Feminist Healthcare In The Heart Of Sierra Leone

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Walking around her clinic in the muggy heat, Gladys, 52, attracts a lot of attention. During the morning’s whirlwind of activity, people rush-up to her from every direction: uniformed-midwives, women with newborn babies strapped to their backs, heavily pregnant women. She speaks to everyone in a gentle, encouraging tone. This is how Gladys starts most of her days as head midwife at the Wellbody Clinic in Kono, Sierra Leone.

Although she’s unfamiliar with the term, Gladys exemplifies feminism in every aspect of her life. Known as Gladys to friends and colleagues, Boyama Gladys Katingor joined Wellbody, a Partners In Health (PIH) clinic, in 2014, and has since been trail-blazing female empowerment. At the clinic, Gladys strives to standardize a modern approach to women’s health care. And in so doing so, is tackling a number of controversial female health topics head-on.  

Sierra Leone is often absent from mainstream media, only receiving attention during times of strife. The largest Ebola outbreak in recent history, however, caught the attention of headline news. Media outlets worldwide told of Ebola’s devastation on West Africa. By the time the deadly disease was finally contained in 2015, Sierra Leone’s already weak health care system was shattered. Health care spending was redirected from a number of areas to combat the outbreak but the largest cut – at 80% - was to female reproductive health. This arguably contributed to a horrifying reality for women in Sierra Leone: a 1 in 17 lifetime chance of dying during pregnancy, delivery, or its aftermath.

Gladys has made it her mission to call attention to the dangers women face during pregnancy and childbirth.

“Last year, I called together representatives from villages all over Kono to discuss why our women were dying,” Gladys recalled. “They said women were giving birth in their homes, sometimes alone, simply because they didn’t have a way to get to the hospital. If a woman experienced a complication, she died.”

Kono is one the poorest districts in the Sierra Leone. Located near the majority of Sierra Leone’s diamond mines, it became a hotspot for rebel soldiers during the decade-long civil war, which ended in early 2001. The desperate need of Kono’s women inspired Gladys to join PIH’s Wellbody Clinic.

PIH started work at Wellbody Clinic in 2014 when it was just one building. It now has six buildings and round-the-clock electricity and water—lifesaving essentials that most wealthy countries take for granted but rare for health facilities across Sierra Leone. PIH also built a birth waiting home at the clinic to serve women who live far away and struggle to reach health facilities in time for a safe, attended birth.

  Wellbody Clinic

Wellbody Clinic

“A birth waiting home was built at Wellbody to help women who need close monitoring during pregnancy. Women stay for a month preceding labor, eat three good meals a day and are left to rest,” Gladys explained.

She continued: “Our most frequent guests are women under 18 years. Most of these are school-going children. The girls are very shy when they come to Wellbody Clinic and feel like they’ve committed a crime. I bring them closer to me, like a mother, and ask them how they are feeling.”

Wellbody Clinic’s birth waiting home sees just a fraction of the country’s pregnant teenagers. In 2013, Sierra Leone had the seventh highest rate of teenage pregnancy in the world, with 38% of women delivering their first baby before the age of 18.

Women staying at the birth waiting home either deliver safely at Wellbody Clinic or are referred to PIH-supported, Koidu Government Hospital, if their pregnancy is considered high-risk. If this is the case, they are driven in an ambulance – an almost unheard of service in Sierra Leone. Postnatal classes are available at Wellbody Clinic following a birth. Here, women are supported in a number of ways, including through family planning services.

“We offer approved contraceptive methods but many women are discouraged from using them by their families. Everyone is happy to listen though, especially the young girls, and we’re now seeing an uptake,” Gladys shared.

Gladys grew up in Longie village, 51 kilometers from Koidu, Kono District’s capital. She is one of the few girls from her village cohort to complete her education. Mindful of how important education is, Gladys heartily encourages training of her colleagues.

“I’m always on my feet, educating my staff and saying, ‘Let’s not let any danger occur to these women.’ We are all looking out for one another. PIH has held a number of good training courses – I make sure my team completes these,” Gladys said.

