Explosives, high-watt light bulbs, monofilament nets, and poison: these are a few methods fisherfolk are using to catch ever-dwindling fish stocks off Ghana’s shores.

Thomas Essuman says Ghanaian fisherfolk know that using poison, dynamite and illegal nets to catch fish is doing long-term damage. Credit: Jessica McDiarmid/IPS

“Before, your boat was full,” says Thomas Essuman, a 20-year veteran of the seas around Takoradi- Sekondi, a city in western Ghana. “Now, you don’t get fish like before.”

As the number of fish continues to decline in this West African nation, those who rely on the sea say they have no choice if they want to catch enough to survive.

“If you don’t use those things, your net will be empty,” says Essuman.

He says that many use light to attract fish. Others use the pesticide DDT (dichlorodiphenyltrichloroethane) to poison fish, or dynamite, to kill large numbers that can be scooped up.

Fisherpeople know the practices are harmful, Essuman says. “They will destroy the country because fishing brings life. If you spoil the sea, the fish don’t come, and how are you going to earn money?”

Samson Falae, who has been fishing in western Ghana for 30 years, says dynamite scares fish out to deeper waters, and boat owners have to use more and more fuel to follow them.

“If you go far out and you don’t get enough fish, you can’t afford to go the next day,” says Falae.

Ghana released regulations to govern fishing in 2010, prohibiting many of these common practices. The regulations also restrict mesh sizes and types of nets, areas where fishing is permitted and sizes of fish that can be caught.

Alex Sabah, the director of the fisheries department in Ghana’s Western Region, says fish stocks are in danger of collapse. There are an estimated 200,000 Ghanaian pirogues now fishing, as the fisherfolk strain to feed an ever-larger population. Boats are going about three times further out to sea than 10 years ago to find fish.

And, he says, they are catching baby fish, small fish that serve as food for larger species, and are decimating sensitive areas such as estuaries. Only one of 30 common fish species in Ghana’s waters is not considered threatened, he says.

“They are destroying the stocks. If the stocks collapse…The little pain now of regulation is better than the bigger pain later.”

But, Sabah says, “We are having a hell of a time stopping it.”

Shortly after the regulations came out, fisheries officers, police and the navy cracked down, making arrests, seizing equipment and laying charges.

Fisherfolk did not take kindly to the new measures, and the situation deteriorated into violence and demonstrations.

“There have been clashes with the navy,” says Sabah. “We arrested a number of them and put them before the courts.”

He says enforcement is hindered by a lack of political will and, at times, interference by politicians eager for votes from the millions who rely on fishing in this West African nation of 25 million people. Politicians have phoned the department and ordered enforcement efforts to stop, says Sabah.

“In that situation, we are helpless,” he says.

Sabah says the introduction of regulations should have been handled differently, and that they are working on a new strategy. The department, he adds, needs to do more to educate fisherpeople on the effects of illegal fishing practices and to win their support for conservation efforts.

The fisheries sector sustains millions of West Africans – as much as a quarter of the workforce, according to the Environmental Justice Foundation (EJF), a London-based charity focused on environmental abuse.

EJF notes fish stocks are under siege from foreign boats illegally harvesting off the coast. The group estimates that sub-Saharan Africa loses about one billion dollars to illegal fishing annually.

But Sabah does not attribute all of Ghana’s troubles to foreign boats. “We cannot blame it all on them,” he says. “Our local fisherfolk are using the wrong procedures.”

Kofi Agbogah, deputy director and programmes coordinator at the Coastal Resources Center in Tadoradi-Sekondi, says regulation measures need to include fisherpeople and provide “enabling conditions”.

“They understand the issues, they know that something must happen,” said Agbogah, whose organisation is implementing a USAID (the government agency providing United States economic and humanitarian assistance worldwide) programme on coastal and fisheries governance.

“But if something happens, will he (the fisherman) get food to eat tomorrow morning? Once you take the net from the guy, he will be prepared to die.”

Sam Kojo stands in a thigh-high pile of brown seaweed that blankets a beach in western Ghana. Behind him, a decomposing mound of Sargassum stretches down the shore past the fishing village of Beyin.

Sam Kojo, chief fisherman of a village in western Ghana, says an influx of seaweed has crippled the fishing industry for months. Credit: Jessica McDiarmid/IPS

“Ever since I was born, I have not seen this,” says Kojo, holding a clump of the seaweed in his hand. He has been fishing since he was 10 years old, but since the weed began washing in about three months ago, he has been unable to work.

“We have a big problem because when we cast our nets, all the weeds would come inside the net and we would catch nothing,” says Kojo, through a translator. “So we decided not to continue fishing.”

Sargassum is the algae after which the Sargasso Sea – an elongated region in the middle of the North Atlantic Ocean – is named due to the large accumulations there. In the past year, it has been showing up in unprecedented quantities on beaches from the Caribbean to West Africa, wreaking havoc on tourism and fishing industries.

It started collecting on the beaches of western Ghana about three months ago, locals say. And in Beyin, it is bringing this small fishing village of a few hundred people to its knees.

Kojo says that with the boats kept ashore, people are going hungry and families can no longer pay their children’s school fees. He says theft is increasing along with the desperation.

His son Raymond says they saw the Sargassum floating on the water a few days before it hit the shores.

“For months now, we haven’t gone to sea,” says Raymond. “We’re hungry. Here, there are no other jobs.”

Beyin has a fledgling tourism industry. It serves as the launch point for trips to Nzulezu, a stilt village in the area that draws several thousand visitors a year. But fishing remains the main source of income.

