The Hastings Community Health Centre is the major medical service provider for the community of Hastings, but it struggles to meet the requirements of the people it has been created to serve.
With a scarcity of drugs, supplies, a leaky roof that has rendered the antenatal examination room moldy and unusable, and patients who cannot afford treatment or even transport to a referral hospital in Freetown , the community's health is at risk.
According to the Community Health Officer of the Hastings Community Health Centre, Sahr Gbandeh, these are challenges faced by all health centres across Sierra Leone. "The Ministry of Health set up health centres in catchment areas to serve the population in that area. Providing outreach services, including transportation, staffing and drug provision is a challenge. Drugs needed for treatment might not be available, so they have to be referred somewhere else", he said.
The government has recently begun supplying basic medicines again after more than a year of failing to provide them. A newly arrived shipment of anti-malarial drugs, oral re hydration salts to treat diarrhea and paracetamol will allow the centre to provide treatment for some of the most common, and often deadly, conditions to children who require them.
According to Dr. Amara Jambai, the District Medical Officer for Western Region, "the last time drugs were shipped to health centres (across Sierra Leone ) was July 2006. The basic essential drugs will soon get supplied in the space of the next two weeks. The drugs delivered to Hastings Community Health Centre were provided by UNICEF for the children." The health centre sees between 30-35 people each day and provides care for those with illnesses, as well as immunization, but specializes in family planning, including prenatal, delivery and antenatal care. There is no doctor, but there are nine nurses, an immunization staff and attendants. The Community Health Officer is also trained to provide services to patients.
If there are any complications with a birth, the woman and child are sent to a government hospital, at either Rokupre, which is currently under renovations, or Connaught . If she cannot afford the transportation to the hospital, the health centre will do what it can to help.
"Maternal and child mortality deaths happen in the rural areas. There are several reasons for that. Transportation, finances, the belief that hospitalization may not be the best option and delays in taking the right decision. Mothers might want to diagnose (her child) herself", said CHO Sahr Gbandeh.
Sierra Leone ranks at or near the bottom of rankings for child and maternal mortality. According to the US State department's statistics on child mortality, 15827 deaths occurred for every 100,000 live births in Sierra Leone. A Harvard Center for Population and Development Study counted 2100 deaths of women while in childbirth for every of 100,000 live births.
Midwife Elizabeth Komeh said that pregnant women often come to the health centre with complications such as anemia, obstructed labour needing intervention and high blood pressure which causes eclampsia. Eclampsia is a serious complication of pregnancy characterized by convulsions. The clinic recently acquired magnesium sulphate to help stabilize these women in order to send them to hospital.
When interventions beyond the capability of the centre occur patients are at risk because they "can't afford transport. We help them, take from the hospital funds, from the service fee. A certain amount of money from the drug sales go to the desolate, people who can't afford. We need cooperation, help for the hospital", said Ms. Komeh.
Fatmata Sesay delivered a baby boy two weeks ago at the centre. Her prenatal care was provided by the local health centre and she and her baby are now receiving postnatal care there as well. She said she the community centre nurses have been a great help through the process. "We pay Le 60,000 to give birth in the health centre", she said.
There are four beds for in-patient care at the centre, 2 for general medicine and 2 for maternity, but the majority of people are seen on an out-patient basis. The health centre does not have staff quarters. If an emergency strikes after the centre is closed, it is more difficult and takes longer, to get care to the sick or injured person.