The Right to Life - Who Pays?

For Bintu Amara, a grandmother from the town of Kenema, in the south of the country, the news that all pregnant women, lactating mothers and children under the age of five will benefit from the proposed Free Healthcare Initiative was of little significance, since her time of bearing and nursing children had long passed. This dramatic change to health care in Salone is to be introduced on the 27th April 2010, the nation’s day of independence, and is being made possible by the British Government through DFID (Department for International Development).



We met Baindu, a friend and the granddaughter ‘Mama’ Bintu, outside of Connaught Hospital, which, as it was a Sunday, was unusually quiet as we accompanied her to Ward 9. The number of people in the ward indicated that the visiting hours posted on the gate were not being enforced, as there were numerous friends and family of patients surrounding the ten beds. Nevertheless the atmosphere was one of calm and quiet, a sharp contrast to the wards of hospitals we have seen elsewhere in Africa and particularly Maputo Central Hospital. It was a fitting environment for an extremely weak Mama Bintu, who was suffering the effects of advanced cancer of the womb.

A subsequent visit three days later coincided with the second day of industrial action by doctors and nurses, resulting in patients being assisted to the hospital exit in response to the advice to return home as no treatment was available for them. In Ward 9 the family of Mama Bintu were preparing her few personal items and making arrangements to charter a taxi for the five hour journey home. She died two days later.

As the strike action of doctors and nurses in Freetown reaches its second week it has just been announced that the talks, involving the President, Ernest Bai Karoma, to resolve the conflict collapsed on 24. March. The health workers union, which represents doctors, nurses and laboratory technicians, is insisting on a dramatic improvement in the pay and conditions, which the Government acknowledges are inadequate but are unable to increase them to the value demanded. At present Doctors receive approximately US$ 150 and nurses US$40 with no additional transport or housing benefits. The increases being demanded are more than four times those figures.


The military, police, other doctors and nurses in training had taken over responsibility of running the two major referral hospitals, the Cottage and Connaught Hospital by providing basic services but the likelihood of this continuing has been put in doubt by the collapse of talks.

The relationship between the Free Healthcare Initiative and the strike action is not immediately obvious and both local media and the BBC world service have so far avoided reporting what is common knowledge in “health care economics”. The wholly inadequate national salary structure for nurses and doctors, results in a common practice of informal charges to patients for a wide range of services, including laboratory tests, injections and prescriptions etc. However when the free services are introduced, patients and the public will expect that such charges will no longer apply, resulting in the loss of the “hidden income” of health care workers. In addition to this, it is envisaged that the free health care initiative will lead to an increase in the number of patients seeking treatment. For a doctor who sees 40 or 50 patients per day in outpatients, an increased work load is not a very appealing prospect, especially if combined with a loss of income.

Emily Spry, a British doctor working for The Welbodi Partnership in Freetown, has expressed her personal and professional difficulties with the strike, on the British Medical Journal’s blogsite.
“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; Voluntary Service Overseas ordered its volunteers to stay away from the Hospitals, as there could be risks in a situation with angry staff and patients... 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.”

At the Theological College, our Salonean colleagues have, with no exception, been supportive of the doctors and nurses, claiming that the national attitude towards employment law and welfare responsibilities is appalling and that the role of the government in addressing the injustice is clear.

A further meeting, involving the President Karoma and the union’s leader Dr. Freddie Coker, was held on Saturday 25th March but failed in its attempt to move beyond the impasse. The immediate response of the Government was to declare that as the industrial action was invoked without providing 21 days notice, it is illegal and all those not returning to work on Monday 28th March will be dismissed and lose all employment benefits.


Today sees the launch of “CARMAASIL”, a campaign to improve the nation’s maternal and infant mortality rates, which are one of the world’s highest and have led Amnesty International to accuse the government of an abuse of human rights. The World Health Organisation indicates that in Salone, there is no more than one doctor to every 100,000 citizens. If this is accurate then there but 60 doctors serving the whole of the nation of 5.5 million.

In conclusion, Emily Spry added “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.”

STOP Press 12.00h 28 March 2010
The BBC Africa Service has just announced that health workers in Sierra Leone say they will end their 10-day strike, after the president agreed in a late-night deal to increase their pay six-fold.