Ernst Peebles, an associate professor of biological oceanography at the University of South Florida, says in an email that mats of Sargassum accumulate wherever ocean currents take them. The influx in Africa and elsewhere probably does not reflect increased local growth of Sargassum.

“More than likely, it is an indication that oceanic currents or eddies are closer to shore than usual. Persistent onshore winds can also help create such accumulations,” he adds.

In 2011, the eastern Caribbean was ridden with Sargassum, which plastered beaches at popular tourist destinations such as Antigua and Barbuda, Barbados and St. Martin. Some resorts closed down while tonnes of the algae were removed. In some areas people were warned not to swim due to the risk of getting tangled in the weeds. Sierra Leone, northwest of Ghana, also experienced an influx in 2011.

Brian LaPointe, who has studied the algae since the 1980s, said Sargassum circulates continuously between the Sargasso Sea, the Caribbean and the Gulf of Mexico, where it is picked up by the Gulf Stream current and can move east to the Azores, and even to West Africa.

Scientists are not sure what has led to the recent increase in the amount of Sargassum in circulation, said LaPointe, an expert at the Harbor Branch Oceanographic Institute at Florida Atlantic University in the United States.

“This is a very widespread phenomenon,” says LaPointe. “Almost every corner of the North Atlantic is reporting really large amounts of Sargassum.”

Nutrient levels in the ocean, particularly near shore, are increasing due to human activities such as fertilisation and the dumping of sewage, which in turn lead to faster algae growth.

The 2010 oil spill in the Gulf of Mexico may also play a role, says LaPointe, by further increasing nutrients the algae feed on. Hundreds of millions of gallons of oil spewed into the water after BP’s Deepwater Horizon rig exploded on Apr. 20, 2010.

“Last year, following the Deepwater Horizon spill, is when we saw this mass influx of Sargassum to a number of areas.”

LaPointe also points to a 2010 temporary change in currents in the Gulf of Mexico. A current “short circuited,” creating the Franklin Eddy, which meant outflow from the Gulf virtually stopped for months.

A blessing for those scrambling to contain the oil spill, the eddy also may have served as a “big incubator” for Sargassum, says LaPointe.

About six months after the eddy broke down, reports of large amounts of Sargassum began coming in.

“This could contribute more Sargassum not just to the west of the Atlantic, but the Azores and Africa as well,” he says.

LaPointe is working with researchers at the University of South Florida to monitor Sargassum movement via satellite imaging, in order to alert local managers of an imminent landing.

Back in Beyin, Ghana, the shore at Tenack Beach Resort is piled high with foul-smelling Sargassum, interlaced with the usual debris: plastic bags, flip-flop sandals, bottles, and other rubbish.

Hotel manager Nana Awuku says customers have complained about the seaweed.

“We tried to clean it but this is beyond us,” says Awuku. “It has to be tackled at a national level.”

He is quick to point out that, while Sargassum is affecting the resort, it is the fisherpeople who are really suffering.

“The bulk of the people in this area rely on the sea for their livelihood, which is fishing,” says Awuku.

Some fishers with deep-water boats are going far out to sea to get beyond the algae, but the added cost of fuel for the longer trip is crippling.

Kofi Agbogah, deputy director and programme coordinator at the Coastal Resources Center in Takoradi, a city about 160 kilometres from Beyin, calls the algae a “food security issue.” The centre studies a more common form of green algae that is also damaging local fishing.

“If fishermen cannot fish because of the presence of this green algae, or brown algae, it means that their children are going to go hungry, their pockets are going to be empty, their wives cannot go to the market.”

Elizabeth Zainab Kargbo was a successful young woman, eight months pregnant and working in Sierra Leone’s civil service, when she had her first seizure.

Elizabeth Zainab Kargbo suffers from epileptic seizures. Suffers in Sierra Leone are often undiagnosed and unaware that their condition is treatable. Credit: Jessica McDiarmid/IPS

No one knew what it was. She lost her job and the baby, and as the attacks kept coming, most of her friends, neighbours and family stayed away.

“When I get the attack and drop down, people are so afraid of me, they run,” says Kargbo.

“They say, ‘Oh, don’t touch her, don’t touch her, it will spread.’ So sometimes when I drop down, I have damages to my face.”

Kargbo has epilepsy, a neurological condition that afflicts an estimated 60,000 to 100,000 people in this West African country of just over six million. Most are never diagnosed and only about 2,500 of them receive medical treatment. Sufferers here are often isolated, driven from their communities, and unaware that what they have is a highly treatable medical condition.

After Kargbo began experiencing seizures, her mother took her to a traditional healer. She was taken into a room and told to remove her clothes – and made to promise that she would not tell anyone what happened.

She wanted to get better, so she promised not to tell, took off her clothes and was molested.

Despite her promise, Kargbo told her mother. That was the end of traditional healers, she says with a smile.

Max Bangura, the coordinator and founder of the Epilepsy Association of Sierra Leone, has heard dozens of stories like Kargbo’s.

Seizures are often attributed to witchcraft, curses or demonic possession, says Bangura, whose association provides counselling and treatment to epilepsy patients and runs a small vocational training programme.

There is widespread belief that it is contagious, which further isolates people with epilepsy. Bangura says even those who have gone to medical centres for treatment have been referred to traditional healers because medical staff weren’t aware of the symptoms of epilepsy.

People with epilepsy are often driven from schools, jobs, homes, and subjected to traditional treatments that, he says, are “tantamount to torture” – cuts, burning, inhaling or drinking potions. One of the association’s members survived drinking two litres of kerosene. Girls and young women are subjected to sexual assault as a purported “cure,” says Bangura.

