March 23rd 2010, Emily Spry: Sierra Leone doctors still on strike

Despite my best efforts, I seem to have ended up with four sick babies and a mother with an infected Caesarian wound, all of us stranded in an unused wing of the fanciest hospital in Freetown.

It all started on Wednesday when the doctors and nurses went on strike across the capital. As I have noted before, doctors here are paid around $100 per month and nurses around $50 per month, not enough to live on in Freetown. After the strike was called, there was a flurry of phone calls and between myself, two German NGO nurses, the VSO doctor and an experienced neonatal nurse, who also volunteers almost full-time with me for the Welbodi Partnership.
The gut reaction was for us to step into the breach at the Hospital. At least to review those who were too sick to be discharged and field the Emergency cases. To be heroes.

But there were lots of questions. Safety for one; VSO ordered its volunteers to stay away from the Hospitals, as there could be risks in a situation with angry staff and patients. In fact, no trouble
materialised, but it wasn’t an outlandish concern.

Secondly, and more complicated, the question of whether we should interfere with the healthcare workers’ decision to shut the Hospital down. Who were we to go against their decision? The healthcare workers know the implications of what they are doing; patients will die. But they feel strongly enough that the upcoming abolition of user fees (the President’s Free Healthcare Initiative) cannot and will not work if their conditions of service are not improved to fill the
gap left by user fees. They feel that this is their only chance to force the Government to meet their demands.

This also leads on to what our role should be here. The Welbodi Partnership’s approach is to form a long-term relationship with the Hospital that will bring slow but, hopefully, sustainable improvement. Breaking a strike is a strategy that could seriously damage important relationships and raise questions about our role.

After long discussions and advice from my boss, all of this led to me staying away on Wednesday and I had a prior engagement speaking at a conference on Thursday. But by Friday, I felt that it was time to go and have a look at what was going on.

In retrospect, it seems that the best way to deal with an insoluble ethical dilemma is to stay as far away from it as possible. As soon as I got into the Hospital, I was sucked right back in.

When the strike was called on Tuesday evening, the staff had discharged most of the children, with only the sickest remaining. By Wednesday, there were less than 30 patients left, gathered in the ICU. Somehow, the German nurses and another volunteer ended up caring for these patients between them, with an occasional doctor review. The Military sent a nurse to relieve them on Thursday night. The Head of the Hospital forbade further admissions (not that the skeleton team
could have handled it) and all patients were turned away at the gate.

By the time I arrived on Friday morning, they were exhausted. Some senior nurses were also murmuring about why the Hospital was still open three days after the strike started. So, with the Prof’s help, we swung into action, reviewing, discharging and ringing around to try to find Hospitals that would take some of them.

The Military Hospital generously accepted some patients and we discharged several more. But we were left with four sick babies, all on IV drugs, two of whom were dependant on oxygen. The manager of a private hospital offered us a room with some beds, but had no extra staff; he had already taken around 15 surgical patients from the main Hospital in town. There was talk of a general strike at the Children’s Hospital, so the security and porters would be gone by Monday.

Late on Friday night, we ended up cramming four cots, an oxygen concentrator, boxes of drugs and equipment, four babies, mums, aunts and grandmas and all their stuff into two cars. A friendly local policeman agreed to lead our strange convoy through town on his police motorbike, haring down the middle of the traffic, flashing and beeping (we have no oxygen cylinder, so we needed a quick transfer for the babies dependent on oxygen). I have never crossed traffic-clogged Freetown at such a pace.

I also never quite imagined myself in this situation, especially in my non-clinical role with the Welbodi Partnership. I tentatively think that we have done the right thing. We made sure that the children already admitted to the Hospital were cared for appropriately, though we didn’t accept any new cases.

There is no doubt that sick children will die because of this strike. But I am not here to break the strike of the Sierra Leonean doctors and nurses whose duty it is to care for those children. I believe that I am here to try to help them build a system whereby all children have a better chance at life-saving healthcare. And paying doctors and nurses properly is a must for that to happen.

But it’s a bit of a minefield, to say the least. As I write this, I do wonder if it will sound insane or just plain wrong from another perspective. Do please let me know.