Travelling with me were Martine Lloyd, Senior Midwife/Nurse UHW Cardiff & Trudy Bufton, Senior Nurse, Midwife (not currently practicing as midwife). These two staff returned to the UK on 13th March whilst I travelled on to Liberia. The visit was fully funded by the Welsh Assembly’s Wales for Africa Fund.

Summary of events.

On Saturday 7th March we met with George Gage, Professor of Community Medicine whom I had met in Cardiff in 2008. I had contributed to his health awareness workshops during my February visit. The four of us discussed the major health problems facing Sierra Leone and of course how best to address them.

Monday 9th March brought the first visit to Princes Christian Maternity Hospital, (PCMH) the main government run hospital in Freetown, from which I reported the terrible statistics of 123 maternal deaths out of 1500 deliveries in 2008. My colleagues were quite shocked at the lack of resources within the hospital and even more by the apparent lack of care by the staff. I explained that IF these staff are paid then it is a pittance.. around £10 per week. It is very difficult to motivate staff, who feel that nobody, including their government cares about them. We took items of basic clinical and training equipment with us, plus text books, all of which we handed to a VSO Midwife tutor to be distributed as appropriate. We saw women in labour, women whose babies had died in-utero and were waiting for induction plus women suffering from pre-eclampsia waiting for C/Sections. We met a woman whose uterus had prolapsed and whose baby had been delivered prematurely. To our obvious surprise we were told that his mother had no breast milk, so the staff were giving him glucose and water using a dropper. He was 2 weeks old with folds of empty skin and glucose was all he had received since birth. There was no formula milk available. As we left the hospital we speculated on how long the child could survive on glucose and water….we decided that it not for long.

Tuesday 10th March took us to the office of Dr Daoh, the Chief Medical Officer along with Professor George Gage, A meeting had not been pre-arranged by Prof Gage, he advised that we turn up on the off chance. Unfortunately Dr Daoh was leaving to attend another meeting, however much to my concern the boxes containing the 4000amps of Magnesium Sulphate were sat in his office. It was agreed that an urgent meeting would be set up. Martine & Trudy went onto the PCMH whilst I went to meet with Professor Gage to meet with the UNFPA’s local Representatives Barnabas Yisa, Dr Mariama Diarra & Dr Peter Sikana. The overall situation was discussed with suggestions on how best to maximize the resources we were providing including getting the message out to the women in the community via the radio. I told them of the leaflets which I had brought with me, displaying the signs of pre-eclampsia in basic form and without any words, thereby overcoming the problem of women not being able to read and write. That day I was made aware of someone at Family Kingdom, (our accommodation) whose family supports a hospital some 6hrs away from Freetown by road. The Nixon Hospital was devastated by the civil war and is now being brought back to fully functioning by Michael Tettey and his wife, an Obstetrician. Thanks to the very generous owners of the Family Kingdom, I was offered unlimited use of the internet and began corresponding by E mail with Michael to see how we could assist. I will refer to this hospital later in the report.

Wednesday 11th March, Trudy & Martine returned to PCMH having purchased formula milk, where they were thrilled to find the baby who had been fed with glucose and water, happily breastfeeding and the mother smiling! I visited Tennyson Williams the Country Head of ActionAid whom I had met on my previous visit. From there I returned to the UNFPA to express my serious concerns over the lack of urgency by the CMO in distributing the Magnesium Sulphate. At that point I established that he had had the parcels in his office for approximately 2weeks. Dr Mariama Diarra decided that an arrangement should be made for me to see the Sierra Leonean First Lady, a nurse who had worked in London. This was done and an hour later I was sat with the First Lady Mrs Sia Nyama Koroma and her right hand man, Mr Titus Boye-Thompson. It was agreed that Titus would assist with resolving this problem and would accompany me to any meeting with the CMO. I returned to the UNFPA and was asked to accompany Barnabas Yisa to a meeting which would be attended and Chaired by the SL Health Minister, the CMO, Representatives of the World Bank, the WHO, UNICEF, UNFPA, UK Department for International Development (DfID) and many other significant individuals. Barnabas Yisa introduced me and by then I had been joined by Martine & Trudy from PCMH. I gave a spontaneous summary of what HFGK was doing in Chad, Somaliland, Liberia and what we hoped to do in Sierra Leone, adding that 4000 ampoules of Magnesium Sulphate were currently in the CMO’s office waiting for distribution. I informed those present that the Welsh Assembly Government was funding our visits as part of their Wales for Africa Project. We received a round of applause and then left.

