From the Editor’s Keyboard

Professional Ethics and Preventable Deaths in Sierra Leone-A Case Study

20 February 2023 at 20:47 | 1285 views

By Kortor Kamara, USA

The 2009 United Nations Human Development Index (HDI) ranked 182 United Nations member countries based on three criteria: life expectancy, adult literacy and gross enrolment in education, and gross domestic product per capita. The report, released on the 5th October 2009, ranked Sierra Leone 180 out of 182, ahead of Afghanistan and Niger. This year’s ranking was based on data from 2007 and does not take into account the current economic crunch. In the 2007/2008, Sierra Leone ranked 177 out of 177.

According to a 2009 World Health Organization report, the probability of a child dying before his/her fifth birthday in Sierra Leone is greater than 1 in 4 (that is, 262 per 1,000 live births compared to a regional average of 145 per 1,000). This ranks Sierra Leone number 1 for under-5 mortality in the world. The infant (under 1 year) death rate for 2007 was 155 per 1000 live births. In Sierra Leone, the chances of a women dying as a result of being pregnant is 2100 per 100.000 compared to a regional average of 900 per 100,000. Healthy Life expectancy at birth in the country is only 35 years.

The 8 Millennium Development Goals (MDGs) that were adopted by 189 nations and signed by 147 heads of state and government including Sierra Leone in September 2000 are geared toward addressing the world’s development challenges. Health is central to the MDGs as goals 4, 5 and 6 of the 8 goals focus specifically on health. In fact all the other 5 goals are either directly or indirectly health-related and it is reasonably understood that they cannot be attained without addressing the issue of health care delivery in Sierra Leone.

This implies that central to the development of Sierra Leone is the role of health care personnel in our nation. What is the level of their commitment to deliver quality health care to the people of Sierra Leone? Has health care delivery in Sierra Leone degenerated into a system of cruel business? Are healthcare professionals held accountable for breaching the codes of ethics of their profession? Do service centers meet basic minimum standards of hygiene? Is some locations ideal for health care delivery? Are some of the surgeries performed in appropriate operation rooms (OR) or in “bedrooms-turned-into-operation rooms?

A typical case study involves location of private surgeries in Sierra Leone. Take for example the location of the “surgery” of some prominent physicians in boisterous overcrowded and unclean environs, such as the Congo market area. How can anyone find cure and healing for any ailment in the noisy Congo market location, let alone undergo a surgical procedure? The facility was originally constructed for human dwelling, and without any remodeling, the physician has been performing surgical operations in this facility without any authority questioning the suitability of the infrastructure. Can you imagine anywhere in the world where such a situation would obtain? Only in Sierra Leone, the fool’s paradise. Is there medical oxygen available in that facility? Is there regular tap-running water?

Is there an over head light for surgical operation in the “bedroom-surgical operating theater”? Is there any equipment for resuscitation in case something goes wrong during surgery?

This was exactly what led to the clearly preventable death of a patient there on 8th October 2009. The patient who was referred by her employer, the Sierra Rutile Company for an appendicitis operation to be done at the Choithram Hospital at Hill Station in Freetown, is said to have been prevailed upon by the surgeon to have the surgery performed at his private surgery. Credible reports further quote the surgeon telling the late lady that Choithram Hospital would benefit the most if he did the surgery there. What tell-tale greed that led to the needless loss of an innocent life.

In view of all the circumstances surrounding the lady patient’s death, could it not be correctly classified as a needless and preventable death? Could the surgeon be held liable for it? Has he not contributed to yet another loss of life in Sierra Leone? Does his action contribute to Sierra Leone’s abysmal ranking in mortality? If Sierra Leone does not meet the MDGs targets by 2015, are our health care professionals and their insatiable greed not to blame as well?

In other countries, the negligent surgeon would be investigated for a suspicious death. Was there negligence (omission as well as commission) on the surgeon’s part? The chances are very high; for example, he is said to have administered the anesthetic himself and performed the surgery at the same time. This is unheard of anywhere else in the whole wide world.

Sierra Leoneans need to step up and hold accountable not only our public officials but our professionals as well. We cannot rely only on our politicians to do it for us. After all, they and their families often go abroad for medical care and treatment to countries where professionals are held accountable for their actions.

Is there a role that the Ministry of Health and Sanitation, the Sierra Leone Medical and Dental Association (SLMDA), and the Sierra Leone Medical and Dental Council (SLMDC) could play in all of this?

They should check out the suitability of our health care infrastructure and their locations in the country. The SLMDA and SLMDC should require continuing education for our doctors, nurses and allied health professionals in order to maintain their licenses like it is done in developed and other developing countries. The code of ethics of the professions of medicine, nursing, allied health and public health must be enforced by our professional bodies. These bodies owe Sierra Leoneans a moral responsibility to do so. The preventable deaths must stop!

Having highlighted the potential liability exposures of the surgeon in the above case study, it is but fitting that if the Ministry of Health and Sanitation is unable to mandate professional liability, malpractice or errors and omissions coverage for physicians and other medical practitioners under its purview, then the medical associations themselves must demand of their membership, professional liability insurance that could cover the negligence and mal-practices of physicians in the country.

A physician’s liability usually results from errors or negligence resulting in injury and or death caused by a medical practitioner in the performance of his duties. Errors such as failure to properly diagnose a disease, resulting in more serious illness, disability, or death; improper performance of a surgical procedure, causing injury to a patient; failure to warn a patient of the hazards involved in a course of treatment.

The family of the deceased patient could rightfully file suit against both her employer, Sierra Rutile Company for a death claim and against its company physician, the surgeon for wrongful death and malpractice. For clearly the standard of care expected of a trained physician was glaringly lacking in the case of the deceased employee/patient.

Sierra Leonean policymakers must realize that in other to move our ranking from the bottom of the Human Development Index, mal-practice healthcare delivery must be seen to have consequences that can quantifiably be measured and compensated to ensure that deaths are not only preventable, but when they do occur, are compensated through insurance policies.