Today we visited more clinics, but are you surprised? A ten minute drive down the road from the hotel and we arrived in Makamp. We pulled off the side of the road and up to the clinic in the drizzling rain. The nurse in charge, Susan, was on her way into the clinic when we showed up. While we awaited her arrival we chatted with the rest of the nurses and village people taking shelter from the rain at the clinic.
The clinic serves 4,378 people from 15 catchment villages. The furthest distance a patient would have to travel for treatment is 6 miles. At the clinic they have 6 CHWs, a few nurses, and a CHO, who was traveling the day we visited. The nurse in charge told us their most common medical cases are for malaria, malnutrition, diarrhea, and pneumonia. They have the RDT device to diagnosis malaria, as well as HIV and STI diagnostic devices.
When asked specifically about anemia and sickle cell they told us, like many other clinics have, that those conditions are diagnosed by symptoms. They did not have a lab and therefore did not have the Hb (hemoglobin level) machine. For anemia, they are able to treat patients with an “iron tonic” if the case is not too sever. Any patient they suspect to have sickle cell is referred to the hospital to be diagnosed with the sickling test. The NIC told us about a case of a young boy, only 14 years old, who suffered from a crisis and could no longer straighten out. They did not have the capability to help the boy and therefore had to refer him for further treatment.
The health professionals at the clinic could not specify the approximate amount of people in the village with sickle cell; however, they did state that they know other people in the village have sickle cell even though they have not visited the clinic for help. They said they could tell by the person’s appearance and the native herbs they would be using to treat the symptoms that they were sickle cell patients. The nurse in charge stated that these people with sickle cell are constantly living in a state of unknown, “everything is a risk all the time”.
We’ve received different life expectancies for sickle cell patients everywhere we have gone but received our youngest estimate yet, the range 12 – 21. They also stated that a person’s life expectancy could be up until giving birth. This addresses the fact that sickle cell patients have a much higher risk for complications during delivery if the appropriate precautions (having blood ready) are not put in place.
As we wrapped up our meeting, a women on a motorcycle pulled up to the clinic. She was visibly and audibly distraught. Thats when the nurse in charge stated she was in labor. We took that as our cue to leave, and after a fast round of thank you’s we were on our way, back on the road.
Ten minutes down the main road and 20 minutes down a bumpy, muddy side street we arrived at Mapaki Clinic. Across the valley on the neighboring hill to the clinic we could see a beautiful orange pillared house, the chief’s house. As soon as we walked in to the clinic’s main office we were greeted by the SECHN and a peace core volunteer, Sara, who was assigned to that clinic. They were very honest with us. When asked about sickle cell, they said that it “effects the bones”, but also stated they did not know a lot about it. At that clinic they said they see a suspected sickle cell patient every 3-4 months who they then refer to Makeni Government Hospital. Towards the end of our visit we were talking with one of the nurses who worked there and she told us she had sickle cell. We are not entirely sure how she knew she had sickle cell; if we understood her correctly she had never been formally diagnosed. She told us that the weather (rainy season) makes her bones hurt more and that she sometimes does not come in for work because of the pain.
In addition to speaking to the healthcare workers, we were also able to ask the Peace Corps volunteer, Sara, about her experiences at the clinic. She told us that while the clinic was not the biggest or the most advanced clinic, the health professionals working there truly cared for the community members they were treating. When supplies would run out and shipments would not arrive on time the health worker would go to the pharmacy themselves to buy necessary medications for their patients (for example, fever reducers) . They would only charge a minimal amount in order make back some (not even all) of the money they spent on the medication.
Sara also told us about the strict prenatal and postnatal care system implemented in that chiefdom. This system ensures that pregnant mothers and their children come in for their necessary checkups by fining them if they fail to show up for a certain number of check ups.
Finally, Sara told us about her observations with the corrupt and ineffective healthcare and referral system used in Sierra Leone. She stated that even though healthcare for under 5s and pregnant/lactating mothers is free, the hospital will delay treating someone if they do not have the ability to pay (move that patient to the bottom of the list). She said that even though malaria tests are supposed to be free for everyone, the hospitals will often charge patients 30-40,000 Leones ($3-4) per test. The patients who are referred to the hospital usually do not have the ability to pay for these services. This was when Sara said that the hospital is “the place where people go to die”. This shocking but true statement explains why so many people delay trips to the hospital even if they have been referred and urged to go by the clinic.
We then came back (to World Hope) and ran in the rain.