Salone’s Achilles Heel

We had just been listening to the BBC World Service’s and Alan Green’s programme, World Football, as we stepped out of the car onto Lumley Beach. ‘Greenie’ had been reflecting on the Achilles- heel injury suffered by David Beckham earlier in the week and its likely impact on his desire to play the world cup in South Africa later this year, as we set off for our less demanding exercise on a stunning location in West Africa. Within minutes of tracing the high tide line, we met a group of men who were squeezed onto the higher drier sand. All attention was on one of them, a man poised with a whistle between his lips with his right arm vertically extended. A shrill sounded and a flurry of flying sand and physical activity followed as the amputees five-a-side football got under way.

The speed and skills of the eight outfield players and the dexterity with which they demonstrated passing moves and step-over skills were mesmerising. So that it took us some time to realise that whilst both goalkeepers had two legs they only had one arm each so that punching a ball was preferred to catching it. The referee was able to remain stationary on the halfway line but he was still a very busy man, as crutches and a single leg makes challenging an opponent for the ball a very problematic task for all the players. Beach football is extremely demanding for able bodied people but this match demonstrated just how fit and strong these young men were as the initial pace of the game showed no signs of slackening as time elapsed.

It was difficult not to recall the words of the BBC on David Beckham. The man has a global iconic status that reaches far beyond football but as we winced at some of the challenges, it was difficult to compare the pain his injury with what the ten footballers in front of us would had suffered, not on a football pitch but a civilian battle field in the Salonean war, that ended a decade ago. Most of the ‘stars of the sand’ on Lumley Beach would have been teenagers when they lost their limbs, the age at which David Beckham signed for Manchester United.

We spoke to Albert Manley Mustapha, the Public Relations Officer for the Single Leg Amputee Sports Club (SLAC). He expressed his disappointment that when David Beckham visited Salone, “ he was kept away from SLAC”. Nevertheless Albert was enthusiastic about the start of the new season and the competition within the country’s five teams, two of them ‘East’ and ‘West’, being based in Freetown. This is a big year for SLAC as they have been invited to participate in the World Cup which will be held in Argentina in October. However, despite the funding from the Federation of International Football’s Street Soccer Section, funding SLAC from within the country is so problematic as to be almost non-existent.



Our personal interest was warmly received and the clarification of the rules, regarding the improper use of crutches, was responded to with additional information on the improper use of the residual imb. Albert spoke with passion and pride for the sport, adding that it had been Salone which hosted the first world cup. The adapted rules includes three breaks in the hour long game, so as players left the pitch to pick up their water packets, they invariably beamed with delight at the two new spectators. Meanwhile, we were left wondering where future funding might come from, for the beautiful game that is played in such tragically unfair circumstances.

In walking and driving around Freetown we are constantly surprised at the ingenuity of children and young men to create recreational spaces on the smallest piece of ground. In some cases it might be the informal kicking of deflated ball, whereas as others, including a patch of land in Tengbeh Town it is much more. Each working day a sign board in colourful chalk lettering announces the day’s football match, be it between Italy and Brazil, England or the Ivory Coast or Ghana. Then, as the heat of the day relents, a 5 a-side football match will draw a crowd from those returning from work or school and the Old Railway Line will be the theatre of dreams for more than just a few.

Universal male aspirations, be they of David Beckham’s dreams, Mohamed Koroma’s or Samuel Bangura’s, are all vital elements in the hopes of engaging in a meaningful activity. In Salone, the universal language of football transcends the ethnic, linguistic and creedal distinctions with an amazingly simple ease. The global dream, of both young men and women to find meaningful work is as acute in Salone as it in any other country on the African continent, although it is never as visible a sporting spectacle.

The Achilles heel in Salone’s socio-economic political life during the 1980s (and before) appears to have been the lack of opportunity for youthful aspirations especially among men, to be satisfied with meaningful work and the acquisition of an appropriate place in society.

It is acknowledged that it was in the preparations for the Trojan war, that led to Achilles damaging the heel of Telephus, an injury that he was subsequently to heal. However no one we have spoken to has suggested that a remedy for any of the current national problems, be it of atrocious health statistics, an impoverished economy, a fragile educational system, or of national unemployment among young people at approximately 75%, will be cured by another armed conflict.

