Marbella slum, Health Clinic

Since the peaceful general elections of May 2002, Sierra Leone has officially entered a post-war phase. Ten years of civil strife caused widespread displacement; hundreds of thousands of Sierra Leoneans became refugees and were internally displaced in the past ten years. Even though the war ended this year, it has altered the demographic make up of the country for good.

The most obvious example of this change is the capital Freetown. Once it was a small capital based strategically where the river meets the sea; now it is a sprawling urban centre harbouring an estimated two million inhabitants. With Sierra Leone’s population estimated at 5.1 million, this means that two in every five Sierra Leoneans live in the capital.

While needs of city dwellers can be very different from those who live in rural areas, some very basic needs are still the same. Two of those needs are healthcare and education.

In the city slum area of Mabella, Concern has been supporting the local Ministry of Health (MoH) clinic since the middle of 2000. The area is home to over 20,000 people and has a daily influx of traders, who come to sell their wares on the large open-air market in Mabella. Locals and traders alike use the clinic in Mabella, when they decide to seek medical advice instead of buying drugs from a market stall. It is a common practise, which not only leads to wrong diagnosis and treatment; it also contributes to drug resistance problems. But it is understandable why many people are unwilling to use Government facilities; due to the war, the MoH is struggling to provide for all the health needs of the population, and drugs and other equipment have been in short supply.

Since Concern began supporting Mabella Health Post, the health facility has undergone significant improvements. Parts of the very small building have been rehabilitated and training has been conducted for local health promoters and traditional birth attendants (TBAs) in collaboration with the District Health Team (MoH).  Community Health promoters also completed First Aid training conducted by the Sierra Leone Red Cross.  Concern has supplied all necessary drugs.  Due to the additional support provided by Concern to Mabella clinic, it has been possible to carry out new immunisation drives and the growth monitoring programme for children under five has been steadily expanding since it began.  Concern has been able to support the provision of a MoH midwife, who works at the clinic twice a week.  The clinic remains a Government health facility, with staff salaries paid by the MoH and much of its success has been due to the good relationships that have been built between the local MoH Team and Concern.

Halima Bangura is a regular at Marbella clinic. She was treated for a persistent cough on several occasions before the nurses started to realise that her cough was more than just persistent. Four-year-old Halima was sent to the hospital for an x-ray and diagnosed with tuberculosis. Alison Danks, the Concern health programme coordinator explains that it was a surprise to see a small girl with TB in the area. “We have followed the progress of Halima closely. There is no known record of TB in this area and now that we’ve found evidence of it, we need to be on the lookout for it. It is a very contagious disease. The nurses in this clinic have done well in encouraging Halima’s mother Mabinti to start the very intensive TB treatment. Halima will have to travel to the paediatric hospital daily to get an injection, and this will continue for 9-11 months.”

“Meanwhile, we have contacted the Ministry of Health and alerted them of the prevalence of TB in Mabella slum. It is no surprise that there is TB here; the area is damp, it is right on the river and by the sea with regular flooding problems every season. These are the sorts of conditions in which the disease can thrive.”

“There is a TB control programme carried out by the MoH, supported by the World Health Organisation (WHO). They train special health promoters to go out into the community and diagnose TB. This is what we hope will happen in this area soon, so that we can prevent the further spread of TB in Marbella. So far we have seen the disease present itself as a rare infection that occurs ‘on its own’. In other African countries TB has made a very strong reappearance as a opportunistic infection that presents itself in people infected with HIV, but this does not seem to be the case in Sierra Leone; at least not yet. The country has infection rates of 6% for Freetown and 5.8% in the rest of the country, which is relatively low compared to other African countries.”

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