One of the items in my bucket list while in the Gambia was to visit the main hospital in Banjul, Edward Francis Small Teaching Hospital formerly known as the Royal Victoria Teaching Hospital (RVTH). It is public knowledge that the hospital is in shambles, but I wanted to see it myself.
We have all heard of the horror stories and chances are you or your family members have a dreadful story to tell about RVTH.
Luckily for me, I was invited for a private tour of the hospital by one of the doctors there. After exchanging a few text messages to try to coordinate a date and time convenient for both of us, we finally met at the main entrance of the hospital building on 8th January 2018.
While we were exchanging pleasantries at the main lobby area, I could not help but be distracted by the pile of junk sitting there all dusty. Then I looked up and saw the terrible condition the ceiling was in – water stains, hanging and missing pieces of the ceiling. The ramp in the lobby area looked jaw-droopingly filthy and the walls looked tired and the paint chipping away.
As we made our way up the ramp headed upstairs, I took the opportunity to express my reproachful feelings about the lobby area to the doctor and asked what was being done about it. He looked at me and said: “Guess what? The First Lady just left about half an hour ago prior to your arrival.” Apparently, the First Lady (bu hess) has been frequently going to RVTH with her entourage and making endless promises. I didn’t see her there that day, but I can imagine her in the middle of her entourage sporting her Prada sunglasses inside the hospital wards.
After we landed on the upstairs balcony, I took a quick minute to take it all in. I moved close to the balcony railing for a bird’s eye view of the hospital grounds. I don’t remember the last time I visited the hospital, but I do have vivid memories of sliding down the ramp in the lobby as a boy for fun; it was squeaky clean and had a sensitized smell then. To my immediate right, there was a group of people congregating by the fence and there were two other separate groups further down. So out of curiosity, I asked the doctor what the deal was with all the different groups of people assembling around the hospital grounds.
As it turned out, they were all there to pick up the corpse of their loved ones to take back for burial. The doctor did not mention, but I assumed they were from far away and huddled up to figure out how they were going to transport their corpse back home for a burial. I could not help but wonder how many other people were there on that day to pick up the corpse of a loved one. I knew right there and then, that I had to emotionally prepare myself for what lies ahead for the tour.
Since most people who go to the hospital were probably there to visit a sick friend or family member, they are usually emotionally preoccupied and focused on the situation of that particular patient, but my case was different. I was not there to see any particular patient and didn’t have the luxury to be emotionally preoccupied, and that left me more emotionally vulnerable compared to those there to see a certain patient.
We first walked into the women’s ward. There were only a few beds scattered around and almost all of them looked like they were on their last leg. They appeared old and tired and some looked like they had been doctored many times before. Everything in that ward was old and murky.
As I try to make sense out of the scene, I overheard sounds of discomfort (moaning and groaning) towards the end of the ward. I looked over and saw a naked woman lying on her side on the last bed next to the back door. One of her legs was amputated at the shin, the other right above the knee, and her back was burnt. My heart sank and I was hit by a tsunami of emotions. I felt an urgent need to leave the ward immediately, I was getting overwhelmed. So I started gravitating towards the back door, which led to an open hallway. That was my way of signaling my “guide doctor” that I wanted out of there, as I got emotionally consumed. On our way through the back of the ward onto the open hallway, we went past the bathrooms. The sight was horrific and the smell hazardously poignant.
Through that open hallway we made our way to the “On Call” room for doctors, which was located in the next block. There are two “On Call” rooms and they are right across from each other – one for the male doctors and the other for the female doctors. When doctors are on call, the rooms are used for waiting and relaxing. It makes good sense of proximity – right there in the hospital.
At a closer look at the doors, you can tell the locks have been changed multiple times; you can see the numerous holes where nails once held in padlock brackets. There, we found the doctor on call on his laptop; I got introduced to him by my “guide doctor”. He told me that he studied in Venezuela and we spoke a little Spanish (I had to jump on the chance). The room was tiny and had two small beds right next to each with little space in between them. The bed sheets were thin and appeared to be the wrong size. Our conversation centered on the massive challenges they face there at the hospital and the lack of responsiveness from the current and former administrations. To me, it sounded like they were being asked to make water flow uphill. Impossible!
