Babes in arms

At Magburaka public health unit in Tonkolili district, northeast of Freetown, the under-five clinic is in full song. Nurses are teaching the waiting women a song advising against being pregnant and breastfeeding at the same time; the logic being they should have two years between pregnancies.

Of 26 children who have been weighed this morning, six are malnourished. Nine-month-old James Kuyaleh weighs 4.9kgs and is severely malnourished, says district nutritionist, Salamatu Koroma. He will be given Plumpy’nut, a fortified peanut paste in widespread use.

Child malnutrition is just one of the challenges facing Concern’s 1,000 Days campaign here. The programme aims to ensure women and babies get the best possible food and healthcare from conception to a child’s second birthday. For most women, getting enough food is one thing, getting the right kind of nutritious food is quite another.

In April 2010, the government introduced free mother and baby healthcare. Many women had given birth at home until then, attended by the local traditional birth assistant (TBA). In declaring that all women should give birth in a clinical setting with trained personnel, the government put many TBAs out of a job. Now, it is illegal to pay them.

Government policy assumes conditions for delivery in clinics are better than those in women’s homes. Often they are, but some, like the health clinic in Mabella, one of Freetown’s biggest slums, offer the most rudimentary of services. One of the clinic’s midwives, Eugenia Bodkin, shows the delivery room in which two women can, implausibly, give birth on side-by-side tables. Heel marks break the leather surface. Bodkin pulls out the delivery “equipment”, consisting of a kidney dish with a few rusty scissors inside. In August, Bodkin delivered 40 babies here.

Community health officer Adama Gondor insists it is possible to get an ambulance through the muddy mile of teeming market in time to transfer to hospital in cases with complications. Transport is a recurring theme. Simply getting to the local clinic can become a life or death issue.

Back at Magburaka clinic, Sister Kadiatu Kamara relates flatly how, on September 1st, a pregnant patient bled to death at home, because there was no ambulance available. The district’s two ambulances are broken down and there is no hope of having them repaired. To nobody in particular, Kamara says: “You see the problem of free healthcare? When you have all of these other problems?”

Concern’s primary health care co-ordinator in Tonkolili, Rosalind McCallum, says: “Road access is a very big challenge for women here. There are many instances of delayed care-seeking because of road access or because of a lack of understanding of the seriousness of the condition.” Two hours offroad at Mayossoh clinic, the local committee has hit upon a solution. With a flourish, they unfurl the hammock they use to ferry labouring women around. The fabric still bears the lettering of its previous life as a food sack, but it is well made and, carried by four or six men, incredibly, the best means of getting a woman to the clinic.

One of the biggest barriers to seeing women and babies thrive in Sierra Leone is the culture, says Dr Mahony, who visited the country earlier this month with Concern. She says this culture fuels early pregnancy, frequent pregnancy, rape and lack of access to healthcare or education. “I found that most upsetting really, that these women are just not important within their society.”