Thursday, June 28, 2007

... And Lows

On the other extreme, several English friends of mine have recently run headlong against the cold, unforgiving, soul-sapping wall of the Sierra Leonean health system (or lack thereof).

Sierra Leoneans will do all they can not to reach this wall, foregoing health care entirely or turning to native herbalists or quack pseudo-doctors, some of which are well-meaning and others pure crooks.

Foreigners often can’t understand this reluctance. “You’re clearly sick or hurt or dying,” we say. “You need to go to the hospital. Otherwise you will get worse. Otherwise you will die.”

So we get involved. We convince people to go to a “real” doctor. We help wrangle them a bed in a hospital. We talk with doctors and nurses. We buy drugs. We pay for treatment.

And only then do we notice that none of it is helping at all. That our money – for bribes as well as legitimate fees – is being sucked down a hole. That no care is being given. That the patient is being ignored, or even abused. That he is still getting worse, and is still going to die.

A friend is fighting this battle with one of the country’s best government hospitals, a place that has received extensive international support and a thorough facelift in recent years. The clean, freshly-painted facility seems from outside a cheery, healthy place, overlooking one of down-town’s main streets.

This is, in every way, a façade.

More than a week ago, my friend brought in an old man who lives in his compound, allowed to sleep under a zinc-roof shack in return for service completed years ago. He is given food and the occasional few thousand leones (few dollars) by the landlord, though he’s not really an employee any longer.

Recently, the old man became sick, and then sicker. No one else wanted to get involved in his care – not the landlord, not his own children – and seemed content to let him die on the concrete, in the rain, under his rusted tin shack.

But my friend, still filled with the optimism (naïve, perhaps) of the wealthy world, couldn’t allow this. He argued and persuaded and finally convinced the landlord to allow him to bring the old man to hospital.

At first, he couldn’t get the man a bed. Turned away day after day, he finally put in a phone call and pulled some strings with a well-connected doctor, and got the man admitted.

Then began the battle with the doctors and nurses. He gave them money: some legitimate fees, some bribes masked as the cost of supplies like gloves and syringes, and others outright requests for money for their own pockets.

The doctors diagnosed heart problems and prescribe a collection of medications. My friend bought the medication, only to be told it was the wrong medicine and he would have to give the nurses money to buy it themselves. (Translation: he should have let them buy the medicine in the first place so they could get a cut.)

He returned every few days to see how the man is doing, and found each time that no one had touched the man since he was brought to the hospital: not to clean him, not to treat him, and certainly not to give any real care. Unable to rise from the bed, the man lay in his own waste. His health had deteriorated rapidly, and as far as my friend was concerned, he hadn’t been given any of the medicine he'd purchased (twice).

Despite this, the doctors and nurses continued to demand money. “We haven’t been paid for months," they say. “We don’t have the supplies we need.” My friend argued and fought, but eventually paid – because, after all, isn’t this man’s life worth another $10? $20? $100?

After a week or so, the nurses and doctors started to mention death, and to prepare my friend for the significant costs involved if the man were to die in the hospital. My friend became convinced they were letting him die because it would be more profitable for them than keeping him alive.

All this made him wonder if the others had been right; if he would have been better just to let the man die in peace. He wanted to help, but was rendered helpless by a system of corruption and inaction, in which the patient’s well-being seems to be the furthest thing from everyone’s mind.

“What more can I do?”, he asked me one night. “And when do I give up?”

As for me, I keep wondering how you fix a system so thoroughly broken. Where do you begin? By paying doctors and nurses more, and hoping that in return they actually care for patients? By firing those who don’t and starting from scratch with recent graduates and new hires? By importing foreign doctors with foreign training and a foreign work ethic?

Another English friend is a medical student, here for 6 weeks to work in a children’s hospital. He listened to my story about the old man without a hint of surprise or horror.

After just a few weeks here, he’s gotten used to watching doctors ignore patients – even when those patients are children and babies. He’s gotten used to banging his head against the wall, trying to improve the quality of care, trying to save a life.

He’s gotten used to seeing babies die.

He came with us to the wedding on Sunday, and every time I turned around he was surrounded by small children and grinning like a schoolboy. There he is dancing with three little girls. There he is touching the head of a small baby, wrapped in a brightly-colored lapa in her mother’s arms. There he is sharing his camera with a crowd of kids. There he is lifting a grubby boy into the air.

“He's just glad to see children who are happy, and aren't going to die in a few hours,” someone said.


Of Highs...

I think I’ve said before, Sierra Leone is a country of extremes. A day is either a joy or a travail. A scene is either of breathtaking natural beauty or of breathtaking man-made misery. An interaction is either a model of warmth and generosity, or an inexplicable barrage of anger or sullenness. There is no in-between.

Sunday was a day of light and celebration, and a reminder of why I love this country and its people.

My housemates and I were invited to attend a wedding in Kissy, a neighborhood in the poorer eastern part of Freetown. The bride, Sento, was the daughter of one of our guards, Santigi Bangura. We were delighted to be invited, and he was ecstatic that we would attend.

The wedding was held in the rocky courtyard behind his home. A makeshift mosque – rough wooden poles covered with a blue plastic tarp, with rows of plastic chairs and the ground covered with prayer mats – housed the ceremony and the Muslim revelers. Other friends and family members spilled over into the surrounding courtyard, perched on chairs and stairs and walls.

As is typical in Sierra Leone, we were welcomed with overwhelming warmth, and – as the “strangers” at the celebration – treated like gold.

We were also swept immediately into the heart of the festivities: I was enlisted as an unofficial official wedding photographer, and even invited (nay, dragged) into the mosque itself, and to a spot on the ground just between the bride and her father. And my housemate Tom was spotlighted as the special musical guest, singing songs of his own creation to the amusement and enjoyment of the Sierra Leonean crowd.

I think the pictures speak for themselves, but suffice to say, it was one of the best days I've spent in Sierra Leone.