By Alie Mozart Sesay
The Princess Christian Maternity Hospital (PCMH), also known as ‘Cottage Hospital’, on Fourah Bay Road, Freetown, is reportedly admitting and treating more pregnant women far above its designed capacity and the quantity of drugs supplied to address the escalating increase in the number of patience regularly accessing medication at the hospital, with the situation rapidly deteriorating into a mere health insecurity.
The PCMH is Sierra Leone’s Maternal Hospital, established in 1925, by the Christian Missionaries, and was handed to the Government of Sierra Leone, in 1954. Until recently, the hospital has a total of one-hundred and forty-one bed capacities, with a single Labour Ward of eight suits, supported with a special Baby Care Unit for complications; four ambulances for emergency; three standby generators of different sizes; a solar panel for backup power supply, and a rehabilitated and functional laboratory.
For normal cases after safe deliveries, the hospital admits lactating mothers and newborns for six to twenty-four hours. Admission period exceeds two or more days, depending on the volume of the complicated case of a child or the mother-a continuation of the ‘Free Health Care Scheme’ introduced by the former President Dr Ernest Bai Koroma-led APC Government in 2010, for under fives, pregnant women and lactating mothers.
As demand for the service increases, the hospital is being overstretched with what experts describe as ‘mismanaged cases and late referrals’ from Public Health Units (PHUs), Community Health Centers (CHCs) and private hospitals across the country, including the Western Urban and Western Rural, from where the very high number of referrals usually come; as a result of quite a number of pregnant women’s attempt to deliver on their own, leading to unavoidable maternal deaths, upon late arrivals
Referrals from within the Western Urban mainly come from Rokupa Hospital, Lumley Hospital, Macauley Street Hospital, Kinghamman Road Hospital and several other private hospitals including Choithram Hospital, to name but a few. A staff at PCMH said the hospital is compelled to run out of drugs as a result of the endless referrals of complicated cases, but “thanks to the Medical Drug Store for compliance”, he added. Many hospitals from where these complicated cases are referred; also lack adequate accommodation plus expertise and drugs, confirmed sources say.
It is discovered that PCMH is not only constrained with accommodation, but inadequate nurses and doctors. According to a report, the hospital undertook a total of about fourteen thousand five-hundred (14,500) consultations in 2016 alone. In 2017, the Out Patients Department (OPD) undertook almost seventeen thousand (17,000) cases, with two thousand four-hundred and forty-one (2,441) referrals; ninety-nine (99) were recorded as unidentified; about nine-hundred (900) from Western Rural; almost two thousand five-hundred (2,500) from Western Urban; thirty-five (35) from the Rural Areas and thirteen thousand six-hundred (13,600) Anti Natal Clinic; totalling six thousand nine-hundred (6,900) deliveries. Seven-hundred and fifty-nine (759) cases of teenage pregnancy-between the ages of 14 to 28, were also recorded at PCMH.
It furthers shows that, from January to June 2018, a total of about eight thousand, five-hundred and forty (8,540) consultations were undertaken by the Out Patients Department (OPD), indicating one thousand, one-hundred and thirty-six (1,136) referrals. This includes six-hundred and forty-five (645) from Western Urban; four-hundred and twenty-five (425) from Western Rural; fifty-four (54) unidentified and twelve (12) from the Rural Areas, accumulating a total of about eight thousand, eight-hundred and thirty-one (831) Anti Natal Clinic.
According to investigation, there has been a remarkable reduction in maternal deaths, following some prudent mechanisms put in place by the hospital management, such as ‘daily management meetings; monthly maternal deaths review, through which some of the causes of deaths are being reviewed, with plans discussed and actions swiftly taken, plus recommendations for punitive actions by an independent Disciplinary Committee, against misconducts of staff,’ among others.
Though bribery and extortion are seen to have drastically minimised, anonymous senior staff at PCMH said the attitude of some patients undermines the hospital management with regards disciplinary actions taken against professional misconducts. Despite these challenges, the Medical Superintendent at PCMH, Dr A.P. Koroma, when contacted, said: “I would like to use the media to encourage pregnant women to regularly visit the hospital for safe delivery, at free of cost”.
Meanwhile, security is heightened at PCMH to discourage the theft of newborns and the Free Health Care drugs. Alimamy Fofanah is a senior Security Officer at PCMH. He explained that the particulars of children and those carrying them for treatment from Ola During Hospital are being recorded, and same is done upon their exit. For newborns, at PCMH, Fofanah added: “Those carrying them must be escorted by assigned nurses, whose particulars are recorded whence they produce ‘discharged cards’ at the Security Post. This is done to discourage the theft of children that used to occur at PCMH; and nurses are also searched upon exit, to further discourage the pilfering of the Free Health Care drugs”.
In a vox-pop interview with some pregnant women on visit to the PCMH, were Mariama Kamara, Fatmata Sesay, Adama Sheriff and others. Kamara commended the hospital management for what she referred to as the fortification of PCMH with CCTV cameras. She said child theft is becoming a thing of the past, whilst Sesay said the demand for money by the nurses, from pregnant women and lactating mothers is being discouraged by the hospital management, adding: “One admires at the polite approach of some nurses in their duty dispensation”. According to Adama Sheriff, “some nurses would reject offers for fear of being reprimanded by the hospital management, on allegations of bribery”.
A senior doctor who asked for anonymity, suggested for the central Government to construct what he refers to as “a National Hospital, somewhere in the capital Freetown, that would contain a Surgical Department, Pediatric, Gynecology, Internal Medicine and adequate accommodation facility, since the PCMH is becoming a challenge-‘biting more than it chews”.