Treatment with phenobarbital, an anti-epileptic drug, costs 10,000 Leones (about two dollars) per month in Sierra Leone and is up to 70 percent effective in controlling epilepsy. But few people access it – and many cannot afford it.

“People do not come out. People do not want to be identified as having epilepsy,” says Bangura. “The stigma attached to the disease makes people not go to health centres because they don’t want anyone to know.”

The challenges of treating epilepsy in Sierra Leone are daunting. The country’s fledgling healthcare system struggles to cope with far more common — and deadly — afflictions such as malaria, diarrhoea and respiratory infections with little infrastructure and few professional health staff. It is one condition competing with many others in a system painfully short of resources.

Dr. Radcliffe Durodami Lisk, the only neurologist in a nation of about six million, runs the Epilepsy Project, which works with Bangura’s association to provide care throughout the country.

Funded by a British charity, the project runs three clinics in Freetown and one in Bo, the country’s second-largest city, which operate out of government hospitals. Workers travel to other areas of the country each month to disperse medication and provide care.

Sierra Leoneans have higher rates of epilepsy than most Western countries, due to risk factors such as meningitis, traumatic births and cerebral malaria.

Many patients cannot afford drugs, even at a cost of two dollars a month, says Lisk.

“It would be great if we could provide free treatment because most of these patients cannot work – no one will hire them,” says Lisk. “We end up giving quite a few patients free medication and trying to absorb the cost.”

But the biggest challenge, says Lisk, is convincing people to come forward and access treatment.

“They do not believe it’s a medical illness,” he says. “They don’t even think of going to see a doctor because as far as they are concerned, this is a demon or witchcraft.”

On a narrow lane behind a mosque in eastern Freetown, a handful of students lean over sewing machines under an awning that juts out from a partially finished building. The epilepsy association’s headquarters doubles as Bangura’s family home, and a vocational training centre, dubbed “The Love Institute” for about 20 people with epilepsy.

Here, people with epilepsy learn trades and are offered counselling, support and treatment. Bangura has been running the association for 11 years with funds from donations and membership contributions.

Chernor Dumbuya was carrying a basket of cooking items home from the market in Freetown, Sierra Leone, for his mother the first time he had a seizure. Thirteen at the time, Dumbuya dropped his load and fell to the ground with froth coming from his mouth. Everyone ran away.

The attacks kept coming, and no one knew what was causing them. Neighbours and friends were afraid of him.

“They all went far away,” says Dumbuya, who is now 28. “They all stayed away.”

Since starting treatment, he has had almost no attacks, and was the first graduate of the association’s three-year training programme, finishing in 2007 and carrying on to work as a tailor.

After years of living in isolation, Kargbo began taking classes here a year ago and the association connected her with treatment. She gets the money to pay for her medication from her church.

“If you expose (your illness), you get help.”

Excerpt:

By Jessica McDiarmid
FREETOWN, Oct 31 2011 (IPS)

The adoption of international guidelines to regulate so-called land grabs has been pushed to next year after negotiators failed to agree on conditions for large-scale land investments and enforcement.

There are fears that a "land rush" in the developing world is leading to hunger, conflict and human rights abuses. Credit: Isaiah Esipisu/IPS

The guidelines, in the making for several years, were sparked by fears that a “land rush” is leading to hunger, conflict and human rights abuses.

More and more investors have flocked to the developing world over the past decade, snapping up huge tracts of farmland. Investment has intensified since the 2008 food and fuel price crisis.

Once in place, the United Nations’s Committee on World Food Security guidelines are meant to protect people, mainly in poor countries such as Sierra Leone, from “land grabbing”.

Earlier in October, a brief flurry of attention from media and civil society surrounded the sessions of the Committee on World Food Security in Rome, where a stamp of approval on the guidelines on tenure of land, fisheries and forests was expected.

However, Olivier De Schutter, the U. N. special rapporteur on the right to food, said in an email following the meetings that details of conditions for large-scale investments remained an unresolved sticking point.

“Another major potential difficulty will be how the (voluntary guidelines) shall be followed up on,” said De Schutter.

Another week of negotiations should take place in January or February to hammer out a consensus on guidelines that will “hopefully” be adopted early next year.

“These are complex issues and I’m not surprised more time is required than expected,” said De Schutter. “I think it is remarkable we are heading towards a very detailed text despite the wide range of interests involved, in which decisions are made not by vote but by consensus.”

A September 2011 report by Oxfam International estimated as many as 227 million hectares of land in developing countries has been sold or leased since 2001. Most of that acquisition has occurred since 2008 and most has been into the hands of international investors, says the Land and Power report.

“There is a fear that arable lands will be scarce in the future and the price of land will continue to increase,” said De Schutter. “There is a sudden realisation that land is something that is in increasingly short supply.

“So there is now a rush for land.”

De Schutter said developing countries agree to sell or lease out large amounts of land in exchange for infrastructure and agricultural development – things cash-strapped governments could not afford on their own.

“They (feel) they have no choice,” said De Schutter.

And corruption remains rife in many countries, with local elites receiving kickbacks for land and inking agreements that benefit their own interests. Transparency International’s Global Corruption Barometer reported that 15 percent of people dealing with land administration services had to pay bribes.

Foreign direct investment to Africa continues to rise to unprecedented levels. The growth in production of biofuels, as well as carbon credit mechanisms and speculation, are key driving forces.

