Friday 28 March 2014

Tarmac & Progress

View looking down to Segbwema from outside the hospital
in  2014
View looking down to Segbwema from outside the hospital
in  2010
 For the first time in Segbwema’s recent history I was able to walk down to the town tonight (for the necessary therapeutic cold beer) on a smooth tarmac road. After the months of construction and dust the highway connecting Kenema and Segbwema is almost finished. In a place where progress since the end of its civil conflict can often seem agonisingly slow, such pivotal developments in infrastructure are worthy of celebration. Improved access to Kenema, Sierra Leone’s 3rd city and on to Freetown should optimistically act as a catalyst for development in the area, improving trade, increasing the availability of services and supplies and will hopefully make the town a more appealing place to live and work, attracting future healthcare workers.  Whilst one of the downsides of increased human travel is certainly highlighted by this week’s Ebola virus outbreak which, according to the World Service, has now possibly edged across from Guinea and Liberia into Sierra Leone, improved connectivity with the outside world should be fruitful for Segbwema and the hospital. My only other lingering doubt is whether the number of road accidents caused by the poor visibility and uneven gravel will be replaced by road accidents caused by motorists over-zealously increasing their speed on the novel flat black surface; only time will tell.
This morning the Anti-Corruption Commission held a workshop for staff and students at the hospital. Sadly corruption remains endemic in Sierra Leone (as no doubt it does in many other countries) extending from million dollar under the table deals at the top of the tree, right down to the grass roots of dishonest primary school teachers expecting a few thousand leones (£1-10) from their pupils to ensure they get the right marks in their exams. Realistically it may take a decade, or more likely a generation, for corruption to be removed from Sierra Leone’s way of life. Nevertheless this transition has to start somewhere and the workshop and unexpectedly uplifting talks this morning focusing on the need for positive role models and prevention of corruption seemed a reasonable place to begin.
When I think about Sierra Leone’s recovery and development I remember a patient I once discussed with a neurology consultant as a student. The patient was an 18 year old who had suffered a traumatic brain injury when he had driven home intoxicated with drugs and alcohol and had a head-on collision with a truck. When I first met him he had been in a rehabilitation hospital for 6 months gradually re-learning how to speak and how to walk. The consultant made the salient point that in addition to the challenges faced by having to regain the basic human functions of communicating and moving, his path to integration back into society was made more challenging by his starting point. He was not a high flyer from a supportive family but had dropped out of school at 16 with no qualifications, been unemployed for 2 years prior to the injury and been struggling with drink and drug problems.  Had he not had the serious car accident, his path to a productive independent adult life would still have been challenging; with the brain injury the magnitude of task increased several fold.  Sierra Leone was certainly no high-flying middle class patient with a supportive family when civil war broke out. Decades of one party rule, corruption, political mismanagement and rampant borrowing had resulted in a slow grinding poverty with erosion of education and economic growth. Whilst I’m sure that if integrity was a value slightly more endemic through both the governmental and private sectors certain gains could be achieved more quickly,  in many ways it is perhaps understandable that some areas of development are not as far forward as we would hope or expect giving their starting point.
Another first this month in Segbwema’s recent history was having a hospital staffed by a grand total of four doctors (possibly a record since the hospital re-opened) thanks to a very productive 3 week visit from a semi-retired GP and his wife. He, like me, had visited the hospital 3 years ago and it was heartening to hear him talk and reiterate the developments that had occurred since then. From surgery happening in a side room between two wards to a rehabilitated and functioning operating theatre, from muddled notes to organised patient charts and from often scantily filled medical cupboards to a well stocked pharmacy. Undeniably, the difficulties and challenges the hospital and community face remain huge and often seem insurmountable. The daily grind can make it hard to appreciate the long term progress that has occurred but perhaps it is important to stand back once in a while to see that gradual positive shift of circumstances and situations. 
On the gardening front the quick grow lettuce leaves were looking very promising until their progress was permanently halted when they were squashed by the bottom of a certain 2 year old girl who was playing exuberantly with a toy car outside the front door. I’m sure there’s a metaphor there somewhere or perhaps I should simply give up on home grown produce.

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