CRADLE TO GRAVE IN SIERRA LEONE - Edexcel

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Hospitals are overheated and overcrowded, there is little antenatal care, and most families can't afford emergency transport. Minette Walters witnesses their ...
CRADLE TO GRAVE IN SIERRA LEONE Giving birth in Sierra Leone is a life-threatening gamble. Hospitals are overheated and overcrowded, there is little antenatal care, and most families can't afford emergency transport. Minette Walters witnesses their desperate plight. Authors in the Front Line is a new series of eyewitness reports by renowned writers who bring a fresh perspective to the human tragedies, flashpoints and trouble spots of the world. The Sunday Times Magazine is working with Médecins sans Frontières* to ensure the authors reach some of the most inhospitable and dangerous regions. For more information on MSF visit www.uk.msf.org

By Minette Waters Adapted from an article that first appeared in The Sunday Times magazine. It's 11pm and I'm in a Médecins Sans Frontières (MSF) operating theatre in Kambia, a remote town in northwest Sierra Leone. I'm using my weight to hold a pregnant 17-year-old girl to a table. Anne-Marie, a Dutch doctor and Marion, an Irish nurse, are scrubbing up in another room, while two Sierra Leonean nurses hurriedly assemble the anaesthetic and equipment for an emergency caesarean section. Heads would roll in England if a consultant saw a 17-year-old in this state. Her seizures have caused her to bite through her tongue, and it's so swollen that it's protruding from her mouth. The nurses have jammed a stick between her teeth but, it looks like a grotesque form of torture. Her name is Wara, and her husband brought her here half an hour ago. One of the nurses asked him why he waited so long but she knew the answer already. It took him 12 hours to borrow the money to make the six-mile drive from their village. Sierra Leone is the third poorest country in the world and, with no public transport, vehicle owners exploit the needy. The closer a patient is to death, the higher the price. Wara will die unless her baby is removed. The good news is it's still alive: Anne-Marie has picked up a heartbeat. The bad news is she knows nothing about this patient except that it's a first pregnancy. Wara has never been to a clinic, nor had her blood pressure checked or treated, and her husband's unsure when the seizures started because, in this society, men do not attend births. This operating theatre bears no resemblance to anything I've seen on Casualty. It's a room in a house, and the table is so narrow that Wara's body covers it entirely. I notice blocks of wood under the legs to raise it to working height, and I worry that each new convulsion will topple us over. Ancient wooden cupboards stocked with swabs and sutures stand in the corners, and dim light is provided by an outside generator. The smell from the latrines is so pervasive that I'm grateful for the surgical mask that filters some of the odour. I feel as if I'm in a Victorian novel. Kambia hospital was destroyed during Sierra Leone's 11-year civil war. With no hospital, MSF rented the largest available house and turned it into a 68-bed inpatients' department by building an extension and erecting a tent in the garden. There's no running water and intermittent electricity. Every bed is full and each patient has one or more caretakers to cook and clean for them. Some days there are upwards of 200 people in a house that was once used as a family home, and the heat can be unbearable. Even at 11pm my gown is sticking to my

back, and I wonder how Dr Anne-Marie and Nurse Marion cope in the middle of the day, when the temperature outside exceeds 30C. A cordon of sterility is established, anaesthetic is administered and everyone starts barking instructions at me as if I'm part of the team. There's nobody to direct the lamp light onto Wara's abdomen so that Anne-Marie can see where to make her incisions. I'm ordered to hold it steady. I manage fairly well, except for one small wobble when amniotic fluid suddenly sprays from Wara like a fountain. Suddenly a tiny boy, weighing just over 3lb, emerges through the incision. He has virtually no colour, he isn't crying or breathing, but he does have a heartbeat. One of the Sierra Leonean nurses scoops him into a green sheet and, together, she and Anne-Marie attempt to revive him with oxygen. We wait in silence until a thready cry and a sudden fluttering in his chest tell us he wants to live. It's an amazing moment which turns all too quickly to tragedy. Marion, removing the placenta, has discovered another foot. It's a little girl, half a pound lighter than her twin brother. Anne-Marie tries to revive her but, with no heartbeat, she instructs all efforts to be concentrated on the viable baby. Later, I ask what would have happened if the second baby had responded. "The same," she sighs. "With only one oxygen set, I have to choose the twin with the best chance of survival." When I finally reach my bed an hour later, I fall asleep. Tragically, Wara’s little son died after three days because he couldn’t suck. Wara recovered but it was a long time before her tongue healed. Her husband still has to repay his loan, but he’s thrilled that Wara’s alive and able to have more babies. He refuses to leave anything to chance, however. In future, she’ll be attending the antenatal clinic.

*Médecins Sans Frontières Médecins Sans Frontières (MSF) was born out of the exasperation of a group of French doctors working in desperate conditions in the Biafra War in the early 1970s. They were determined to create a movement to deliver independent humanitarian aid wherever it was needed, and particularly one that would speak out about the plight of the victims it helped. Thirty years later, MSF is now an international medical aid agency with a reputation of not only being the first to arrive in a crisis-hit area, but often, the only organisation to be there at all. The movement was awarded the 1999 Nobel peace Prize.