The 16 Days is an annual international campaign to raise awareness about violence against women and to push individuals, community organizations and government to take action to prevent it.  The campaign in Sierra Leone is coordinated by the Coalition on Women’s Rights, a collaborative working group of national and international NGOs, community based organizations and UN agencies.  In the next two weeks, these groups will be advocating for implementation of Sierra Leone’s three Gender Acts.  Parliament passed the Acts, which among other things protect women’s rights to property and protection from domestic violence, earlier this year and now activists are working to make sure that local and national government actually take action to protect the rights guaranteed in these laws. 

The first thing that struck me at the kick-off was the number of men in the audience—they must have made up more than a third of the group.  I have attended many women’s rights events in the States as well as regional conferences in Southeast Asia, and I have never seen such high male participation in these events.  The people in attendance were of course a self-selected group of activists, so I do not think that the gathering was representative of Sierra Leone at large.   Though it’s hard to accurately quantify, discrimination and violence against women remain huge problems here.  But I am interested in talking to people a bit more about why there are so many men involved in the campaign here.

There was also a wide range of organizations represented at the kick-off event and in the march—everything from Sierra Leoneans working for the UN to local Muslim women’s associations.  The most sobering part of the march was meeting a group of girls who attend schools sponsored by the NGO Forum for African Women Educationalists (FAWE). One of the FAWE representatives told me that most of the girls had been brought into the school specifically because they had been raped and sexually abused. Most of the girls were between 11 and 13 years old, and they repeatedly told me their names and asked me not to forget them.   

Tomorrow I am heading back upcountry to Kenema to attend a workshop for the area’s paramount chiefs to educate them about violence against women and push them to take action against it in their communities.  I’ll also be visiting one of the closing refugee camps to meet the women who are taking over a women’s center that was formerly funded by international NGOs.  Stay tuned for updates on my trip! 

Thursday was a big day in Sierra Leone as the new parliament and president, Ernest Bai Koroma, were inaugurated in a festive ceremony at the national stadium attended by an estimated 50,000 plus Sierra Leoneans.  In some ways the inauguration signalled a big shift in Sierra Leonean politics--Koroma defeated Solomon Berewa who at the time was the incumbent vice president and a member of the Sierra Leone People's Party (SLPP), which many of its supporters view as instrumental in extracting the country from the civil war.  Koroma represents the All People's Congress (APC), which governed the country up until the outbreak of the war in the early 1990s.  At the time of the elections, many commentators saw Koroma's victory as a signal that ordinary Sierra Leoneans were fed up with the corruption and lack of tangible economic growth under the SLPP and were looking for new leadership to change the country's course on these matters. 

In the last week, Koroma has emphasized that he will tackle corruption to spur economic growth.  Last week the BBC got hold of a confidential audit commissioned by Koroma, which reveals gross levels of incompetency and mismanagement under the former government, according to the BBC.  It is currently unclear how the information revealed in the audit will be used (i.e. will anyone responsible for the past corruption be audited?).  And, of course, there is the larger question: will Koroma and his new government actually be able to change the situation or will it end up perpetuating the cycle of corruption? 

On a related note, Reuter's Alternet also has a great blog post today by freelance journalist Alex Klaushofer musing on the implications of corruption in Sierra Leone and other developing countries for aid organizations and other international organizations.  The Koroma-commissioned audit, for example, revealed that an unidentified international donor contributed $500,000 for a government-run project that never reached the intended recipients.   According to Klaushofer, aid organizations constantly struggle to make sure the money they receive from donors is being used properly and is benefiting the targeted populations.  Yet for almost all of the large international NGOs and UN bodies in Sierra Leone working with the government is a significant part of their program strategy since they want to help train and equip the government to take over public services once international actors pull out.  Is this an effective strategy when the government is corrupt and/or incompetent? Are there any other options? 

I am just beginning to think about these issues...so I appreciate any thoughts or additional links on these issues from readers!

