The airport is situated on the northern side of a wide river, with Freetown situated on the south, so a journey by hovercraft or helicopter is necessary to get to the city. I chose the former. The speedboat does not run at night!

Luned Jones joined me on my first day in SL which was spent with Prof Gage at a workshop for staff working in all areas of healthcare including administrative staff and cleaners. The purpose of the workshop was to provide basic information on topics such as Malaria, HIV/AIDS, the importance of clean water & hygiene, Reproductive Health & Sexually Transmitted Diseases. All the topics were well received and discussed openly.

On Monday 2nd February we attended the Princess Christian Maternity Hospital (PCMH) for a visit which had been pre-planned and for which an agenda had been drawn up, starting with a welcome reception at which we were introduced to senior obstetric clinicians, midwives, hospital administrators and pharmacists. I was invited to explain how we in HFGK would assist their hospital in trying to reduce the numbers of women dying in pregnancy and childbirth, clearly an issue which causes the staff grave concern. During this meeting, the conditions upon which HFGK will supply the medicines were stated, that of no requests for money from families, named individuals to take responsibility for the medicines and appropriate feedback on women treated/usage for predicting future shipments.

Following the reception, we were taken on a tour of the hospital, where we saw evidence of a resource poor environment, a lack of basic equipment including an autoclave. (Instruments were soaking in sterilizing fluid on the wards to be dried and re-used.)On our arrival in the labour ward, we were told that a mother had died that day, plus her baby. We noticed a group of staff standing around a cot and when we looked, a baby was laying lightly wrapped and not breathing. We were told that he had cried at birth and then collapsed, followed by an attempt at resuscitation. I listened in with a stethoscope, but clearly the infant was dead adding one more death to the total for that day. We saw a very sick looking mother who had given birth to healthy twins. The mother appeared anaemic, prompting the Matron to remind the staff to get the family members cross matched when they arrive for visiting! Baby clothes which I had brought were distributed amongst the appreciative mothers.

Dr Smart, one of the Consultants in the Reproductive Health Programme took us to his office where we were introduced to some of his team including midwives. He showed us the statistics for PCMH and stated that in 2008; of 2000 deliveries 121 women had died. In 2007, 141 women had died with 4 deaths in one day. There was no evidence of how many babies had died. He expressed concern about the number of caesarean sections which are undertaken at this hospital, >700 per year out of 2000 deliveries. He welcomed the support which HFGK would provide and informed us that they do occasionally have Magnesium Sulphate from the UNFPA but that provision is patchy with long periods without the drug. He showed us the path outside his office where he explained “the mortuary trolley is rolled past my window. When I hear that trolley, my heart sinks!”

The Matron took us to her office which was piled high with boxes and large bags on the floor, containing rice and onions. She explained that people donate such items to the hospital and prefer to give them to the Matron, thus ensuring that the items get to the patients.

We returned to the accommodation, reflecting on what we had seen and heard, we realised that SL has a monumental task ahead but we felt that we wished to contribute in some small way to improving the situation for mothers and staff.

Tuesday 3rd February was spent with student midwives, discussing what we hope to do. The tutor explained that every one of the 40+ students wished to leave SL when they qualify and work in the UK. There was a distinct lack of text books, with most of the lectures being given verbally and frantic note taking, rather than students being able to refer to text books. There is no internet access at the hospital for the students. I had the opportunity to address the class, explaining what we in HFGK hope to do and I was received with groans of relief when I mentioned providing the medicines. Despite being only 5months into their training, they recognized the significance of these two drugs. Again, I stressed the conditions upon which we would provide them and in particular the women being given them free of charge. I also took time to give the students an honest account of life in the NHS with all the pressures, expectations and that despite the salaries being considerably better than theirs, midwives are leaving the NHS in large numbers. I spent time with two Australian midwives ho are going to be in Freetown for the next year, discussing how we could assist in sending/bringing items of equipment and of course bringing clinical staff to assist with training.