The majority of land deals in Africa are for export commodities, including biofuels and cut flowers, rather than food production, according to Oxfam International‘s report.

In Sierra Leone, a small West African country of about six million people that emerged from a long civil war in 2002, the democratically elected government of President Ernest Bai Koroma makes no secret of its desire to lure foreign investment.

In a recent presidential address, Koroma pointed out that agriculture contributes to nearly half the country’s GDP and a quarter of its export earnings, as well as employing about two thirds of the population.

While touting the government’s small-scale farming programmes, Koroma hailed “huge investments” by the private, mainly foreign, sector.

“These private sector enterprises have not only made substantial investments in the agricultural sector but have created thousands of jobs for our people,” said Koroma, whose government offers an array of incentives and tax breaks to foreign investors.

According to a report by the California-based Oakland Institute in early 2011, nearly half a million hectares of Sierra Leonean farmland had been leased or was under negotiation, while the World Food Programme estimates that about half the population remains food insecure.

The Sierra Leone country report of Oakland Institute’s Understanding Land Deals in Africa series suggested that large-scale land acquisition is characterised by a lack of transparency and disclosure, weak legal frameworks and confusion surrounding land availability.

“Land is being cultivated for agrofuel production as opposed to food production for local markets, raising serious doubts about the value of investments for local food security,” says the report.

The report stressed the conditions “are ripe for exploitation and conflict” and called for international institutions and donor partners to withdraw support for large-scale land acquisitions in the country.

Earlier in October, dozens of people were arrested in southern Sierra Leone following protests against a land deal. Locals said they were not consulted or given information regarding the deal, which leased 12,500 hectares to a Belgian company, Socfin. More than 100 protesters blocked access to the site.

Joseph Rahall, of the Sierra Leonean non-governmental organisation Green Scenery, said local government and landowners are vulnerable to exploitation.

“Sierra Leone is very new in this business, the business of large-scale investment in land,” said Rahall. “I know there could be a balance, if it is properly thought out. But we have not, we’re just jumping into it without critical analysis, without proper research.”

He stressed any principles adopted internationally need enforcement in Africa and cannot be something companies just say they adhere to.

Employment and economic development is simply “the bell they ring to sweet talk people into accepting these things,” said Rahall.

A 2009 report, “Land grab or development opportunity? Agricultural investment and international land deals in Africa”, noted land acquisitions have the potential to result in loss of land for large numbers of people.

“As much of the rural population in Africa crucially depend on land for their livelihoods and food security, loss of land is likely to have major negative impacts on local people,” said the 130-page report by the U.N. Food and Agriculture Organization, the International Fund for Agricultural Development and the International Institute for Environment and Development.

“These may only partly be compensated by the creation of permanent or temporary jobs.”

De Schutter said benefits are rarely spread across the board to the most needy and decisions are not necessarily transparent or in the interests of the poor.

“In general, the development of plantations increases inequality, instead of decreasing it,” said De Schutter.

“The majority will not benefit.”

The guidelines on the security of tenure of land, fisheries and forests “could be a significant advance,” said De Schutter. “It can make it more difficult for governments to ignore the demands of the local community.”

Excerpt:

By Abibatu Kamara and Jessica McDiarmid
FREETOWN, Sep 12 2011 (IPS)

The six-year-old girl pulls her T-shirt up to show the dozens of pale lines across her back. They are fresh scars from the lashing she received from her caregiver after she lost 500 Leones, the equivalent of about 10 cents.

Street boys congregate in downtown Freetown, Sierra Leone, for free food and care provided by an NGO. Credit: Jessica McDiarmid/IPS

The burns on her hand are from when her caregiver stuck it in a fire. That time she had disobeyed, and then refused to submit to a beating.

The half-inch high bump on her head with a thick scar at its summit was from when her head was smashed into a wall. What she did to warrant that one, she is not sure.

She doesn’t know how she came to be given the huge lump above her elbow.

Every scar has its own story, says the warm-eyed social worker, to whose side the girl is glued.

But hers is not such a remarkable case, at a recently opened girls’ shelter in the teeming core of Freetown, Sierra Leone’s capital city.

This West African nation of more than five million is still recovering from the devastation of a decade- long civil war that ended in 2002.

Its government has signed various international agreements and passed its own Child Rights Act in 2007. The four-year-old legislation enshrines basic rights and provides for structures to enforce them.

But many argue those rights still exist on paper only.

Agencies tasked with enforcement are overwhelmed and under-resourced, while those providing shelter are unable to cope with the need. Deep-rooted traditions and near-universal poverty fuel the abuse of Sierra Leone’s children.

Theresa Ojong, a programme manager for Don Bosco Fambul, says government needs to take the issue seriously and provide for more advocacy, sensitisation – and people need to speak up.

“We have this culture of silence in this country,” says Ojong, whose organisation is a local branch of an international NGO that provides shelter, counselling and rehabilitation for homeless and vulnerable children in Sierra Leone.

“(The government) has to come out very strong because it is they who have the policies. They are only being talked about, but they are not being implemented.”

In its 2011 country profile, Amnesty International reported that Sierra Leonean children faced serious violations in many domains, citing child labour and inadequate government programmes to address the needs of youth such as war-affected children and orphans. Street children are particularly vulnerable to abuse, with little or no protection.

“The government failed to uphold and enforce its domestic legislation and to respect its international treaty obligations to protect children and guarantee their rights,” says Amnesty International.

Mariatu Bangura, Director of Children’s Affairs at the Ministry of Social Welfare, Gender and Children’s Affairs, says a number of provisions in the Child Rights Act are in place. Others are in the works; some are under amendment.