From there we went to a couple of other wards and briefly stopped by at the sluice prior to heading to the ICU. The sluice room is where used disposables such as incontinence pads and bedpans are dealt with, and medical and surgical instruments are sterilized and disinfected. The room looked like a disaster! The entire room was layered with dust, there was a broken table with broken chairs on one side of the room, and the sink was soiled.
As I stood there listening to the doctor explain the condition of that room to me, I was paralyzed by a feeling of deep concern and could not help but think of the infinite possibilities of infections. With unsanitary conditions being a major cause of infection even in advanced countries during surgery, I could only imagine what the rate of infection would be with the condition of the sluice I saw at the RVTH. The risk of surgical complications increases dramatically when doctors work in unsanitary conditions. We then ventured into the ICU where I was met with the shock of my life! They had no monitors or the most basic material to work with.
The used incubators that were donated to the hospital by diaspora Gambians were all destroyed due to the erratic electricity situation, and the two I saw there were barely working. The story was the same with the oxygen concentrators. The ICU hardly had any equipment in it, and most of what was left there was purely for decoration so that the room wouldn’t look empty, but they serve no other purpose. 
A hospital with not a single X-Ray Machine, a Radiant heater for new born babies, or a ventilator, is appalling! I was also taken into a room where a woman with cervical cancer was sitting by herself. According to the doctor, it could be treated either with radical hysterectomy or chemotherapy and the drugs are not available in the country, only in Senegal or Europe. “Cervical cancer can often be found early and sometimes even prevented entirely, by having regular Pap-smear tests. If detected early, cervical cancer is one of the most successfully treatable cancers.” I found this on the American Cancer Society’s website, but I wonder what the chances for survival are for that woman.
Not long before my visit, I was told that the Permanent Secretary visited the ICU with Momodou Malcom Jallow, a Gambian origin and a Swedish law marker, who was very much angry with them regarding the situation of the ICU because they lack the most basic material to work with, yet they are busy traveling, attending endless workshops, and driving luxury vehicles while leaving ordinary citizens who put them into office to die.
The tour took me to so many places in the hospital that I could not even keep track. By the time we got to our final destination, the Accident and Emergency (A&E) ward of the hospital, my head was almost saturated with information; I had been trying to retain and compartmentalize the vital materials from the visit for future reference. I thought I had seen it all prior to walking into the A&E, but what I saw was even more shocking. Actually, it’s more like what I didn’t see there left me even more stunned.
The ward was bare and there were no equipment in sight! I was introduced to the doctor on duty, and of course, a conversation about the hospital and the enormous challenges they face ensued. Hearing from the doctors was tough because you can sense the frustration and desperation, and that can potentially affect the quality of their work. I could only imagine how they felt as doctors working in such impractical conditions. The hospital had no medicine and people have to buy their own medicine from private pharmacies. In certain cases, if a patient couldn’t afford to buy the medicine they needed for them to perform a critical procedure, the doctors called outside private pharmacies to guarantee the patient for a purchase on credit, and if they default, then the doctors are on the hook for it. What a tough situation for a doctor to be in!
Although I have been in emergency rooms before and have an idea of what they do in there, I still wanted to look it up and here is what I found. “An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.” The tour ended, but our conversation did not.
My “guide doctor” walked me to the car and we stood there and talked for another half hour, dissecting and analyzing the hospital’s condition and the predicament of the doctors and patients. My final question to him was this “with all I have seen here today and everything you have told me, why are you still here?” And he answered “when I see patients I have treated in the streets or at gatherings and they thank me and show appreciation – that’s what is keeping me here.” Ndeysan, suma yaram daw sisassi! I could not help but think to myself – only if he had everything he needed to be able to better exercise his passion for healing the sick – passionate but disabled!
Finally, I was in the car and driving back with all the hospital images circulating in my head. It was like a flash flood, the kind that consumes everything, choking the life out of anything in its relentless path of destruction. The visit had been emotionally draining and very discouraging, but I was glad I chose to go. Too often, I hear dreadful stories about the hospital, so it was good for me to see for myself and get firsthand information.
