I have been lucky to visit many of the countries where Concern Worldwide works. In my travels, I met many people and witnessed many things, some inspiring and some heartbreaking.
My most recent trip to Sierra Leone was no different.
Sierra Leone is a country emerging from ten years of civil war and armed conflict. I saw commitment to work from the ground-up to rebuild. The people are positive and hopeful. The government is active and forward-thinking. I was there last February, and in a year and a half, I have seen progress.
This is partly because of an initiative that the government took in 2010 to provide free health care to women and children. Today, more women and children are accessing health care, and more of them are aware of when and how to access it.
However, there are still major challenges. Some clinics still struggle with having a steady stream of supplies, like antibiotics. We still don’t have all the information we need to understand why people are dying and what they are getting sick from. For example, we know that 60 percent of births are happening in birth facilities, in the presence of a trained birth attendant, but that’s only half the picture. Where is the other 40 percent giving birth? Who is with them? Why did they not go to a health facility?
With the average lifespan in Sierra Leone only 46 years old, death is a common topic in Sierra Leone. I often heard my colleagues talk about people dying, whether their brother, sister, neighbor, or friend of a friend. While in the United States death is subtle, happening at home or in hospital beds, in Sierra Leone is it all around, all the time. Many of these deaths are preventable—proof that while there has been progress on making medical care more accessible, it is still not enough to fully move the needle.
We know that the only way to break the cycle of disease and death is to give them the knowledge they need to do it themselves. Training and education are central to everything we do in Sierra Leone. We work with local people to identify problems and create solutions and develop systems to tackle those problems not just today, but long into the future. By investing in the skill set of the people we are there to serve, we are guaranteeing that our interventions are effective and sustainable.
That’s how you move the needle on preventable illness and death.
We also work to educate women on how important it is to deliver their child in a facility, rather than at-home. Once a mother understands how much safer it is for herself and her baby, she is very likely to seek care at a facility. We work with each mother to develop an individualized birth plan that works with local resources, like traditional birth attendant and community health workers, to find any danger signs in her pregnancy, establish where she will deliver, and set up a system in case of emergency. To make sure the expectant mother is well-supported in her community, we train local birth attendants, community health workers, and nurses how to not only identify a high-risk pregnancy, but also how to respond when there is an emergency.
We do all of this so that there is a system in place for safer deliveries. With her birth plan in place, the mother knows when and where to seek care and has a well-trained traditional birth attendant or community health worker in her community who can accompany her to the nearest health facility to deliver her baby as safely as possible.
The most important aspect of this system is that nowhere along the line does Concern need to intervene or provide external resources—the local people are the ones making it work.
While in Sierra Leone, I visited what we call the “pregnant and breastfeeding women’s group,” where women come together to talk about antenatal care, facility delivery, and nutrition. One woman stood up and said that she went into labor in the middle of the night and started having preeclampsia, a potentially fatal condition due to high blood pressure during pregnancy. She continued, saying that she want to get her local traditional birth attendant, who went with her to the health facility in the middle of night. At the facility, she delivered a healthy baby. The reality is she is alive because she and the traditional birth attendant knew what to do in an emergency and acted on it.
I also met a woman who gave birth just earlier that week. She delivered at home because it was late at night and could not get to the facility. She already had six children and sadly lost two more. The community’s traditional birth attendant said that woman called only after the baby was born and when we asked the mother she had taken the baby for a check-up and immunizations, she said no. We asked if any of her other six children had been immunized and did not get a concrete answer that we felt comfortable with. Still in the maternal period, she could have infections and not even know it.
We explained that we had to take her and her newborn baby the next day to a health facility for a check-up and why it was so important that she see a health professional. When we came to take her to the clinic, she wasn’t home. It turned out that she had walked to the health facility on her own. To me, what this case shows is that mothers, when they understand what is at-risk for their own health and that of their children, they will seek care on their own. It’s just up to us to give them the knowledge so that they can make healthier decisions for themselves and their families.