“We are really trying to enforce the Child Rights Act,” says Bangura. “It is to some extent working. Before now, we’ve been having a lot of abuse cases that have been swept under the carpet.”

The ministry, however, is allotted just 0.9 percent of the annual budget, and doesn’t always receive the full amount, says Bangura. Numerous international agencies contribute to the effort.

“As a ministry, if we could really get government commitment on that, that would go a long way.”

Sierra Leone remains near the bottom of the United Nations Human Development Index, with an estimated 70 percent of the population living on less than one dollar a day. The gross domestic product per capita in 2008 was 332 dollars.

In its African Report on Child Wellbeing 2011 by the Ethiopia-based African Child Policy Forum, Sierra Leone was ranked among the bottom eight African countries for its investment in child welfare.

Child abuse is referred to the Family Support Unit (FSU) of the Sierra Leone Police, tasked with investigating and prosecuting crimes such as domestic violence, sexual abuse and child trafficking.

About 40 units with 435 police personnel and 60 social workers service the country. They have five vehicles – on loan from the United Nations Children’s Fund – and some motorcycles to do it, says FSU head Aiesha Bangura.

In 2010, the FSU received more than 4,200 reports of sexual abuse and domestic violence. About 2,200 cases are under investigation and only half of those have led to charges being laid. There were 57 convictions.

Back at the girl’s shelter, the battered little girl speaks in a small voice, her hair braided straight up the sides of her head to the crown, where it splays out every which way.

The little girl’s mother died in childbirth, says social worker Yatta Thomas. One in eight women die as a result of pregnancy in Sierra Leone. The government launched an ambitious programme of free health care for women and young children last year in a bid to address one of the world’s highest rates of maternal mortality.

The girl was passed through various hands, ending up with an unwilling caretaker who had half a dozen mouths to feed and no means to do it.

She frequently lost her temper, beating them.

It’s a vicious cycle, of poverty and abuse, says Thomas.

At Don Bosco’s headquarters in Freetown, some 60 boys plucked off the streets go through a 10-month rehabilitation programme before, usually, reunification with families.

The NGO estimates there are some 2,500 children on the streets of Freetown, pushed from their homes by sexual and physical abuse, trafficking, hunger and other factors.

More than three-quarters of street boys under 12 reported unwanted sexual acts perpetrated by older street boys. Nearly a third reported experiencing physical violence at the hands of police.

“The policemen, who are actually in charge of security and justice on the streets of Freetown, are sometimes guilty of the gravest human rights violations from brutal beating up to forced labour,” says the report.

Don Bosco takes a bus of food and nurses and social workers to a vacant lot downtown each evening where they host street boys who do not want to go to the shelter or for whom there is no room. The youths play games, get food, medical attention, and support.

One boy, who estimates he’s lived under market stalls for about five years, says he lost a family member’s money long ago and was too afraid to go home.

“I didn’t want to be beaten, so I decided to stay on the streets,” says the youth, who is perhaps 14.

He collects scrap metal and sells it for money, sleeping outside with a posse of other boys for protection from gangs, criminals, and police.

“It’s a hard life on the streets. The big criminal guys, older boys, attack us at night for our money,” he says. “If we have no money, they light plastic bags on fire and put them on us.

“Some of us want to go home. No one wants to stay.”

Excerpt:

By Poindexter Sama and Jessica McDiarmid
FREETOWN, Jun 20 2011 (IPS)

There is a brief bustle and then a woman wails as the small body is wrapped in cloth and set on a cot by the door of the paediatric ward. Nurses in pristine white uniforms continue to pad quietly around the large room at Ola During Children’s Hospital in Freetown, Sierra Leone’s capital city.

Infants are crammed two or three to a bed, sometimes more. Since the introduction nearly 14 months ago of free health care for pregnant women, lactating mothers and children under five, the number of people coming to seek treatment has shot up. Staffing and equipment has not risen to match, leaving health workers struggling to deal with the influx.

Sierra Leone’s ambitious plan to tackle one of the world’s highest rates of maternal mortality and infant death has garnered much praise from both international donors – who fund the majority of the program – and from within the country’s own borders.

In a country where one in five children dies before their fifth birthday, and one in eight women dies from complications of pregnancy or childbirth, free health care is seen as a huge step forward – and an enormous challenge.

According to a recent report by Sierra Leone’s ministry of health and sanitation, government-run hospitals saw about three times as many children under five – nearly three million – in the first 12 months of the program as in the preceding year. More than 126,000 women gave birth in hospital in the first year of the program, compared to about 87,000 in the previous year. The number of maternal complications treated in hospital increased from about 8,000 to over 20,000.

“Although the number of health staff has been increased since the launch of (free health care) it is still insufficient to match the service delivery demand,” said the report, entitled “The Free Health Care Initiative: 1 Year On.”

At Freetown’s largest public hospital for women and children, Dr. Mahmoud Idriss Kamara says the pressure on staff posed by the patient increase is wearing everyone down. Kamara sits behind a battered table, answering questions in between instructing staff, shuffling files, answering phones and signing the death papers for the child who’d just died. He has more than 24 hours left in his shift before he’d be able to get some sleep.

Across the ward, nurse Lucy Macauley says staff exhaustion leads to a poor standard of care for patients. She says they need help and the increase in workload should be accompanied by pay raises. “We’re working harder, but for the same pay,” says Macauley. Much of the equipment is obsolete and there are chronic shortages of supplies, she says, and the complex, which houses a maternity hospital and a children’s hospital, has an inadequate water supply – often, there simply isn’t any.