Later that evening, after retiring into my silent corner, I could not help but ask myself whether RVTH was a hospital or a hospice, given what I saw and the information I gathered, to me, a hospital is a health care institution where patients go to seek treatment, and a hospice is where chronically ill, terminally ill or seriously ill patients go to live in the last months and days of their lives. With the number of families going to RVTH on a daily basis to pick up the corpse of their loved ones, one could easily argue that the RVTH is more of a hospice than a hospital, without the comfort of attending to the emotional and spiritual needs of patients, which is the essence of a hospice.
Now this brings me to my landing point – the GARD strike. We are all aware of the explosive accusations of theft of medicine and equipment by the doctors, from the Minister of Health in the presence of other doctors from the region, which I believe was the straw that broke the camel’s back. The minister said “When we talk about corruption in the health system, we all know how it is. These young doctors will just go and practice pharmaceuticals and some of them will open pharmacies with the resources that we have. I am very sure of what I am saying because I was the PS.” That statement coupled with the frustrations of their working conditions, some of which are highlighted in this piece, led the doctors on strike.
As a Permanent secretary, the Minister claims she knew but did nothing about it? And now as a Minister, she was making a public accusation without providing a single documented case – it begs the question. Furthermore, why would the ministry even issue licenses to doctors working at the hospital to open pharmacies? That’s a huge conflict of interest! Maybe the ministry should revisit their pharmacy licensing policy? I would suggest for them to give all the pharmacies a ninety-day-notice prior to revoking their licenses and have them re-apply, this will be a good way to screen applicants and avoid the conflict of interest, in an effort to correct the system.
Regardless of your status or financial health, as long as you live in or frequent the Gambia, you are a potential victim of “A Dead Health Care System”. If you suffer a major medical emergency there, they might not be able to stabilize you prior to flying you out, and that may significantly diminish your survival chances. So it is incumbent on all Gambians to demand from the government the healthcare we deserve. No country can succeed without a healthy population, and the recent death rate is alarming.
By Momodou Ndow
It is bad, very bad, the question is what do we as a country do about it.
First lets try to understand the system set up.
1. Public Health:
Made up of Primary or Village Health Service. ( VHS ), Secondary or Minor and Major health Centers and Tertiary or Hospitals like Edward Francis Small.
Our village health service should be separated into 1. Women clinic 2. Male clinic. This will increase acceptance and compliance predicate on our cultural and religious beliefs.
2. Private Health Sector: Those poorly staffed and poorly equipped shops all over the country.
Challenges:
All are broken beyond repair. The reasons are, Lack of funds and Expertise
Solutions:
1. Clean water.( People that drink contaminated water will always be sick ).
2. Disease prevention by surveillance and monitoring. ( TB, Malaria, Diarrhea disease and other childhood illnesses, HIV, STD, Hep A,B & C )
3. Immunizations.
4. Nutrition.
To get clean water we need constant electricity, we have to examine our energy policy and implement it, we have no choice but to get the money from investors and partners who we must give substantial investment incentives and concessions to. Clean water will reduce several childhood and adult illnesses and have direct positive impact on overall health.
The VHS will be used as immunization centers to attain increase compliance. Our schools, churches, mosques, community centers will also be staffed periodically to give both child and adult immunization. We need a comprehensive electronic recording and tracking system to record, monitor and track numbers and impact.
IDSR ( Integrated Disease Surveillance and Response ) regulations and policies will be introduced at all levels of public health.
We need a modified payer system that targets diaspora Gambians to pay a small sum say $50/month or equivalent to cover loved ones at home to have access to care both private and public. Any reserve will be pumped back into the system.
Gambian investors and private health sector operators should be encouraged to develop a lucrative medical tourism sector that will boost the system and the tourism industry.
Healthcare leadership must develop strategic partnership with successful entities outside of The Gambia to help train, mentor and supervise professional development of young Gambian physicians. New rules need to be examined concerning dual work for public and private health sector at the same time.
There is need for infrastructure development and maintenance. This require expertise and the know how to raise private funds for public good. We must understand that governments don’t have the cash to build hospitals, Foundations and high net worth individuals do.
Gambians in the diaspora should form partnership with our hospitals and government to engage in ongoing dedicated and targeted fund raising efforts to reconstruct and maintain our tertiary hospitals.