It is the prayer of Saloneans, women and men, young and old, urban and rural, Muslim and Christian, that the dreams of prosperity and peace will be fulfilled through a democratic process of socio –economic reconstruction, in partnership with international agencies and funding, so that the aspirations of all its citizens are addressed.

“An eye for a bird”.

Besides being a great phrase “An Eye for a Bird”, is also a book title. The reputation of Eric Hosking, as a respected bird photographer, grew dramatically, when, in 1937, he lost an eye whilst photographing a Tawny Owl in Wales. “An Eye for a Bird” became the title of his autobiography, published in 1970.

Forty years later, on the veranda of a house in Freetown, it was more of ‘an ear for a bird’ before dawn, as the noises from a family of Scope Owls could be clearly heard from anywhere in the house. Some of the sounds, including the tschh hiss, mixed evocatively with the call to prayer from the nearby Mosque but it was the din on the zinc roof that had us out of bed so early. The legs of the owls are short, thick and sturdy, and rich yellow in colour. We have watched the owls, especially the two young ones, hop around on the tree branches, as well as being stationary when we see them on the nearby school buildings’ roofs. With no ceiling insulation in our house, the percussion noise on our roof was easily heard and we realised that the loud clumping noises of heavy clawed feet were coming from the abattoir above our heads, with the killing and dissecting of frogs and small rodents, that had not been presented on the ground as pre-filleted meals.



Working at the theological college requires sharp eyes and ears for cross cultural information that assists communal integration, as it is the small details that frequently cue the nature of an activity and provide a vital element in the living and learning process.

A recent ‘away-day’ event, to a location just west of Freetown, provided us with a generous opportunity to discover more about our colleagues, as ancillary, administrative and academic members (both full time and part time) were expected to attend the day, as made clear by the Principal, Rev Olivia Wesley. It began with the sharing of transport in mini-buses that would have benefited from the U.K’s “scrapage scheme” long before there was talk of a global financial crisis. “There’s always space for one more” is the mini-bus motto, even if the body of that “one” is more out of the bus than in it.

We were heading south along the peninsular to Ebenezer Church, in Goderich village which is really a small town. There are numerous Ebenezer churches and chapels around Freetown and the one in which we were meeting was of the Methodist variety and built originally in 1841. Until the mid 19th century, Goderich was largely a Krio Christian village. Today it is a densely populated Muslim and Christian community, situated on a peninsula that is bordered by both a stunning beach and a mangrove swamp. The subsequent humidity level was therefore a constant reminder of what working at sea level requires of both mind and body, as even sitting on cushioned church pews was demanding.



The previous day had been a national holiday in recognition of the Prophet Mohammed’s birthday, and it was quite obvious that it had provided the opportunity for a number of the women to be attended to by a hairdresser. And the chosen dress code was, as it is so often, one of, “as smart as possible” by some of the men as well as all of the women. Keeping to the time-table was also very African too, as we adhered to what is commonly referred to as BMT. ‘Black Man’s Time’. So what if we were two hours behind schedule before we got to “lunchtime”? No one blamed the chair, the retired head-teacher of the Methodist Boys’ High School, Nathaniel Pearce, whose skill and energy for indigenous languages involves trying to ensure that a Krio Old Testament will be published later this year.

We are attending one of his classes at college and find it intriguing to see how mature students’ oral competency in Krio, is not always easily translated into its written form. It was estimated that some 200 different languages could be found in Freetown in the mid 19th Century and despite English having a major influence in the development of Krio, other languages including Yoruba and Portuguese have had a marked effect too.

The first proverb one we were taught was “ ɔkrɔ nɔ ba lɔŋ pas in masta”. In English, “okra does not grow taller than its master”.

This refers not only to the physical height of the okra plant, but that it is supple enough to be bent over to be harvested from, and therefore unable to be superior and greater than the one who planted it. The proverb has several interpretations, one being that as many Krios employ housekeepers, caretakers, office messengers, and houseboys, all of which are always subordinate to their master. This proverb could also apply to a young man who has studied overseas to acquire an academic qualification and then after working for some years, returns home with a European wife and much wealth. In the village square he sees the elders gathered in a meeting but, instead of observing the normal decorum that a youth accords elders, he ignores them thinking his wealth and education have made him higher and greater than the inhabitants of his village. He is then approached by an elder in his semi-tattered dress who reminds him of his origin by quoting the proverb “ ɔkrɔ nɔ ba lɔŋ pas in masta”

It was appropriate that this was the first proverb that we, in this case, as students, were invited to reflect upon, in an institution, which pursues degrees and diplomas in a variety of areas. This was the context for considering such traditional wisdom. The college also offers us a cross culture context in which to consider that, in coming from a British culture where owls are often presented in literature as being wise creatures, who are consulted by others for their counsel, we nevertheless observe the same birds, in a different context and appreciate that for most Saloneans, owls are associated witchcraft and its powers.

