Sierra Leone, September 21, 2023 — Musa Yahyah’s harrowing experience while giving birth under a mango tree in Sierra Leone highlights the grim reality faced by many pregnant women in this West African nation. Despite some progress, Sierra Leone continues to grapple with alarmingly high maternal mortality rates. According to the World Health Organization, the country recorded an estimated 443 maternal deaths per 100,000 live births in 2020, underscoring the urgent need for improved maternal healthcare services.
For numerous women living in remote, rural areas, access to adequate medical facilities remains a challenge. The exorbitant costs of transportation to hospitals, coupled with poor road infrastructure, a nationwide shortage of ambulances, and inadequate patient referral systems, compound the problem. Tragically, by the time these women reach a hospital, precious time may have already been lost, putting their lives and those of their infants at risk.
Amadu Musa, a nurse at Médecins Sans Frontières (MSF)’s mother and child hospital in Hangha, Kenema district, underscores the gravity of the situation. “Late referrals can be fatal, and some medical complications could be avoided if women with obstetric emergencies were able to reach health facilities on time,” he warns.
To address these critical challenges, MSF operates in Kenema, Mile 91, and Magburaka, Tonkolili district, working alongside local healthcare teams to respond to maternal and pediatric medical emergencies. In the first seven months of 2023 alone, MSF’s teams in these regions assisted 3,326 women in delivering their babies, with 505 of those deliveries requiring emergency cesarean sections.
MSF also plays a pivotal role in providing timely transportation for women and children in need of emergency care. Kennedy Uadiale, MSF medical coordinator in Sierra Leone, emphasizes the need for an effective referral system and more ambulances to reduce maternal and neonatal mortality rates. Between January and July 2023, MSF’s eight ambulances transferred 372 pregnant women and new mothers to hospitals for life-saving care. These women faced a range of life-threatening conditions, including pregnancy-induced hypertension, post-partum hemorrhage, anemia in pregnancy, and antepartum hemorrhage.
Recognizing the limitations of traditional transportation methods, MSF has stepped in to cover the costs of motorbike-taxi trips, the only available alternative in many areas, to transport women to health facilities. In the first seven months of 2023, MSF funded 900 such trips, enabling pregnant women to access care promptly.
Umo Ngamanga, an 18-year-old from Moyamba district, shares her story of overcoming geographical barriers. “I started experiencing labor pains at night, but to get to the health center in Foindu, 10 kilometers away, you have to walk for two hours as well as cross a river,” she explains. Despite her challenges, Umo’s baby received the care he needed, thanks to MSF’s intervention.
Additionally, MSF has trained traditional birth attendants in Kenema district to identify danger signs in pregnant women, facilitating referrals to the closest health centers or dispatching an MSF ambulance for advanced care when necessary.
While MSF’s efforts have made a significant impact, much work remains to be done to sustain the progress achieved over the past 23 years. Mohamed Morchid, MSF head of mission in Sierra Leone, emphasizes the need for continued investment in emergency transport services, staffing, maintenance, and fuel costs for existing ambulances. He also calls for innovative and sustainable models to support emergency transport needs, particularly for patients requiring immediate medical attention.
“We encourage the Ministry of Health and Sanitation, as well as health and development partners and stakeholders, to make additional investments in emergency transport. This would help save many more lives,” Morchid urges. As Sierra Leone strives to reduce maternal and neonatal mortality rates, concerted efforts are required to ensure that every pregnant woman has timely access to quality maternity services.
