Preventive Medicine in Sierra Leone? Not for Women


I am sitting in the office of a development organization in rural Sierra Leone. Next door, at the district hospital, a group of school children are lining up for a parade. Today is ‘free immunization day’ and the community is holding a celebration to create awareness. I cynically think, ‘shouldn’t every day be free immunization day,’ before heading out to join the festivities.

First in the parade are the women. They wear multi-colour dresses, sing in the Mende language, and carry an uprooted banana tree on their heads. A local man, wearing a team Canada hockey jersey despite the 30 degree heat, explains to me that the song is about how too many women are dying.

After all this district of Sierra Leone has one of the highest maternal mortality rates in the world – about two out of 10 women dying during childbirth.  The man tells me the women are singing for forgiveness from their ancestors, and that the banana tree is a sign of repentance. It’s believed that women are dying because their ancestors are angry with them, and that if they repent women will stop dying.

He says, ‘This is preventative medicine in Sierra Leone.’

Out of respect for the local culture, I bite my tongue. I don’t say that I believe women are dying because the hospital doesn’t have safe water, electricity, medicine or doctors. I don’t mention that the practice of polygamy, and the acceptance that men may have many girlfriends, means that sexual networks are created where women are exposed to sexually transmitted disease they cannot protect themselves from or access treatment for. I don’t mention female genital mutilation, which nearly every girl in this community experiences, but no one speaks about out of fear of the mysterious power of the
traditional secret societies.

Instead, I listen to the women’s song until it is drowned out by the sound of a helicopter landing. Out of the helicopter step two white men in suits – also here to witness free immunization day. The community people are happy to have visitors. They have more generosity of spirit than I do.

I am incensed at the financial (and environmental) cost of flying in two foreigners for no obvious purpose. I think about how much money was spent on the helicopter fuel – how it could have been used on life saving medications, a new generator for the hospital, or to fly in someone useful – like an obstetrician.

The man I’ve been speaking to says two girls from his village died yesterday during labour. I think about the women’s song of repentance. I agree that there is definitely blame to be allocated for deaths like the two village girls’. But I as look at the helicopter, at the empty shell of a hospital, at all of us standing around watching, the only thing I am sure of is that it is not the fault of the impoverished women.

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