Kick Polio Out of Sierra Leone!

In the Southern Highlands of Papua New Guinea in the mid 1970s, it was not uncommon to be buying fresh vegetables and notice that the lady selling her produce was missing part of one or more fingers. Leprosy was prevalent in the region and one aspect of the disease involved the loss or part of the ear, the nose, a toe or two and perhaps a finger. However both the Huli and the Mendi tribes practised a mourning ritual, which involved a widow severing her own fingers with a blow from a hand held rock. It was therefore never easily evident as to what had caused the loss of a food seller’s finger(s).



We were reminded of this episode when encountering numerous people in wheel chairs in certain locations in Freetown. Whilst an occasional wheelchair user can be seen in many places there are a couple of locations where they socialise in groups and demonstrate their chair-skills and occasionally take to mixing it with the traffic and getting a tow from a vehicle by holding onto its tow bar. At first we had thought these young people might have been victims of the war as some are missing lower limbs but it became evident that most had withered rather than missing limbs. They, mostly young men and women, appear to have suffered polio and the need for immunisation programme which has just begun would support such a probability. The West Africa wide programme covering 19 countries was initiated in Sierra Leone, where polio was once thought to have been all but eradicated.


Over the next few weeks, 400,000 health workers and volunteers will be going from house to house to ensure 85 million children under the age of five, are be immunised against polio with an oral vaccine. In Sierra Leone, ten years after the last reported case, new cases of the most contagious type of polio have surfaced in the country. Polio, which attacks the nervous system, has clearly not been stamped out and previous joint efforts by the Red Cross and United Nations. The current programme is supported by Rotary International, who have donated $30 million towards the first round of vaccinations.

Dr. Thomas Samba is responsible for child health at the Salone Ministry of Health. He says the biggest challenge is getting the vaccine to the most remote areas of the country. In the interior and the northern province of Koinadugu, ( see map above) where roads are few and far between, local chiefs have hired bicycles, and on the coastal Sherbro island, the fishermen are helping to transport vaccination teams in boats. Another logistical challenge involves the vaccine which must be kept below 8 degrees Celsius, a challenge in a tropical country where electricity is limited even in the capital, Freetown.
A 2009 polio immunization campaign failed to stamp out the disease because it did not reach enough children with vaccines. This year, Sierra Leonean children will receive an additional dose after three weeks and a third dose one month later to ensure the population builds up immunity to the disease. The success has been impeded in the past by some religious leaders suggesting the vaccinations were an attempt to spread HIV and would cause sterility. The new campaign hopes to reach 1.2 million children under five years of age, across the country.

Through the eyes of visitors.

When living and working overseas there is always a sense of eager anticipation when you are about to receive a visit of family or close friends, who for a short period will be sharing your new habitat with you for the first time. Such visits are even more significant when the people concerned have visited you in numerous locations over several decades and in the case of Barry and Jan Eldred, had shared our own first-time encounter with Salone fifteen months previously. What follows are their impressions from a visit that was initiated by a conference on literacy held in Freetown in late February. What is not, and cannot be included, is a full account of the hours of conversation that emerge in reflections and analysis of the cross-cultural encounters, which inevitably flow at the end of the day.



“To get to Janice and Peter’s new home from the UK involved an overnight journey to Heathrow, 6+ hours flight to Lungi Airport in Sierra Leone; a short bumpy mini-bus ride to a simple wooden jetty; a 35 minute water taxi ride in a motor launch which hits the waves with force and a 45 minute wait at the quay side until we realised that the text we had sent to Janice and Peter never got there. After a friendly negotiation with the booking official who called a taxi and agreed to accompany us we drove into the city to The Old Railway Line (the name of J and P’s road) where the driver enquired of a group of women sitting outside a Methodist Church where the Methodist compound might be. They directed us to the Christian Churches of Sierra Leone compound where we enquired where Reverend Peter might be living and, sure enough, they were able to direct us to The Methodist Compound, 19A The Old Railway Line. The gateman ensured that we were expected and the familiar, welcoming voices of Janice and Peter rang through the warm night air; we’d arrived! They were dismayed that we had not been able to contact them but we were all delighted with the care, consideration and guidance offered by the local people to ensure we were safely delivered to our destination.

