In Kono District, in the Eastern Province of Sierra Leone, where diamond-rich earth was once exploited to fund a decade-long civil war, a new legacy is being built in its capital, Koidu.
Behind a steel fence, the rooms of a new maternity centre, the Maternal Center of Excellence, are emerging – and about 60% of those wearing hard hats on site are women. Most are working in construction for the first time and are conscious they are helping to build the region’s future. “It is for us, the women who will give birth here. That’s why we are putting in effort to build the hospital,” says Hawa Baryoh, 21, who works in quality control. “That is why you see plenty of women here,” she says proudly.
The building will serve the Koidu government hospital next door, and promises a change for the region and country, which in 2019 had one of the highest rates globally for maternal mortality with a healthcare system blighted by civil war and Ebola, which killed 7% of its healthcare workers. Despite an improvement in maternal deaths from 1,165 per 100,000 live births in 2013 to 717 per 100,000 in 2019, the rate remains high.
A walk around the noisy site reveals women involved in every inch of the work, from welding and brick laying to carrying heavy head pans. Until last year, Baryoh was earning five to 10 leones a day (20p to 40p) selling corn on the street. Now, as the breadwinner for her family, she is helping to train other women on the site.
The 166-bed facility, which is due to partly open by the end of next year, is funded through a public-private partnership by the international nonprofit Partners In Health and the Sierra Leone government.
John Chew, the site supervisor from Build Health International, the nonprofit construction partner on the project, is part of the team working even through the rainy season. Many of the women on site credit him with providing a safe space to work and encouraging them to expand their skills. News that women were treated well and fairly spread through word of mouth in Kono and more and more women came seeking employment until they made up most of the workforce. “I’m very proud of them,” says Chew. “We build this for tomorrow and to train others.”
Baryoh says she hopes the project will give other women courage to work there, too: “What men can do, women can do.”
Isata Dumbuya, the director of reproductive, maternal, neonatal and adolescent health at Partners In Health Sierra Leone, was born in Kono, but has spent a large part of her life in the UK where she trained in the NHS as a midwife. She returned about five years ago and has set her sights on improving the region’s maternal healthcare. “I still had ties here and I kept hearing that it had the worst maternal mortality rate in the world. You feel a sense of wanting to do something about this, we’ve been hearing this for far too long,” she says.
Dumbuya says part of her work has been changing mindsets so that death in childbirth is not accepted as normal. “If you are used to seeing people die from preventable things, even when people do die, you don’t see the grief,” she says. “[I would say] I need you to be angry and to be passionate and I need to do everything in my reach to ensure it doesn’t happen again.
“The first year I was here, there was one week where we had seven people die and I nearly lost my mind.”
Dumbuya originally envisaged staying for 18 months but hope has kept her in Kono. “You keep on seeing the results, even the little things,” she says. “That keeps you going, and every year when you hear the reduction in maternal mortality rates you think, collectively, if we keep on going, we can make this happen.”
In the blue and cream maternity unit of Koidu government hospital – which will eventually transfer its maternity services and special care baby unit to the new centre – Dumbuya greets the nurses, midwives and patients with a hug or a joke. Since 2015, the hospital has benefited from improved facilities, with the help of Partners In Health – its maternity unit now has 24-hour electricity to provide caesarean sections. Every month they hold community blood drives where they encourage pregnant women to identify family members or friends who can donate blood.
“No one should be able to come here and die as a result of not being able to have a blood transfusion,” says Dumbuya. One of the leading causes of maternal mortality according to data from Unicef is an obstetric haemorrhage, which account for 46% of maternal deaths in Sierra Leone.
Sia Icaru, a rice farmer, sits on the bed next to her one-day-old son. She is one of those who benefited from the unit’s increased capacity for caesareans. According to the hospital’s data, staff performed 105 caesareans in June, but midwives are still working to destigmatise the procedure. Icaru says she had no issue with it: “I knew they would take care of me here, whenever I come here, the doctors speak to me nicely. I’ve had all my children here.”
Her eldest is now nine and while she is happy to hear about the new maternity centre, she says she will not need it – as she wants this to be her last child. The hospital also offers family planning services.
The goals for the new centre include a five-fold increase in family-planning visits, as well as a reduction in the rate of facility-based maternal deaths to less than 1%, and stillbirths to less than 2%.
There is huge anticipation among staff about the new centre, and some have said they want to go back to school to improve their skills before it opens. Sister Cecilia Jah, the triage midwife, is excited, but also worries about how many people may come once it opens. People already come from as far away as Freetown to give birth in Koidu because of its good reputation.
Under the 2010 free healthcare initiative, user fees for drugs and consultations were abolished for pregnant women and lactating mothers to reduce obstacles to accessing medical care, and Dumbuya says they expect to see about 300 people a day when the new centre opens.
Bondu Fillie, 25, who is nine months pregnant with twins, sits outside the birth waiting home at the Wellbody primary healthcare clinic, a five-minute drive from the hospital. She has lost two babies previously and this will be her first time giving birth at the facility. She is happy to be here. “They feed me, they review and monitor me,” she says, as Dumbuya sits next to her and compliments the size of her belly. The waiting home provides accommodation where expectant mothers in high-risk categories or who live far away from the hospital can be monitored in their final months and weeks of pregnancy. The clinic currently refers patients to the Koidu government hospital, but that will move to the new maternity centre once it is open.
Dumbuya highlights the importance of the new maternity centre as a training ground, with the possibility of developing exchange programmes with other hospitals abroad. “It’s not just about maternal and neonatal health,” she says, “but building a space where national staff can come to learn and grow and develop their skills, because for too long we’ve been dependent on people coming into the country.”
There is still a shortage of healthcare professionals in Sierra Leone, which has the lowest density of medical doctors in west Africa with about three doctors per 100,000 individuals according to data from 2020.
“It’s a dream come true. Aside from being spacious, it will meet the needs of what people actually want: quality,” says sister Therisa Mye-Kamara. “This will put Kono district on the healthcare map. We will be the super best.”
