Monday, November 16, 2009

Sierra Leone Revisited

My favorite billboard in Sweet Salone, courtesy Helen Weld

There was an article, with very good photos, in the Los Angeles Times on Sunday about Sierra Leone through the lens of health. And I have to say, with sorrow, that it captures the situation dead-on. As Helen, who brought me to Sierra Leone way back in September 2008, wrote, this is all so sad and too familiar. Those of us who have lived and worked in Sierra Leone are not shocked by these stories or these statistics. The fact that one in eight women in Sierra Leone dies in childbirth is not surprising.

It was strange to read about key players that I have met or knew about, including the First Lady. It's a small country, but it faces huge challenges. Sierra Leone was an incredibly difficult place to live, and the farther away I get from it, the more unbelievable my whole experience seems. Sometimes what I experienced there is a ghost--forgotten, or pushed aside, only to reappear, to rise out when it's not wanted. I'm honestly still working through a lot of what I saw, what I did, what I lived. It was one of the hardest things I've ever done. Much of what I wrote about last year did not and could not capture the sheer insanity of the situation because I did not, and still do not, feel comfortable putting much of what I experienced out in a public place. Not because I went through a hard experience that I don't want to share, but for other reasons, and particularly because a blog is so public, even if few are reading mine.

I don't have the faintest idea how Sierra Leone or any supporting governmental or non-governmental organizations are going to begin to address the problems there, because they're at every level and cover every sector imaginable. Deep scars and anger, which I witnessed firsthand, from the civil war; corruption at all levels; an exploitative economy based on diamond mining that only enriches a few and subsistence farming of few nutrient rich vegetables; massive environmental degradation made worse by cheap and quick mining practices and the use of wood stoves for lack of anything else; utter lack of basic infrastructure from roads to electricity to clean water; devastating tropical diseases including malaria and yellow fever and diseases of poverty including typhoid; lack of rights for women and a worrying trend towards sexual violence during periods of unrest; crime that has no deterrent beyond vigilantism; and a health system that is beyond broken and seems beyond repair at points--and these are only the first scratches on the surface of a much deeper and more complex reality. In my own experience, there was no waste facility at the hospital, which meant that I watched dogs and vultures eat human tissue thrown out behind the operating theatre and children play with used syringes, which also littered our patients' garden. There was no running water at the hospital, which meant that our patients suffering from fistula, including ones with foot drop, or limps due to nerve damage, had to carry buckets of water on their heads from the hand pump well several times a day to wash themselves, since they were constantly leaking urine that gave them painful chemical burns if left uncleaned. I had a letter sent to a government official requesting treated mosquito nets for our patients so that they would not contract malaria, which could make them anemic and therefore delay surgical repair of their fistulas or cause life threatening risks, only to find that I'd committed a political faux pas because the official had "eaten" the nets. There were electricity cuts to the Bo Government Hospital, where I worked, on a regular basis, including extended blackouts that lasted several days, despite the fact that the hospital was supposedly on an emergency grid. This meant that the autoclave for sterilizing surgical equipment would not work and surgeries were performed by flashlight, if at all. I saw life saving equipment, vehicles, and other materials misused, misappropriated, and disappear. I saw people die because they did not have enough money, or because medical personnel were too overwhelmed or undertrained to offer treatment. I saw things that, as I wrote above, I cannot detail here.

It's very easy to get lost in this, even if there are good people living their lives and struggling for survival every day that are defying the odds, people who do not steal and who are able to surmount the lack of infrastructure. People like the strangers that helped me and a group of friends without regard for their own safety. People like the patients I worked with every day, who are able to laugh despite the fact that many of them were shunned and abandoned by their communities. I saw some of these women forgive their families for pushing them away and return to live their lives. Sometimes I'm not sure if we, as a global community, can even start to pick up the pieces of Sierra Leone. But I feel that something must be done. There's still time.

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