New Internationalist

Promises, promises

Last week at the UN General Assembly in New York, British Prime Minister Gordon Brown spearheaded an aids deal to promote free healthcare in developing nations. Against this backdrop Sierra Leone's President Ernest Bai Koroma instantly pledged to expand access to government health facilities in his country.

On a recent field trip with the Ministry of Health and Sanitation, I realized just how important this promise is. The current life expectancy in Sierra Leone is only 42 years. Then there's the dubious distinction of having one of the highest maternal mortality rates in the world. The aim of our little excursion that day was to clamp down on unlicensed private hospitals and clinics in the city. In Sierra Leone, the market is ripe for private healthcare; unfortunately, in most places the quality is not worth the extra money. 

Our first stop was a place with no sign board, in the east end of Freetown. Situated at the top of a rickety flight of steps, the narrow hallways were illuminated by flickering light bulbs that successfully enhanced the depressing atmosphere. The beds were sunken and stained; the mosquito nets grimy with overuse. The floors were cockroach friendly and the dispensary was stocked with boxes of expired medication. Upon being questioned the proprietor insisted that he had recently applied for a license even though he couldn't produce the paperwork. The clinic had no patients so the ministry bolted it down until further notice. 

The next stop was the Arab Clinic, a chain with numerous centres around Freetown. The reception and the surgery area were separated by a blue plastic curtain. Used syringes lay tossed around like pencils. Patients were crouched in beds with crudely fixed IVs sticking out of their arms. The doctor in charge was a Guinean physician who could not provide his credentials on demand and the receptionist a lanky, bearded man who only spoke Arabic. Both were placed under arrest and the patients evicted without compensation. 

I asked the man in charge of the raid, Dr Edward Nahim, what these patients were supposed to do. 'It's their fault for coming here, they should have gone to a government hospital,' he bellowed. Dr Nahim also happens to be the sole trained psychiatrist in Sierra Leone, which speaks volumes about the quality of state healthcare. The whole country of a little over five million depends on one psychiatric facility in Freetown. All government centres are overworked and understaffed and underfunded. 

The ministry had the right idea to close down these bogus private hospitals. But at the moment there's no real alternative on offer. And throwing patients out into the streets is not the solution. Sierra Leoneans are obsessed with Barack Obama and the current fixation is the healthcare debate in the US. Can this small West African country dream of universal healthcare? Just as President Obama's supporters are holding him to his campaign promises, Sierra Leoneans will expect President Koroma to keep his word.

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