By Umaru Fofana
She raced from the outpatient unit towards the direction of the screening centre at the Kenema Government Hospital. In her firm grip was her child who must be less than three years old. She also clutched under her armpit a plastic bottle containing chlorine - a symbol of prevention which is ubiquitous in the eastern headquarter town.
Her son was throwing up and having a running stomach. He is suspected to be suffering from the viral haemorrhagic fever, Ebola. Not sure if that's the same boy I was told by health workers at the hospital had been throwing up and bleeding since the previous day.
Manneh, not her real name, looked worried. Such is the risk a mother would take for her child that she clutched her mobile phone between her teeth as she dashed. The wind blew off her head tie without her knowing. Torment galore!
I did not stay to find out what her son's Ebola test result was. I had to leave Kenema to travel to Johannesburg in South Africa where I am attending a global forum. The forum has brought together more than 800 leaders and public health experts "to review new data and call for accelerated action to improve maternal, newborn and child health".
Sierra Leone is the worst in the world, according to the latest UN World Health Organisation figures in the area of maternal health with 1,000 of every 100,000 women dying to bring a life. This grim statistic is bound to get even apocalyptic with the Ebola outbreak in the country.
According to the Medical Officer for Kenema District, Dr Mohamed Vandi, women are the hardest hit by the outbreak in part because when it broke out early this year in Guinea, a traditional healer - Sowei - across the border into Sierra Leone treated many patients who'd come with the hitherto unidentified illness. When she eventually died, because of her traditional standing and the lack of knowledge about the disease, women washed and buried her without protection. Most, if not all, of those who took part in her burial by touching her body, contracted the virus. And the knock-on effect on other women who treated those other women continues to be reverberate and has become a vicious circle for many women in and out of Kailahun.
But more women could be dying also because most nurses in the country are women. Many of them have lost their lives while trying to save other people's lives in this daunting battle against a debilitating disease. And their corpses were badly handled by other women. And on and on and on. So you would imagine the impact Ebola has had and will continue to have on women especially pregnant ones and, inevitably, their children.
It is therefore surprising - and perhaps shocking - that at the Partnership for Maternal, Newborn and Child Health (PMNCH) forum in Johannesburg yesterday, no speech by anyone mentioned the effect of Ebola on women and children in Guinea, Liberia and Sierra Leone which are ravaged by the viral fever.
This, besides the grim maternal and child statistics that are all too associated with Sierra Leone, is perhaps a strong reason why I think the Minister of Health should have been here - or someone else in her stead senior enough to make policy statements and request for more assistance to deal with the epidemic. No-one from the ministry is here. And no reasons given, as one of the organisers told me.
At a press conference, I asked the UN World Health Organisation's Assistant Director-General for Family, Women's and Children's Health about the impact of Ebola on maternal and child survival. Her face collapsed as she started playing with her fingers as if to say "you caught me off guard". Flavio Bustreo said "It is very important to note that women and children are most at risk [of Ebola] and especially when they are pregnant women and need specific care". She said her organisation had "teams on the ground that are monitoring the situation especially that are linking pregnant women and children to the care that they require. The situation is especially critical in rural areas because those linkages are more difficult."
And she is right. Rural areas especially in the east of the country which even in the best of times are in the throes of depravity and deprivation, can only be doomed at this time of the Ebola onslaught.
Maternal and newborn health has to be a priority far more than it is now. It is 500 days to the United Nations target date for the attainment of its Millennium Development Goals. Incidentally two of those eight goals are about maternal and child health. And the key emphasis here by speakers is not only access - towards which some efforts are being made in almost all developing countries. That will not change much or for long. Rather the focus in Sandton in Johannesburg is on QUALITY health care and accountability. Both bring Sierra Leone to mind and here is why:
It would be dishonest of anyone to not give credit to the Sierra Leone government for its initiative that introduced the partial free health care which removed payment of user fee or out-of-pocket expenditure. This has led to a huge increase in the numbers of women who turn up at maternal and children's hospitals, where such are available. That notwithstanding the number of women dying daily in Sierra Leone due to child birth is shocking. The number of children lost to the same is enormous. And some of the newborns are passing away even before their first birthday. I hate statistics and I won't bore you with any more.
On the issue of accountability leakages in the health sector even a child born three years ago knows what I am talking about. Drugs meant for mothers and children disappear. It took the donors themselves to detect the disappearance in Sierra Leone of money sent by the Global Alliance for Vaccination and Immunisation (GAVI Alliance) for the country's children. Never mind the struggle many hospitals go through in navigating between the huge numbers of mothers and babies and pregnant women that visit, and what they can afford to give them as medication. Never mind the issue of blood for women in labour. Or even the frequent setting alight of the central medical stores without consequence.
Grim? Well imagine the number of under-aged girls who die because they are not meant to carry a pregnancy and some dirty old men sleep with them or even "marry" them. Even with our laws protecting children and women, these things happen with impunity and the victims keep becoming nothing but a statistic.
Like in most of the world, there have been appreciable outcomes for mothers and babies. However for many countries especially the most vulnerable this progress has been too slow, says Dr Mohamed Yillah of Evidence for Action/Mamaye Sierra Leone.
He says the next 500 days should be made to count meaningfully. And he asks how that will be made to happen without concrete steps rolled out by governments like Sierra Leone's.
500 days ago it looked as if the world was coming to a standstill when it was marking the next 1,000 days to the MDG deadline. 500 days on, what has changed?! In the case of Sierra Leone it requires specific timelines to make it happen or almost. The Ebola outbreak should not be an excuse for the government to say, in 500 days time, NA D EBOLA MAKE WE NOR ABUL. Rather someone should have been at this conference from the government meeting with the movers and shakers in world health - from the UNFPA boss to his WHO counterparts - who are all here.
"Changing the trajectory of progress from a slow rising curve to that of accelerated progress that reflects wide political commitment and accountability" is a concern of Dr Yillah's.
"We cannot continue to do more of the same. We need drastic, pragmatic approaches that ensure consequences for poor accountability from our African governments" he opines.
When I asked Gracia Marcel about some sort of incentive for governments that show action beyond rhetoric, she replied the best incentive was for governments in such poor countries that provide not only access but quality access to the health of women and children to feel good that they have made this happen.
I agree with her. But I also think some reward or punishment by donors should be encouraged for those countries that do well or those that do not.
Dr Yillah believes "African governments must commit, deliver and show accountability or face exclusion from certain catalytic resource pots" should they fail to live up. This, to my mind, is needed for countries whose leaders sit cross-legged and arms-folded towards corruption unless when they want to end careers they don't wish to go beyond their say-so.
This way we can dash to the finishing line and attain maternal, newborn health interventions for our country. Roadmaps should be crafted and implemented for the next 500 days. That way, Manneh will not have to risk her own life desperate to save her three-year-old son from a possible Ebola infection - I hope the boy survives. Or even her future child. God save the mum. God save the baby. God save the child.
(C) Politico 01/07/14
