Last Friday and Saturday, before the Africa Mercy drew into Freetown I had a short trip up north to Tonkolili District with Brima on behalf of Medical Assistance Sierra Leone (MASL). Perhaps a quick geography lesson wouldn’t go amiss. Sierra Leone is marked on the African continent below in orange, with a map of the country below that.
One of the many things they help fund in Sierra Leone is hernia surgeries. Hernias are incredibly common in Africa – they are the protrusion of an organ through the wall of the cavity that normally holds it in. I won’t go into details for fear of offending any medics out there (do please comment and correct me on anything), but they are often caused by hard physical work. I’m sure I needn’t tell you that heavy lifting and long working hours on farms and in other physical labour is part of life out here.
The remote clinic I visited in Tonkolili district in the Northern province has had more than one hundred hernia patients visit this past week. I was hoping to photograph these masses, however not everything goes to plan. From my very first visit to Africa six years ago I realised that having translators that can speak the same language does not mean communication will be effective.
I arrived at Mamasasausanka clinic around 4.30pm on Friday after six hours in Brima’s Peugeot, only to discover that the hernia patients had all been dismissed the day before. This is usual, but Brima had requested they stay for an extra day so I could photograph them. Naturally I only discovered this after realising there was no one there to photograph – of course asking 100 patients that have families to look after to stay an extra day for no apparent reason was unrealistic.
However they did fetch a few willing (well, close) patients from the village for me so I managed a few rough interviews and portraits.
I met up with Fatmata Turay who runs the clinic (above with the clinic vaccinator David Koroma). She examined the patients that had been brought in. They all had very similar stories. They are swamp farmers (rice farmers) or diamond diggers or women with domestic duties that had first noticed discomfort or pain or swelling between two and fifteen years ago.
Many of the patients had stopped their daily duties and jobs as much as five years ago, putting pressure on other family members, often young children to provide for them. This can have obvious consequences. I was introduced to one boy that had recently had a hernia removed. He was four years old.
Another thing they all had in common that was certain was that they needed hernia operations and were not due to have them because they could not personally afford it. They have no choice but to rely on aid and charity from overseas. The clinic can do little more than to provide paracetemol and antibiotics for when infections sometimes develop. It is organisations like MASL that provide the money to get the operations, including transport and food costs away from home as well as medical bills.
We drove for a couple of hours back to Makeni where Brima and I stayed the night, giving a lift to a mother and her child who had an appointment at Holy Spirit Hospital the next morning. She sat in the waiting room throughout the night, her baby wrapped up, shielded from mosquitoes.
The following morning Brima and I visited the same hospital. There I met four hernia patients that were due to have their operations yesterday (Monday 28th February).
Abbass, Sheku and Osman are all swamp farmers in their forties and fifties. All of them have had to stop working for their families and all are very much looking forward to having their hernias removed so they can get back to work.
The same applies to Fatu, who’s daughters have been doing all the domestic duties for the past three years.
However there is of course a substantial danger in getting straight back to work after having a hernia removed. The danger being that the area of muscle through which the organ protruded the first time is now very weak and likely to suffer the same hernia again. I didn’t get a chance to meet the doctor this time round, but hopefully I will when I spend more time up there. I know for many operations in the UK a mesh is put around the area to prevent the organ from protruding. The below example of a woman who had a hernia operation in the last year can show that it can grow back quite easily. She said it is not as painful this time round, but these are still early days.
Finally this boy was also brought to me when I visited the clinic. Ibrahim Fofana is 22. Just two months ago he has a fit healthy farmer. He quickly became feverish and got very cold in the evenings. When taken to the hospital he was told that he probably had problems with his liver and possibly his kidneys. I showed the photograph to Dr Radcliffe Lisk who works for MASL and is returning to the country. He noted that it is likely liver cancer, which is often related to a Hepatitis B infection. The message has been passed on to take Ibrahim to Connaught hospital under his recommendation.
There is always hope in cases like this, but little expectation. It is just a small example of how desperate life can get in such a short time over here.