Page last updated at 10:48 GMT, Tuesday, 27 April 2010 11:48 UK

Sierra Leone gives new hope to mothers and children

New-born twins at a hospital in Sierra Leone
Isata Sesay's twins were some of the lucky ones

By Umaru Fofana
BBC News, Freetown

Isata Sesay is busy packing up to leave the country's main maternity referral hospital in the densely populated east end of the Sierra Leone capital, Freetown.

She is obviously relieved that she and her two-day-old twins survived their ordeal.

Last year, I watched five women die in the space of two nights at the Princess Christian Maternity Hospital.

Two pregnant women come to us for delivery, they are both in a bad shape but we tend to the one because she has money and abandon the other because she hasn't
Dr Ibrahim Thorlie

In March alone, 11 out of 281 pregnant women who gave birth at the hospital died of severe infection, bleeding, obstructed labour and pregnancy-induced hypertension, says the hospital's director Dr Ibrahim Thorlie.

The situation is no better for Sierra Leone's new-born children.

The United Nations ranks the country as the worst place in the world for a child to be born, with 159 out of 1,000 dying before they turn five.

"It is expensive, very expensive to give birth here - and dangerous as well," says Ms Sesay, as she fills her bags with the basic medicines she has had to bring to the hospital herself.

"I hope the new healthcare plan works for us the masses who can barely afford it and save our life."

'Shameful choices'

Sierra Leone has launched a free healthcare programme for pregnant women, breast-feeding mothers and children under five-years-old.

The plan is expected to save the lives of 1.25 million mothers and children, at a cost of $19m (£12m).

Nurses give aid to a pregnant woman before delivering a baby at the maternity ward of the central hospital in Freetown.
Health workers feared free treatment would lead to a flood of patients

Dr Thorlie, who is also Sierra Leone's consultant obstetrician and gynaecologist, thinks charging pregnant women and mothers consultation fees and forcing them to buy drugs that can cost hundreds of dollars has "forced us to act against our conscience".

"It is shameful the choice we are faced with sometimes," he says.

Life expectancy: 46 (men), 49 (women)
One in eight women risk dying in pregnancy or childbirth
For every 1,000 children born, 140 die
Highest mortality rate in the world for children under five
Sources: UN, Amnesty International

"Two pregnant women come to us for delivery. They are both in a bad shape but we tend to the one because she has money and abandon the other because she hasn't."

Since expectant mothers often cannot afford to buy blood and other basic items, doctors have sometimes been forced to let them die, "not because we wanted to, but because we had to", says Dr Thorlie.

Funding for the free healthcare plan has been provided largely by the UN and the UK, with the latter promising a year's supply of drugs and money to help ensure that health workers receive "a fair wage".

The UK's offer to subsidise workers' salaries comes after a two-week-long strike in March by public health workers over pay and conditions.

'Dying for giving life'

They feared that free health care would result in more patients streaming into the hospitals and longer working hours.

The dispute was resolved when the government offered salary increases of between 200% and 500%.

A woman waits for treatment in the maternity ward at Makeni government hospital, Sierra Leone.
Pregnant women have to buy blood and medicines required for their care

But workers' pay is not the only issue.

President Ernest Bai Koroma has admitted that Sierra Leone is not completely ready for the start of the free health care programme.

"We know some of the work cannot be completed before the 27 April," he said, referring to the fact that the refurbishment of many of the country's hospitals is not finished.

The UN World Health Organization has provided the main towns with blood banks - and solar panels to keep them cool.

Many believe Sierra Leone's poor road network and shortages of doctors, hospital beds and ambulances pose a serious challenge to the new healthcare plan.

But despite these concerns, Sia Nyama Koroma, the country's first lady - herself a trained nurse and mother of two - is determined to push ahead with the programme.

"From now on, no woman should die for giving life," she says.

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