Back to the Future: Return to Sierra Leone, 15 Years from Now

Eighteen years after I first left, I found myself a tourist, a JC (just cam), which I heard the people call me often in the land of my forefathers, “oh, native land…land that we love, our Sierra Leone,” as the words to the national anthem are sung. Along with some members of my extended family, I traveled to Freetown, Sierra Leone in December 2006. While there, I was able to make many observations. Dirty streets, some lined with all sorts of waste and refuse on the right and left side, some muddy, red, dusty, rocky. Surrounding them are makeshift houses, abject poverty mired in the guttered devastation and suffering of an 11-year civil war—life is hard here. While only there for three and a half weeks, my time in Freetown, Sierra Leone is one that will stay with me for a long time. Seeing everything I saw there saddened me, but it makes me wonder if I were to return there after another 18 years has past, what would I see then?

With a 180th ranking in the 2009 UN Human Development Report, one of the highest infant and maternal mortality rates and lowest life expectancy rates in the world, a health care system in major need of rehabilitation, Sierra Leone is the perfect storm of case studies as a country raising critical global health concern. Like other West African countries lacking the means to identify and deal with new disease threats, there are shortages of medicine, trained doctors, reliable electricity, clean water and such basics as sterilized gloves. As such, with the help of an effective U.S. global health strategy over the next 15 years, Sierra Leone can transform to become a success story for global health.

According to a recent poll by the Kaiser Family Foundation, the U.S. global health strategy over the next 15 years should have an emphasis on health infrastructure rather than fighting specific diseases. More specifically, however, given what I saw in Sierra Leone, the U.S. global health strategy needs to take a long-term, modern, comprehensive approach, involving strengthening key and strategic components of the health system as a whole, such as building human and institutional capacity i.e. improving the doctor to patient ratio and major supplies, and increase primary care coverage. Ideally, this strategy should extend beyond the reconstruction of physical infrastructure and actually set conditions for functional and sustainable peace. With the economic downturn, a new influenza pandemic, and climate change, the need for a focus on health system strengthening is more acute than ever. In many developing countries as in Sierra Leone, primary health care centers, created to provide preventive and curative health care for diseases such as malaria in remote and underserved areas, are the main point of access to healthcare for the rural poor. Thus, infrastructure strengthening in the form of building more of these centers would greatly increase health outcomes. As Carlos Fuentes once wrote, “Global health cannot exist without local health.” Therefore, for this strategy to be effective, it must incorporate elements of community-based models on the local level, in which women and communities are empowered with information and access. Lastly, this strategy should have a moral framework, centered on reducing gaps in preventable mortality and morbidity, ensuring a good standard quality of care for all.

So, 15 years from now, when I return to the land of my forefathers, what will I see? Will I see children without low weight and stunting, clean water and proper sanitation, and a healthcare system that meets the needs of the people? I can only hope that this is the case. Yet, given the Kerala phenomenon and the story of a 14-year old Malawian boy, living in poverty and famine, who was able to build a windmill from spare parts and scrap to power his family's home, anything is possible. Accordingly, with the implementation of the U.S. global health strategy I described, global health can be improved over the next 15 years.