By Scott Kraft,
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 clearly had 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
Told of those events the next day,
Living standards are improving across much of the world these days. Free markets in
That tide has mostly bypassed sub-Saharan
"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."
Yet it has the second-highest rate of infant mortality in the world, behind
A decade-long civil war in the 1990s drove people from the countryside into the capital,
The war compelled thousands of the most educated Sierra Leoneans to go into exile in the
The country managed a democratic election in 2007, but widespread corruption makes international donors wary. President Ernest Bai Koroma, a businessman who fled to
A few months ago, a 6,200-ton shipment of donated rice from
The sorry state of the country's roads has limited development. In the capital, cars and SUVs inch along narrow roads swarming with pedestrians. There are no traffic lights.
Even traveling to
There are a few signs of economic life. Wealthy businessmen and government officials keep two nightclubs, Old Skool and the Office, thumping until dawn, with Playboy videos on flat-screens, top-drawer Scotch on the shelves and parking lots filled with Lexus SUVs. Large mansions are going up on the outskirts of the capital.
Michael Kargbo, a Sierra Leonean who ran a construction company in
"Most of the guys in power today are guys I either went to school with or knew in the States," he said, pausing at the site of a two-story hillside home under construction. As he spoke, Koroma's motorcade, escorted by soldiers with sirens and flashing lights, sped by. From his Mercedes, the president waved to Kargbo, who smiled and returned the greeting. As the motorcade disappeared, Kargbo said, "Business is good and getting better."
For some people, perhaps. But the country remains a political tinderbox. Tens of thousands of former child soldiers, who were forced into militias that killed, raped and hacked off the limbs of victims, have melted back into society. Some, like Lamin Bangura, who became a rebel fighter at 12, now drive motorcycle taxis, known as "okadas," in the capital.
"We used to steal, but now we can make a living," said Bangura, 27. A dangerous living. Okada drivers are harassed by policemen seeking bribes and taxi drivers who resent the competition.
But large numbers of those former rebels are unemployed, and their anger, combined with their military training, poses a threat to political stability.
"We have been stigmatized by society and the government turns a blind eye," said Kabba Williams, 24, a college student who leads a group of onetime child soldiers lobbying the government to create jobs. "If there is a war, and someone is looking for mercenaries, they can find them right here, unfortunately."
The most immediate crisis, though, is health care. The country has only two pediatricians, and Thorlie is one of four obstetricians. All work at Princess Christian.
Doctors Without Borders set up clinics in Bo, the second-largest city, during the civil war. Now it's time to begin pulling out and move to other countries in crisis, but
"We're in a difficult situation," he said. "If we leave, who would take over? It might create another crisis."
When Koroma took office in 2007, his wife, Sia, launched a global effort to draw attention to the public health crisis. An oil industry chemist before the war, she started a career in nursing during the couple's years in
"We are faced with so many problems -- illiteracy, poverty, youth unemployment and the need for gender empowerment," she said. "I'm trying to be an advocate for women and children, because they are the most vulnerable."
The first lady's office in the hilltop presidential lodge recently was filled with donated items, including sewing machines and farm tools. Outside, next to the first couple's empty swimming pool, a dozen hospital beds were stacked under an awning. The health are system needs a lot more than a few beds, though.
Government salaries for doctors range from $100 a month to $200 for specialists; experienced nurses earn $80. The salaries are among the lowest in the world; doctors in
To supplement their salaries, doctors negotiate payment with patients before treatment, and at the end of each day they share that money with nurses and aides. If the patients don't pay, the doctors give the nurses money from their own pockets. Otherwise, Thorlie said, they won't show up for work.
"It's the worst thing in the world for a doctor to have to discuss payment with his patients," said Thorlie, who has been chief of medicine at Princess Christian for 25 years. "If two people come to me with a fever, and one agrees to give me 10,000 leones (about $3) who do I treat first? This situation is bad for us, and it's bad for patients."
In practice, he says, he and his doctors treat all patients, paying or not. "But for those who can afford to pay, they should pay," he said.
That sentiment has put him at odds with the Ministry of Health.
"Our policy is free medical treatment, and we have to enforce that policy," said Sheiku Tejan Koroma, appointed health minister in March. "We know that our salaries are the lowest on Earth and we need to increase them. The problem is that we don't have the money." But, he added, "This is a corrupt system we've inherited and they are more interested in their salaries than in their fellow man."
The health minister was an engineer at Texas Instruments in
Early this month, the health minister was indicted on charges of illegally awarding contracts.
Thorlie, who presides over a staff of 12 doctors, wears a pressed dark tunic and a perpetual expression of weary stoicism. Although many of his colleagues left for lucrative jobs in the
He was speaking in his office, where he relaxes by listening to country music. Jim Reeves' "Not Until the Next Time (Will I Cry All Night for You)" was playing on his computer.
Thorlie has grown increasingly frustrated with the Health Ministry. He had a heated argument with a ministry official recently over a proposal to outlaw home births to help reduce the infant mortality rate.
One of the obstetricians at Princess Christian, Dr. Kamson Kamara, was an emergency room doctor in
The difference between his old job and this one "is the difference between earth and sky," he said, sitting in the doctors lounge between surgeries. A hospital aide knelt on the floor wiping splattered blood off the doctor's shoes -- and off a floor lamp that Kamara brought from home to use in the dimly lit operating rooms.
"It's really pathetic," he said. "People are dying here and it's getting worse every day."
Two nurses appeared and Kamara reached into his pocket, giving each a few bills of the local currency. "I have to keep them happy," he said. (LA Times)