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Last Updated: Tuesday, 22 January 2008, 12:32 GMT
Survival is tough in Sierra Leone
Kumbah Marrah and Skeku
Kumbah Marrah's son Sheku remains vulnerable
BBC Medical Correspondent Fergus Walsh has been to Sierra Leone which has the highest rate of child mortality in the world.

In the past ten days I have seen dozens of newborn babies and I have been present at several births.

But although all children may be born equal, their life chances very much depend on where they are born.

In Sierra Leone one in four children will die before their fifth birthday. In Sweden it is one in 350.

Many things that can make a big difference cost very little money
Frederica Wyse

I set out to discover the reasons for those startling statistics - what makes Sierra Leone worse than any other impoverished country?

It took around six hours to drive from the Sierra Leone capital Freetown, to Kabala in the north.

We made the journey in three 4x4 Unicef vehicles bumping along the red dirt roads through the lush green tropical landscape - trees packed with bananas, oranges and lemons.

When I said I was travelling through Sierra Leone people at home asked me was it safe to travel there - lingering but vague memories of one of Africa's bloodiest civil wars which ended in 2002.

The reality is that the biggest danger you face there - and in most developing countries - is from a car accident and the subsequent lack of skilled medical treatment.

As we drove the 200 miles north I kept wondering what set this country apart from other developing countries.

I've toured hospitals in Nigeria, Malawi, Vietnam and Bangladesh - all have a better record on child survival than Sierra Leone.

Little infrastructure

The almost total lack of infrastructure is one reason.

The roads - or tracks - are in appalling condition making the transport of medical supplies - and sick patients - a lengthy struggle.

In Kabala itself, a sprawling settlement of more than 100,000 people, there is no mains electricity or sanitation.

Finnah Kamara's newborn son delivered by caesarean
Finnah Kamara's newborn was son delivered by Caesarean

In one of the alleys of Kabala we came to the single-storey mud house of the Marrah family.

Kumbah Marrah was cradling her newborn son in her arms.

Next to them were her husband and their two daughters. All five share one cramped room.

Imagine giving birth here: in the dead of night, without any medical help or pain relief; in a room without electricity or running water.

This is the reality of childbirth in Sierra Leone.

No pregnancy checks

"I was scared for Sheku (her son) and for me", she said.

"I was not due for another month and when he looked so small, I wondered would he survive."

Kumbah had no check-ups during the pregnancy - but at least now he has had the first round of immunisations.

Despite the warm sun Sheku is heavily wrapped in a blanket and a woollen hat.

Kumbah strokes his tiny fingers as she talks.

"At first he wouldn't take breast milk," she said. "But now he is feeding so I hope he will get bigger soon."

Sheku remains highly vulnerable. Pneumonia, diarrhoeal infections, and malaria are all major killers in Sierra Leone.

There are all treatable - but the antibiotics and other medicines are often in short supply.

Often children are brought to one of the basic health clinics too late.

Slow improvement

Things are changing slowly.

Kabala now has a brand new maternity unit funded by the un children's organisation, Unicef.

Dr Samuel Kargbo
A lot of doctors who qualify in Freetown, go abroad - some forget that the greatest need is here
Dr Samuel Kargbo

Next month a hospital will open on the same site. The buildings are spacious and clean, but appearances can be deceptive.

The hospital has almost no medical equipment. There is no x-ray machine or intensive care facilities. The operating theatre has no heart or pulse monitors.

But the hospital does have dedicated staff led by perhaps the most remarkable doctor I've ever met.

Samuel Kargbo stayed in Sierra Leone throughout the horrendous civil war.

He brought basic health services and vaccines to children who lived in the rebel areas.

He had to negotiate his way across checkpoints and his life was frequently at risk.

Now he is one of just two doctors in a region of nearly 300,000 people.

Having trained in Russia, Germany and the UK, Dr Kargbo could easily get a job overseas.

But he refuses to leave. "A lot of doctors who qualify in Freetown, go abroad", he said.

"Some forget that the greatest need is here".

He earns around $200 - 100 - a month.

Emergency operation

We watched as he performed an emergency Caesarean section.

The baby was blocked and would die unless it was delivered.

Apart from the operating table and an overhead lamp there is almost no equipment in the room.

Room where Kumbah gave birth
Facilities are rudimentary

The matron acts as anaesthetist; the mother's blood pressure is checked by holding her wrist.

And yet despite the severe limitations a baby boy is safely delivered.

Dr Kargbo says that had this happened a year ago before the maternity unit opened the baby and possibly his mother, would have died.

Finnah is 28 and has now given birth five times.

One son died and three others survive.

"I'm going to keep trying for a girl", she said.

Dr Kargbo asked her how many more pregnancies she was prepared to have in order to have a girl: "Fourteen, fifteen, sixteen?", he joked.

Then he tells us that he sometimes sees women who have had sixteen children.

"Sixteen chances of dying in childbirth," he said.

Poor record

Sierra Leone has a dreadful record on maternal health.

One in eight mothers will die in childbirth.

Unicef is trying to help improve the lot of women and children in Sierra Leone.

"Many things that can make a big difference cost very little money," said Frederica Wyse, a Unicef health worker.

"We encourage women to come and have check-ups during pregnancy.

"We offer them bed-nets to protect against mosquitoes, immunisation and so on.

"We advise them that exclusive breast feeding can protect their infant from a range of diseases."

Frederica told me that many women still think infant formula is best, but they can't afford it so they water it down.

Things are slowly changing in Sierra Leone, but it will be years before health care is even up to the average of developing African nations.

Meanwhile, for mothers and young children, it remains a country fraught with dangers.

Sierra Leone doctors find working conditions tough


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