Years after the end of the civil war and despite a multi-million dollar aid budget, a growing health crisis is developing in Sierra Leone.

Sierra Leone's failing health Posted  March 10,2014 By Tamba morkway-Sossah http://tambasosa-troubleshooting zone.blogspot.com This small West African country is heavily dependent on foreign aid, particularly from the UK - with over 60% of its budget supplied from abroad. It is estimated that up to 40% of the population remain traumatised by the war, yet the country has just one trained psychiatrist. Despite the aid there is little basic infrastructure, and the largely privatised healthcare system is beyond most people's means, forcing them to seek alternative, potentially dangerous healthcare, such as witch doctors. The healthcare system was largely destroyed in the war along with much of the other vital infrastructure. Now the Sierra Leone government is struggling to improve facilities - many of which were burnt down or destroyed. In some areas there is a skeletal system in place, heavily subsidised by foreign aid, and supplemented by healthcare charities and aid agencies. Foreign non-governmental organisations supply 60% of the Ministry of Health's budget, and spend almost double the amount the government spends on healthcare. But the system the Government has developed is largely privatised - meaning that patients are charged a fee for treatment they receive. When 70% of the population live below the poverty line, and 26% live in extreme poverty the costs are all too often seen as an unaffordable luxury. Children, pregnant women and the elderly are all supposed to receive free treatment but in practice that doesn't always happen.  So for many people in Sierra Leone other forms of care have become the norm. I was taken to visit a local witch doctor, Pa Bassi, on the outskirts of Freetown. The two hour journey to get to his mud built house is regularly undertaken by those who come to visit him. On the day I visited he told me that he had 10 patients waiting to see him. He specialised in the treatment of mental disturbances. It has been estimated that up to 40% of the population of Sierra Leone have been traumatised by the effects of the war and require psychiatric help. But the country has only one psychiatrist, and only one mental hospital. Only the very disturbed are admitted - so for the many people suffering from less severe mental illness, there is no-where else to go. Pa Bassi offered to show me one of his standard treatments. It was perfume. At the side of his house his patients waited. Because they were mentally disturbed, many of them had been restrained - chained to heavy objects to prevent them from running away. Pa Bassi demonstrated - pouring perfume in the eyes of two of the boys waiting to be seen. This, despite their screams, he claimed was good for the brain - as it cleared out the system.  So great is the stigma of mental illness, that people leave their relatives with him, and sometimes never return. My translator told me that Pa Bassi was a humanitarian because he saw patients without charge. A woman I spoke to had paid for treatment by giving vegetables in return.   World Health Report 2014, Mental Health: New Understanding, New Hope, is available at w The west African state of Sierra Leone went through a civil war lasting 15years that ended in 2002. With only one psychiatrist, two trained psychiatric nurses, and a population of four million, the country was in a weak position to deal with the mental health needs of its population during the years of reconstruction. A survey by the World Health Organization in Sierra Leone in 2002 found that 2% of the population was psychotic; 4% had severe depression; 4% had substance misuse; 1% had mental retardation; and 1% had epilepsy. WHO advocated the creation of community based mental health services.   Latest update: 05/03/2014 - health - Sierra Leone By FRANCE 24 (text)   400,000 patients, one psychiatrist   400,000 mental patients count on Sierra Leone's only psychiatrist or ineffective traditional medicine for treatment. Dr. Nahim uses controversial methods, but do people have the choice? (Report: I.Taoufiki) Sierra Leone’s civil war was one of the bloodiest conflicts in recent African history. It ended in 2002 but the invisible wounds of war are still raw. According to the World Health Organisation (WHO), there are 400,000 mental health patients in Sierra Leone as a result of the conflict. Psychiatrists and psychologists treat only 2% of the ill, while the remaining 98% are treated by traditional doctors. Six years after the official end of the war, health conditions in the country are deplorable. The psychiatric sector is in especially bad shape. France 24 met with patients of Dr. Nahim, the only psychiatrist in the only psychiatric hospital in Sierra Leone, a country with 6 million inhabitants. He lacks resources and time, and his methods can seem shocking.   Sierra Leone (Liz O. Baylen / Los Angeles Times) Dr. Ibrahim Thorlie, chief of medicine at Princess Christian Maternity, has grown increasingly frustrated with the power outages, shortage of drugs and low pay for his staff. Many of his colleagues left for more lucrative jobs in the U.S. and Britain, but he chose to remain. "If I didn't stay," he said, "who would?" Sierra Leone (Liz O. Baylen / Los Angeles Times) Nurses Ajaratu Davis, right, and Kadiatu Jalloh complain to a Health Ministry official about the low pay for those in the medical profession. Doctors say they often pay nurses out of their own pockets to ensure they'll show up for work.   Sierra Leone (Liz O. Baylen / Los Angeles Times) At Princess Christian Maternity Hospital in Freetown, Theresa Mattia, 19, is about to undergo an emergency C-section in an operating room illuminated by small generator-powered lights. According to the United Nations, 1 in 8 women in Sierra Leone die in childbirth. The rate in the United States is 1 in 4,800.