I set off for Bonthe Island and Koinadugu late last year, along with trusty partners from the local district health management teams, the Health for All Coalition and the Messianic Ambassadors for Africa.
Too many pregnant women have been choosing not to deliver their baby in health facilities since Ebola reared its head. And too many women and babies were dying as a result, deaths which could be prevented. How can we help women regain trust in their local facilities? How can we help strengthen communities’ response to Ebola? We had our work cut out.
Using the FIT scorecards, we encouraged people to ask questions about what their facilities were like, raise concerns about gaps in services, consider why women were not using the clinics and agree what issues they would like to take further as a community.
They now had access to the information about their facilities and access to the decision makers. The communities were ready to act.
While the reasons given for women not attending may not surprise you, it was an important exercise and helped focus our minds on what can be done. The feedback across the two districts on why women are not accessing clinics, especially pregnant women are as follows:
- Fear of contracting the Ebola virus from the health workers and other patients - there are rumors that people are being injected or given drugs with Ebola virus
- Free Health Care drugs not being available and pregnant women are concerned that they cannot pay for the cost recovery drugs
- Sometimes the clinics are just too far and the need to cross rivers to get to clinic on Bonthe Island
- Some people mentioned the attitude of health workers and how it can scare them away
So, what did they do? Some communities already had by-laws in place which would fine a woman who delivered at home and any traditional birth attendant who supported her. They also gave out information about particular drug peddlers and asked villagers to report them.What was extraordinary was how much the communities knew what the gaps were in their health services, how much they tallied with the FIT scorecards:
- Inadequate drug supply, especially free healthcare drugs
- Inadequate number of staff - some communities reported having one health staff in a peripheral health unit
- Poor accommodation for the health staff
- Challenges of conveying referred patients to hospital, especially for Bonthe Island
- The health workers complain to them that they do not have protective equipment
- Lack of safe water in health facilities, again especially in the Bonthe Island
Again, the communities decided to act, how could they fix the gaps? They chose to help with accommodation for health staff, but also to join together to advocate for better services. One community authority took me aside and said
MamaYe, please also add your voice to ours and when you go back to Freetown, please remind the Government to help equip our clinics, our clinics need to be ready to receive and treat patients, especially our women and children
It was inspiring to watch all of these villagers working out all the different things that they could do to prevent Ebola reaching them, with talk of check points and house-to-house visits. The chiefs committed to report all illnesses and deaths immediately, while others said that they would promote the toll line 117.
To reinforce all this hard work, we used the radio to give feedback to the whole community, hoping to amplify the message. We heard from the audience that they had understood what we had been saying and we even got thanks from some callers for the work we had been doing to make local clinics safe.
We are all pulling together to stop this outbreak. Even though the number of new cases is declining, there is still so much more to do.
Let us hope that this will keep the people of Bonthe and Koinadugu safe from Ebola, and their women and babies safe in pregnancy and childbirth.