Olivier Asselin – Maternal and Child Health – Sierra Leone

Olivier Asselin has just been selected as one of the Magenta Foundation’s Emerging Photographers for 2011, for some of the work he did last year on maternal and child health in Sierra Leone.

Leaving the comfort zone

I enter a few photo contests every year, and then completely forget about them. On the rare occasion where I win something, it’s always a nice and completely unexpected surprise. Last week, while on assignment in Western Cote d’Ivoire, I received a message from fellow Rogue photographer Tim Smith. He was congratulating me for making it among the Magenta Foundation’s Emerging Photographers for 2011. Tim’s work also had won the honours.
I shot the winning images last year in Sierra Leone while documenting maternal and child health for UNICEF. I had a lot of freedom for that assignment, and I was basically just going around clinics and hospitals, shooting what I saw, and trying to get a sense of how bad the situation was.

Finnah Conteh, 26, recovers after a c-section surgery in the maternity ward of the Magburaka government hospital in the town of Magburaka, Sierra Leone on Monday March 15, 2010. She lost her child due to obstructed labor – medical staff said she hadn’t come early enough to save the child. This was her third pregnancy, she has only one living child.

Sierra Leone has one of the world’s highest rate of maternal mortality. The health care system is overcrowded, understaffed, and in dire need of better infrastructure, drugs, and pretty much everything else. As is the case in many developing countries, Sierra Leone’s best doctors work in the US or the UK – the country has only one doctor for every 33,000 people (Canada has around 1 for every 500). When I visited last year, some of the main provincial hospitals had only one doctor. They often relied heavily on volunteers without any formal medical training, and many health facilities dealt with shortages of not only drugs and medical supplies, but also water and electricity.
One day, after showing up at a random health post in a far flung village, at the end of a dirt road, I found a four-year-old boy lying on a bed, panting. He was suffering from malaria – one of the top killers of children in Africa – and his mother had to carry him all the way from their village, on a forest track over several kilometers. What she didn’t know was that the small health post was out of drugs to treat malaria. To make matters worse, the woman had waited too long to bring her son, and it was already too late to evacuate him to the nearest hospital. All the health worker could do was to give the boy a few tablets of paracetamol (Tylenol). Within five minutes of my arrival, and before I could even figure out what was going on, the boy died before my eyes.
His mother ran out, screaming, and jumped into the river. Witnesses later said she’d wanted to drown herself. I tried to get a few shots, not knowing what to do, feeling completely overwhelmed, completely out of place. I wanted to tell myself that this was my job, the reason I was there, but I just couldn’t shoot. I just couldn’t. Sleep was long to come that night. I kept feeling like I should’ve tried harder, tried to get photos that truly told the story about what was happening there. I felt like my work hadn’t done justice to the situation, I felt like I had failed.
I really tried to push myself during the rest of the assignment, and to find the balance between telling the story, and intruding. A few days later, in another village we could only reach by boat, we found a 2-year-old boy, Blackie, who was suffering from severe dehydration. The local nurse tried to put him on IV to get some fluids back into him, but couldn’t find a vein on the boy’s tiny arms. She told the mother that her child had to be sent to the hospital, or he might die. Luckily for him, we were there, with a boat.

Marie Tabeh wipes a tear as she stands next to the bed where her two-year-old son Blackie lies suffering from severe dehydration at the health center in the village of Yoni, on Sherbro Island, Sierra Leone on Thursday April 22, 2010.

But his mother refused – she couldn’t go without telling her husband – who was back in the village an hour’s walk away. Local men tried to force her into the boat, as she screamed and cried, but finally had to leave her sobbing on the beach. The nurse herself would come along and take the child to the hospital. As this whole scene took place, there I was shooting, trying to push myself to get in there even though it was uncomfortable. Half of me felt like I shouldn’t even be there, the other half convinced that I really had to be.

Marie Tabeh cries after refusing to accompany her two-year-old child Blackie in the boat that will carry him to the district hospital. Suffering from severe dehydration, the boy needed to be referred to the district hospital. Marie refused to follow her child without the approval of her husband; medical staff had to leave the mother behind to save the child’s life.

A few days before I left Sierra Leone, the government announced the abolition of medical fees for pregnant and lactating women, and for children under five. With the announcement came the engagement from various international organizations to help fund the reconstruction of the country’s health care system.
I went back to Sierra Leone this year. Turns out malaria is still killing children, and birth-related complications continue to claim the lives of hundreds of women and newborns. The latest data shows that one in five children won’t make it to their fifth birthday.
But when I showed up in Gbandiwlo, another of those remote villages – this one way, way out – after two hours of driving on one of the worst roads in modern history, in the middle of the bush somewhere near the Liberian border, the health center was fully stocked with all the essential drugs – including malaria medication. I was there to photograph workers installing a solar-powered fridge. That fridge would allow the health center to stock vaccines, and help ensure children could get vaccinated against diseases like polio or measles.

Trainer Frances Fornah teaches a group of midwives using a birthing simulator at the school of midwivery in the town of Makeni, Bombali district, Sierra Leone on Thursday March 24, 2011.
I also saw nurses and midwives being trained, hospitals being renovated, and mothers who no longer hesitated to visit the hospital for fear that they couldn’t afford the fees. We’ll have to wait a few years to see how things really improve, and if all these solutions can be sustainable, but for the moment, it’s encouraging.

Community Health Nurse Isatu Djalloh looks over two-year-old Blackie as he slowly recovers at the district hospital in Bonthe, Sierra Leone on Thursday April 22, 2010. After medical staff struggled for over 30 minutes and gave the child oral rehydration solution, an IV was successfully injected, and Blackie started to stabilize.

Oh, and Blackie made it.

Olivier Asselin is a freelance photographer based in Kinshasa, D.R. Congo.

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