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Death without answers: an agonizing 24-hour search for medical help in Guinea-Bissau | Global health

In their 15 years together, Maimuna Catchura did not know that her husband was ill. But one night in late January, 39-year-old lawyer, activist and musician Bernardo Catchura could not sleep and complained of a severe stomach pain.

The pain forced Catchura to get out of bed at her home in Bissau, the capital of Guinea-Bissau. Tonight he would navigate the nation’s health care maze, visiting pharmacies, clinics, and hospitals. Before the night was out, he even considered crossing the border into Senegal to seek help.

But wherever he looked, no one was available to help the father of three, and less than 24 hours after his pains began, he was dead. It was a sad fate for the man who had spent decades campaigning to improve Guinea-Bissau’s healthcare system.

Maimuna Catchura holds the photograph of her late husband with two of the couple's three children outside their home in Bissau.
Maimuna Catchura holds a photograph of her late husband with two of the couple’s three children, outside their home in Bissau. Photography: Ricci Shryock

Catchura was a prominent member of the activist band Realistic scientists, who used music to reach out and mobilize young people and protest against government failures. “What happened was exactly what he was always talking about in his songs about the healthcare system,” says his widow, Maimuna.

Guinea-Bissau, a country with a population of 1.9 million in West Africa, has well-preserved environmental parks and a proud history of hard-fought national liberation. But its people face chronic instability and economic inequality. Almost 70% of the population live on less than $ 1.90 a day and more than 10% are food insecurity. Life expectancy is 58 years.

Health experts say that at every step on the road to healthcare, patients face bumps like fake drugs, a shortage of medical equipment and expertise, and frequent strikes by healthcare workers.

When painkillers weren’t helping, Catchura called a private clinic. No one answered the phone, so a friend took him and his wife to the public military hospital in Bissau.

Most of the roads are unpaved, but because January is the dry season, the trip only took 20 minutes and was relatively smooth. In the rainy season, torrential downpours leave craters in the city’s red earth and make travel difficult.

A scene in the center of Bissau, the capital of Guinea-Bissau.
A scene in the center of Bissau, the capital of Guinea-Bissau. Photography: Ricci Shryock

At the military hospital, doctors said Catchura needed surgery, but had no facilities to operate. They sent him to the largest public hospital in the country, Simão Mendes.

But Guinea-Bissau was in the grip of a national strike by health workers and, despite its status as a referral hospital that should offer specialized treatment, no one in Simão Mendes was qualified to treat Catchura, his family says.

Aissatu Forbs Djalo, a doctor from Simão Mendes and a member of the national union of health workers, says that wages are too low and often not paid. Doctors are paid an average of £ 250 a month and nurses up to £ 130.

“The government budget does not allow the health system to pay the doctors what they need,” says Djalo.

Aissatu Forbs Djalo, a doctor at the Simão Mendes hospital in Bissau and a member of the national union of health workers.
‘Many people die from preventable diseases’ … Aissatu Forbs Djalo, a doctor at the Simão Mendes hospital in Bissau and a member of the national union of health workers. Photography: Ricci Shryock

Political instability has paralyzed public services, especially medical care. In 2016, Guinea-Bissau had one doctor for every 10,000 persons.

There have been 10 complete coups or attempts in the country since independence in 1974.

“Until we have a stable government, which can complete its mandate, we will not be able to stabilize the public sector,” says Dr. Magda Robalo, High Commissioner of Covid-19 and former Minister of Health. “To have money to pay workers, you need to be able to collect money.

“There is no supervision or performance reviews. There is no meritocracy ”.

An ambulance passes through the center of Bissau.
An ambulance passing in the center of Bissau … traveling outside Guinea-Bissau even for minor health problems is common. Photography: Ricci Shryock

A doctor who owned a private clinic advised Catchura to go there. But when he got to the blue-and-white one-story building, the lights were off. The clinic had closed for the night.

Catchura considered embarking on the four-hour drive to neighboring Senegal. Traveling out of the country even for minor health problems is common, but now I was in severe pain.

“Many people die from preventable diseases,” says Djalo. “If someone has a cardiovascular disease, they can die for lack of specialists and we do not have diagnostic equipment.”

Simão Mendes had a partnership with a hospital in Senegal where he could send patients, but Covid restrictions ended it.

At 7 a.m., Catchura and his wife returned to the private clinic, where he waited four hours to be admitted. Maimuna went home to make soup for her husband. I was sure he would be hungry when he returned from surgery. But there was no operation.

Catchura died and Maimuna still does not know the cause. Failure to identify the reasons for death is another common occurrence in Guinea-Bissau, where Djalo says there are few pathologists.

The Catchura's eldest daughter, Melisiana, 13, studies at home
‘Bernardo was always focused on school,’ says Maimuna … the Catchura’s oldest daughter, Melisiana, 13, studies at home. Photography: Ricci Shryock

Robalo says there are many obstacles to fixing the broken system, but one approach would be to strengthen community health provision, which has worked in other countries. “We can build a bottom-up system that can take care of people far from hospitals,” he says. According to Unicef, 66% of the population live more than 3 miles of a health center.

What happened to Catchura amounts to negligence, says his friend, fellow activist and gang member Lesmes Monteiro, but the circumstances are all too common. “There are many Bernardos.”

Maimuna, dressed in black as a widow, has tears running down her face as she talks about her husband. She wanted her three children to study, she says. “Bernardo was always focused on school.”

School is canceled due to Covid-19 and teacher strikes, but in the mid-morning sunlight, the two older children study on the terrace, their heads buried in books, as their father had, with hope to improve your country.

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