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FORGOTTEN COUNTRIES : The crises begin at birth : Sierra Leone's broken public health system is just one reason the destitute nation poses a threat that reaches far beyond its borders.

FORGOTTEN COUNTRIES / First of two parts

November 15, 2009|Scott Kraft

FREETOWN, SIERRA LEONE — When the power went out that night, Dr. Ibrahim Thorlie was operating on his fifth patient of the day in a maternity hospital with a shortage of antibiotics and running water. His colleague was doing an emergency caesarean in the next room. In the corridor, a bucket on the floor held a stillborn baby.

Thorlie turned wordlessly in the darkened room and lifted his gloved hands. Sweat beaded up on his forehead like dewdrops. A nurse reached into the surgeon's pocket and pulled out his penlight, a pas de deux they had clearly performed many times before.

An aide was dispatched to start the generator and, eventually, a few low lights flickered on in the operating rooms. The rest of the hospital remained dark.

The power had failed two nights before, but no one on duty knew how to operate the generator. So Thorlie had awakened the deputy health minister, who woke the minister of energy, who contacted the electrical substation and got power restored. (The substation, it turned out, had taken a bribe to divert electricity to another neighborhood.)

It was an all-too-typical week at Princess Christian Maternity Hospital, which takes on the most difficult cases in a nation of 6 million.

Told of those events the next day, Sierra Leone's first lady, Sia Koroma, a trained nurse, sighed. "It's hair-raising, but it's true," she said. "And that's one of the government's best hospitals. The others are worse."


Bypassed by prosperity

Living standards are improving across much of the world these days. Free markets in Southeast Asia and Eastern Europe have transformed those regions into economic powerhouses. A high-tech revolution in India has lifted millions into the middle class, and the quality of healthcare has improved in the unlikeliest of places.

That tide has mostly bypassed sub-Saharan Africa. More than $1 trillion in foreign aid -- a major chunk of it from the United States -- has been pumped into Africa over the last half-century. Yet, on most of the continent, people are poorer and less healthy than before.

Since Sept. 11, 2001, world attention has been focused on the danger posed by disintegrating states such as Afghanistan, Pakistan and Somalia. Some lesser-known developing countries, though, also are incubators of strategic threats, including terrorism, narcotics smuggling, human trafficking, the small-arms trade and public health crises.

West Africa is of particular concern to world health officials. With shortages of medicine, trained doctors, reliable electricity, clean water and such basics as sterilized gloves, countries often lack the means to identify and deal with new disease threats.

"As we turn over more and more rocks in more and more places, we find more passages for disease," said Dr. Scott Dowell, director of global disease detection at the U.S. Centers for Disease Control and Prevention. "Most aren't going to be the next HIV or SARS, but it's pretty hard to tell which ones will and which ones won't."


Money and corruption

Sierra Leone is one of those nations where decades of foreign aid have failed to appreciably lift the fortunes of the people. The country is a charity case: 60% of its public spending comes from foreign governments and nonprofit organizations. Since 2002, it has received more than $1 billion in aid.

Yet it has the second-highest rate of infant mortality in the world, behind Angola; even Afghanistan ranks lower. The United Nations says 1 in 8 women die giving birth in Sierra Leone; the rate in the United States is 1 in 4,800. Life expectancy in Sierra Leone is 41 years; in Bangladesh it's 60.

A decade-long civil war in the 1990s drove people from the countryside into the capital, Freetown, and today a city built for 250,000 is home to 10 times that number. Tens of thousands camp out in shacks on a lush mountainside with views of the Atlantic but no clean water or electricity.

The war compelled thousands of the most educated Sierra Leoneans to go into exile in the United States and Britain. They make annual visits home, where they are known as the JCs, for "Just Comes," and are both envied and resented. A few have moved back, some to cash in on their contacts with government ministers who oversee the country's diamond and gold reserves.

The country managed a democratic election in 2007, but widespread corruption makes international donors wary. President Ernest Bai Koroma, a businessman who fled to London during the war, has cracked down with mixed results. After a judge accused of bribery was recently arrested in his chambers, lawyers pushed for rules to prevent police from arresting judges in the courthouse.

A few months ago, a 6,200-ton shipment of donated rice from Japan disappeared soon after arriving in port. When $10,000 disappeared over the summer from a project to alleviate child poverty, the director threatened to pull the plug if the money didn't reappear. It did.

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