According to recent reports, very few women receive antenatal care from trained practitioners like doctors, nurses or midwives. Sierra Leone also lacks a standard antenatal care package so there are no records to indicate how many women receive basic services like having their blood pressure checked, receiving micronutrients or having blood drawn for hemoglobin estimation.  According to the WHO, neonatal mortality in Sierra Leone is above the average for Africa at 56 per 1,000 live births. 

In addition to spotty and poor antenatal care, many women in Sierra Leone do not access skilled health practitioners when giving birth.  As of 2000, only 42 percent of births were attended by skilled health personnel like doctors, nurses and midwives.  Many births are attended by traditional birth attendants (TBAs); a UNICEF study in 2004, however, showed that the Ministry of Health sponsored training provided to TBAs has had little effect on maternal mortality rates.  This fact has prompted some NGO service providers to discourage the use of TBAs as service providers and they have instead encouraged them to direct women to services at local health units and hospitals.  Of course, this is not unproblematic either, since health units and hospitals can be difficult to access (rural roads are generally still difficult to navigate and adequate vehicle are scarce), they charge for their services, they frequently run out of supplies and they are understaffed. 

There are currently no data on the rate of post-natal care in Sierra Leone, though it’s likely low given how few women access adequate health facilities when they give birth.  Post-natal care is crucial for spotting life threatening complications to the mother and child.  Last week when I was in Kenema, for example, a newborn in the hospital maternity ward exhibited signs of irregular breathing, indicating possible distress.  The nurses were able to spot this problem, check the infant and provide appropriate care—most newborns in Sierra Leone are not fortunate enough to have that sort of intervention.

I hope this post provides a little more context on the issues I raised last week.  Look out for more stories from the field in the weeks to come.

Despite my recent illness, I have been on the move.  On Tuesday I traveled east to Kenema, Sierra Leone’s third largest town with an estimated population of 254,539, for a series of meetings and field visits.  During the week I visited the Kenema Government Hospital, which is a prime example of how the government is struggling to provide essential services to the population.  Located off a dirt road pocketed with pot holes, the Kenema Government Hospital is a one story building made up of meandering open air corridors and small wards.  My visit focused on the maternity ward, which receives material and technical assistance from my employer, the International Rescue Committee.  (Material support entails activities like supplying essential drugs and supplies, while technical support includes training staff on issues like drug management and conducting education campaigns to let the community know about services available at the hospital.)

The visit started off on a positive note—my colleagues and I visited a young woman who had given birth to a baby girl the day before.  The young woman had been brought into the hospital on the ambulance (a project funded by IRC and run by a group of dedicated Sierra Leonean drivers) because she was suffering from obstructed labor, one of the most common preventable causes of maternal and perinatal mortality in developing countries.  In this case, the baby was delivered through an emergency c-section, and mother and child were recovering in the hospital during my visit.  Sierra Leone has one of the highest maternal death rates in the world, in part because of obstetric complications and the lack of access to medical care during labor and delivery.  But with the introduction of the ambulance system and education campaigns to alert community members to the presence of services at the hospital, the many young women have a better chance of surviving pregnancy and giving birth to healthy infants than before.  There is still a much larger demand than the hospital can conceivably meet, but it’s a start. 

During my visit, I also spoke with a number of staff members about some of the challenges facing the hospital.  Like many other sectors of society, the hospital often confronts shortages of drugs and other essential supplies.  There is also a stunning lack of doctors in Sierra Leone—the hospital’s maternity ward had three doctors on call but only one is an obstetrician-gynecologist.  In fact, there are only about 200 fully trained doctors in all of Sierra Leone, and according to hospital staff, many young Sierra Leonean doctors are clustered in Freetown where they can open their own private clinics and make more a better living than they would working in the provinces.  And at private clinics and government facilities alike, patients need to contribute to the cost of their treatment.  Unfortunately, many of them cannot afford to shoulder these costs, though international agencies and NGOs do currently cover certain medical services for all patients free of charge in Kenema.

In the next few months I will be talking to different organizations and other actors working in the health sector in Sierra Leone.  Please let me know if you have any questions you would like for me to explore, or feel free to post comments with your own thoughts and experiences on this subject.  Thanks!