Sierra Leone’s poor healthcare system – Doctor wale should not have died

connaught hospital

Dr. Marcella Ryan-Coker: Sierra Leone Telegraph: 01 July 2021:

This post is just a long rant about why I am so frustrated with the absence of systems in the Sierra Leone health sector. No, this is not political! I am just outraged.

Also, before you come for me and start quoting scriptures about how we will all die, I know the scriptures. And I also know that God wants us to live a long and fruitful life.

But like my colleague Dr. Wahid Awonuga said in his Facebook post yesterday, living in Sierra Leone immediately cuts that life span into two.

The last few days have been very gloomy for the junior doctors and the Sierra Leone Medical Community. We lost a soldier! Dr. Omobowale Gabriell was an Anesthesia Resident at Connaught Hospital, University of Sierra Leone Teaching Hospital Complex. He had a Diploma in Anesthesia and only just passed his primary exams a couple of weeks ago. We were so excited for him. We knew his pass was a win for Anesthesia but also for Sierra Leone. He was one of the good ones, the perfect resident and ‘crowned prince’ of Anesthesia.

Wale was dedicated to his family, his job, and the church. All our conversations were on one of these three subjects. He was a fantastic colleague, mentor, and friend. Wale was one of those people who never let hierarchy or age get in the way of your relationship. I didn’t even realise he was way older than I am until he died. He was always ready to crack jokes and make conversations. Wale was full of life.

Wale was involved in a road traffic accident a few days ago, sustaining a head injury. He was admitted to the same ICU where he worked day and night tirelessly to make sure his patients had a fighting chance. But he did not get that chance. The system he worked so hard for failed him in all the ways it could.

First, let’s start with how the major referral hospital in the country does not have a constant electricity supply or a back-up generator. How is this even possible?

Just thinking about being in the ICU with an on-off power supply… how do you keep your patients alive?

How do you stabilize and monitor critical patients with inconsistent electricity supply?

Then let’s talk about how this same major tertiary referral hospital in the country along with all the other public hospitals do not have CT scans.

Wale had to be moved from the hospital twice to private health care facilities with CT scans. Do you know how much more traumatizing for the brain that is? Being on an ambulance on these very bumpy and congested roads racing to get a scan done.

My heart sinks just thinking of the whole process of moving someone with a traumatic brain injury from an ICU bed into an ambulance, then out of the ambulance into the facility… to and fro.. twice! All because the hospital where he is admitted does not have a CT scan.

While other developing countries are moving towards the use of MRI scans, all our public hospitals cannot boast of A SINGLE FUNCTIONING CT scan. This is the case for many other investigative modalities in the country. Making a definitive diagnosis in Sierra Leone is one of the biggest challenges in managing some critical conditions.

You know what else could have helped Wale? Having a neurosurgeon and a neurosurgery unit in the country. Like many other specialties with very few or no specialists, if you need neurosurgery in Sierra Leone, and don’t have the time or money to fly out of the country, just say your last prayers.

You would think that with the burden of trauma in Sierra Leone and the many cases of head injuries which we see regularly, that by now, we would be pushing more for these.

Most cases that require neurosurgical interventions are life-threatening emergencies. Wale would have benefitted from specialized neurosurgical care. He could have still been with us today.

On Saturday, I was on-call at work. One of our patients had developed a brain abscess from head trauma. He could also benefit from the drainage of this abscess by a neurosurgeon. But we have none so we have to depend on antibiotics and hope for the best outcome.

Doctors are only covered by insurance during outbreaks like COVID-19, for example. And this was even after we fought with MOHS to be protected. When doctors die, their families only get the meager NASSIT benefits.

We are paid so little that we cannot even save decent amounts from our salaries to afford to be comfortable. But we have been painted in such a bad light by senior government officials and politicians. As soon as we start the conversation on working conditions and pay for health workers, we are perceived as money-hungry and not wanting to serve our people.

When our colleagues fall ill, we have to start fundraisers to support them. The aid that Medical Board provides often does not even cover half the cost of their treatment overseas. We want decent wages. We want health insurance, so if we die in service, our families and kids will have decent lives.