Thursday 12th March brought the meeting with the CMO at midday. Martine had accompanied and stayed with a very nervous pregnant local woman to hospital. Dr Daoh arrived in his office at 13.45, looking rather nervous and informing me that I had 15mins to speak to him. I noticed that the boxes were gone. After a brief but very frank discussion, we left but I understand that he had received calls from several concerned individuals regarding the shipment and has been asked to meet with the First Lady. Following the meeting it was agreed that future shipments will be dealt with by the UNFPA, the First Lady’s Office and Dr Smart, the Head of the Reproductive Health Unit at PCMH.

Friday 13th brought a visit to the Marie Stopes Hospital. I felt that it was important for my colleagues’ visit to end their first experience in a developing country on a positive note, by seeing what was possible when resources are made available for maternal health. We were met by Martyn Smith the Director who, much to our relief explained that his organization was going to assist with training sessions for PCMH staff every Friday afternoon. I travelled onto the PCMH to meet with Amy the VSO Midwife in order to discuss the distribution of the equipment which we had brought, plus how best to use the leaflets on eclampsia. One of her students was brought in to give a view on them and it was then agreed that each student would, as a project take some out into the streets and give them to pregnant women, offering any explanation necessary. That evening, Trudy & Martine left to return to the UK.

Saturday 14th I met with Professor George Gage in order to evaluate the week, which he felt was very positive despite the problem with the CMO’s office. By then we learned that the problem had been resolved with the Magnesium Sulphate in the care of Dr Smart who was working on a distribution list.

On Sunday morning 15th March I flew to Monrovia, Liberia as I had been concerned about the lack of communication from the individuals within the hospitals where we had agreed to donate the Magnesium Sulphate and Misoprostol. I had no concerns about the integrity of the individuals, just about the lack of priority in communicating with us. I joined two women from Swansea and the organization Women4Resources with which I have been working closely in order to raise reproductive health issues and empowerment. One of the people who met me at the airport is a friend of the Vice President of Liberia and having heard my concerns regarding the lack of communication, arranged for me to meet with the VP. I arrived in Liberia at 11am and at 5pm I was sat in the home of the VP who asked me to write to him formally expressing my concerns. This was done the next day at the Internet Café and hand delivered to his home.

Monday 16th and after I had written my letter to the VP, I arrived at ELWA Hospital where I was met by midwife Esther Kolleh, the first person I had ever met at ELWA and the Medical Director. I asked about the numbers of women surviving pregnancy and childbirth and was thrilled to be told that the numbers of women dying were going down and down. I explained why I was there and they informed me that the Hospital Administrator had been suspended (nothing to do with our medicines), hence the lack of responses to my messages. I was taken to the pharmacy where I saw the current supply of Magnesium Sulphate and Misoprostol. After lengthy discussion with the two Pharmacists & the Medical Director it was agreed that a report on usage and therefore women treated would be sent to us within 2 weeks. From ELWA we went to the Women’s Group where I explained and distributed the eclampsia leaflets. They were well received and understood. These newly empowered women now regard themselves as advocates for women in their communities and enthusiastically agreed to spread the word about eclampsia.

