Alarming newborn and maternal death crisis in rural Sierra Leone

A woman in labor at Waterloo Community Health Center in Sierra Leone is treated for shock and spotting with a local remedy of elevated feet. Five midwives from the hospital attended a Helping Babies Breathe training hosted by Project HOPE and volunteers from Latter-day Saint Charities in January 2024. The week-long training covered essential skills to help resuscitate newborns and provide postnatal care that ensures babies can survive. Midwives at Waterloo deliver about 200 babies each month, many of whom are high-risk pregnancies that were referred from outlying rural communities. Two months before our visit, the hospital opened a theater to perform C-sections, which means that more women in the area with high-risk pregnancies are now delivering at the hospital. Before the C-section theater opened at Waterloo, women who needed one had to go to the capital, Freetown, over an hour away. Many women could not afford transportation or would choose not to get the procedure due to fear or traditional beliefs, leading to high maternal and neonatal mortality rates. Project HOPE will be providing additional support to this C-section theater after a needs assessment on this trip. For more information, see interview transcripts with Dalanda, Adama, Fred Langeland, and Mark Sheffield. Photos taken on January 18, 2024.

Sierra Leone Telegraph: 20 February 2024:

In Sierra Leone, the challenges surrounding childbirth pose life-threatening risks for women and newborns. The country currently ranks fifth in the world for infant mortality rates, with 34 deaths per 1,000 births.

Additionally, Sierra Leone grapples with one of the highest maternal mortality rates globally, where over 717 women die per every 100,000 births due to complications related to pregnancy or childbirth.

Last month, as a part of The Church of Jesus Christ of Latter-day Saints work with Project HOPE, a group of four U.S. volunteers travelled to the Western Area Rural district of Sierra Leone to train a group of 30 midwives on recognition and treatment of post-partum hemorrhage, neonatal resuscitation, and essential newborn care. These midwives will then train other health care workers in the thirty-two facilities supported by this program.

Photo: Project HOPE’s Banneh Daramy at follow-up visits for babies previously discharged from the Special Care Baby Unit.
Follow-up visits for babies previously discharged from the Special Care Baby Unit..Inside the Special Care Baby Unit at Ola During Children’s Hospital in Freetown, Sierra Leone, doctors and nurses provide urgent care to newborn babies who are fighting infectious diseases, asphyxia, and other serious health conditions.The unit treats over 250 newborn babies every month, including babies who are referred from rural villages hours away.
Many of the babies in the SCBU were born premature, some as small as three pounds at birth, and almost all the babies on the day we visited were on oxygen. Most newborns stay in the unit for about a week, though some of the babies in the SCBU had been there for extended stays, including one who had been for two months.
Project HOPE has sent rotations of volunteers to the SCBU to provide surge support and help improve the working conditions inside the unit. We have also sent biomedical engineers who have worked with the hospital’s maintenance team to repair oxygen machines, CPAP machines, and more, and we are repairing the SCBU’s water tank so the unit can have running water. Project HOPE previously helped build a Kangaroo Care Unit next to the SCBU, but it was temporarily closed on the day we visited due to fire.

Year round, Project HOPE is actively supporting health workers and health care facilities across the country to improve maternal and infant health outcomes including helping create, implement, and fund Sierra Leone’s first bachelor and master’s program in neonatal nursing through the College of Medicine and Allied Health Sciences at the University of Sierra Leone.

Annette Ofodum, Project HOPE’s Country Representative for Sierra Leone, said:  “The reality for pregnant women in rural areas of Sierra Leone is grim. The overall health system is poorly funded and women in rural communities frequently give birth in clinics without electricity, running water, and basic amenities. These clinics often lack essential medicines such as oxytocin to prevent postpartum hemorrhage or vitamin K which is universally administered to newborns at birth. Should complications arise, these clinics do not have supplemental oxygen, resuscitation equipment, or a way to transport critically ill patients.

“The health workers that staff such clinics have limited training opportunities to acquire the knowledge and skills necessary to provide high quality care. Because of medicine and supply shortages, health workers sometimes purchase critically needed items themselves at local pharmacies.

“Hospitals in major cities like Freetown are hours away, usually requiring motorcycles to drive on rough roads due to a poorly functioning emergency response system. If women give birth at night, pharmacies are closed and there are no ambulances available. Preventable deaths of women and newborns occur every day.

“Birth should never be a death sentence for women or newborns. The maternal and newborn death crisis in Sierra Leone is solvable, beginning with the education of the next generation of health workers and ensuring clinics are equipped with the essential medicines and supplies required for life-saving care.

“Throughout my work, one truth is evident – knowledge is power. By educating midwives on essential maternal and newborn care they can disseminate this information to other health providers that attend births in their communities, initiating a cascade effect that benefits our entire country. Progress and Project HOPE’s work would not be possible without generous and on-going support from the Ministry of Health, Health Minister Dr. Austin Demby, and The Church of Jesus Christ of Latter-day Saints.”

Photo: Isatu Fatmatah (wearing black tshirt with red writing) is the mom of twin boys born prematurely on January 6, 2024 (no names yet). On this day she visits the Special Care Baby Unit with her mother, Isatu (pink shirt with writing), for the follow-up clinic with her twins at Ola During Children’s Hospital in Freetown, Sierra Leone.
Project HOPE supports the SCBU with volunteer rotations, training, and equipment support.
Inside the Special Care Baby Unit at Ola During Children’s Hospital in Freetown, Sierra Leone, doctors and nurses provide urgent care to newborn babies who are fighting infectious diseases, asphyxia, and other serious health conditions. The unit treats over 250 newborn babies every month, including babies who are referred from rural villages hours away.
Many of the babies in the SCBU were born premature, some as small as three pounds at birth, and almost all the babies on the day we visited were on oxygen. Most newborns stay in the unit for about a week, though some of the babies in the SCBU had been there for extended stays, including one who had been for two months.
Project HOPE has sent rotations of volunteers to the SCBU to provide surge support and help improve the working conditions inside the unit. We have also sent biomedical engineers who have worked with the hospital’s maintenance team to repair oxygen machines, CPAP machines, and more, and we are repairing the SCBU’s water tank so the unit can have running water. Project HOPE previously helped build a Kangaroo Care Unit next to the SCBU, but it was temporarily closed on the day we visited due to fire.

Yenoh, a midwife in Jui, Sierra Leone, said: “You feel guilt within yourself because of the death of the baby. What have I done? What am I to do?

“We refer patients to the hospital. Some of them don’t want to go. They want to deliver here [at the local clinic]. But if they can’t deliver here, they know it’s because of complications. In terms of transportation, during the day you see vehicles, but late at night you don’t. If you want to refer patients, there is no vehicle. If we call an ambulance, they will tell us they do not have an ambulance. If we have two patients here and want to refer them, we go to the community to find people who have vehicles who can transport them. Some drugs are not available. During the day we can go to the pharmacy, but at night we can’t do it.”

Project HOPE’s work in Sierra Leone began in 2015 in response to the government’s call for assistance to help contain the Ebola outbreak Project HOPE provided over $16 million worth of medicine and medical supplies, to help treat and contain the Ebola outbreak. Over the last eight years, Project HOPE has worked closely with Sierra Leone’s Ministry of Health to support local and national maternal-newborn initiatives. In the future, Project HOPE aims to assist the Ministry of Health in enhancing comprehensive services for HIV, TB, and Malaria, strengthening health systems, and integrating mental health services across various health program areas.

Photo Credit: James Buck for Project HOPE. 

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