The devil is in the detail

Our Medical Coordinator, Dr Emily Spry, is writing for the BMJ about her experiences at the hospital...

http://blogs.bmj.com/bmj/category/emily-spry/

The devil is in the detail

It might seem odd that the most challenging folk to work with here are not the Sierra Leonean ones. Sometimes the toughest part is dealing with the endeavours of my fellow “whiteman”.

“Development” can be a painful business. It’s painful because of the contrast between what is promised and what is possible, what is dreamed versus what is ever implemented or achieved.

In a country as poor as Sierra Leone, it is so easy to “see” solutions, so easy to make big promises - so much could be fixed with so little, everywhere you turn. Or so it seems.

The truth is, of course, that if it were easy, someone would have done it long ago.

The devil is in the detail, every time. And the details are messy, dirty, tiresome and impossible to uncover from the sanctity of an air-conditioned office.

A classic example is the two giant generators sitting quietly in a building at the back of the Children’s Hospital. Installed during the “rehabilitation” of the Hospital in the early 1990s, just after the war, these were paid for by an African Development Bank loan.

Despite the fact that the regular power cuts leave the hospital operating by candlelight, they have never been used. Why?

Generators of that size use 16 gallons per hour of fuel such that running them would cost 240,000 Leones (around 40 pounds) per hour.

This fuel cost per hour is around the price of employing a full-time nurse for a month. Even if the Hospital received its meagre budget from the Ministry (which it has not so far in 2009), the generators are useless.

Who on earth would buy such a thing with money meant to get the hospital back on its feet? And why are they not held accountable?

In fact, these generators were paid for by Western tax payers. Even more painfully, they are paid for by the ordinary Sierra Leonean who should have got rather more development bang for their aid buck. Every dollar wasted is not just a dollar wasted. It’s a dollar that should have been spent on something better.

Being white here, and particularly British, bring great benefits to one’s self-esteem. Many Sierra Leoneans credit the British army with ending their decade-long war and we are often joyfully hailed as “IMATT” (the remaining British military representatives here) as we drive our old Landrover around town. Strangers regularly thank us for our work, without ever asking what we are actually doing in Freetown.

But when I look at how often the “whiteman” has stood so proud and magnanimous and then failed to deliver, I feel acutely ashamed.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.