The hospital has been under scrutiny since an incident earlier this year when a woman died there from severe complications while the doctors scheduled to be on duty were absent. Those doctors have since been suspended.

The cost of the first year of free health care is estimated at 36 million dollars, the majority of which is put up by donors. But reports of corruption within the system are widespread. Patients recount being asked to pay for services and medications that should be free, or having to buy drugs when hospital supplies are said to have run out.

Umu Fofanah says she went for an ultrasound during her pregnancy because her doctor was concerned about the position of the baby. “When I went to do the scan, I was asked to pay 35,000 leones,” says Fofanah. “Not only me, but about 10 of us who were present.”

Other expecting mothers paid the roughly eight dollars for a scan that should have been free, says Fofanah. “But I had no money to pay, so I was sent home.”

Fofanah told a friend who happened to be the wife of Amnesty International’s Sierra Leone country director, Brima Sheriff. When he learned what had happened, he sent monitors with her to subsequent appointments or accompanied her himself to ensure she received free treatment.

“People are still paying for a lot of drugs and a lot of services,” says Sheriff. “This is not a secret. Everyone knows that people are still being asked for money, and it’s going into the private pockets of someone, at the expense of the women. The free health care was supposed to be for women but cost is still stopping them.”

Jonathan Abass Kamara, the public relations officer for the ministry of health and sanitation, says the government is always ready to react to reports of “the contravention of the principles of free health care.” Kamara cited several examples of medical staff being disciplined for extortion of patients or otherwise breaking the rules.

He says the initiative’s aim of reducing maternal mortality and infant death has been achieved, though exact figures are not yet available.

A 2009 Amnesty International report identified cost as the largest barrier to women and children accessing health services. In a country recovering from a decade-long war that ended in 2002, 70 percent of the population lives on less than one dollar a day. There are fewer than 100 doctors for some six million people and most health facilities are poorly equipped and lack basics like water supply and electricity.

While calling for better monitoring and accountability measures, Sheriff applauds the initiative and points out that there are a lot of positives to the free health care system. “But we need to recognise that it needs to be improved. We need to ensure that gaps are not left that allow some to defraud others.”

Excerpt:

By Poindexter Sama and Jessica McDiarmid
FREETOWN, Jun 16 2011 (IPS)

Bubble-wrapped pills are scattered across the crude table in a busy market beside crumpled boxes of lubricant, paracetamol and anti-fungal powder.

Regulators say many of the drugs sold on the informal markets in Sierra Leone are fake or substandard, posing a huge risk to the public. Credit: Poindexter Sama/IPS

A young man approaches and mutters a few words. The proprietor shuffles through the piles of sexual aids that cover the table – generic viagra, ‘man-woman’ cream (lubricant), dubious-looking condoms – before cutting a section containing two antibiotic capsules off a sheath. He hands them over, collecting in return 600 Leones, the equivalent of about 15 cents.

So-called “drug peddlers” ply the streets of cities and villages across Sierra Leone and much of West Africa, selling pharmaceuticals, often counterfeit or substandard, at reduced rates.

Strides have been made over the past few years to ensure drugs are safe and effective, but medical practitioners still cite these drugs as one of the largest obstacles in their fight to save lives. In Sierra Leone, still struggling to overcome the devastation of an 11-year war that left the nation in ruins, efforts remain beset by hurdles such as weak infrastructure, a lack of regulatory regimes in neighbouring countries, and few resources stretched in many directions.

Pharmacies in Sierra Leone are regulated under its Pharmacy and Drugs Act. Enforcement has been stepped up substantially in recent years, but what to do about those peddling on the streets remains elusive.

Drug peddler Abubakarr Keai says the majority of his supply comes from Guinea, where drugs are sold at cheaper prices and easily smuggled in over West Africa’s infamously porous borders. Other times, he buys them from local pharmacies.

He’s been selling since the war – when the formal healthcare system disintegrated and peddlers were the only option – and says he’s never had a complaint about his products. He recommends drugs and describes how to take them, though he can’t read most of what’s written on the packaging.

Keai says police frequently harass drug peddlers. Occasionally, authorities seize his drugs and arrest him. Sometimes he even goes to jail for a while.

“But there are no job opportunities, so even if we are arrested, we’ll start selling the drugs again when we are released,” says Keai. “We are doing this to survive.”

The registrar of the Pharmacy Board of Sierra Leone, Wiltshire Johnson, tasked with regulating drugs in the country, says about half the drugs sold in Sierra Leonean pharmacies three years ago were fake or substandard. Now, Johnson estimates more than 95 percent of products from pharmacies tested by the board are real.

Johnson says Sierra Leone is left vulnerable, however, because while it has beefed up its monitoring and enforcement of the formal sector, the country imports all its pharmaceuticals – some 30 to 40 million dollars worth a year. A crackdown on formal imports has been largely successful.

“The people involved in the formal sector realise you can no longer bring bad drugs to Sierra Leone,” says Johnson. “Our big challenge is the informal sector, the illegal sector, the drug peddlers.”

Liberia and Guinea, which neighbour Sierra Leone, have virtually non-existent drug regulations. The borders between countries are porous, allowing traffickers to move supplies in with relative ease, and customs and border officials are poorly paid. It doesn’t take a large percentage of profits from a lucrative drug trade to convince someone to overlook a few cartons of packages of – supposedly – penicillin.