This tone of care, respect, interest, politeness and good humour are lasting features of this, our second visit to Sierra Leone.


We had accompanied J and P on their discernment visit to Sierra Leone in November 2008 and now we were able to see how well they are settling into their new home and work. It was opportune because Jan had been invited to speak at a conference on Family Learning and Literacy in Freetown, organised by the British Association for Literacy in Development and hosted by the British Council; Barry agreed to carry the bags and we extended our stay by a week in order to spend some ‘quality’ time with our ‘old’ friends. The 2 day conference was stimulating; a great opportunity to make links and network and resulted in resolutions for action. Janice and Elizabeth, from the MC Training and Skills project, were able to attend too. The following week was spent in a mixture of activities meeting adult literacy and learning organisers and providers; visiting the Training and Skills project; talking with the Institute of Sierra Leonean Languages (of which there are 16); taking part in a Krio literacy class and discussing and debating how best adult literacy and adult learning could/should be provided in a context of development and many competing resource priorities. We visited an HIV-AIDS support group – approximately 130 people, organised by the MCSL, heard moving testimonies about living positively and stimulated interest in possible adult or family literacy learning (30 people immediately put up their hands to express interest and we estimated 80% of attendees signed in with a thumb print). We talked with health workers and learned of the realities of child mortality and maternal health but also how the opportunities for training can have a huge impact, such as through the introduction of triage in a hospital. We took gifts and letters from Mary Jefferson and have a bag of tie-dye products as well as letters to return to her.



How best to use aid/donations/support was a recurring theme of our conversations. Should industrialised nations offer aid at all except in emergency situations? Does it encourage dependency? Does it encourage power relationships which developing nations don’t need and want? Does aid distort what developing nations really want to do? What position should churches take when they want to respond with care and compassion but don’t always see the best way to express it? We recalled both the writings of Dabiso (Dead Aid) and Pasini (The Wisdom of Whores) in challenging received/perceived wisdom about how best to work in partnerships between industrialised and developing nations and communities. We were able to have a lunchtime conversation with Steven Poxon and John Spencer from the North Lancashire District of the MC as they passed through Freetown en route to Kailahun where another Training Workshop, supported by the MC, was being opened and dedicated; the same issues arose and were aired.



But it wasn’t all celebral! For Barry there was an international football match in the national stadium and numerous personal conversations with some of the thousands of stall holders and street traders, keen to tell their stories and even offer to have their photos taken. (Unusual in a city where most people are shouted at and threatened for taking photos in the street.) We shared worship on Sunday morning – albeit brief because the real celebration was to be a church family picnic on the beach- and an early morning Ash Wednesday service in the guts of a new, large, partly built, M Church in the city centre. We had several beach walks at Lumley – a long white strand close to the city – and a day at No. Two River Beach where the idyllic setting is run by a village co-operative including car-parking, thatched open-sided round houses to provide shade and hospitality, chairs and umbrellas and freshly cooked lunch on a beach most of us only imagine in our dreams or, at best, see in brochures.



However, we were constantly reminded of the abject material poverty of this country; the unmade roads, the rubbish, the unclean water and the daily challenges of simply surviving in a context of massive unemployment and no welfare support. This is the setting in which Janice and Peter are living, teaching at the Theological College and working with and alongside the Methodist Church, as well as other faith communities, to have the greatest possible influence on change. We were impressed by how they have created a welcoming home, with good food, laughter and their inimitable hospitality, in spite of non-drinkable water and intermittent power supplies, endless dust, unremitting heat and the nightly calls of the dogs and the goats which roam the compound. They are relaxed, energised and clearly in their ‘zone’. We are delighted that our joint discernment visit of 2008 seems to have resulted in the potential for great rewards and satisfaction for all in the mission partnership.”
Jan and Barry Eldred
February 2010