Sierra Leone (meaning Lion Mountains) is a small country on the west coast of Africa. 'Sweet Salone'
as it is locally known is blessed with beautiful mountains, colourful jungles and tranquil stretches of wild beaches.
The Sierra Leoneans are generally friendly but as a country in the extremes of poverty, many people are still on a daily survival mode.
A few statistics for those who like numbers:
-- Population of 5.7 million people (UN, 2009), of which an estimated 1.7 million (though many think a lot more) live in the capital city Freetown.
-- Ranks 180 out of 182 Human Development Index (UN,2007) (considering Life expectancy, Literacy Rate, Gross Domestic product per capita (GDP) indicating standard of living)
-- One of the 10 poorest countries in the world. Gross National Income per capita (US$) 320 (World Bank, 2008)
-- 7th worst Under-fives Mortality rate in the world. 194 deaths per 1000 live births, meaning that 2 out of every 10 children die before reaching age 5. (UNICEF 2008).
-- 21% of under fives suffer from moderate-severe malnourishment (Unicef, 2008)
-- 350,000 children aged 0-17 orphaned (Unicef, 2007)
-- 53% of population living below the international poverty line of US$1.25 per day (World Bank, Unicef, 2007)
-- 25% births by hospital delivery. Delivery care coverage (Unicef 2008)
-- Child Disability 34% 1999-2008 1 in every 3 children has some kind of disability
-- Life expectancy 47.3 years
-- Adult Literacy 38.1%
-- The main languages are Krio or English (for the educated) or many of the tribal languages which are still very much spoken throughout the country – Mende, Temne, Limba, Koranko amongst others.
-- Religion 60% Muslim, 30% Christian, 10% animist and other traditional beliefs (Bradt 2008)
References:
www.unicef.org/infobycountry/sierraleone_statistics.html
http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_SLE.html
http://www.bradt-travelguides.com/search.asp
http://news.bbc.co.uk/1/hi/world/africa/country_profiles/1061561.stm
Sierra Leone is recovering from a 10 year civil war, which finally ended in 2002. The war was started over many issues – diamond mining, politics and power being the main ones. The war was long and bloody and at the time the news in the West was plastering many images of amputations, child soldiers and brutal cruelty which will be engraved on many people's minds. Sadly, for many Sierra Leoneans it was real living nightmare, not one single person went unaffected, and most lost at least one direct family member. The infrastructure of the country was destroyed and essential services like health, housing, water and sanitation, education and transport leave much to be desired.
So why are there so many
disabilities in Sierra Leone?
A newborn in Sierra Leone has a low chance of surviving until age 5. Antenatal and early child health care is rarely available and where it is, it is expensive – a luxury most cannot afford. This is one of the reasons there is so much disability in children.
Few statistics can be found on disability as they are not generally diagnosed having rarely ever seen a doctor who is able to identify these kinds of problems. But from our experience, complications with obstructed labour can often leave the baby with mild - severe brain damage (Cerebral Palsy) due to asphyxiation, or other neurological problems such as Erb's Palsy, if the child and /or mother survive at all. We also see many other children with developmental delay due to probably genetic disorders, which also occur in the West, but in SL they will never be recognised or diagnosed. There are those who are born with problems due to drugs the mother may have taken during pregnancy such as Thalidomide, or other maternal health issues that were left untreated such as TB, Polio or HIV.
If a child is born healthy, other causes in their early years commonly result in disability. Malnutrition and lack of stimulation can cause delays in development. Fits caused by epilepsy or disease cause brain damage leading to Cerebral Palsy. There are many accidents both at home with open fires for cooking and kerosine lamps causing burns, and on the roads leading to soft tissue and bone injuries. Then there are those children who get ill with common illness such as TB, Meningitis, Polio, Malaria, Osteomyelitis or even a simple wound infection. These can all end in sever permanent disability if not treated promptly with good medical knowledge.
The illiteracy in the country combined with the strong belief in traditional medicine or witchcraft mean that medical care is delayed with detrimental effect. When a child gets ill, families will often wait before seeking help. They can think the illness is a curse or punishment from God, and if they make the right sacrifices or see the witch doctor, that the symptoms will go away. And when they don't get better, they return to the witch doctor for more 'help and advice'. Or, they might go to one of the many illegal pharmacists to get drugs or injections. These pharmacists are generally business people who have little if any training in diagnosing and prescribing. They will sell the vulnerable family a concoction of many different drugs, which on looking with the trained eye, one or two might be ok – vitamins or pain relief, but many others are at best wrong but not harmful, at worst heavy and inappropriate dosages and potentially damaging. By the time they do seek professional medical help, the illness has taken hold severely causing irrecoverable damage leading to permanent disability and sometimes death.
With the joint working of the government and many aid organisations, thankfully immunisations against preventable diseases particularly Polio, Measles and TB, are now being widely given. However as you can imagine during the years of the war, this was not the case.
There is one Rehabilitation Centre in Freetown, run by the Ministry of Heath alongside an INGO (International Non-Governmental Organisation). They have a Physiotherapist and several Rehab Therapists who work with a Technical team producing prosthetics limbs and leg splints as well as distributing any equipment they may have such as crutches and wheelchairs. ~Enable the Children~ has good ongoing working relations with them, however it is recognised that children with disabilities are not able to attend there regularly. The families do not have the time or money to travel there as the parents undergo daily pressures of selling or farming to gather the little money they can to feed the rest of their family, this becomes more of a priority.
Travelling to the families and treating them in their own homes, means better care for the children, this is exactly what ~Enable the Children~ are trying to do. We are well networked among other disability related organisations and hospitals and we often receive referrals from them. Sierra Leone's Ministry of Social Welfare also recognise and encourage our work. We hope that we will continue to strengthen these relationships for the further holistic development of health care in Sierra Leone as the country as a whole rebuilds and re-establishes itself after it's horrific past.