Sierra Leone: Helping pregnant women reach hospital in time

“When I went into labour, I started making my way to the nearest health centre, but then I felt one of my two babies coming, so I spread my cloth under a mango tree and gave birth on my own,” says Musa Yahyah. “A traditional birth attendant helped me deliver the second baby under the mango tree. Afterwards, she called a motorbike-taxi to take me and my twins to MSF’s mother and child hospital in Hangha, because I was bleeding a lot. They gave me a transfusion of two pints of blood, then me and my babies were finally fine.”

Despite major progress made this century, in 2020 Sierra Leone still ranked 18th in the list of countries with the highest number of women’s deaths in childbirth, with an estimated 443 maternal deaths per 100,000 live births, according to the World Health Organization[1]. Many women in Sierra Leone live in remote, rural areas, far from health facilities, and cannot afford the high cost of transport to reach a hospital. This is compounded by poor roads, a countrywide shortage of ambulances and a lack of proper patient referral mechanisms. By the time a woman experiencing complications in childbirth does manage to reach a hospital, it may be too late.

[1] https://www.who.int/publications/i/item/9789240068759

18-year-old Umu Ngamanga and her brother-in-law, Albert Ngamanga, been driven by a private moto-taxi to Hinistas Community Health Centre in Mile 91, Tonkolili District, in the Northern Province of Sierra Leone; following a referral by the medical staff of the Foindu Peripheral Health Unit (PHU) due to the medical complications of her newborn. MSF supports 12 Ministry of Health and Sanitation’s (MoHS) Peripheral Health Units (PHUs) in the surrounding of Mile 91 town, in Yoni Mabanta, Yoni Mamaila, and Malal Chiefdoms, including one Community Health Center, Hinistas, in Mile 91 town itself, where patients with severe symptoms can be referred. When ambulances are not available, MSF covers the cost of the moto-taxi transport, to ensure cost or distance to the adequate level of healthcare facility is not preventing pregnant women and their children from accessing lifesaving emergency healthcare. For those in need of hospital admission, further ambulance referral to the MSF-supported Magburaka Government Hospital is available, the main secondary healthcare facility in the district for more advanced care. “I started experiencing labor pains at night, but it takes me two hours of walking and crossing a river to get to the nearest PHU, which is in Foindu, 10 kilometers from my home. My baby could not eat and had fever, so I took him to the PHU the next day after I gave birth. He was immediately taken by motorbike to Hinistas Clinic in Mile 91. After close monitoring, he was later taken to the Magburaka Government Hospital by the MSF ambulance and after receiving care he got well and was discharged”.

“Late referrals can be fatal and some medical complications could be avoided if women with obstetric emergencies were able to reach health facilities on time,” says Amadu Musa, a nurse at MSF’s mother and child hospital in Hangha, Kenema district. “We had a patient from Daama village, about two hours from our hospital, who was pregnant and was referred very late. When the doctors did a scan, they found out that the baby did not have a heartbeat. The mother was also very anaemic and in a critical condition.”

MSF’s team in Kenema carry out emergency caesareans and other lifesaving surgery for pregnant women and new mothers. MSF teams also work in two other locations in Sierra Leone – in Mile 91, and in Magburaka, Tonkolili district – to help local health staff respond to maternal and paediatric medical emergencies. In the first seven months of 2023, MSF teams in Kenema, Mile 91 and Magburaka helped   3326 women deliver their babies, 505 of them by emergency caesarean.

MSF’s work in Sierra Leone also includes running an ambulance service to get women and children in need of emergency care to hospitals as fast as possible.

“There is a significant need for ambulances to transfer pregnant women experiencing complications from local clinics to hospitals,” says MSF medical coordinator Kennedy Uadiale. “A good referral system is key and needs to be prioritised to ensure a decrease in maternal and neonatal mortality and save more lives.”

Between January and July 2023, MSF’s eight ambulances transferred 372 pregnant women and new mothers with their babies to a hospital for emergency care. The women faced a range of life-threatening conditions including pregnancy-induced hypertension, post-partum haemorrhage, anaemia in pregnancy and antepartum haemorrhage. MSF also reimburses women for the cost of taking a motorbike-taxi, the only alternative transportation available in most places, to health facilities paying for 900 trips in the first seven months of 2023.

Umo Ngamanga, aged 18, comes from Moyamba district in southern Sierra Leone. She gave birth to her first baby at home because she was unable to reach the nearest health centre in time. “I started experiencing labour pains at night, but to get to the health centre in Foindu, 10 km away, you have to walk for two hours as well as cross a river. My baby could not feed and he had a fever, so the next day I took him to Foindu. He was immediately taken by motorbike-taxi to Hinistas community health centre, and then by MSF ambulance to Magburaka hospital. After receiving care, he got better and I was able to bring him home.”

MSF has also trained traditional birth attendants in Kenema district to monitor pregnant women and watch out for danger signs, referring them to the closest health centre for medical attention, or calling an MSF ambulance to take them to hospital if they need advanced care.

MSF’s activities to support care for mothers and children in Sierra Leone are crucial, but much more is needed if the country is to continue the progress made in the past 23 years. “Health programming in the country needs to include staffing, maintenance and fuel cost for existing ambulances at the National Emergency Medical Services (NEMS),” says MSF head of mission Mohamed Morchid. “It is also important to consider creative and sustainable models supporting emergency transport needs from patients’ houses to their nearest health facilities, as this remains one of the main barriers identified by our patients in terms of their access to quality medical care. We would encourage the Ministry of Health and Sanitation, as well as health and development partners and stakeholders, to make additional investments in emergency transport. This would help save many more lives.”  

In Mile 91 and Magburaka town, in Tonkolili district, MSF teams work with the Ministry of Health and Sanitation to provide healthcare for mothers and children in local health centres and Magburaka hospital. In Kenema district, MSF teams finished the construction in 2019 of a mother and child hospital in Hangha where its teams provide comprehensive emergency obstetric and newborn care. In Makeni regional hospital, in Bombali district, MSF teams provide treatment for patients with drug-resistant tuberculosis. MSF has been working in Sierra Leone since 1986.





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