My Little Buttercup, Or what happened when I visited a community health center near Bo

I wanted to see a community health center, where clinicians might have seen suspected Ebola cases three years ago. So, I asked my driver, Idrissa, whether he could ask some of his local contacts about the location of the health center in Gondama. I hadn’t been to Gondama since 2003. It wasn’t too difficult to get to, we knew. I had, in fact, seen a sign for the place when we were driving elsewhere. So, on Wednesday morning, we drove over a weather pitted road to the health center. When we arrived, a guard opened the gate to the modest facility. At least a half dozen men and a few women were in the waiting area.

Odd, I thought. My experience was that women tended to go to health centers, but not a lot of men – not because men don’t get sick or hate health centers, but because women and children are often the target of community health interventions (but that is another discussion for another day).

Two women greeted me, and nodding toward the group of men and women in the waiting area, told me that the community health workers (CHWs, they called them) were all there, ready.

Odd, I thought. Impolitic as it was to think or say, I didn’t really care about CHWs. Not today. But I did ask whether there were any female CHWs because, judging from the small group gathered, there didn’t appear to be any. “Yes, there are women there,” they said almost indignantly. I corrected myself and asked sheepishly, “But are there more men than women, or about the same number of both?” They laughed – more like harrumphed – and told me, “Well, it’s not 50-50,” a reference not to an actual ratio, but the way gender parity was often discussed colloquially in Sierra Leone’s development industry.

I followed the women – I’ll call them Amie and Fati – into an office where we sat at a table. The small room was crowded with furniture, and the walls were covered, predictably, with posters from the ministry of health related to women and children’s health. They began to interrogate me about what I wanted to know, and asked me if I wanted to look at their rosters, and when I would be talking to the CHWs who had gathered to meet me. The CHWs had been waiting and were becoming impatient.

Then it occurred to me: they thought I was someone else! (The reference in the title of this post is to that mistaken identity scene from Three Amigos, if you hadn’t caught it). I told them, “I’m not here to meet with CHWs.” I told them that I was just around and happened to come to Gondama. I didn’t have any specific questions, really, but did they happen to see Ebola three years ago? Yes, but they referred them to the district hospital. Having been a consultant once upon a time, I mentioned that unlike a consultant, I was not interested in extracting information from their registers, their CHWs or them. I simply wanted to observe. Their eyes widened. But surely, I was from an NGO. Nope, I wasn’t. This kind of admission – that you had no NGO affiliation or specific agenda besides ‘observing’ — can make you seem unserious if not untrustworthy. Everyone has a mission, whether they admit to it or not.

The facility’s in-charge, as in most of the places I visited during this short, unannounced trip, had been called to Freetown for a meeting. Whatever his shortcomings, among them was that did not give them enough information about who would be visiting, their purpose, or even the time these inquiring strangers would be arriving. I suspected that their confession was a bit of shade towards their co-worker, but it was also some shade towards the process itself: people were coming all the time to gather information; strangers like me were interchangeable with each other. The logos on our white Land Cruisers could be swapped and they would be none the wiser; the stranger could be from Boston or Washington or London, Johannesburg or Nairobi. The source of the information to be extracted was a circle of gathered CHWs or maternal registers, or immunization charts mounted on the walls or…

“Won’t you come and look at our labor and delivery area?” asked Amie. Inside the maternity ward were a couple of midwives who asked me if I too was a midwife. I told them no, but I’m a mother of two. (No comparison, though. Their work can be rough). There were four or five padded tables separated by curtains and fitted with stirrups. In a separate room, there were a few beds for new mothers who would, after their deliveries, be discharged after 72 hours. On a wall near the entrance, I read the instructions about when to deliver oxytocin, and briefly recounted the induced delivery of my daughter five years ago. Then I told them about the worried look on my obstetrician’s face when she couldn’t stop the bleeding during my second delivery. I mentioned how my son’s heart rate began to decline rapidly, how I strained to block out any semblance of panic by pushing. “Eeeeeehhh,” they said almost in unison, sucking their teeth at the very real trauma of childbirth. But the boy was healthy and strong. I would have panicked for nothing. I reached for my phone. “Yu wan si mi pikin dem?” Yes, sure, they said. I showed them pictures of my babies. Then I gave them my card and said I’d be going so they could prepare for the real guest.

They wished me luck on my quest — whatever it was. I wished for them a not-too-much longer wait for the stranger who wanted to meet with the CHWs.

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