The Barrow administration is well advised to seek assistance from Consultants to achieve the desired goals of rebuilding this broken sector.
Finally the leadership that can build the kind of system that we will all be proud of must have,
1. Management skills
2. Technical skills
3. Political skills and
4. Fundraising skills
God Bless The Gambia.
Good points Dr. Sarr.
Is the writer the Dr. Ndow who is a doctor and professor in Scotland for many years?
I like his comments that “… you are a potential victim of ‘A Dead Health Care System’. If you suffer a major medical emergency there, they might not be able to stabilize you prior to flying you out, and that may significantly diminish your survival chances …”
Essentially, when you move from a developed country like UK to live in a developing country like The Gambia, “diminished survival chances” in a medical emergency is a calculated risk one takes to do what one loves.
I don’t think so. I believe the professor calls himself James N’Dow. I believe he is a Urologist and he is opening or trying to open a health center in Gambia with help from Baylor in Texas.
Sounds like Mommodou Ndow is inspired to follow a dream. Bless him and good lack. Did you see EPIC EPIC Lebron James this mornng (1 AM!). He is THE ONE AND ONLY G.O.A.T – Greatest of All Time! Move over Michael Jordan.
“luck”! Old age dementia symptom!
Very sad and depressing to read. I’m tempted to say that we, The Gambian People, aren’t serious about nation building. How else can such a situation be explained?
I think governments can build and maintain good quality hospitals, but only with the right leadership and mindset. Without the financial muscle of a strong and wealthy private sector, we cannot but start thinking differently in how we build our country.
And that begins with our choice of leadership. We cannot continue to be led by a parasitic leadership that lacks imagination and originality in everything they do, but good at spending scarce state resources on itself.
The suggestion for the diaspora to contribute is great, but we must have a government that knows how to tap into this vast diaspora resource, through policies, strategies and mechanism that are also appealing to the diaspora. “Love” of country alone is not enough, especially when suspicion of monies ending up in private pockets is more likely to be true than baseless.
Bax, I must say that you mostly speak for me and I thank you for your thoughtful insight.
I wish to say that Gambians of like minds must work to educate the public and create awareness in the vital needs of the health sector in The Gambia.
One only has to imagine being critically ill in The Gambia to come up with the sad reality that untimely death may be the ultimate end. Particularly where one doesn’t have the resources to pay for for services at AfricMed, Westfield or Sherab. Or where it’s clear that admission to an unsanitary local hospital leads to a nosocomial infections that may cost more to treat than the original condition that triggered the hospital visit in the first place.
Therefore, it’s common knowledge that visitors from overseas, out of an abundance of caution, secure medical and other insurance that will enable immediate evacuation for life saving treatment back home. This government must encourage public-private partnerships in supporting and revamping the health sector as a matter of urgency albeit with affordability being a key objective!
When doctors and nurses pick their noses in plain sight, there’s a lot that needs to be done to bring us to world public health standards. A lot of work folks!!
Bajaw, Kinteh(Kemo) & Co, Jollofnews 23rd May 2018
Are you satisfied/happy with the report about our EFSTH, our main hospital? Where is the 50-million-dollar gift that China immediately gave the Gambia when this USELESS man took over? That money alone could have offset the shoddy, delapidated conditions in our hospital. But instead they took it to build Mai Fatty’s mansion in Kotu, Barrow’s mansion in MankamangKunda, Amadou Sanneh’s mansion in Bansang; send Ousainou Darboe, Barrow, Amadou Sanneh, Badara Joof’s children and families to pursue further studies abroad, defray costs on per diem emoluments incurred at useless trips abroad, pay off useless expenditutes at the “office” of First and Second Ladies, pay off hotel bills for Fatoumatta Tambajang & Co at useless conferences…… All these horrendous malpractices on public funds right under your nose, Bajaw, are wittingly taking place, yet you so naively subject every matter to the Jammeh sydrome that you bear.
The lives of our children are being mortgaged by INCOMPETENT, CORRUPT and SELFISH people yet you sit on the fence to defend a clique of VERY BAD and USELESS administrators.