We want to afford house helps so we don’t hop on motorbikes trying to shuttle between work and school runs. This is how Wale met his death. I want to talk about the lack of road safety interventions, but that will be a topic for some other day.

So many things are wrong with health care in Sierra Leone. I don’t take waking up with good health for granted because God forbid, a health emergency. Public hospitals still struggle with water and electricity supply.

Many of them still don’t even have oxygen support or essential drugs needed for emergency care. It irks me so much that top officials never go to public hospitals. THEY KNOW! They know how broken the hospital system is.

Once, I referred a very top government official to Connaught hospital for a metatarsal (foot) fracture. He made sure to introduce himself to me and immediately said ‘No’. He didn’t know that I already knew who he was but I honestly didn’t care. Because healthcare should be the same quality for everyone regardless of socioeconomic status. He told me he would arrange to fly out of the country in the next few days rather than go to Connaught.

The Orthopaedic (bones, muscles, joints) Department at Connaught (the major tertiary referral hospital in the country) is ill-equipped to deal with the burden of trauma that the department handles daily. They manage almost all the cases conservatively or refer to Emergency hospital. This is not a secret, but little or nothing is being done to change it.

I am happy that the national Postgraduate College of Health Sciences has been opened. It gives some hope that things might start to change. I am hoping that the college’s push for better equipment and facilities at the teaching hospitals to make them more conducive for teaching and learning and improved patient care.

Often, we wonder why doctors go away and never come back. But this is why. THE SYSTEM IS BROKEN on so many fronts. Who would want to come back to this?

Who would like to work so hard for a system that will fail you at the slightest health emergency? I am tired! Tired of typing, tired of thinking of all the things that need to be fixed, tired of thinking of all the things that could have given Wale a fighting chance-a chance to live, save more lives, and be with his wife and two girls. I am tired of saying RIP to my colleagues, my family and my friends.

What can be done to change this? How do we move away from this?


  1. Heartfelt congratulations to you, Young4na. What you and your organisation have done is simply phenomenal. Your commitment to improving the lives of some of our most vulnerable and needy compatriots underlines your deep and faultless patriotism and provides – even if partially – an answer to the very pertinent questions that Dr Ryan-Coker poses at the end of her remarkable article.

    More precisely, your charitable initiative puts to shame our political leaders both past and present for their gross dereliction of duty in allowing our country’s health system to go to the dogs. And perhaps more importantly, it shows the rest of us what to do to contribute meaningfully to such core areas of national development as health and education.

    I have no doubt that Dr Ryan-Coker will herself see great merit in what you and your organisation have accomplished, thus giving cause for her to be optimistic. Indeed, given her own medical knowledge and experience and your own result-orientated organisational skills and endeavours, there is every reason to believe that as far as the future of our country is concerned not all is lost. For in the final analysis, Sierra Leone can count on her patriotic sons and daughters at home and abroad and who have no narrow party-political, regional and tribal interests to serve, to step up and give their all to save her.

  2. My senior brother, professor Abraham Amadu Jalloh and our distinguished diplomatic veteran, honorable Sahr Matturi, thank you both for your commendation. In all respect, Sierra Leone belongs to us all and in extension, each of us have a civic responsibility in advancing her developmental aspiration. I have great admiration towards you 2 gentlemen and several of our compatriots, folks like professor Dauda Yillah, the indomitable Great SAYEDNA, my elder brother adjunct proffessor Alimamy Turay, and a host of others who partakes in this intellectual platform, courtesy of the greatest patriots of all time, honorable ART.

    Now when it comes to the question of politics, while i cannot rule anything out in life, at the moment, though i am highly favor in my chiefdom, i have no intention of getting involve into politics. The truth is, the current political climate and the self seeking political undertones, practice by 99% of our politicians will outrightly ostracize me, if i dare attempt to be a member of parliament. I frankly can’t imagine me belonging to a cabal of corrupt self seeking individuals.

