A Life Changing Week in Liberia
Liberia is three years out of a 14 year civil war. Many vestiges of the war remain. Larger buildings are just burnt out shells. Bullet hole damaged cement walls, street light poles down etc are a regular sight. The electrical grid was destroyed in the war so there are no working traffic lights and just a few operational street lights. Only those with their own generators have electrical lights at night. Travelling about Monrovia, the main city in Liberia, you go through UN Military check points surrounded by barbed wire and sand bags with soldiers holding rifles pointed vaguely your way.
It is a very strange feeling although not to imply that I didn’t feel safe. The UN military are the good guys. In fact, there are still about 15,000 UN troops here, but that is down by several thousand from a year ago and they are beginning to dismantle some check points. To me they seem almost silly considering how many people are out and about on the streets. I think there main purpose today is to prevent violence from flaring up again. The ship’s security director told me this could easily happen if not for the UN presence. I am quite sure, however, there is much more current danger from the chaotic and uncontrolled traffic and just the massive number of people that seem to be on foot walking, waiting and just living along the road sides just about everywhere. The poverty here is all encompassing. It hits you like a shock wave the very moment you walk out of the small airport that is about an hour and half from Monrovia.
Although I have travelled around rural India, China and Colombia, I have not experienced anything quite like this. The average life span for men and women is under 40 years. Child mortality up to age 5 is 24%. The illiteracy rate and official unemployment rates are both at about 80%. Housing conditions are not good at all. Tiny shacks, mud huts and decrepit buildings line the roads.
As I indicated, people appear to simply live their lives, cooking, cleaning, and selling small items and foods or whatever on the sides of the roads. There is reportedly still a small middle or upper class here, but signs of it are sparse. From a health care perspective there are 24 Liberian doctors and three dentists for a population of about three million. There were once more, but they fled during the long war. You can do the maths to see that essentially professional health care of almost any sort is simply unavailable except to the tiny few who can afford it.
The ship I am staying on is part of the Mercy Ship NGO (mercyships.org). It has about 80 hospital beds and four very compact but modern and well equipped operating theatres and a variety of other health care facilities including the only CAT scan in the country. The ship is staffed with about 400 volunteer employees who stay anywhere from one month to two years. Volunteers come from 40 different countries.
The medical professionals, food preparers, engine room mechanics and everyone else are volunteers. They are supported by 200 more, mostly volunteer employees, at the ship’s headquarters in Texas, which is where my younger brother Russ lives and works. He is Director of procurement, sourcing the 15 container loads of medical equipment, food and supplies to keep the ship functioning.
Volunteers not only work for free, they actually pay a fee to support their living expenses. Many are supported by their churches or have other benefactors. I had a nice private guest cabin. With the exception of a few senior folks all other including medical volunteers share cabins. There are a number of husband and wife volunteers with about 40 children on board. They run a school with 4 – 16 year olds and it all sort of feels like a very communal lifestyle. You can imagine the HR challenges of the constant turnover, although this is balanced by the complete dedication to and focus on the mission. As a representative of esg, I felt very welcome.
The hospital specialises in several types of surgeries that address local West African health issues. Most of these are grouped into cataract removal, I watched one of these operations, (prevalent here even among younger people), removal of benign but grotesquely large facial and neck tumours that eventually will kill the patient through suffocation or starvation, post burn removal of deep scar tissue that causes gross disfigurement and disablement, facial reconstruction to rebuild faces disfigured by bacterial infections, fistula repair surgery which is the closing of wholes in the bladders or colons of women that result from difficult deliveries (these women leak urine or feces constantly and are ostracized by their communities) and limb replacement resulting from war damage.
This is the ships second year in Liberia and they report a marked decline in limb replacements having treated many already with, fortunately, new cases not being created (by war anyway). The ship operates not only on the energy of its volunteer employees, but, except for most food which they must buy, almost entirely on the donations of medical device, technology and pharmaceutical companies. The list of donor companies would be recognizable to all of us. On a humorous note, even Starbucks is a donor since the chairman of Mercy Ships is on the board of Starbucks. I do enjoy the lattes.
Monday I spent the day on ship touring several wards and then gowning up and observing several major surgeries. When I say observing, I mean standing at the operating table virtually right next to the surgeon. It was just amazing to watch a surgeon skilfully remove a tennis ball size tumour from around individual nerves in a patient’s neck or see disabling scar tissue from a massive burn being gently removed around the tendons and nerves of another patient’s wrist and arm that will result in her being able to use the arm again. Because the only night time light source for most the population is kerosene lamps, burn injuries especially among children are rampant.
