...and back again
on Freetown Blog (Sierra Leone), 17/Mar/2010 21:56, 34 days ago
When I left Sierra Leone last December, I did hope that I would be returning at some point, but never expected it to be this quick. What started as an email exchange with Faye from the office of Tony Blair in Sierra Leone in January ended in my arrival back here 3 days ago, on contract with the Ministry of Health for 7 weeks.The reason for the urgency is that Sierra Leone is due to launch free health care for pregnant women, lactating mothers and children under 5 on 27th April. This is part of government efforts to work towards Millennium Development Goals and to end the reputatoin of the country as having the highest maternal mortality rates in the World.To say that this is an enormous task is to understate the point: Ministry staff and partner agencies have been working flat out refurbishing facilities, ordering supplies, setting up supply chains and related infrastructure. But... at the heart of the challlenge is staffing. Health service provision here has always been associated with informal charging by health workers (and it was often the only way for them to keep functioning when salary levels were so appalling). The government knows that free health services must mean an end to informal charging and that big increases in salaries are required, but has been struggling to come up with rates that are both affordable and acceptable to staff.Now if you know anything about the health service in UK, you will know how much opposition there was from the professions when the free NHS was first launched in 1948 (when they realised the effect it would have on their private income) and you will also know how much bad will was generated by salary reforms over the past 5 years (never did so much new money create so much dissatisfaction). Well, translate that to a very resource poor environment and you might get a glimpse of what is happening here. Yesterday (Day 2 for me) the nurses went on strike in the main teaching hospital and when I left work today it seemed things were getting worse rather than better.So,  it is hard work at the moment, very hard. But I get a sense that underneath it, people know this is an important time, and they don't want to screw up. And busy though they are, they haven't been too busy to welcome me back with open arms. And that is great.There is the slight matter of finding myself somewhere to live and related domestic arrangements.I'm staying with friends at the moment (in a very nice house), but need to get it sorted, just as soon as I get time to...