    • Thanks Mr Young4na, totally agree with you. Sometimes politics is not the only route available to citizens to help develop their country. As former President Kennedy once said,:”Ask not what your country can do for you, but what can you do for your country” He was spot on in the 1960s. And those words should be the guiding principle under which we aspire to develop our country.

      You yourself, Mr Abdul Rashid Thomas the editor of the Sierra Leone Telegraph , the Sierra Leone national football team, and so it applies to many thousands of patriotic Sierra Leoneans, our medical doctors, Nurses, Members of the Republic of Sierra Leone Armed forces, the Sierra Leone police, members of the Prison service, Fire fighters, Nurses, Teachers, refuse collectors, our famers, the diaspora that keep sending remittance back home, the artists, sports people, anyone that tries to make a difference, and I dare say some of our politicians that have never involved themselves in stealing from the state, are all part of our duty to the state of Sierra Leone to make our own little contributions. At the end of the day, it all adds up to a healthy, and vibrant society.

  3. Like everything else in this our beloved nation, medical facilities and other healthcare infrastructure are highly neglected and ill-equipped for any form of health emergency. As narrated here by Dr. Coker, in this eye opening article, almost all public hospitals in the nation lack essential medical paraphernalia requires for acute illnesses and emergency healthcare. With the abundance of natural resources endowed into our hands, one will think our politicians will be humane enough to prioritize the saving of human lives, by making sure at the very minimum, several major hospitals across the nation are equipped with modern medical diagnostic equipment along with medical specialist in diverse fields of medicine.

    If cost is a factor, just as many of us buy used vehicles for our personal use, why not at the very minimum go for second-class (used) medical equipment that have been certified to be in 100% working order and safe? I am sure many of us in the diaspora who work in the medical field are aware of medical facilities occasional upgrading of equipments, with old ones usually donated or auction at the lowest level. One will think our current crop of politicians, a good number of who happen to have lived in the western worlds, will envisage such opportunities, acquired medical equipment for each major hospitals at each district to save citizens lives.

    Last week, through the tireless effort of my charity organization, i am glad to announce that, i was able to oversee a successfully donation of over 80 used wheelchairs and other assistive devices to the National Rehabilitation Center for the disable citizens and several hospitals across the nation, including Connaught and Emergency at Godriech.

    • Congratulations my brother Young4na, for your highly admirable efforts in helping set up this charity that has identify rigthly, the huge challenges facing one of the most neglected, and vulnerable peoples in our society. A country not long ago, that just emerged from a brutal civil war , was just the right call and judgment you made to help many a victims from that war, with out your efforts will found themselves grounded in their homes.

    • Many thanks Young4na. This is what is expected of true Patriots of our beloved country. To politics now. The present MP from your area would be worried about you I reckon. Are you interested in politics Young4na? I believe many more people on this glorious platform are determined to shake up politics in Sierra Leone in the future. These sorts of help are a start in my view. The MP from my area need not worry because I’m not interested in politics. But, “we day na road”. Thank you very much Young4na and may God bless you and your charity.

  4. Where do we go from this terrible gloom? Nobody wants to go home and gets deprived of the fundamental human rights to good health. Our elected officials are not equipped to perform their duties to the country. They are not educated. The lack of management skills has exposed the country to such damage. The people are dying for lack of knowledge. We need trained functioning experts to make things right again. Oh, they have two SIMS and are not required to contribute to government affairs. The people of Sierra Leone are bathing in the exuberant of their verbosity. Amend the Constitution so experts can come and restore the broken parts.

  5. Given the political polarisation in Sierra Leone , its hard to walk the political suspension tight rope of speaking your mind out in our country, with out being pigeon hole, or tagged as an opposition supporters, or a government lacy.What Dr Ryan Coker achieved, was to set out his stall without stepping on any ones toes. And he certainly didn’t take any prisoners in his latest endeavours. which in itself is unique , and a great achievement on his part. The state of our health services in Sierra Leone, epitomised every thing that have fundamentally gone wrong in Sierra Leone. Nothing tells you about the state of your country’s development and how well it is performing in the economic rat race of the world , than the way your health care systems in your country works for the benifets of its citizens . We can’t sugar coat it, otherwise we will be abuseing our own conscience, and what we believe our country should be , instead of what it is made to be by our fellow Sierra-leoneans.