Through her work at Wellbody Clinic, Gladys has directly confronted a number of universally-debated women’s health issues. She has pioneered a feminist approach to these, caring for women in a way that first and foremost protects their rights.

  Sister Boyama Gladys Katingor spends time training her midwifery team at Wellbody Clinic, Sierra Leone.

Sister Boyama Gladys Katingor spends time training her midwifery team at Wellbody Clinic, Sierra Leone.

“Abortions aren’t legalized in Sierra Leone yet but people do it anyway,” she said matter-of-factly. “They’re performed on girls in villages who come to Wellbody Clinic afterwards in very bad health. I have to refer them to the local hospital where there’s equipment to complete the procedure safely. If abortions were legalized we could offer them in an environment that women trust. Many girls’ lives would be saved this way.”

One-fifth of global maternal deaths result from unsafe abortions and Sierra Leone is no exception. Illegalizing abortion has proven time and time again not to prevent women from undergoing the procedure. In fact, higher rates often occur in countries where this is the case, but unsafely and at extremely high risk to women.

Gladys also finds herself advising women about female genital mutilation (FGM), a procedure commonly carried-out on adolescents. In Africa, around 3 million girls undergo FGM each year; Sierra Leone is one of the only countries where the rate is over 90%.  

“When I was a child I became part of this. It was not my choice but something my parents wanted. It was an excruciating procedure,” Gladys shared. “When the cut is done, veins are tampered with and you can sometimes bleed a lot. If you bleed like this, which I did, the whole village will call you a witch. It feels horrible to be called that.”

FGM often takes place in a small hut, in an area known as “the bush,” on the outskirts of a village. Multiple girls will stay in the hut at any one time while the procedure is performed on each of them.

“There is nothing you can do but sympathize with one another. The village elders are looking after you and believe they’ve done a loving thing,” Gladys said. “But it’s just better if you don’t do it. Most girls today are scared of the pain and tell their families they won’t go through with it. If a girl confides in me at Wellbody, I will tell her of the hazards and advise her against having it done.”

Although Gladys looks bemused at the revelation that she is a feminist, she undoubtedly embodies the term. Her role at Wellbody Clinic enables her to provide care for a community so often overlooked; one where so many powerful and capable women are yet to realize their full potential. What’s more, she looks for opportunities outside of her work as a midwife to empower women to take charge of their own wellbeing.

“Women are always being pushed behind in my country. People think that if a woman has power she will feel too proud of herself. Well I say, why? Why will she have more pride than a man?” Gladys said firmly.

Despite feeling that opportunities for women aren’t where they should be, Gladys expresses her excitement for Sierra Leonean women of the future. “At Wellbody Clinic, I always talk to women, both staff and patients, about their education. I tell them, whatever happens you must reach some heights. Whatever your family says, keep going. I say don’t lie down, wakeup and keep moving; you are not just here to give birth, you are our leaders of tomorrow. We will not be left behind.”

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Partners In Health (PIH) is a global health organization committed to providing a preferential option for the poor in health care. In 2014, PIH eagerly embraced the government of Sierra Leone’s request to help with the county’s Ebola response. They pledged to support the Ministry of Health and Sanitation not just during the emergency, but for years to come. Like their work in Haiti, Rwanda, and seven other countries, PIH wanted to help Sierra Leone to build a durable, high-quality health care system for all.

Since the Ebola epidemic formally ended in 2016, PIH has supported several health care facilities across Sierra Leone, tackling a number of persistent health care challenges in partnership with the Ministry of Health. They do daily rounds in hospitals and clinics, operate an ambulance service, stock pharmacies, install generators to guarantee continuous electricity, and fix broken plumbing, while renovating medical buildings. They help local clinicians improve the quality of care they deliver through clinical mentorship, and modernize medical record systems. The list goes on, and will only continue to grow.

While there’s more to do for Sierra Leone’s health care system, the ministry and PIH also have much to celebrate. Take, for example, Wellbody Clinic: In a country with the highest maternal mortality rate outside of a war zone, it hasn’t seen a single maternal death since 2016.

Article by Emma Minor of Partners In Health