Wednesday 4th February began with a meeting with Tennyson Williams, Country Head of ActionAid. Tennyson is a friend of one of HFGK’s Trustees so a visit was inevitable. He told us of his very personal interest in this subject as his pregnant Head of HR had died suddenly in 2005. He was particularly pleased that HFGK will be supplying the drugs free of charge and is very keen to see a publicity campaign with every mode of communication being used including radio as many women are illiterate.

From Tennyson’s office we travelled to the UNFPA office where we met Barnabas Yisa the local Representative and Dr Jarrie Kabba-Kebba an Obstetricia and National Programme Officer for Reproductive Health. The discussions were very productive and all were in agreement that a concerted effort would have an impact on the terrible statistics on maternal mortality. It was also agreed that the information regarding the free medicines should be publicized and a written agreement should be produced to be signed by all the stakeholders. It was suggested that I meet the CMO & Health Minister during the visit but this proved to be impossible at such short notice and we agreed that this would take place on our next visit.

My final meeting of the day was with Dr George Bernard Frazer, a highly respected obstetrician. Dr Frazer worked for some time in Aberdeen UK and is therefore fully aware of the value of our NHS. He was fully supportive of what HFGK is hoping to do and suggested individuals with whom we could work at the hospitals. Luckily the people Dr Frazer suggested were the very people I had met on Monday, so I felt a growing confidence in those who would be working in partnership with us. One of the most serious areas of concern for Dr Frazer was midwives pay. I told him of the discussions at the School of Midwifery on Monday and he confirmed that pay is around £40 per month. A newly qualified doctor earns about £100 per month.

Thursday 5th February and I returned to visit Professor George Gage to update him on the progress of my visit. From his office we went to see Mr Alhassan Seisay the deputy CMO for Sierra Leone who was thrilled at what I told him about our plans. He also stated his confidence in the individuals I mentioned within the Obs/Gynae Dept. He asked that the shipments be sent directly to the CMO, which was agreed.

Friday 6th February brought a visit to the Marie Stopes Private Hospital. A care package costs about $75. The Country Director Martyn Smith informed me that in 2008 of 1000 deliveries they had 7 deaths. Martyn added that he was confident that 2 of those deaths were contributed to by the traffic in Freetown, a fact that I could understand having been stuck several times during my short visit. I was given a tour of the hospital, clearly a world away from the government establishments including the provision of oxygen cylinders and an autoclave. I had intended to return to PCMH but was informed by the taxi driver that the traffic between the two hospitals was even worse than usual and would probably take more than an hour to get to with an even longer journey back to the accommodation.

Saturday 7th February was spent at a second workshop, this time for children whose ages ranged from 10-18yrs. The subjects were the same as those discussed the previous week, however the level of myths and apathy were nothing short of frightening, particularly those around HIV/AIDS including a theory that it doesn’t exist. I summarized what HFGK hoped to do and despite the ages of the audience, they fully understood what I was describing. One of the 10yr olds was an orphan, although I didn’t discover whether his mother had died in childbirth.

Sunday 8th February brought the preparations to leave Freetown. Our flight was at midnight. It was suggested that because of leaving in daylight to cross to the airport, I try the speedboat which I agreed to do. On arrival at the terminal, the water seemed very calm… the proverbial millpond so I felt fairly relaxed about my maiden journey in a speedboat and all was well until we hit the midway point of the journey. I think that a week on, the base of my spine has now recovered!

CONCLUSIONS & RECOMMENDATIONS.

Sierra Leone is clearly struggling to reduce the rate at which women are dying unnecessarily during pregnancy and childbirth. Poverty is at the heart of the majority of this country’s health related problems. In the UK pregnancy and birth are anticipated with joy and positivity. In Freetown, as with Chad and Liberia, I found myself looking at pregnant women wondering whether they would survive the gestation period and at groups of schoolgirls, wondering how many of them would be future victims of maternal mortality. The prospect of any one of these precious individuals and her baby dying for the want of medicines which we in HFGK can provide leads me to recommend that we initiate the provision of the two main drugs, Magnesium Sulphate and Misoprostol as soon as possible.