Sierra Leone has one of the highest maternal death rates in the world. One in eight women risk dying during pregnancy or childbirth and thousands of women bleed to death after giving birth. In a country where less than half of deliveries are attended by a skilled birth attendant, teaching basic skills can play a direct role in saving lives. GP Alex Burns works as a VSO volunteer in a government hospital in the north of Sierra Leone.
How is it working as a doctor in Sierra Leone?
The same words may appear on the ‘hospital’ sign on the front of a building in Sierra Leone and the UK, but what happens inside is very different. I have seen a lot of mothers die since being here. After having never seen or heard about still birth in the UK, I have seen a huge number of cases here. In Sierra Leone, there are very few pieces of equipment in the room; I’m always stunned at how bare they are. In the UK there would be electrical devices, various lines, canulars and lots of medical gadgetry. Here the walls are empty... often you will only find a bed and a patient in a room.
What have you been doing?
Most mothers in Sierra Leone die of several simple causes, bleeding, eclampsia, obstructed labour – these are all complications that can be prevented, and complications you barely encounter in the UK anymore. The way to handle them is normally very cheap and accessible, so I’ve been trying to implement simple and effective methods to try and save mother’s lives in maternal health wards... trying to get nurses, midwives and untrained health assistants to recognise a sick woman and help with delivery.
Best and worst bits of working in Sierra Leone?
I enjoy tropical medicine, I’m a bit of a geek – I find all the worms and parasites that invade the human body here fascinating, and as a medical practitioner it’s been nice to refresh skills in areas you don’t get the opportunity to develop in the UK. One of the hardest things about working here is the amount I sweat during the day, it is unbelievably hot and humid here and it can be hard to concentrate when you are soaking through your clothes!
Any memorable moments?
I do a fair amount of work in paediatrics and obstetrics here. On one occassion I was teaching a trainee midwife how to induce a labour, we wanted to do this because the woman in question had eclampsia. It’s a condition that no longer exists in the UK and the reason why every pregnant women has their blood pressure checked so regularly in the UK... but here it’s a real killer, and results in the mother having fits like an epileptic as well as high blood pressure. To stop the fits you need to remove the baby and the placenta - so that’s the advantage of getting the baby out sooner. I taught the Sierra Leonean midwife who used to be a traditional birth attendant how to do this, and she did it on her own the next day. The end result was a healthy mother and baby boy.
There are other VSO volunteers at the hospital where you are placed – how does that work?
My fiancée Natasha, a paediatrician, is also working in the hospital. Our skills can be complimentary at times. We work together quite a lot, especially in obstetrics, as a paediatrician she is specialised in resuscitating the new born child so often a delivery I’ve been orchestrating produces a child that she can resuscitate. One of the most constructive and nicest things about working in Makeni government hospital, is working alongside a VSO volunteer midwife trainer in the midwifery school; she has been teaching students herself and it’s been quite nice to see that theory put into practice in the hospital.
Is there a need to continue the work you have started?
There are undoubtedly hospitals across Sierra Leone that would benefit from having more doctors, midwives and nurses for one year or longer, to implement simple and effective ways of treating patients, and saving lives. I’ve seen a lot of change in Makeni government hospital in the last nine months and I hope to achieve much more in my remaining time here – but we are two doctors in a country of six million people.
What would you say to someone considering volunteering with VSO?
I think VSO’s work here is important, training professionals is a very effective way of making change, the personal interaction you have with the people you train is something that lasts a long time. You need to think very hard about where you imagine yourself being for a year and what you imagine you will be doing, exploring the various options of how your skills can be put to best use. When someone is placed somewhere they want to be, I think they are a far more effective volunteer.