 |
| 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.