Johnson says the pharmacy board works with police and the judiciary to enforce the pharmacy act, but argues that tougher punitive measures are needed to deal with drug peddlers.

The current law tops the time in prison at two years and the fine at five million Leones, about 1,200 dollars.

But the actual punishments meted out are usually far lower – between 100,000 and 300,000 Leones, or 20 to 60 dollars – doing little to discourage the practice, says Johnson.

“It’s a mafia, they just pay the monies and go back to the street and sell,” he says. “Tougher penalties are the only way we can really change.”

The regulatory laws on pharmaceuticals are currently under review.

Umaru Kamara, a pharmacy technician at Connaught Hospital in Freetown, says many, if not most, of the drugs for sale on the streets are substandard or fake.

It’s a regular occurrence in the hospital for staff to notice that medication – which patients will buy outside for cheap prices instead of at the hospital pharmacy where drugs are sold on a cost-recovery basis – isn’t working. Investigations reveal that the drugs the patients bought aren’t what they should be.

The dangers of substandard and counterfeit drugs are many, says Kamara. For example, fake antibiotics lead to worsening infections and complications, while substandard antibiotics cause drug resistance.

“(Drug peddlers) either give the wrong dose, give the insufficient dose so it will have no effect, or give an overdose,” says Kamara. “They can kill thousands of people.”

While education campaigns seek to inform the public of the risks of fake or substandard drugs, poverty gets in the way. Drug peddlers often offer lower prices and will sell a single dose, rather than having to buy a course of treatment all at once.

“Drug peddling is directly poverty related,” says Johnson. “It’s a social issue of survival.”

From the peddlers on the street to the patients buying their products to the people smuggling cartons of weak amoxicillin through the jungle, crippling poverty – some 70 percent of Sierra Leoneans live on less than one dollar a day – means there are few other options.

In April of last year, Sierra Leone introduced free health care for pregnant and nursing women, and children under five, including free medicines, in a bid to improve one of the world’s highest rates of maternal mortality and infant death. The ambitious program has seen a huge rise in the number of women and children accessing treatment, but drug supply remains a challenge, driving many to the streets to find medicines even when they’re covered by the program.

“You can have all the doctors, all the free health care, but if you don’t have the medicines, people are still going to die,” says Johnson.

Excerpt:

By Abdul Samba Brima and Jessica McDiarmid
FREETOWN, Jun 6 2011 (IPS)

Samuel Weekes remembers when the hills stretching out beyond the heart of Freetown were green.

Houses are climbing up Freetown's surrounding hillsides as government fails to enforce laws to protect soil stability in Sierra Leone's largest city. Credit: Abdul Samba Brima and Jessica McDiarmid

“Fifteen, 20 years ago, those hills were covered in trees. Today, most those trees have been cut down, mostly for housing purposes,” says Weekes, the director of population studies at Fourah Bay College in Sierra Leone’s capital city.

Freetown is wedged between the Atlantic Ocean and steep hills leading inland. On the hills around the city, homes cling to steep slopes, some held together by “packings” – as the locals refer to the makeshift terracing. There are no roads here, only steep paths held together with stones. In some areas, residents have to literally scramble up to the next level of terrace.

In a community near the university, two infants were killed when a boulder came loose from the slope above and crashed through their house last year. But resident Ibrahim Conteh says they don’t know of any building codes they should follow to erect their homes safely.

“Heavy rain can come and just pass through the house and cause accidents to happen,” he says, standing near a three-metre drop to the roof of a house below. “We try our best to make sure we put in place things to try make sure no bad things happen.”

“People find it difficult to find a place to live, so they come here.”

When they want to build, says Thaimu Turay, they clear off the trees, break the stone and make packings. “No one tells us how or where to put our structures,” he says. Weekes says government needs to plan carefully and enforce existing regulations limiting the amount of building that can happen on hillsides.

“How much of that is being done, I don’t know,” he says. “Government has to be very proactive to set limits beyond which they should not go and those limits have to be closely monitored.”

Yet as the city’s population balloons to well over a million people – exact figures are not known – space is becoming ever harder to find. More and more people are clearing to make way for homes – some grand mansions, others no more than a few sheets of tin pieced together – raising fears of landslides and other calamities as development spreads unchecked up the mountainsides. Those fears are fresh on people’s minds now as the rainy season’s daily deluges begin.

Weekes attributes the burgeoning crisis to unbridled population growth and rural-urban migration, as thousands flock to the city in hopes of better opportunities. Part of that is due to what Weekes calls “skewed development.”

“There’s a vast difference between Freetown and other urban and rural areas,” says Weekes, sitting in his office at West Africa’s oldest Western-style university. “If you can improve development in other urban areas and in rural areas, you might be able to relieve some of the stress on Freetown.”

Dr Kolleh Bangura, the director of Sierra Leone’s Environment Protection Agency, says the growing population is forcing people to build on the hills, with little regard to building regulations.

There are zones where construction is banned, but “there is no respect for these green belt areas,” says Bangura.

He says it’s difficult to control the building, despite the dangers it poses, citing the “politicisation” of the issue and the brutal murder several years ago of a lands official who went to demolish illegal structures on a hillside.

The government puts little pressure on those carving up the hills now, says Bangura, who warns laws must be revisited and resources expanded to deal with the growing population.

Experts warn that if growth continues at its current rate, “serious problems” will beset this city, not just with loss of forest cover, but sanitation, water and electricity supply and other infrastructure, which is already hugely lacking.

Freetown is far from alone when it comes to the scramble to find space for ever-burgeoning populations on inhospitable terrain. From Pakistan to the United States to the Philippines, people are settling on steep ground, with sometimes devastating consequences.

