By Umaru Fofana
Late June 2015. I travelled to Kailahun as part of a documentary film I was making for NHK - Japan’s public broadcaster. It took me to the length and breadth of the district, a place which has - not once not twice - served as the conduit for calamity into Sierra Leone with no one yet having heard the cry of its people. Last year it again served as the funnel through which the current Ebola outbreak would drip into the rest of Sierra Leone. It is a district that is painfully slow to move in and around, but Ebola quickly developed wings and flew to its nook and cranny before venturing to elsewhere in the country. Even for a country infamous for its dysfunctional health care delivery system, Kailahun has no health care system to deliver. And the few health workers there struggle trying.
Tracing the possible steps of the virus it was apparent Ebola had killed scores - perhaps hundreds - of people in villages in and around Buedu, Koindu, Sokoma, Kpondu, etc before the first case would later be confirmed in a woman who had travelled from the area to Kenema after she had miscarried. Victoria Yillia would later survive and, thankfully, she gave birth to a baby boy last month.
Victoria was spared particularly because her husband, a young college student in Kenema, insisted that she be brought to Kenema where a relatively functional health facility existed and the Viral Hemorrhagic Fever centre had been there for many years. On the phone Anthony mustered his wife’s courage and strength to be able to put up with the pain and anguish that had now become her middle name, as she sat on a motorbike for several hours - bleeding profusely and ceaselessly - until she got to the Kenema maternity hospital. That was in May 2014.
And if that sounds harrowing, the truth is that many more women across Sierra Leone had had to endure that almost daily, and still do so today. And many more children and the elderly have had to die needlessly due to the poor state of the country’s health care delivery system. To make matters worse, more young people are dying today than I have ever observed in my 42 years on the face of the earth almost all lived in Sierra Leone. And it is worrisome, not least because it is not being talked about let alone being addressed by the authorities who do not even seem of feel bothered by these needless deaths. My doctor friends say it is largely due to vital organ failure - kidney and liver - that many young men and women are dying today in the country almost without foreboding. And when you imagine that a dialysis machine is as rare here as the chances for a street trader at Sani Abacha Street to go to on space tourism, you can guess the rest.
Back to my trip to Kailahun. In Buedu among a long list of people I spoke with were health care workers. Some of them had got infected by Ebola in the direct line of duty and had recovered. Today they feel neglected - perhaps rightly so. Amadu Kanneh, not one of the survivors, is the community health officer at the Buede Health Centre and came across as a man committed to seeing into the health needs of a people on whose faces was clearly written HUNGER and POVERTY. But what can he do with nothing! His staff are not on a salary - all because of a rotten system taken over by bureaucracy for which the Sierra Leone public sector is so notorious: nurses, like teachers, complete their studies by the ski of their teeth and are required to wait for months un-end - or even for over a year - before they are approved to work. I saw similar situations in many other places - a clear sign that this country’s health care services must be rebuilt from scratch. But where does the money come from to be able to do that and how can it be handled in a country where corruption is the order of the day?
During my recent vacation abroad, I met with a long list of Western politicians, diplomats, journalists, activists and researchers in Britain and in the United States. In addition to thanking me for keeping the world informed about the Ebola outbreak, they wanted to pick my brain on how to rebuild Sierra Leone’s health care delivery system, assuming one was ever built beyond the facade.
For a minute, forget about the thousands killed by the outbreak in part because of the inertia of our leaders which saw them take their eyes off the ball. Also forget for another moment about those children orphaned by the virus, or those who got infected and recovered and have virtually been abandoned by the authorities. Sometimes I wonder whether anyone is collecting data on those Ebola Survivors who could not continue with their recovery and eventually died because the nutritional intervention needed after such a debilitating recovery battle was at best poor. Now, let us think about whether Sierra Leone can respond to Ebola should there be another outbreak - however negligibly - as has so often been talked about as a possibility. Or Ebola besides, how are we responding to other health issues that have beset the country in the last one year leading to more and more young people dying abruptly, needlessly.
Setting up a serious health care delivery system for Sierra Leone will be hard. Not only because world leaders’ attention is shifting to the carnage and insecurity in the Middle East and the issue of migration that has preoccupied Europe lately, but also because handling whatever resources will come in from abroad will require a delicate balancing act.
For a start the Sierra Leone government hardly has any credibility or respectability left in it when it comes to dealing with donor funds not least those meant to respond to the Ebola outbreak. This is in part owing to the naming aunt report and the unhelpful way in which parliament handled it. There is therefore no one in the donor community that I know who is prepared to give a single US dollar directly to the government of Sierra Leone for Ebola recovery. Of the dozens I spoke to in Washington DC and London not one entertained that possibility. That would be like giving groundnuts to squirrels to keep for next year’s farming, goes the impression. And with elections approaching that can only make a bad possibility become a nightmarish certainty.
The alternative is not very positive either. Often the thinking is that because of kleptocracy donors tend to give their monies to their own nongovernmental organisations. These are very transparent and forward-thinking organisations. However their administrative and other costs for running the project sometimes eat up around 40% of the total amount earmarked to rebuild - the health sector in our current case. It may well be better than the higher percentage that could be stolen if channeled through the official government system, but a huge amount going away nevertheless reminding one of the infamous Phantom Aid so famously talked about by ActionAid. This leaves us with very few options - I would say probably only one.
Owing to their expertise in the health sector and considering how they've been the biggest and most effective responders in the current Ebola outbreak, I would say engage the French charity Medecins Sans Frontiers to set up Sierra Leone’s health system and let it function the way it should. I doubt they can spend more than 25% on administrative and other costs in carrying this out. And this is something the requires quickness. I understand the Chinese are coming - they may well be as bad as the other situations we are confronted with - and worse. They will bring in even their labour and charge us for all that. Clearly this is a catch 22 situation a country faces where people are put in positions of trust not necessarily because they are trustworthy. And God is not going to come down. So let us make it work ourselves. See you later.
(C) Politico 01/09/15
