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Dying with out solutions: an agonising 24-hour hunt for medical assist in Guinea-Bissau | World well being

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In their 15 years collectively, Maimuna Catchura had not recognized her husband to be in poor health. However one night time in late January, 39-year-old lawyer, activist and musician Bernardo Catchura couldn’t sleep, and complained of extreme abdomen ache.

The ache compelled Catchura from his mattress at his home in Bissau, Guinea-Bissau’s capital. That night time he would navigate the nation’s medical care maze, visiting pharmacies, clinics and hospitals. Earlier than the night time was by way of, he even thought-about crossing the border into Senegal to get assist.

However wherever he appeared, nobody was accessible to assist the daddy of three, and fewer than 24 hours after his pains started, he was useless. It was a tragic destiny for the person who had spent many years campaigning for enhancements to Guinea-Bissau’s healthcare system.

Maimuna Catchura holds the photograph of her late husband with two of couple’s three children outside their home in Bissau.
Maimuna Catchura holds {a photograph} of her late husband with two of the couple’s three youngsters, exterior their house in Bissau. {Photograph}: Ricci Shryock

Catchura was a number one member of the activist band Cientistas Realistas, which used music to succeed in and mobilise younger folks and protest towards authorities failings. “What occurred was precisely what he was all the time speaking about in his songs concerning the well being system,” says his widow, Maimuna.

A rustic with a inhabitants of 1.9 million in west Africa, Guinea-Bissau boasts well-conserved environmental parks and a proud historical past of hard-fought nationwide liberation. However its folks face persistent instability and financial inequality. Nearly 70% of the inhabitants dwell on lower than $1.90 a day and greater than 10% are meals insecure. The life expectancy is 58 years.

Healthcare consultants say that at each step on the street to medical consideration sufferers face potholes reminiscent of pretend remedy, shortages of apparatus and medical experience, and frequent strikes by well being staff.

When painkillers weren’t serving to, Catchura referred to as a non-public clinic. Nobody answered the cellphone so a buddy drove him and his spouse to the general public army hospital in Bissau.

Most roads are unpaved, however as a result of January is in dry season, the drive solely took 20 minutes and was comparatively clean. In wet season, torrential downpours go away craters within the metropolis’s purple earth and make journey tough.

A scene in central Bissau, the capital of Guinea-Bissau.
A scene in central Bissau, the capital of Guinea-Bissau. {Photograph}: Ricci Shryock

On the army hospital medics stated Catchura wanted surgical procedure, however that that they had no services to function. They despatched him on to the nation’s largest public hospital, Simão Mendes.

However Guinea-Bissau was within the grip of a nationwide well being staff’ strike, and regardless of its standing as a referral hospital that ought to provide specialised therapy, nobody at Simão Mendes was certified to deal with Catchura, his household say.

Aissatu Forbs Djalo, a physician at Simão Mendes and member of the nationwide well being staff’ union, says salaries are too low and sometimes go unpaid. Medical doctors are paid on common £250 a month and nurses as much as £130.

“The federal government finances doesn’t enable the well being system to pay the docs what they want,” says Djalo.

Aissatu Forbs Djalo, a doctor at Simão Mendes hospital in Bissau and member of the national health workers’ union.
‘Lots of people die from illnesses that may be prevented’ … Aissatu Forbs Djalo, a physician at Simão Mendes hospital in Bissau and member of the nationwide well being staff’ union. {Photograph}: Ricci Shryock

Political instability has crippled public providers, particularly healthcare. In 2016, Guinea-Bissau had one physician for each 10,000 folks.

There have been 10 accomplished or tried coups within the nation since independence in 1974.

“Till we have now a steady authorities, which may full its tenure, we will be unable to stabilise the general public sector,” says Dr Magda Robalo, excessive commissioner for Covid-19 and a former well being minister. “So that you can have cash to pay staff, you want to have the ability to acquire cash.

“There isn’t a supervision and efficiency critiques. There isn’t a meritocracy.”

An ambulance drives passes in downtown Bissau.
A passing ambulance in downtown Bissau … travelling exterior Guinea-Bissau even for minor well being complaints is commonplace. {Photograph}: Ricci Shryock

A physician who owned a non-public clinic suggested Catchura to go there. However when he arrived on the one-story, blue and white constructing, the lights have been out. The clinic had closed for the night.

Catchura thought-about embarking on the four-hour automobile trip to neighbouring Senegal. Travelling exterior the nation for even gentle well being complaints is commonplace however he was, by now, in intense ache.

“Lots of people die from illnesses that may be prevented,” says Djalo. “If somebody has a cardiovascular sickness, they could die on account of lack of specialists, and we shouldn’t have diagnostic tools.”

Simão Mendes had a partnership with a hospital in Senegal the place it might ship sufferers, however Covid restrictions ended it.

At 7am, Catchura and his spouse returned to the non-public clinic, the place he waited 4 hours to be admitted. Maimuna went house to make soup for her husband. She was positive he can be hungry when he returned from surgical procedure. However there was no operation.

Catchura died and Maimuna nonetheless doesn’t know the trigger. Failure to establish causes for dying are one other widespread prevalence in Guinea-Bissau, the place Djalo says there are few pathologists.

The Catchuras’ eldest daughter, Melisiana, 13, studies at home
‘Bernardo was all the time centered on college,’ says Maimuna … the Catchuras’ eldest daughter, Melisiana, 13, research at house. {Photograph}: Ricci Shryock

Robalo says there are numerous hurdles to fixing the damaged system, however one strategy can be to bolster group well being provision, which has labored in different international locations. “We will construct a bottom-up system that may deal with folks far-off from the hospitals,” she says. In line with Unicef, 66% of the inhabitants dwell greater than 3 miles from a well being centre.

What occurred to Catchura quantities to negligence, says his buddy, fellow activist and band member Lesmes Monteiro, however the circumstances are all too widespread. “There are plenty of Bernardos.”

Maimuna, wearing widow’s black, has tears streaming down her face as she talks about her husband. He wished their three youngsters to review, she says. “Bernardo was all the time centered on college.”

College is cancelled due to Covid-19 and academics’ strikes, however below the mid-morning daylight the 2 oldest youngsters examine on the veranda, heads buried in books, as their father’s as soon as had been, hoping to enhance his nation.

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