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Ebola Crisis in Sierra Leone Masks Other Health Woes

Women and children share a bowl of rice and cassava as they wait to be screened for the Ebola virus at the Wellbody Alliance clinic in Gbense Chiefdom in Sierra Leone's rural Kono District. All visitors go through a triage process to identify any possible Ebola cases. This includes a questionnaire, temperature check and hand washing with a 0.05 percent chlorine solution. Image by Michael G. Seamans. Sierra Leone, 2015.

Alusine Kamara is weighed during a checkup at the Wellbody Alliance delivery center in Sierra Leone. Alusine was the first baby to be born in the center. His twin brother was born hours before at their home. Complications arose during Alusine's birth that prompted his mother, Salome, to go to the clinic for medical care. Image by Michael G. Seamans. Sierra Leone, 2015.

A sign outside outside Kono Government Hospital informs citizens of the free health care law for all pregnant and lactating women as well as children 3 and younger in Sierra Leone's Kono District. According to an international report, 48% reported they have payed a bribe for medical or health services in the last 12 months. Image by Michael G. Seamans. Sierra Leone, 2015.

Salome Kamara, left, sits on her bed with one of her twin boys as a friend holds the other boy at her home in Dorma Village in Sierra Leone's Kono District. Kamara gave birth to the first twin on this bed; the second twin was breeched and required a medical facility. Image by Michael G. Seamans. Sierra Leone, 2015.

Physician Andy Hall with Partners in Health instructs Esther Nguajah, a traditional birthing attendant, on how to shed her personal protective equipment at the Wellbody Alliance delivery center in Kono District, Sierra Leone. Image by Michael G. Seamans. Sierra Leone, 2015.

Mr. Fengai, a traditional healer, performs a ritual ceremony to prevent a miscarriage for a young woman, Bintu Willam, who has already lost two babies in Kamadu Village in Sierra Leone's Kono District. The ceremony requires participation from both her husband, Komba Bockerie, left, and, Bintu. Image by Michael G. Seamans. Sierra Leone, 2015.

Aminata Kamara, 25, is being treated for uncontrolled bleeding at Kono Government Hospital in Sierra Leone. Two days earlier Kamara underwent surgery to have her dead fetus removed. Image by Michael G. Seamans. Sierra Leone, 2015.

A woman stands outside the delivery room as her daughter receives critical care at Kono Government Hospital after a miscarriage in Sierra Leone. Image by Michael G. Seamans. Sierra Leone, 2015.

Aminata Kamara, 25, is prepped for a blood transfusion during treatment for uncontrolled bleeding at Kono Government Hospital in Sierra Leone's rural Kono District. Image by Michael G. Seamans. Sierra Leone, 2015.

Ana Lebbie, left, raises her hands in prayer as she sits with her son-in-law Sayoa Kamba, center, and Sayoa's mother, Njalai Kamara, while intensely waiting outside the delivery room for the birth of a second twin at the Wellbody Alliance delivery center. The first twin was born at home with no problems. The second twin was breeched and required immediate medical attention. Image by Michael G. Seamans. Sierra Leone, 2015.

A team of traditional birth attendants and nurses rejoice after delivering the first baby in the newly opened Wellbody Alliance delivery center in Sierra Leone. The mother, Salome Kamara, gave birth to twins. The first birth was at home; the second twin was born in the clinic after complications arose. Image by Michael G. Seamans. Sierra Leone, 2015.

KONO DISTRICT, Sierra Leone — Although one of this country's poorest districts has been Ebola-free for six weeks, the deadly virus continues to mask or hamper other health issues for pregnant women and newborns here.

Home births without trained medical staff contribute to one of the world's worst infant mortality rates. Ebola's death toll in Sierra Leone, about 3,800, is dwarfed by the 39,000 children under age 5 who die each year, often of preventable causes like pneumonia, diarrhea and malaria, according to the World Health Organization.

One in 20 newborns in Sierra Leone die within the first month.

Only 45% of women here use skilled birth attendants. Many women are reluctant give up ideas they associate with a child's spiritual health. For example, professional midwife Boyama Kacingor, of Kono, said some traditional healers tell pregnant women that eating eggs, a source of protein, will cause their children to become thieves.

Despite a national law that guarantees free health care to pregnant women, children and nursing mothers, nearly half of Sierra Leoneans told a survey by Transparency International they had recently paid a bribe for health services — a practice that prices some poor women out of the delivery room.

Sallie Cunceh, a driver from the city of Makeni, said he paid about $35 when his son was born at a hospital in Freetown, the capital of Sierra Leone. "If you don't give it, they will leave your wife suffering," he said. "Give them whatever they request."

Problems of corruption, access and mistrust — all mostly rooted in poverty — limit the options for women like Salome Kamara, 27, who last week went into labor with twins. Her home has no electricity or running water, a tin roof, a dusty dirt floor and walls of mud.

With help from a traditional healer who lives nearby, she gave birth to a boy, named Lansana, on the bags of grass she and her husband use as a mattress. The newborn's cries sounded healthy in the early dawn, but the second child was breech.

The sudden complication prompted the traditional healer to ask for help from a new delivery center in Kono that had just opened. Wellbody Alliance, which has operated a health clinic for nine years, has been building trust in the community, partly by staffing the center with traditional healers from surrounding villages.

That call about Kamara triggered the deployment of a medical team that included Finda Samuel, who has delivered babies in Kono for 15 years, but is now trained as a traditional birth attendant for Wellbody.

Samuel helped deliver Lansana's brother, Alusine, who became Wellbody's first birth.

Kamara's experience serves as an example for women moving from delivering babies at home to clinical births, said Storm Portner, the clinic's co-manager of community programs.

Ebola has also had an indirect effect on the clinic. The delivery center was scheduled to open last September, but delays because of the Ebola outbreak caused an estimated 600 pregnant women to be sent elsewhere, Portner said.

The main clinic has also seen its patient counts plummet because of the panic over the virus — from 20,000 in 2013 to just 11,400 last year.

A 2014 report for Kono Government Hospital, which became stigmatized after a stint as a temporary Ebola treatment center, showed the Ebola virus killed 18 children under age 5. But indirect effects prevented an estimated 3,300 newborns from being registered, a first step in getting free health care in the country.

Ronald Marsh, the hospital's medical director, said it's difficult to know how many deaths could be indirectly attributed to Ebola, but "of course, it's way more" than the 226 Ebola deaths in the district.

Meanwhile, hours after the birth of her twins, Kamara nursed Lansana on a clean bed in the delivery center. Samuel and other health workers brought her food and helped make her comfortable. And the staff gave her a lapaa as a gift — a brightly colored cloth wound around the waist like a skirt.

For future births, Kamara said, "I will choose the clinic."