Disturbing evidence of deplorable healthcare delivery in Sierra Leone

Sierra Leone Telegraph: 11 September 2016

president-koroma-at-connaught3

The Ebola incursion in Sierra Leone in 2013, which led to the death of over 5,000 people was blamed on the country’s crumbling healthcare service, poor governance and corruption.

The response of the international community to the emergency posed by the crisis, especially from Britain, China, USA, Canada, and Cuba, boosted by the World Bank and IMF, had mobilised hundreds of millions of dollars for the government of Sierra Leone.

Prior to the Ebola virus entering Sierra Leone, thousands of people were dying every month from simple, treatable health conditions, which because of poor diagnosis, inadequate resources, and inappropriate treatment, degenerated into complex and life threatening diseases.

Compounded by acute shortage of clean, safe drinking water, poor sanitation and lack of access to electricity, most hospitals in the capital Freetown had themselves become death traps. But that was pre-Ebola.

Ten months after the declaration of the end of the Ebola epidemic in Sierra Leone, and despite spending hundreds of millions of dollars to transform and build the resilience of the country’s healthcare service, today a report published by the Campaign for Human Rights and Development International (CHRDI) contains disturbing evidence of very poor standards of care in the capital Freetown.

Sierra Leone is now fast sleep-walking into its pre-Ebola era. Why? These are the disturbing findings of the CHRDI investigation into conditions in hospitals and community healthcare centres across the capital Freetown:

Devastating impact of service failure across the health care sector in Freetown

We in the Campaign for Human Rights and Development International (CHRDI), have discovered that  failure in service provision, implementation of misguided health policies, plans and projects; and above all corruption, have had a devastating impact on the health care sector in Freetown.

bola-ward-connaught-hospitalHealthcare problems in Freetown range from inadequate policy monitoring, mistreatment of patients, shortage of drugs and medical supplies in public health institutions, poorly equipped health centres, lack of labs, lack of modern medical equipment, scattered storage facilities for drugs, to proliferation of poorly constructed health centres with no water facilities.

We are also aware that even with these limited resources, the problems are further compounded by rampant corruption, impeding access to quality, equitable and effective health services.

Our recent research into the Health Sector shows that there is stagnation in the growth and development of administrative staff, disregard for policy and authority and poor work ethics among frontline health workers.

We have also discovered that most of the drugs supplied from the Central Medical Stores to sub-medical stores across the country and selected Peripheral Health Care Units (PHCUs) are either expired or close to expiration .

Our study also proves that Government-owned hospitals in Freetown inflict more pain on patients and their relatives, than the ailments that take them to the hospitals. Nearly all the public health facilities in Freetown lack basic modern medical equipment.

The Universal Declaration of Human Rights by the United Nations is the global expression of the rights of every human being and it includes the right to adequate healthcare.

The Republic of Sierra Leone 1991 Constitution echoes this in CHAPTER II -FUNDAMENTAL PRINCIPLES OF STATE POLICY (Fundamental obligations of Government) Section 8-2B, which says, “The State shall recognise, maintain and enhance the sanctity of the human person and human dignity”.

This means that there should be adequate medical and health facilities for all persons.

In view of the above, we in CHRDI believe that it behoves us to bring the following to light and urge the Government of Sierra Leone to take the necessary steps to address them and fast.

connaught-hospital5CONNAUGHT HOSPITAL AND MORTUARY

Our study on the Connaught Hospital Mortuary revealed that dead bodies have already surpassed the freezing capacity. The facility can no longer accommodate the daily influx of dead bodies.

Bodies are laid on the bare ground because there is no available space left in the freezing room.

At the outpatients department, there is a culture of laissez faire and corruption by nurses and paramedical staff who often turn down appeals to treat dying patients because they cannot pay bribes.

ebola lock down - connaught hospital - APNurses speak to their patients in very harsh tones and would not attend to them on time if none of them knows or is related to them.

Nurses at the Ear, Nose and Throat Department including the Eye Clinic, collect money from patients before issuing them registration cards and deceive people into believing that it is a normal and legal practice.

The Intensive Care Unit, where sick people rely on electricity for their survival, often experience power cuts and the stand by generator is often without fuel.

Our findings also show that the hospital relies on outside sources for water supply. The water facility within the hospital complex is not sufficient.

We were told that the Hospital has about 1,200 staff but only 700 are on their pay roll and the rest are volunteers. The volunteers receive incentives and training because it is a Teaching Hospital.

We also observed that there is some improvement in the Emergency and Accident Unit where a British charitable organisation called Kings Sierra Leone Partnership has brought in some advanced equipment.

