Making It Happen: Reflections on Maternal Care in Sierra Leone

I have traveled and worked in over 40 countries filming and recording the, rituals and traditions around pregnancy and birth and have seen many shocking things but nothing prepared me for the emotional challenge of what I witnessed in Sierra Leone.
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I have traveled and worked in over 40 countries filming and recording the, rituals and traditions around pregnancy and birth and have seen many shocking things but nothing prepared me for the emotional challenge of what I witnessed in Sierra Leone. Within two days I saw five stillborn births and two maternal deaths in young women. What made these even more tragic was that they were preventable deaths.

Aminata, 29 years of age, was carried into the referral hospital in Freetown in the final stages of her fourth pregnancy. She was suffering from acute elampsia and was so ill that she could only be moved in a sheet hauled by her husband and other male relatives. Her medical history should have alerted the health professionals of the need to carefully monitor her throughout this pregnancy: Her first pregnancy had resulted in still born twins, the second in a live child, now 6, and her third labor was another still birth. When Aminata finally delivered, both the twins she was carrying were stillborn. The babies were delivered at 12.55 and Aminata died at 18.00hr from her condition. Pre-eclampsia is a serious condition but is very effectively treated with a small dose of magnesium sulphate, which, if given in time, would have saved Aminata and her twins.

I watched as Aminata's kind and gentle husband was told the news of his babies' deaths, he buried his head in his hands and later I saw him and his brother carrying away two tiny cardboard boxes for burial. Only 29 himself, that man had lost five babies and his wife.

The following day I was trying to interview one of the doctors working on the maternity ward who, in order to explain why he was too busy, showed me into a room where a young woman Fatimata was recovering from a caesarean operation, performed too late and which had resulted in the baby's death. Fatima was extremely ill with delirious septicemia and resisting the attempts by the medical team to insert a tube. She too died a day later..

All too often when a baby dies, the mother is not given the news until a relative can be with her. The look of helplessness of a waiting mother, who has only been told that her baby is poorly and therefore taken away, is heartbreaking. I often left the maternity unit in the evening and if a bed lay empty the following morning, I instinctively knew that the mother had not been happily discharged with her baby but that she or the baby, or both, had probably died.

There were of course uplifting stories with happy outcomes. Musa had four children and had gone in the early stages of labor to the local health center to meet Bintu, an experienced maternal child health nurse. Bintu, in her wisdom, realized that Musa was in danger and that she "should not see the sun rise twice in labor." The referral hospital was only 12 km away, but due to the incredibly heavy traffic the journey for Musa took 2 hours. Bintu accompanied her and Musa finally delivered a healthy boy via a vacuum extraction. If the necessary equipment had been available in the health center, the hazardous journey to the general hospital could have been avoided. It was a happy outcome for Musa, but so often it is not. Giving birth in Sierra Leone is a lottery.

On my third day, I traveled to the Jembe Health Center to film an evaluation session of the community health officer who as part of the Making it Happen program, had been trained in resuscitation of newborns only three months earlier. As we were packing up and about to leave, a woman rushed into the health center with what looked like a dead baby. The nine-month child had apparently drowned in a washing up bowl while her mother had been out of the room for a few minutes. The Tanzanian doctor who had been part of the training team shouted 'emergency!' and what followed was a superb example of teamwork at its best. Despite equipment regularly locked away to prevent theft or damage, it took only a matter of seconds to locate the necessary Ambo bag and using this and cardiac massage, the doctor was performing the exact procedure that had been taught. After five minutes the baby made a sound. The quick response, teamwork and the skill of the doctor had brought her back to life.

Some weeks later, back in London, I hosted a wonderful celebration for seven midwives all working in the busy maternal unit in Southmead Hospital in Bristol. These plucky women had raised nearly £14,000 for SafeHands by swimming the English Channel. This was no mean feat -- two had to learn to swim and fitted training into every non-working minute needed military organization. Huge tankers, jellyfish, nausea and biting cold had to be overcome. They completed their challenge within 16 hours. They chose our charity because they knew how very lucky British mothers are to have the choices about how, where and even when they give birth, cared for by highly skilled professionals: they wanted to support women in countries such as Sierra Leone where pregnancies often have very different outcomes

SafeHands for Mothers really does make a difference and I have seen the positive impact that training has on improving skill levels of health professionals and therefore the lives of mothers and their newborns.

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