THE DETERIORATING HEALTH SYSTEM
Rtd Senior Lecturer
Former Head Dept. of Pathology/Bacteriology
A few years ago, I wrote about the deteriorating state of the health care system, which is deteriorating. I remember as a junior doctor in the 60s. The Connaught Hospital as a referral hospital was functioning twenty-four hours.
The departments of Radiology (X-ray), Laboratory, Dispensary, Surgical departments including the theatre with anesthetists on duty. Have we as a nation and powers that be, sat down and seriously reflect whet are the aetiological factors responsible for its deterioration or are we waiting to do a postmortem when it has collapsed.
The fundamental cause is the condition of service. There is no spur for the employees, salaries are ridiculously low and are not sustainable. The equipment in the establishments are old. The integrity of those who should administer the smooth running of the Ministry are questionable. We have seen how billions of Leones ending up in private pockets, monies that should have gone to the development of the health sector.
To date the results of the investigation was never made public. Nobody was ever brought to book. New x-ray machine was left to rot because it couldn’t fit into the refurbished Radiology department, not to mention the CI Scan costing millions of Leones. The renovated wards have no window mesh to ward off mosquitoes. I can go on and on.
We are losing our best doctors and specialists because of the poor condition of service. It is slanderous and discourteous to the honourable profession for doctors after spending seven good years mastering the act of medicine to be rewarded with a salary of less than four hundred thousand Leones per month. Salaries that NGO’s pay their security guards or drivers. Not to mention the pittance ancillary health workers are paid.
Today a ninety-five percent of our specialists are old and pensioned. Some have to be re-employed on contract because we are actually short of doctors and specialist. Bringing foreign doctors into the country is highly commendable in order to fill the gap.
But suppose there is a diplomatic row with donor countries and the expatriate doctors are suddenly withdrawn. The whole health service will fizzle out. We shall have to start at level one.
The country needs specialists are experienced medical officers most of our present doctors are young vibrant, sharp, intelligent but most inexperienced. We need at last not less than five specialists in each specialty for a start.
The nation should be ashamed to say that we only have one specialist in the whole country in very few areas. We do not have Dermatologists (Skin doctor), neurologists (Nerous system), Urologists orthopaedic surgeons, Cardiac surgeons. We need more physicians and specific fields etc.etc.
I am appealing to the government to solicit scholarships and funds to train our doctors. Records have shown that after medical school and house job, this is the appropriate time to train them as specialists. It is a myth that once they go abroad they will not come back.
The medical school is proud that two of its graduates are back. A renowned cardiologist and an internationally recognized microbiologist. Also our graduates are doing well at the emergency hospital at Lakka. They are an asset to the country.
Meanwhile, we can use Sierra Leonean doctors in the Diaspora. We have eminent specialists in Europe and the America. A few years back I met a British colleague I have known for years, an orthopaedic surgeon. Fortunately he is a member of the Sierra Leone Scottish friendship group.
The ideal was to contact Sierra Leone doctors in the Diaspora and friends of Sierra Leone interested to help in the health sector without pecuniary rewards. On my visit to London I flew to Scotland out my own expenses met him had a meting and decided how to start such a scheme.
Coming back to Freetown I made an appointment with the then Minister of Health of the former regime. I saw her gave her the papers and our proposals. The only thing we needed was accommodation boarding and lodging. It was a sort of working holidays. Fortunately or unfortunately there was the general election fever.
I have never been so embarrassed when I had to send an e-mail to tell him that am sorry there is nothing I can do. Such golden opportunity was lost. The Australian government offered scholarships last year for postgraduate studies and other allied specialties in health. To date nobody can tell me the outcome.
It is humiliating that we have to send patients to Ghana, very soon to, we will be sending them to the Gambia for procedures that we can handle here. We have to develop our own medical sector. Doctors are not given the opportunity to refresher courses at least sponsoring doctors abroad for six-months every five years would help the situation.
I have known doctors that for over thirty years have not replenish their medical knowledge because they cannot to afford to finance the advance course. We are fortunate to have a retired experienced returnee, Pathologist from a renowned hospital from Britain; I hope the country will make use of him.
It is therefore an understatement to say we do not have the manpower recourse. Incinerators were installed in all the hospitals, where postoperative combustible materials e.g. infected septic gauze amputated limbs and other tissue were incinerated. Today most of the above products are thrown away as trash.
If you go down to thee beaches used syringes, needles, empty containers of infusion fluids are washed ashore. There is no mechanism, I am familiar with, that organizes the disposal of medical waste both from the general hospitals or private clinics including radioactive material like isotopes.
The British Council in collaboration with the Ministry of Health and Sanitation organized a workshop in 1977, 10-14th March on clinical waste disposal and its managements. R3ecommendations were made to the Ministry of Health and Sanitation, because I was lucky to attend, I am sure the recommendations are shelved and tucked some where in the Ministry.
The laboratory is the nerve centre of a modern hospital, there was a time when the Central Laboratory at the Connaught Hospital was the envy of the sub region. The laboratory was manned by well trained staff. We had PhD’s, MSC’s, BSc’s and certified laboratory technicians now call scientists.
We even had a forensic unit manned by trained forensic scientists. The laboratory was open twenty-four hours. We need to upgrade train the staff and give scholarships for further training abroad.
It is imperative that we established accident and emergency unit like the one we have at Goderich run by Italians. The unit should have its own theatre doctors specially trained to handle accidents and emergencies like hear attacks, head injuries burns etc. to set up such a unit you need experienced staff.
I can recommend if the government so wishes to invite a recent retired director of A and E new own hospital in London. His contribution to the accident and emergency unit was splashed over radio and television in England I don’t see why he cannot be invited to advise on how to set up such unit. To augment the unit we need to have well trained paramedics with their own specially equipped ambulances.
In conclusion we have to look for funds to train our young doctors both within the sub region and beyond. Let it be a policy that after every five or seven years he can be attached to modern hospitals for refresher courses or organize to bring in experts for a several weeks to retrain them.
We can make use of the Commonwealth universities not work or the Commonwealth Secretariat. There was a time the College of Medicine was frantically looking for a principal when we could have approached the above institutions. By bring specialists expatriates we can develop an exchange programme that will benefit our students and graduates. This will internationalize our medical school and it will able to get equipment.
Finally the government has to have a think-tank to advice on the hospital requirements and management. The government has to monitor every Leone that goes through the health sector.
By Dr. Boye Roberts