KINGHARMAN ROAD HOSPITAL

At the Kingharman Road Hospital, there is no free health care, no water supply, very few beds and few medical personnel.

GEORGE BROOK COMMUNITY HEALTH CENTRE

At the George Brook Community Health Center- Dworzack Farm, only six nurses are assigned to the centre. The Community Health Officer (CHO) hardly visits the facility.

They have no pipe borne water, and have to rely on a street tap located in front of the hospital.

A single room with three beds is used as a Post Natal Ward and patients are often left uncared for.

Huge numbers of pregnant School girls between the ages of 14 to 18 always flood the Centre for treatment that they don’t receive.

ROKUPA HOSPITAL

The Rokupa Government Hospital has less than Twenty-five Nurses who respond to thousands of patients from communities within that area, according to their register. Their toilet facility is in bad shape, with poor water and sanitation facilities.

There is rampant bribery for treatment , mostly perpetuated by the Nurses.

SUSAN’S BAY HEALTH CENTRE

The Susan’s Bay Health Centre has only four nurses, headed by a matron. The entire slum communities ranging from Government Wharf to Guard Street, Dovecot Market and its environs rely on the Centre for treatment.

The few Nurses assigned to the Centre often show up late for duty and sometimes do not show up at all. We observed that it is due to negligence on the part of the Ministry of Health and Sanitation who have deliberately refused to motivate the Nurses, especially the volunteers.

PRINCESS CHRISTIAN MATERNITY HOSPITAL (PCMH-COTTAGE)

At the PCMH Hospital (Cottage), we discovered that there are insufficient bedding facilities at the Post Natal Ward. The facility is highly congested, with Pregnant and Lactating mothers sleeping side-by-side on a single bed and two to three children sometimes put on a single bed to sleep.

We also discovered that within the last six months, some women lost their babies during delivery and as a result of botched caesarean operations. There are only two specialist gynaecologists at the hospital and they do all the operations.

We also discovered that there are secret abortions going on at the hospital. 
 We observed massive congestion and an inadequate number of nurses attached to each ward.

The patient population is far beyond the available staff. Although a shift system has been introduced by the Ministry of Health and Sanitation, giving the right to nurses to report for work on a shift basis i.e. in the morning, afternoon and night, there are still challenging issues as some nurse still do not show up for duty.

Our team observed that some night duty nurses never show up. Some come to the hospital in the morning to register, only to leave after a few minutes, pretending that they worked overnight.

Our investigation also revealed a case of eight missing children. Only three have been discovered and the remaining five have not been seen till date. However, two of the child trafficking matters are in court but are yet to reach a logical conclusion.

A senior official from the Health Ministry admitted to us that child stealing had been going on in the hospital for a long time and that they were doing their best to handle the situation.

She disclosed that a total of 2,305 volunteer nurses who participated in the fight against the deadly Ebola virus are recorded in their data base for Freetown only.

This brings us to the conclusion that the number of nurses reported by the ministry to be attached to that hospital is untrue. We believe that if a physical verification of nurses is requested, it will reveal that there are still ghost health workers in the system.

MACAULAY STREET HOSPITAL

At the Macaulay Street Hospital, under-five children are never given free medical treatment. Whenever a sick child is taken to the hospital for treatment, the senior nurses would pretend the required medicines for the treatment are not available.

We also gathered that after a certain prescription is issued to patients at the hospital, the nurses will claim that such drugs are not available. If their relatives have the money to procure the medicines, they would be made to wait for several hours on the pretext that the medicines are sold at a far distance.

34-MILITARY HOSPITAL, EMERGENCY HOSPITAL at Goderich and the KINGTOM HOSPITAL

At this juncture, we wish to note that our Research Team was denied access to the 34-MILITARY HOSPITAL, EMERGENCY HOSPITAL at Goderich and the KINGTOM HOSPITALS respectively.

They were instead sent to one Jonathan Abass Kamara – Public Relations Officer (PRO) in the Ministry of Health and Sanitation, to obtain a pass before they could access the facilities.

Report Conclusion

In conclusion, we want to highlight the following Key Findings:

  1. Poor accountability mechanisms: in all of the hospitals and health centres, the amount paid by service users is sometimes not what is indicated on the hospitals’ price lists.
  2. Cases of conflict of interest are affecting the quality of health services: This was evident among government doctors or senior staffs that consult within the sector of health, especially those stationed in the western area of the country.
  3. We also discovered delays in service delivery: In some hospitals and health centres across Freetown, patients/ clients wait for incredibly long hours before receiving medical attention.