    Our health service has seen decades of under funding for medical equipments, and an army of underpaid health professionals, risking their lives and limbs doing their under appreciated jobs. And government ministers that acts like the wreaking balls in our national development aspirations, has the brass neck to label our hard working health workers demanding a seat in the decision making tables as politiopportunist. Everyday, they wake up, leaving there families behind and doing what they are trained to do, Dr Rayan Cocker’s article have reminded us there are thousands of his fellow colleagues that are giving it there all, to try and make Sierra Leone a better place for all not for the few.

    The unfortunate passing of Dr Omobowale Gabriel, may his soul rest in peace, is sad and unnecessary, but for the lack of investments in our health care systems, this unimaginable tragedy that hits his famliy and a great loss to our country, shows how far we have to go to truly say our country is on the right tracks. The issues here, is that, the social contract between the citizens, that are ready to give up their rights and freedom, in return for government protection and looking after your welfare has been broken.

  6. You are right, Dr Ryan-Coker: what you have written is not political. Rather, it is a factual, detailed and heart-rending account of what happens to people needing emergency health care in a country where the health system has over the decades been a tragic failure. I share your distress, gloom, frustration, desperation and pessimism relating to the non-existence of what it takes to give every compatriot of ours a fighting chance if she/he for whatever reason and at any time sustains injuries requiring appropriate medical intervention. Again, your despair conveyed by every word in your very moving account has nothing to do with politics. It springs and rightly so from a deeply felt loss brought on by a dying national health system.

    And yet the origins and nature and perhaps the way out of the woeful state of that health system are downright political! This is because those who have governed our country all these years have never taken a key responsibility of theirs seriously, namely looking after the physical and mental well-being of the nation by investing adequately in such vital areas as its health system. Much more important to them have been their personal desires and ambitions leading to their wholesale capture of the nation’s resources that should have been better utilized to make such unnecessary deaths like that of your good friend Wale completely avoidable. May Wale’s soul rest in perfect peace.

    How inspiring nonetheless to have you on the ground, serving our motherland selflessly and to the best of your ability. Please do not throw in the towel and leave. No one else can serve our nation better than we. Sierra Leone is our only home. I hope our political leaders and other important decision makers will on reading your devastating diagnosis of the state of our health system examine their conscience, rethink their priorities and put the interests of their fellow citizens – their health needs – above all else.

  7. Turning and turning in the widening gyre
    The falcon cannot hear the falconer;
    Things fall apart; the centre cannot hold;
    Mere anarchy is loosed upon the world,
    The blood-dimmed tide is loosed, and everywhere
    The ceremony of innocence is drowned;
    The best lack all conviction, while the worst
    Are full of passionate intensity. W B Yeats

    • I’m an American doctor working in Kono clinic. Sierra Leone has trillions of dollars in minerals in this District alone. Take responsibility and mine your minerals. Perform large scale mining and get all the medical equipment you need. America has a lot of CT SCANNERS and MRI machines and they all use minerals that come from your mines.

      • Dr Dillard, there you have the crux of the matter. The mentality of the governing class is that the amenities, in some cases basic, of life are only for them. If the mining was opened up to ordinary people, then they would be able to access such amenities and God forbid might even remove them from power. In most houses only the child of the elite is allowed to go to school, drive a car or eat protein. For the remainder, any such aspiration is viewed as criminal and they will suffer the consequences.

        The above encapsulates the mindset of the governing class.

      • Bless you brother I am here in Kono and your message is quite understood. If the little Gambia has what we had, nobody can mess with them. Some years ago I visited one of the European countries, a white lady asked me “where are you from young man? I answered with a light smile; I’m from Sierra Leone. She wondered asking me, what are you doing here your country is already rich?. This young lady started telling me some stuff about Sierra Leone that I never come across myself. Kono District alone can solve Sierra Leoneans economic problem.

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