Weekes attributes the burgeoning crisis to unbridled population growth and rural-urban migration, as thousands flock to the city in hopes of better opportunities. Part of that is due to what he calls “skewed development.”

“There’s a vast difference between Freetown and other urban and rural areas,” says Weekes, sitting in his office at West Africa’s oldest Western-style university. “If you can improve development in other urban areas and in rural areas, you might be able to relieve some of the stress on Freetown.”

Cyril Mattia, spokesperson for Freetown City Council, says Sierra Leone’s civil war, which ended in 2002, brought many people to the city. Some never left. The growing population, he says, is “destroying the very fabric of the municipality.”

Mattia says many of the structures carved out of the hillsides are not authorised.

He says the bulk of responsibility for planning and enforcement of the city lies with the national government, but the municipality works on “sensitisation” to encourage people to avoid unsafe areas.

“Most of the land has been encroached upon and they are very hard to remove because of political reasons,” says Mattia. “We have huge rainfall in this country and people are also playing with the soil.

“Eventually disaster will occur.”

Excerpt:

The yard at Peter Saye’s is full: of kids, of cooking pots, of chickens, goats, and piles of belongings. Women carry firewood and stir coals, plait hair and snap at the children scampering around in the dust. There are nearly 100 refugees sheltering here from the violence across the border in Côte d’Ivoire.

Ivorian refugees fill the yard at Peter Saye's mission in Butuo, Liberia. Credit: Jessica McDiarmid/IPS

Forces supporting Alassane Ouattara, the internationally-acknowledged victor of November 2010 elections have rapidly moved rapidly from the north of the country – which they had controlled since the 2002-2003 civil war.

Their recent rapid progress south to encircle the economic capital, Abidjan, which has become the last stronghold for the incumbent president, Laurent Gbagbo, precipitated a rapid increase in refugees seeking shelter in Liberia.

Local populations are overwhelmed and help has been slow to arrive. International attention and support is diverted by major crises elsewhere, and a set of hangups, holdups and logistical obstacles are creating a catch-22 in a crisis that looms larger by the day.

Logistical challenges

In Nimba County, where the bulk of the more than 100,000 Ivorian refugees in Liberia are scattered through nearly 100 remote communities, the U.N. refugee agency says food will now only be supplied to those who move to transit centres, designated host communities or a main camp some 60 kilometres away.

But many refugees prefer to wait it out near the border where they can look for lost relatives and scrounge traditional foods – rice and cassava – rather than taking a bumpy, hours-long ride in the back of a cargo truck to a camp where they’ll be fed on a diet of bulgur wheat.

“I would be pleased to go to Bahn except for the distribution of bulgur wheat,” says Gayegbaye. “Because of that, I don’t want to go there.”

As long as there is any food along the border, they’ll stay put, he says.

There are songs and poems composed about the horrors of bulgur wheat, a staple commonly distributed by the World Food Programme in the region. The complaint is nearly universal: it makes your stomach run. In other words, diarrhoea.

WFP officials say they’re aware of the concerns and are trying to secure other staples. It takes time, says deputy country director Jerry Bailey.

“We’re facing a problem with our pipeline in terms of arrival times and transport,” says Bailey. “It’s trying to get rice from neighbouring countries… If we can’t get rice, we go ahead with the bulgur.”

The agency is struggling with an ever-changing situation, particularly in Nimba where refugees are spread over a vast area, much of it barely accessible by road, as well as constantly moving back and forth over the border frequently.

Maintaining roads and bridges will be extremely difficult once the rainy season starts in April, some of the communities sheltering refugees will be virtually out of reach for months.

The border is infamously porous and there are widespread reports of mercenary movements along it. Fighting at times is so close it’s audible from Liberia, in a region where wars have had a tendency to jump borders.

UNHCR spokesman Sulaiman Momodu says refugees need to move for security and effective aid delivery, stressing the need to manage people’s expectations as agencies grapple to deal with the crisis.

“We are in an emergency. We are trying to stabilise and move to the regular thing that happens in a refugee situation, where you establish camps,” says Momodu. “But there’s a need for people to move.”

Funding shortfall

And as the fighting has moved swiftly south through Côte d’Ivoire, so has Liberia’s refugee crisis. More than 24,000 refugees have recently entered Grand Gedeh County, south of Nimba, and the scramble is on to put needed infrastructure in place there despite vast funding gaps.

The UNHCR requested 55 million dollars for an anticipated 50,000 refugees in January. Now, with more than twice that number estimated in Liberia alone, the agency says it needs more than 132 million dollars. To date, it has received only about 17.5 million dollars.

“The bottom line is we need funds, and so far we have not received enough, there’s still a gap,” says Momodu.

Peter Saye is one of thousands of Liberians whose food supplies, meant to last until the next harvest in six or more months, have been decimated. He’s given away everything in his kitchen and his storeroom; his cassava patch is nearly gone. The water from his pump is running dry and the latrine overflowing.

People go back and forth to get food from Côte d’Ivoire, she says, but pro-Ouattara soldiers who now control the area across the river take most of it. Still, Pellagie says they won’t go to a camp.

“(Saye) is really taking care of us, so we see no reason to go to the camp,” says Pellagie.

His friends worry what he will do since he’s given away all his food, but he says whatever he has is for all.

“They can stay as long as they need. Whatever we have, we will share. When food runs out…”

He pauses, chuckles. “Well, we’ll all just be sitting. We can just pray that God will provide.”