Stop playing the blame game for its sake, Babu. The situation at the EFSTH is the result of sustained, long term neglect and underfunding by the APRC, being the administration for the past 22 years. Dilapidation of structures like the EFSTH does not happen overnight. It is a long term degenerative process and the narrative does seem to suggest that the structure’s dilapidation is at an advanced state.
The Barrow Administration, being the government in office today, should be criticised for any administrative, hygienic or maintenance failures experienced by the hospital, but to give the impression that they are solely responsible for what the author had described after his visit is dishonest and misleading.
I know Dr I. Sarr admonished about “fixation” with the past, but you (Babu) can’t be left to get away with your distortions and falsified narrations. The truth is that Yaya Jammeh had “killed” the EFSTH by diverting much needed funds and resources into his false HIV/AIDS Treatment Lies.
Babu, I don’t have any evidence to substantiate your alleged corruption herein; nor have you presented any evidence beyond assumption…?
Yes, the Health sector, just like all other services, is “abhorrent” in short – (please, all excuse my unGambian kaabu nka-language); of the mandatory ability for purpose (required), in all sense of argument, for the sector’s purpose for existence; urgent necessity is required for all in puts required to be sought & solicited for the urgent uplifting for a better health; reproductive health in particular & the female gender are amongst the most disadvantaged & affected adversely by the health sector short-comings….
But the Bitter-cola, given by the Lady Minister in her ‘honest opinion’ among other observations to bettering remedy, which was vehemently opposed to, by some of the “player employees” (as interested parties) was just “calling it spade”; the facts, among many, must be acknowledged & accepted, & (be able to) “tackled head-on” to pave way to any meaningful (achievable) realisations….
Your other ‘opinionated criticisms’ above are (your) entitlement (that) Bajaw got no answers to currently; hope someone else can step in for answers….
God bless Gambia…
Bax, Bajaw,
“Babu, I don’t have any evidence to substantiate your alleged corruption herein; nor have you presented any evidence beyond assumption…?”
Of course I have presented evidences. Where is the Chinese donor money, over 50 million dollars? Where can you mention as material or logical evidences to substantiate the good use of that money? That’s my evidence.
Stop closing your eyes to the truth. The evidence is there. What has your Barrow government done in 1.5 years especially with the 50-million-dollar Chinese gift?
In the same period during the APRC government, there was at least a university extension programme under way, the airport and TV station constructions under way; a bit of improvement in our impoverished economic and social conditions then.
Like the Jawara administration that enjoyed all the international (Western) HYPOCRITES’ alliances, support and fanfare, the Barrow adminstration just under played the trust given him by Bax, Bajaw and all the other coalition followers in and out of the Gambia, to flatly fail their expectations. We in the opposition, are not surprised at their failure; knowing the calibre of unqualified, corrupt, corruptible and untrustworthy people you voted into office.
Nonetheless, the future belongs to all our children except theirs which they are quick in shaping/planning favourably while forgetting the children of the immense poor mayority.
I never commented on the Gambian doctors’ refusal to work until the minister retracted simply because I know they were all (the Hon. Minister, the doctors) exercising their democratic rights. But they all had to take the country first and all other things next. I have lived long in Holland to see such exercises of one’s rights so it was nothing new to me. As it ended in an amicable accord, I was relieved, as relieved as the patients and their families.
Remember Bax, during the APRC government, there were no shortages of drugs and in fact they added 4 more hospital structures to the single ESFTH they inherited.
In 1994, Jammeh either found some public corporations running surpluses or forced them to fund his projects. I know because the Kalagi Middle School was funded by Gambia Ports Authority, under then MD, Mr Andrew Silver. Barrow hasn’t got that luxury because Jammeh emptied the Central Bank, through Executive Directives.
“No shortage of drugs”! You must have visited only Kaninlai Clinic because drug shortage was, and still is, a chronic problem.
Babu, “…no shortages of drugs…?”; certainly NOT “The Gambia, in West Africa” we all know of; maybe in Proverbial wishful-land (that’s) falsely promised (at the onset) 1994; to be financed by the Murderous kanilai Evilness messiah from “Allah’s world Bank” fund…??
Your perception of economics on the Chinese loan you quoted herewith, isn’t necessarily the same, nor as simple as abcde….
I’m not in government to answer the rest of your opinionated questions…