The Ministry of Health and Sanitation is one of the largest ministries of government in terms of its budgetary allocations and operational activities. It is responsible for the overall formulation of national health policy and the supervision of health facilities, among other functions.

So in this case, we would like to conclude that it bears the greatest responsibility for this decadence and should be made to account for all the anomalies and be forced to make the changes where they are due and very fast.

About CHRDI

Campaign for Human Rights and Development International (CHRDI) is a Rights based social-policy advocacy Organisation. We Draw attention to the responsibility of duty-bearers to uphold human rights, and seek to support rights-holders to claim their rights.

CHRDI is in Special Consultative Status to the United Nations Economic and Social Council and accredited to many UN Agencies.

5 Comments

  1. It is so sad to see and hear about these sort of deplorable conditions and unbelievable behaviours of doctors and nurses in hospitals back home. Unfortunately the government sits back and watch these practices go unchecked.

    I work for the healthcare system in London although you cannot compare it to Sierra Leone, however, the practice and ethics of looking after people should be the same.

    The medical doctors in UK are regulated and monitored by the medical council and the nurses are regulated by the Nursing and Midwifery Council. They oversee the behaviour and practices of both doctors and nurses on and off duty.

    In fact there is a yearly fee to be paid by all practitioners in order to keep you on the register and you will not practice if your registration lapses. As a practitioner, if you are guilty of any malpractices such abuse to patients, bribery, stealing and administering wrong medication you will called for disciplinary hearing and worst case scenario you will be charged with gross misconduct and fired or struck off.

    My question is where are all these regulators? What is the role of the nursing and medical board in Sierra Leone?
    Who protects the patients? Who speaks for the public?

    All the organs of the society has been politicised. There is no accountability and no one is responsible for anything.

    What a sad way to lead our people. Bribery in the health care system? Where are the “ethics” that these spent 7-8 years to study.

    It is a shame that it is the very educated people who are letting down our poor people. Can someone with a voice please speak for these voiceless people?

  2. Connaught Hospital – was once the most renowned hospital in the sub region. An uncle of mine (now in his 80’s) told me that when he was a teenager, Nigerians and Ghanaians used to travel all the way to Freetown for free medical care at the Connaught Hospital.

    The matrons in those days and even up to the 80’s, had pride in their surroundings and made sure that the hospital was cleaned several times a day. The basics were available: mops and disinfectant. As a child, I remember that the hospital shone and had the smell of disinfectant.

    The wards were clean, did not leak during the rainy season and there was medical equipment available on the wards for use by doctors and nurses. There were medicines available for all ailments.

    However by the mid 80s, many top class doctors, sisters/nurses and matrons started retiring. These people respected time management, cleanliness, knew their job and respected their offices and had sound work ethics.

    After the terrible rule of Sheki, who by the way, unsuccessfully tried the bribe doctors so that he could infiltrate the medical profession. There were instances where he literally called them to his office to offer them suitcases of money as a bribe, to know what the doctors were saying about him. Many refused and rejected these offers. However a few accepted and thereby started the decline and divide and rule policy.

    The situation in the hospital took a nosedive when Momoh came to power. He was clueless and suddenly the medical and nursing staff found themselves with no salary for months on end. Everything else was failing – electricity and fuel suddenly became very scarce and many staff had to walk to work or queue for hours on end for petrol.

    With no salary, mouths to feed, rent to pay, school fees to pay, doctors, nurses and other staff had to survive and started charging consultation fees. The porters working at the hospitals suffered even more. They depended on the goodwill of patients’ relatives to give them money. They ran errands for staff as well and got paid. The hospital hygiene became very poor.

    The medical equipment on the wards started disappearing to be sold outside; the pharmacy system in the hospital (cost recovery) now sold only basic medicines. Nurses had to make food at home early hours of the morning and would bring it to the hospital to sell to colleagues or patients – to make ends meet. The massive previously well maintained kitchens now had to use wood to prepare patients’ meals creating smoke pollution on the hospital’s grounds.

    Patients had to bring in a generator with fuel for their surgical operations and if it ran out of fuel during the operation, a torchlight would be used. Many people died as a result. Intensive Care Unit was just a quiet private room for severely ill patients and still is – nothing more.

    Nowadays, Connaught Hospital is a shadow of its former self and not fit for purpose.
    There is a CT scanner at the hospital but it works only when the electricity comes on. So if your appointment is at 9am and the electricity comes on at 4pm, then you have a long wait.

    How can things change for the better?

