Sierra Leone Telegraph: 11 September 2016
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.
Healthcare 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 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.
Nurses 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.
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.
In conclusion, we want to highlight the following Key Findings:
- 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.
- 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.
- 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.
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.