By Kemo Cham and Fatmata Marian Sesay
In Gaindema Village in the northern Tonkolili District, a combination of factors have made access to healthcare a major challenge for the people. A long distance from the nearest health facility, poverty, and apparent lack of awareness have left the people susceptible to the dangers of a whole lot of sicknesses, including malaria.
Gaindema, a mainly agrarian community, lies three miles away from Mike 91, one of the largest towns in the district and home to the nearest health facility to the village. Little wonder that among the many needs of the inhabitants of the community, health facility is the topmost priority.
“We face a lot of difficulties trying to get treatment for our women and children,” says Abdulai Serry.
Mr Serry, who has two wives, sums up the concerns of the rest of the community who say due to the long distance they have to cover to access healthcare, they often have to make a choice between given in to exploitative Okada (commercial transport motor bike) riders and walking, which sometimes happen at a huge cost.
Okada is the only means of public transportation for the community.
“Whenever a child or a pregnant woman falls ill, we spend a lot of money to seek treatment. We pay for Okada in excess. They demand for extra charges when they know the person is sick and we are desperate, laments Mr Serry.
Because of this situation, pregnant women are forced to miss out on antenatal clinic schedules and parents prefer going to the herbalists instead of taking their kids to the health center.
This, notes Community Health Officer, Sallieu Kamara, means that they always have to deal with many cases of people arriving at the health facility late.
Kamara is a senior nurse at the Hinistas Clinic Health Center in Mile 91, which covers mainly the Mile 91 community and six other communities scattered around it, include Gaindema.
Kamara explains that like in the rest of the country, Malaria is the major cause of illness in the communities they serve. The parasitic disease accounts for about 80 percent of daily cases, data provided by the facility shows. Majority of the cases are children and pregnant women.
According to Nurse Kamara, they record over 600 cases of malaria in a month. This number goes up to over 800 during the rains, the peak period for malaria infection in Sierra Leone, he says.
It can costs a minimum of Le3, 000 for a one way ride from Gaindema to Mile 91. Some of the women say they sometimes pay Le4000 for a one-way ride.
A minimum of Le6, 000 transportation for two-way is way too much for many of the inhabitants of this community where the people rely entirely on subsistence farming, and for a few, petty trading, to survive.
The best option for many of them, therefore, is to trek the three miles distance.
But for some, like Ruth Kamara, they would rather stay at home and seek traditional remedies. A suckling mother, Ruth has reported three times for postnatal checkup. She is supposed to attend clinic four times, she says, noting that she has no idea where she would get money for transport for her next trip.
Unlike Ruth, Zainab Y. Kamara, who is heavily pregnant, is dangerously far behind schedule. She has already attended antenatal clinic twice, even though nurses told her she must go four times. She has no intention of going back.
“I have to walk and I can’t do that,” she says.
“We find it difficult because some of us our people don’t have bike, our husbands don’t have money. So if we have an emergency at night, we find it difficult to respond rapidly," adds Mariatu Sankoh, another pregnant woman in the community.
"We want government to help us. The distance is too far,” she stresses.
According to Mr Serry, the general concerns of the community is not only how to get the money for transportation, but also the deplorable condition of the road and the rough nature of the riders, which expose them to constant risk of accident.
“Sometimes when we transport the pregnant women by Okada it leads to complications, which often forces the nurses to refer them to Magburaka, which increases the cost on us,” he says.
“We get a lot of miscarriages due to traveling by Okada and because of that many people opt for the native way of treatment,” he adds.
Magburaka is the district headquarters town of Tonkolili. It is located some 34 miles from Mile 91.
One of Samuel Turay’s two wives recently walked her way between Mile 91 and Gaindema. According to the husband, she had money to pay for only one way. And on her way back she had to walk. Her condition got worst on arrival home. Turay says he had to take her back to the health center for further treatment.
Turay's elder wife recently went for immunization and the bike that carried her had an accident.
“This is why it is difficult for us to travel on this road,” he stresses.
Sierra Leone has a national Malaria prevalence rate of 40 percent, according to the National Malaria Indicator Survey 2016, the latest available data from the Ministry of Health and Sanitation (MoHS).
Malaria is the leading cause of sickness in the country, especially among women and children, with an estimated 1,000 deaths annually among children under 5 years, according to World Health Organization (WHO) data.
Malaria is a major fueling factor of maternal and infant mortality in the country.
The Sierra Leone government says malaria treatment is free for every category of people in all government hospitals. And this, according to the people of Gaindema, holds true for Hanistas Clinic Health Center. Their concerns though, is accessing the center.
But according to CHO Kamara, there is no need for the people of Gaindema to complain about access to health facility as they have a lot of options at hand.
“The solution is that government has trained Community Health Workers [CHWs] and they are in various villages to handle such situations for communities which are far from health centers,” the CHO explains to KMN’s Fatmata Marian Sesay, who is based in Mile 91.
According to Kamara, the government’s policy to establish health facility in any community is determined by its proximity to the nearest health facility.
“Every three miles away government should erect a health facility,” he says, noting that communities which do not meet this threshold have CHWs, who are locals in these communities and who are trained to handle mild cases.
Kamara says besides the CHWs, all health centers have health workers who go out on outreach to both sensitize community people and to provide them treatment.
“The people need to notify the health workers early. Every village has a CHW and they can test for malaria. If after treatment in 24 hours the condition of the patient doesn’t improve, they can refer them to other health facilities,” he says.
Kamara also says that they have observed that people don’t complete their treatment, which exposes them to relapses, adding that failure to report early to health centers, due to reliance on herbalists, has led to many a complicated cases which forces the center to refer many people to the regional hospital in Magburaka.
“We send a lot of complicated cases of malaria among children to Maburaka. When a case of malaria is complicated, the child goes into convulsion and they say it’s evil spirit,” he says.
Civil society organizations complement the efforts of the Ministry of Health through sensitization, to encourage people to seek conventional treatment. One major means of this is through radio engagement.
Saidu Bah is the Station Manager of Radio Bomkolenke, which is based in neighboring Yelle; it hosts series of such radio programmes. Mr Bah says that because that part of the country has a hot climate the people tend to spend long time outdoors, during which period they get exposed to mosquito bites, hence the high prevalence of malaria cases.
“A lot of the people here have bed nets and they say they sleep under them,” says Bah, who is a member of the Kombra Media Network (KMN), the media arm of the Kombra Network (KN), which is an affiliate of the local NGO FOCUS 1000.
KN, which also comprises religious leaders and mainstream civil society activists, engages in community sensitization to encourage people to practice recommended and safe health behaviors.
“As Kombra Network, we are trying to play our role to sensitize the people. We are monitoring the Free Health Care. Many a times we hear people say they are told to buy medicine from the pharmacy. What we find out is that truly the medicines are delivered, but they are not enough. The government really needs to increase on the drugs supply,” Bah says.
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