Makeni is the capital of the Northern Province of Sierra Leone. The population is about 200,000, so it’s MUCH bigger than Mapaki.

There are good things and bad things about being in Makeni. The city is loud and much more crowded than Mapaki, and things are further away from each other of course. I am staying at Heidi’s house, which she shares with a few other people. The house is great – lots of space and conveniently located close to her office (it has no running water or electricity though). The only unfortunate thing about the location is that they are close to a mosque, which has prayers every morning at 5:30 am. These are quite loud and have been waking me up. I’m hoping I’ll get used to it after a couple of nights and am going to try sleeping with ear plugs tomorrow night.

On the plus side, there is much more available in Makeni than in Mapaki in terms of food. You can get vegetables (lettuce, tomato, carrots, cucumber, beans), fruit (apples, bananas, plantains, oranges, grapefruit) and a lot of other stuff – chocolate powder (to make cocoa), coffee, soya sauce, tuna, eggs, etc. Some of this is available in Mapaki as well, but much of it, especially the vegetables, is not, so that part is a treat. Yesterday I even had ice cream! I think the box said that it was egg flavour, but it was still yummy :-) Something cold to eat on a hot day is always nice.

Speaking of hot days, it hasn’t been as hot here as I initially expected. I don’t have a thermometer, so I’m not sure of the temperature, but I would guess it’s usually in the high 20s or so. It’s not usually super muggy, although some days are worse than others, but it does rain almost every day. It’s nice when it rains because it cools things off a bit. The cloud cover that we often have makes it feel less hot as well – yesterday it was sunny and it was wicked hot in the sun. I’m sure as the rainy season comes to an end (October) and the dry season starts, it will get hotter.

One of the other things I have been enjoying about being in Makeni is getting to know some of the other expats working here. There are several VSO volunteers working for local NGOs based in Makeni. Amy and Rabia work for Future in Our Hands, Sahiel works for MADAM (I can’t remember what the acronym stands for but it’s something to do with development and agriculture I think), and KK works for CAFOD (Catholic Association for Development).

The Krio lessons are going well – so far we have learned basic greetings, how to ask for a few things, for directions, food, prices. We did a whole thing on how to bargain, which is key here. Some prices are fixed, like for smaller food items, or in some of the shops, but you really do have to bargain for any larger items. I don’t consider myself a good bargainer, but perhaps now that my Krio is a bit better I will have more opportunity to practice.

Freetown – September 10

My second full day in Salone (term of endearment for Sierra Leone) was spent in Freetown. Freetown is a bit of a frenetic city. There are people and cars and noise everywhere, even at night. It actually took us most of the day just to get out of the city. We went for brunch at a café called Bliss and I ate the last pastry I’ll probably eat for a long while. We then had a few errands to run, but actually spent much of the day waiting.

By the time we arrived in Makeni, the capital city of the Northern Province (about a 2.5 hour drive on the only paved highway in the country) it was dark. It gets dark here around 7 or 7:15, and by 8 pm it is pitch black. The dark is a bit hard to get used to. For one thing, it’s kind of a weird feeling for it to be dark so early yet still warm. For another thing, when it is dark, it is REALLY dark, since there are no street lights and very few outdoor lights. Lanterns or candles are generally used in the evening and I have been making liberal use of my headlamp too (thanks Chris!).

We stopped for dinner in Makeni (meat on a stick from a street vendor, yummy!). then drove on to Mayagba, where the cdpeace main office is located, and where Heidi and I spent the night. Heidi was living in Mayagba, but has just moved to Makeni in order to be able to easily access the internet every day (if you want more of a background on Heidi, or anyone else I’m mentioning, see the “people” post, which I’ll update whenever I meet someone new – I will bookmark it in the links section). We arrived in Mayagba after 11 pm, so no one was around. People generally seem to go to bed early and get up quite early here, which suits me just fine! MKK (Mohammed K. Kamara), who runs the guesthouse for cdpeace, did get up to greet us and make sure we had everything we needed though.