Tuesday 17th March brought a very productive meeting with Fiindor Jackson the Co-Chair of the Liberian Health Committee at the Parliament building. Fiindor is a former nurse who stayed during the war and worked on the front line caring for the injured. He agreed that the level of communication to HFGK was not appropriate and would offer any help he could. From the Parliament building I was taken to the UNMIL (United Nations Mission in Liberia) Radio station as an arrangement had been made by the Liberia Consular in London for me to talk on air about our contribution towards tackling maternal mortality. It was agreed that I would be interviewed live on the following day at 8am and then return later to record a 45minute interview to be broadcast on 24th. I returned to the accommodation and then revisited the local women, who were in the middle of a major baking session, the products of which would be sold later that day from large buckets carried on their heads.

Wednesday 18th March and after leaving the UNMIL and the live broadcast, we went to JFK Hospital where I met with the Hospital Administrator and the Chief Pharmacist with whom I had left the medicines in October. The records were all in order but nobody had done as we had requested that of informing HFGK of stocks and women treated on a regular basis. I was assured that this would be resolved immediately, with a report to me by the time I got back to the UK (this was received as promised.) I then went to meet with John Harris, the Chief Pharmacist at Redemption Hospital who is centralizing the city’s pharmaceutical supplies. John danced me around his very small and sparse (desk, computer and one chair) office saying “Angela the numbers of women dying are going down and down and down! Everyone wants to come to Redemption!” He then asked whether we would consider supplying the two drugs to another hospital in Monrovia. I explained that I hadn’t been aware of a fourth maternity hospital in the capital and that as long as the same governance arrangements were in place that I am sure the Trustees would not have a problem. John explained that he would be controlling the supply from the central pharmacy and would be reporting back to us directly. John then took us to the hospital where we met with the Administrator, the Chief Pharmacist and a senior midwife. It was ante-natal clinic day and the ground floor was filled to capacity with pregnant women and their families. The supply was agreed and in order to avoid any delay in treating the women, John returned to Redemption to bring back a number of ampoules and tablets for immediate use. The return to the UNMIL Radio station for the recording went well, with a promise to send me a CD of the recording.

Thursday 19th March and I flew back to Sierra Leone. The Immigration staff who asked why I was in the country all expressed gratitude for what we are doing and passed me through without any problem. Our eclampsia leaflet is now displayed on the wall of the Immigration Office in Monrovia’s City Airport! On my return to the Family Kingdom I was informed that Michael Tettey from the Nixon Hospital (mentioned earlier in this report), some 6hrs from Freetown was travelling to meet me that evening. We met along with Julian Adey, the person who initially requested that we make contact. We talked for 3hrs during which Michael gave me some shocking statistics on maternal mortality at his hospital, including that in January 2009, there had been 11 deliveries. In February there were 12 deliveries. From 1st January until the date on which we spoke there had been 10 maternal deaths plus a further 7 babies had been stillborn. The causes of the maternal deaths were…. 4 from eclampsia, 2 from obstructed labour, 1 caused by a ruptured uterus, 1 had a retained placenta, 1 from malaria and one woman was brought in dead. Michael then informed me that there was a source of top quality medicines available from within Ghana and that he had purchased antibiotics from this company. He promised to make contact with the Head of the company to establish whether Magnesium Sulphate and Misoprostol were amongst the medicines available. Clearly this would enable HFGK to make considerable savings on shipping, but would only be considered if the drugs in question were of the highest possible quality. The following morning I contacted Dr Smart at PCMH and arranged for Michael to collect 100amps of Magnesium Sulphate, plus some items of equipment. (I have now received from Dr Smart, the circulation list for hospitals to receive the medicines and the Nixon Hospital will receive regular supplies in future.)

On Friday evening I left to return to Lungi Airport and fly home, satisfied that the objectives had been met, thrilled and very emotional that the news of the numbers of women dying was getting better and better, stunned that I had, in the course of 5 days met the First Lady of one country and the Vice President of another.

As additional information, on the Thursday before I left for this visit, I received a call from Glenys Kinnock’s Office asking whether I could accompany her to 10, Downing Street on Monday evening 9th March to meet the Prime Minister and his wife as part of the International Women’s Day celebrations. I had to decline but asked that Glenys tell them where I was and why I was there! Yes… I did pinch myself!