By Emma Black

On April 12, 2025 Aminata Kamara, a 42-year-old trader from Waterloo, felt her world crumble when nausea and exhaustion wouldn’t quit. I thought it was stress, she says, her voice thin, at Chinese Hospital, doctors urged tests at Connaught Hospital 5,000 new Leones spent, no answers yet, at Life Care Hospital Wilkinson Road, a liver test cost 1,500 Leones to do test she said, you’re sick, but money decides if you live, she sighs. Her fear, Liver cirrhosis, a silent scarring that’s tightening its grip across Sierra Leone.

Cirrhosis severe liver damage from years of injury strikes when scar tissue chokes the organ’s work, often too late to reverse. In Sierra Leone, it’s a growing threat, hitting adults hardest between 30 and 50, with men like Ibrahim Sesay, a 48-year-old driver, among the most common faces. That’s when drinking, hepatitis, or poor diets catch up, says Dr. Abdul Conteh, a Freetown hepatologist. No exact age pins the peak data’s spotty but hospitals see midlife adults flooding wards.

Cirrhosis doesn’t strike alone. Chronic hepatitis B, rampant in Sierra Leone, is the top culprit, infecting 10-15% of adults and scarring livers quietly. Heavy drinking, a social staple for some, ranks second men down palm wine or omolé (local gin), unaware each sip builds scar tissue. Nonalcoholic fatty liver disease, tied to rising obesity in urban areas like Freetown, is creeping up, especially among women like Aminata, whose diet leans on oily stews. Rarer causes autoimmune hepatitis, iron overload (hemochromatosis), or bile duct disorders hit smaller numbers but add to the toll.

I drank for years, admits Ibrahim, now battling jaundice and swollen legs at Connaught. No one warned me, Hepatitis B, often caught in childhood, lurks symptomless until middle age, when fatigue, weight loss, or yellowed eyes scream trouble. Rural folks, far from clinics, miss early checks, arriving only when bellies swell with fluid (ascites) or confusion clouds their minds.

Aminata’s journey mirrors thousands. Chai’s basic tests couldn’t confirm cirrhosis Connaught’s labs, overwhelmed, charged 5,000 leones for bloodwork and scans. At Life Care, a liver function test (checking bilirubin, enzymes) runs 1,500 leones, but pinpointing causes like hepatitis or alcohol damage needs more often 10,000 leones total for scans, biopsies, or viral tests. It’s a fortune, says Fatmata Bangura, a nurse. “Many give up.”

Sierra Leone’s health system, battered by Ebola and underfunding, leans on patients’ pockets. A 2021 study found 70% of Freetown hepatitis B patients had liver damage, yet few afforded full diagnoses. Cirrhosis cases, untracked nationally, likely number thousands yearly mid-30s to late-40s dominate, men slightly more than women, per hospital logs. Poverty kills faster than the disease, Conteh says.

Early catches can slow cirrhosis antivirals for hepatitis, sobriety for drinkers, diet shifts for fatty livers. But symptoms like bruising, itchy skin, or men’s breast enlargement (gynecomastia) often show late, when scars are thick. Aminata’s still testing, praying it’s not advanced. Ibrahim’s on meds, hoping to dodge a transplant a pipe dream here.

Health Minister Dr. Austin Demby’s pushing hepatitis B vaccines and rural clinics, but change crawls. No one should die because they can’t pay, Aminata insists, echoing X posts lamenting Health is for the rich.” For her and Ibrahim, every Leone spent is a bet on life cirrhosis doesn’t wait, and neither can Sierra Leone.