Moriba lay on a mattress on the ground in pain as a nurse used a stethoscope to determine if her baby was still alive in utero. A sizeable chunk of its diamond trade is still smuggled.
It has gold, and is one of the world’s biggest producers of rutile, a titanium ore. It has the biggest iron ore deposit in Africa, the third largest in the world. And with the capital Freetown (almost a straight line 7,000km south of Ireland – there’s no time difference) sitting on one of the largest natural harbours in the world, it’s perfectly suited for transporting exports.
In Lungi airport, health workers in white coats greet disembarking passengers with hand sanitiser and call for vaccine booklets for a record of a yellow fever injection. One of the women attending, Mary Sesay, 21, with her five-month-old baby David, got a laugh from the crowd when she speaks about how ragged the equipment is, miming a baby falling out of the torn harness they use to weigh infants. “I want to wait until I am 18.” The men around her start spluttering with laughter. But you have poverty in homes, they use the girl as a source of money, so if she wants money and he comes to her, she offers [sex] for money.” And what about contraception?
A six–hour drive brings us to the Bonthe district of Sierra Leone in the south-west. Away from the jovial and boisterous singing and chatting, a tiny, lonely-looking figure sits in a corner. They didn’t want to treat me, they didn’t want to wake up.” Beside Sesay, her mother, Nafisatu Salakoley, adds that the nurse said patients don’t appreciate them when they visit the clinic during the daytime and then turn up at night “bothering them”. A group of men absentmindedly listen to our conversation, and I ask Sesay if she would like to have another child. To find out what young people actually think about the situation, we go to a local school. For example, if my parents are poor, my parents don’t send me to school, they will use me as a source of money . Some even don’t want to use condom because it will reduce sensation during intercourse.” They conclude that 18 to 20 was the right age to have children. “We want to be educated.” At the crossing of the river Jong, a passage of canoes and crocodiles, a wooden platform ships vehicles across, two at a time, pulled by a metal coil.This is one of the most inaccessible areas in the country, with terrible terrain and under- resourced health services. Some of them we get to by using boats, but it uses a lot of fuel.” Bangure, a no-nonsense nurse, says there were three maternal deaths in January. Most of the fathers are almost the same age.” Tucker interrupts, “Last week, we had a 12-year-old. If you people can do something and not just talking, talking, talking about it. With one question, tears fall rapidly down her cheeks and she wipes them away quickly. Unlike the other women, she doesn’t have a baby with her. She came to the clinic where worn-out nurses argued about treating her. Sesay finishes the story, “I gave birth to the baby alive, but it was not healthy.” That was it. At Centennial School, a boy kneels outside a classroom in the midday sun with his hands behind his back as punishment. By that rationale, they should be having children now. Across the river at a clinic in Gbaninga, traditional birth attendants have been retrained as community health workers. Working without pay, they’re proud of what they’re doing but hindered by a lack of resources and equipment. Some teens, their children have not started walking and they’re pregnant again.” For these women, their main request was a bicycle so they can cover bigger distances.People had their doubts, they couldn’t understand the disease, or that when people died you couldn’t touch them. ’ People thought it was something that didn’t exist. “We cannot get facilities, and can’t get supplies if we can’t get there. Heavily pregnant women are transported using hammocks, they carried to shore by men from the village. On the white sand beach at Yoni, health workers in blue shirts stand on the shore and sing songs to greet the arriving boat. That list: a delivery bed, a fridge, a steriliser, delivery kits, transport, an adult weighing scales, an ambu bag (a bag valve mask to resuscitate children), a phone, staff quarters, an incinerator (they currently use a fire pit to dispose of items) and, finally, electricity.We had to teach people: Ebola is here and it’s killing people.” Trinity College’s Centre for Global Health partnered with the Ministry of Health and Sanitation in Sierra Leone and World Vision Ireland and UK in m Health, or mobile health, and Sesay refers to an innovation where community health workers (CHWs) register pregnancies and communicate with nearby health facilities with mobile phones. “In the district, the biggest issue that causes maternal death is delays . The women walk in procession from the beach through coconut trees and across a bridge built over a stream. A few boxes of drugs are scattered around: ibuprofen, gentamicin injections, needles and a large roll of dusty gauze. A tarpaulin outside is made from bags from Sierra Rutile Ltd, a UK-listed mining company that recorded revenue of 3.4 million in 2013 and is currently undergoing a -million expansion of its operations in Sierra Leone. Houses have been repeatedly patched up and added to over the years, with higgledy-piggledy two- and three-storey buildings creating a filmset look, half-western, half- Shire. It still feels like that, just with people in it now.Sierra Leone has the highest rate of maternal death on the planet.
Una Mullally reports from the Bonthe District in the rural south-west, where teen pregnancy rates are high and basic necessities are scarce.
Out of over 14,000 reported cases, Ebola killed 3,955 people in Sierra Leone between May 2014 and February of this year.
The outbreak shut down the education system, impacted on mining, scuppered economic growth, and placed an already creaking health system under incredible pressure, creating a knock-on effect on health in general, not just people infected with Ebola. Sierra Leone is one of the most dangerous places in the world to be pregnant and to give birth.
It has the highest maternal death rate in the world and one of the worst infant mortality rates.
It’s hard to put such a desperate scenario in context, but if we compare it to Ireland, the latest statistics show we have nine maternal deaths per 100,000.
On the main roads, police checkpoints are accompanied by health workers screening for Ebola, checking temperatures with infrared guns. We have a nursing school in the district, but because of the hard-to-reach parts of the district, they prefer to go to another district. ” During the Ebola crisis, teen pregnancies spiked when schools were shut down. We are talking to them about family planning, but if you think of the hard-to-reach areas, we don’t have the logistics. If they go to the health facilities, it’s a long distance . “When we talk about teenage pregnancies,” she says, “we talk about [girls aged] 11, 12, to 14. The baby was delivered.” For girls so young, rape has to be a factor, “Yes, you must expect that. Her husband is 16.” Tucker also says in some cases young women hide contraception from their partners. “Because of the terrain, not all NGOs are working here. At times, there are some bylaws – that if a woman is pregnant you have to go to a health clinic – but if a woman is pregnant, and they have to travel eight, nine miles, sometimes they are carried by hammocks. We want to know what people are going to do in terms of help. Pregnant at 14, her baby died two weeks previously shortly after she delivered. In a classroom of 17 to 20-year-olds, they give their opinions on pregnancy and contraception. They discuss what they didn’t know before and what they know now. “We are doing it to help our community,” Iseta Farma says. “We were given a mobile phone by World Vision to register pregnant women, but the coverage here is very bad,” Jusu says, “We need bicycles. During the rains we want to cover long distances and we can’t.” One of the biggest logistical challenges in getting pregnant and breastfeeding women to health services is presented by water.