Thursday, October 28

“We applaud if no one dies”: Covid forces tough decisions in Sierra Leone | Global development


Northurse Magdalene Fornah was on duty at Freetown’s Connaught Hospital when she learned that Sierra Leone had its first confirmed case of coronavirus. It was five years later Ebola it had killed some 4,000 people in the small country, devastating the fragile healthcare system. Shortly after that initial case was announced last March, the UN estimated that 3.3 million people in Africa could die from Covid-19.

Like the rest of her medical colleagues, Fornah had no idea that this nightmare scenario would not come true. “When I saw the first patients, I was scared,” he says.

He vowed to learn from his experience with Ebola, especially personal protective equipment. “We shouldn’t joke with him [PPE] get dressed, ”Fornah drummed on the staff. “That is a mistake we made before.”

Fornah is a petite woman of great value. She worked front-line at Connaught’s Ebola outpatient post and contracted the disease herself. But EPI is scarce in a country that is among the 10 poorest in the world. Donations from the World Health Organization, the UN and others brought masks and gloves for the isolation unit. But with the focus on Covid-19, other rooms were quickly running out of supplies.

Magdalene Fornah, a nurse at Connaught Hospital in Freetown, had limited access to personal protective equipment and contracted Ebola herself.



Magdalene Fornah, a nurse at Connaught Hospital in Freetown, had limited access to personal protective equipment and contracted Ebola herself. Photography: Malte Werner

“We are experiencing serious challenges with the supply of PPE,” says Sorie Conteh, a specialist in Connaught’s department of medicine. “We have to ration it.” On a balance sheet at Connaught, one of only three government hospitals of its kind, Conteh lists CT scans, endoscopes and ventilators as missing.

Early Sierra Leone had 13 fans for a population of nearly eight million. With only 79 deaths to date officially, this shortage was not overly critical. However, while Covid is not proving to be the deadly disease in Sierra Leone as it is in many Western countries, perhaps due to its younger population, its impact is being felt in different ways.

At Ola Durante Children’s Hospital, the only one of its kind in Sierra Leone, Nellie Bell has to fight disease and chronic shortages. In addition to lacking a working x-ray machine, the 42-year-old doctor is limited by a lack of “simple things” like thermometers.

Until recently, Bell was the only pediatrician in a country where one in ten children dies before their fifth birthday. It then became the second recorded coronavirus case in Sierra Leone. With Ebola still fresh on people’s minds, the government cracked down and Bell was quarantined in a military hospital. When several staff members also tested positive, his entire hospital was shut down.

“I can’t name a number, but I’m pretty sure a good number of children died,” says Bell. With the closure of Sierra Leone’s only pediatric referral center, children and young people died in ambulances waiting for a place to go.

Ishmeal Charles, founder of the Sick Pikin Project (“sick child” in Krio or Creole), tells a similar story. His organization sends sick children abroad for life-saving surgery. When the government closed the airport even before Covid-19 reached Sierra Leone, Charles’s young patients could no longer travel by plane. “In these four months we lost seven babies,” he says.

Ola during the hospital reopened after six weeks, but it can still only function at a third of its capacity. Even with only 100 patients instead of 300, Bell and his team must make tough decisions. When a child was diagnosed with severe respiratory distress, he wanted to try Cpap (continuous positive airway pressure ventilator). But none of the three machines was free. “We had to decide: ‘Which one is more likely to die if we don’t give Cpap?'”

The pandemic has had a serious impact on health care in other ways The growing number of malaria cases is in line with the WHO’s fear that progress in fighting the mosquito-borne disease could be reversed as they are reassigned. resources to deal with Covid. At the beginning of the pandemic, parents refused to go to hospitals for fear of contracting the virus or, since Covid and malaria share fever as a symptom, people feared being quarantined.

Dr. Nellie Bell, second from right, was until recently the only pediatrician in a country where one in ten children dies before their fifth birthday.



Dr. Nellie Bell, second from right, was until recently the only pediatrician in a country where one in ten children dies before their fifth birthday. Photography: Malte Werner

Shifts without dying children remain rare at the clinic. “We applaud when that happens,” says Bell.

In Ola’s ICU during, a three-year-old boy lies still in bed, his eyes slightly open. “Malaria has reached his brain,” explains one of Bell’s colleagues. The prognosis of the child is bad. One third of children admitted with malaria do not survive; more die without reaching the hospital.

At Connaught hospital, Fornah has little time to consider whether malaria or Covid is the bigger threat. “Both are dangerous,” she says, wrapped in PPE, before heading to the isolation room.


www.theguardian.com

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