Maternal health crisis in Sierra Leone

Source: WaterAid - UK - Mon, 8 Feb 2016 13:00 PM
Author: WaterAid - UK-based INGO
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It has slid from news headlines, but Ebola is still part of the daily reality in West Africa. Hours after the World Health Organization declared the outbreak over in January, Sierra Leone officials reported two more Ebola cases.

Kenema Government Hospital in Sierra Leone is a major regional centre which already had expertise in handling Lassa fever, another haemorrhagic fever. However it was overwhelmed by Ebola and lost 37 of its own medical workers to the deadly virus. Just five doctors are now left at the hospital to treat a population of more than 500,000.

A Water-Aid - VSO study found a 30 percent increase in maternal deaths and a 24 percent increase in newborn deaths in Sierra Leone between May 2014 and April 2015 in part because women were afraid to go to hospital and attempting to deliver babies without skilled care in unhygienic conditions at home. Some 87 percent of homes in Sierra Leone do not have toilets and 37 percent do not have access to clean water.

WaterAid is working in the region to improve water, sanitation and hygiene in healthcare facilities; the non-governmental organisation hopes to reach 130,000 new mothers and their families in its programme work here and in other countries in its Deliver Life appeal.

All photos WaterAid/Monique Jaques

  • The Kenema Government Hospital was a major centre for Ebola treatment at the height of the crisis and continues to receive complicated medical referrals, usually by motorbike. However stigma persists around going to hospital, particularly among pregnant women and their families who fear contracting Ebola amidst the irregular water supply and poor sanitation.

  • Hawa Kallon, 35, waits outside before being given a bed at the Kenema Government Hospital. Pregnant, she arrived at hospital with a fever and waited in quarantine until both Ebola and Lassa fever could be ruled out.

  • Kaidatu Conteh, 18, who is eight months pregnant, draws water for her bath outside Kenema Government Hospital, Sierra Leone. Despite its status as a regional centre, the hospital’s supply of running water is intermittent, leaving medical staff and patients with a long walk to the nearest functioning tap. Toilets are basic and often out of order. As a result infection control is a constant challenge.

  • Midwives, nurses and doctors deliver the baby of Christiana Dassana at Kenema Government Hospital. This was a regional centre for Lassa fever, another haemorrhagic fever, even before the Ebola pandemic, and medical staff continue to take careful precautions for fear the virus has been undetected. Lead midwife Sando Kamara said they are struggling to draw pregnant women back to medical clinics, and they are contracting infection from poor hygiene practices at home. “The problem we find with young mothers is that they’re afraid to access prenatal care,” she said.

  • Midwives work on Christiana’s newborn who struggles to breathe after a long, obstructed labour. As much as 50 percent of malnutrition and stunting can be attributed to chronic infection linked to dirty water and poor sanitation, and women who had their physical development stunted are more likely to experience obstructed labour, making such difficult deliveries tragically common. Delays in seeking skilled care in a hygienic environment also contribute to rising levels of maternal and newborn mortality.

  • Kema James, 18, rests after delivering her baby at Kenema Government Hospital after a long, difficult labour. Kema arrived at the hospital on the back of a motorbike, a journey of 30 minutes over bumpy back roads while in labour, after midwives at the provincial health centre became concerned at the lack of progress. Midwives said her baby contracted an infection in utero.

  • Midwives and nurses lead a prayer session at Kenema Government Hospital, Sierra Leone. New mothers and their newborns are dying at even more frequent rates than before the Ebola crisis; hospitals are still ill-equipped to control infection with limited water supply and poor sanitation, and stigma around going to hospital for fear of contracting Ebola persists.

  • A baby rests on a mother’s bed in the post-natal ward at Kenema Government Hospital. The maternity wards are frequently without running water or working toilets and patients are expected to bring their own bed linen; midwives say they are struggling to attract women back for prenatal care and delivery.

  • A maternity ward worker takes a breather after a difficult day on the maternity ward; an 18-year-old died in childbirth on this day, one of many who have succumbed to infection and obstructed labour in a crisis in maternal health in the country. The midwives in the hospital work tirelessly to provide the best possible care but infection control is difficult without a reliable supply of water, working toilets and rigorous hygiene practices.

  • Jeneba Sandy, 22, sleeps next to her healthy newborn at Kenema Government Hospital, Sierra Leone. Happily she has had a straightforward delivery. Medical workers are struggling to convince pregnant women to return to clinics for prenatal care after the Ebola crisis.

  • A burial team member carries a cardboard box containing a baby who has died after obstructed labour and infection. Burial teams still wear full protective gear in Sierra Leone out of concern Ebola virus may have been undetected.

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