    The staff have to be paid adequately and on time and competent people should be put in charge – not political appointments.

    Establish a competent whistle blowing system in the hospital to reduce and eventually eliminate corruption and allow patients to complain if need be.

    Policies must be put in place and there should be management personnel that police these and make sure that these policies are implemented and that they work.

    Staff should be given lessons on etiquette and customer service starting from the porters who man the gates at Connaught Hospital.

    We have so much sun – the roofs of Connaught Hospital should by now be lined with solar panels to solve the electricity problem in the hospital.

    We need specialists en masse in all specialties to deal with the complex needs of patients. Equipment should be available in the hospitals – so that patients can come to OUR hospitals and not to hospitals in Ghana, Guinea, India and beyond.

    How can a country have 1 psychiatrist?? By now there should be at least 10 doctors and more training to be psychiatrists and create incentives for them to come back home after their studies – offer them good housing, a car, regular monthly salary. We have to retain our medical and nursing staff or else the health system cannot run properly.

    There should not be 1 cardiologist but 20; we need oncologists to care for the large amount of patients being diagnosed with cancer; and the list goes on…..

    We cannot as a country be importing medicines and many fake ones at that. Train pharmacologists and the international community can help us open pharmaceutical industries to produce our own authentic medicines. We would appreciate this more than an airport at Mamamah.

    We have to act fast to improve conditions to prevent another deadly outbreak like Ebola or worse.

    These are just starting blocks and maybe then, this president and future ones will feel safe to use Connaught instead of dashing off to other countries for medical care at the slightest sniffle.

  3. This is unbelievable! Is this what you call a government? It is rather a din of crickets put together and named government – worst than a child’s play.

    CHRDI, thank you once again for bringing to light the deplorable conditions the Ernest Koroma APC government has made the Sierra Leonean people to live in. It really troubles ones conscience to swallow such kind of recklessness and irresponsibility by a government, in the service of its people. This is the worst case scenario so far in bad governance in this country.

    This APC government, apart from being clueless and incapable of managing the affairs of the country, they have also appeared to be ill-disposed toward the people.

    They haven’t got the minimal consideration for the people they represent. In the midst of this entire shambles, government officials are on the spree in pursuit of personal gains to the detriment of the well-being of the masses.

    The stunning disappointment of the people is, seeing how the state teams up to unleash such unfair treatment on them. The endemic culture of corruption in our governments over the decades, has eroded the foundation of the society. Generations have perished along the way, as they couldn’t tap their usefulness in our fifty-five years of self-rule.

    It is our responsibility as citizens to reconsider redressing this alarming situation, work together in good will, put in place the right order of things for good governance. The country is fast lagging behind our peers in the region due to poor governance and rampant corruption, and they always get away with impunity. The citizens bear the brunt of the consequence.

    Some of these consequences are Sierra Leone’s weak status and standing in the community of nations across the globe. Sierra Leone is hardly found in services list of countries. This makes Sierra Leoneans vulnerable to higher charges for services received. While other countries within our surroundinsg enjoy lower charges. This is simply because we haven’t got much to offer to the world in terms of progress and development.

    The deep-rooted cause for this is our poor governance and rampant corruption, which continues to undermine our Human Development.

    Sierra Leoneans must echo strongly these words into the ears of our governors: LETS CALL IT A DAY! ENOUGH IS ENOUGH!

  4. The CHRDI report on the state of healthcare in Freetown is extremely disturbing and should make all Sierra Leoneans hang their heads in shame. Why do we allow our people to be mistreated when they seek medical attention? How come all the public health facilities in Freetown lack basic modern medical equipment?

    Why are medical staff allowed to demand money for a service which is supposed to be free? It is beyond belief that the intensive care unit at the Connaught Hospital, which is supposed to be the leading hospital in the country, experiences power cuts and has an emergency generator which often has no fuel.

    I think the Minister of Health should call in the heads of all the medical facilities in Freetown and demand immediate change.

    Medical staff who do not report for work or who demand inappropriate payment should be reprimanded. Doctors and nurses who do not comply should be charged with serious professional misconduct and if necessary be struck off.

    The government has to send a message to all unscrupulous health professionals that their behaviour will not be tolerated.

    The Health Minister should bring in the Anti-Corruption Commission to monitor all public health facilities; and should demand a monthly report from all their heads to ensure that the stipulated guidelines are being adhered to.

    The people of Sierra Leone deserve adequate medical services. After all, a healthy nation is a wealthy nation.

  5. The deplorable “healthcare system” with evidence of corruption was present when I was given a tour in 1981; it appears nothing has changed.

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