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This post is just a long rant about why I am so frustrated with the absence of systems in the Sierra Leone health sector. No, this is not political! I am just outraged.

Also, before you come for me and start quoting scriptures about how we will all die, I know the scriptures. And I also know that God wants us to live a long and fruitful life. But like my colleague Dr. Wahid Awonuga said in his Facebook post yesterday, living in Sierra Leone immediately cuts that life span into two.

The last few days have been very gloomy for the junior doctors and the Sierra Leone Medical Community. We lost a soldier! Dr. Omobowale Gabriell was an Anesthesia Resident at Connaught Hospital, University of Sierra Leone Teaching Hospital Complex. He had a Diploma in Anesthesia and only just passed his primary exams a couple of weeks ago. We were so excited for him. We knew his pass was a win for Anesthesia but also for Sierra Leone. He was one of the good ones, the perfect resident and 'crowned prince' of Anesthesia. Wale was dedicated to his family, his job, and the church. All our conversations were on one of these three subjects. He was a fantastic colleague, mentor, and friend. Wale was one of those people who never let hierarchy or age get in the way of your relationship. I didn't even realise he was way older than I am until he died. He was always ready to crack jokes and make conversations. Wale was full of life.

Wale was involved in a road traffic accident a few days ago, sustaining a head injury. He was admitted to the same ICU where he worked day and night tirelessly to make sure his patients had a fighting chance. But he did not get that chance. The system he worked so hard for failed him in all the ways it could. First, let's start with how the major referral hospital in the country does not have a constant electricity supply or a back up generator. How is this even possible? Just thinking about being in the ICU with an on-off power supply... how do you keep your patients alive? How do you stabilize and monitor critical patients with inconsistent electricity supply? Then let's talk about how this same major tertiary referral hospital in the country along with all the other public hospitals do not have CT scans. Wale had to be moved from the hospital twice to private health care facilities with CT scans. Do you know how much more traumatizing for the brain that is? Being on an ambulance on these very bumpy and congested roads racing to get a scan done. My heart sinks just thinking of the whole process of moving someone with a traumatic brain injury from an ICU bed into an ambulance, then out of the ambulance into the facility... to and fro.. twice! All because the hospital where he is admitted does not have a CT scan. While other developing countries are moving towards the use of MRI scans, all our public hospitals cannot boast of A SINGLE FUNCTIONING CT scan. This is the case for many other investigative modalities in the country. Making a definitive diagnosis in Sierra Leone is one of the biggest challenges in managing some critical conditions.

You know what else could have helped Wale? Having a neurosurgeon and a neurosurgery unit in the country. Like many other specialties with very few or no specialists, if you need neurosurgery in Sierra Leone, and don't have the time or money to fly out of the country, just say your last prayers. You would think that with the burden of trauma in Sierra Leone and the many cases of head injurieswe see regularly, that by now, we would be pushing more for these. Most cases that require neurosurgical interventions are life-threatening emergencies. Wale would have benefitted from specialized neurosurgical care. He could have still been with us today. On Saturday, I was on-call at work. One of our patients had developed a brain abscess from head trauma. He could also benefit from the drainage of this abscess by a neurosurgeon. But we have none so we have to depend on antibiotics and hope for the best outcome.

Doctors are only covered by insurance during outbreaks like COVID-19, for example. And this was even after we fought with MOHS to be protected. When doctors die, their families only get the meager NASSIT benefits. We are paid so little that we cannot even save decent amounts from our salaries to afford to be comfortable. But we have been painted in such a bad light by senior government officials and politicians. As soon as we start the conversation on working conditions and pay for health workers, we are perceived as money-hungry and not wanting to serve our people. When our colleagues fall ill, we have to start fundraisers to support them. The aid that Medical Board provides often does not even cover half the cost of their treatment overseas. We want decent wages. We want health insurance, so if we die in service, our families and kids will have decent lives. We want to afford house helps so we don't hop on motorbikes trying to shuttle between work and school runs. This is how Wale met his death. I want to talk about the lack of road safety interventions, but that will be a topic for some other day.

So many things are wrong with health care in Sierra Leone. I don't take waking up with good health for granted because God forbid, a health emergency. Public hospitals still struggle with water and electricity supply. Many of them still don't even have oxygen support or essential drugs needed for emergency care. It irks me so much that top officials never go to public hospitals. THEY KNOW! They know how broken the hospital system is. Once, I referred a very top government official to Connaught hospital for a metatarsal(foot) fracture. He made sure to introduce himself to me and immediately said 'No'. He didn't know that I already knew who he was but I honestly didn't care. Because healthcare should be the same quality for everyone regarldless of socioeconomic status. He told me he would arrange to fly out of the country in the next few days rather than go to Connaught. The Orthopaedic department at Connaught (the major tertiary referral hospital in the country) is ill-equipped to deal with the burden of trauma that the department handles daily. They manage almost all the cases conservatively or refer to Emergency hospital. This is not a secret, but little or nothing is being done to change it. I am happy that the national Postgraduate College of Health Sciences has been opened. It gives some hope that things might start to change. I am hoping that the colleges push for better equipments and facilities at the teaching hospitals to make them more conducive for teaching and learning and improved patient care.

Often, we wonder why doctors go away and never come back. But this is why. THE SYSTEM IS BROKEN on so many fronts! Who would want to come back to this? Who would like to work so hard for a system that will fail you at the slightest health emergency? I am tired! Tired of typing, tired of thinking of all the things that need to be fixed, tired of thinking of all the things that could have given Wale a fighting chance-a chance to live, save more lives, and be with his wife and two girls. I am tired of saying RIP to my colleagues, my family and my friends.

What can be done to change this? How do we move away from this?

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