Also on Monday, we had lunch with several department heads. We mostly listened to their concerns. In any case, we had a very lively discussion about the ship’s mission, what made each of them volunteer for this service and the important role to be played by medical device and pharma companies. (There is a representative from Abbott Diagnostics and BD, two very large multi national medical companies who supply the ship medical equipment to the value of $300,000 per year at no cost.
On Tuesday, we went off ship to visit a local hospital called Redemption Hospital. It is about seven miles from here. Here is where words will fail me and I don’t think I can adequately describe what I saw. The hospital with about 60 beds is surrounded by simply absolute poverty. The facility itself is a collection of dilapidated open, cement block rooms. No air conditioning of course (Liberia is hot and extremely humid) and many windows have no screens. People are lying about here and there. Beds in wards were just wood frames with ancient and very well used mattresses. Dozens and dozens of people were waiting patiently in line for lab tests or to be admitted. The lab is essentially two microscopes. The lab refrigerator (for media storage) was empty. There were a few Vaccutainer blood collection tubes about and virtually no instrumentation. The operating room was in such condition that (and I know this sounds arrogant) we would not take our pets there for care.
I visited the "pharmacy". It was fairly well stocked with some syringes but the technician there virtually begged the representatives from the medical/pharmaceutical companies for more once they learned where he was from. They often run out of the most basic supplies including syringes. Last week they were down to just four bags of IV fluid before they finally found more. The sights and the smells of this facility will stay with me for quite some time. And yet there are signs of hope. This hospital was run by Doctors Without Borders for the worst of the crisis. They left shortly after the immediate crisis was over and I was concerned to learn they do not leave too much capability behind.
However, for the past seven months the hospital has been managed by a representative from the Clinton Foundation as part of their initiative to upgrade local health care facilities. In addition to the work we are aware of from Clinton, Denise reports this capability building of local hospitals is another parallel initiative they are trying. In spite of the backing of Clinton, she is completely by herself. It is as if she is trying to empty a super tanker with a tea spoon. She lacks many of the basics. I learned how difficult it can be to make a valuable contribution. They have received a new clinical analyzer from a European company. No one knew how to use it when it got here and the reagents did not survive the shipping.
Denise is trying to get a supply brought in by UN helicopter from elsewhere in Africa. During our visit we saw a technician from the Mercy Ships training a small group of Liberians on how to use the machine. The class even without reagents could not have been more attentive and engaged Mercy, that day, was also running a dental clinic at the hospital. Recall, with one dentist for each million residents dental problems go unchecked and often become fatal. Across an alley, Doctors Without Borders, was still running an outdoor childhood immunization clinic, full of energetic and smiling young children and their mothers.
Wednesday we travelled some way out into the bush to an area called Tenegar. It was probably not too far in miles, but it was a bone jarring ride on dirt roads through small villages where people have no vehicles and housing was often just mud brick huts. Health care even as it is, is accessible to them after a very long walk. Some walk for days and if they are bringing someone who is not mobile they carry them in a wheel barrow.
Our destination was a rural 10 bed clinic that Mercy Ships is restoring. The clinic was built in the 1960’s, but was destroyed by war in 1992 and has been a vacant shell ever since. Mercy employs local village volunteers to do the work. They were just putting the roof on now. Mercy will supply the clinic with materials and the Liberian Government has committed to staff it. I talked to one worker who told me about how, during the war, he had to sometimes hide with his family in the bush for days to escape the rebels. He said if they saw you they just killed you. (Reportedly almost every Liberian lost someone). He and his four or five co-workers were so thankful for the work that Mercy Ships is doing. In fact, everywhere we go people wave at us when they see the Mercy Ships logo on the side of the jeep.
Thursday we visited a fully functioning health clinic in an area called Gayetown. We reached this after about an hour drive from the ship. The location was also a very long way down dirt roads from any other health care facility, especially if one was on foot. Mercy Ships had completely rebuilt this facility on its visit last year. Today was eye clinic day and there was a large crowd patiently waiting for their turn to see a care provider. There were clearly more people waiting than were going to get into the clinic on that day. This was a simple, but very clean and well stocked facility providing a service to area residents that simply would not be available if not for Mercy Ships.
After our visit to the clinic we continued on for a short way to the Congo Bible School that Mercy Ships had also rebuilt last year. We heard that virtually all schools were closed for many years during the war and many children were pressed into military service. The children at this school included 200 former combatants. The school appeared to be well run and well attended. Just outside of the school gate we were surrounded by a group of about 30 small children. Some were too young for school but others looked old enough. They all begged us to take their pictures. Since they are very poor and likely do not have mirrors at home, seeing themselves through a digital camera view screen was a very big treat for them.
My last day, I witnessed one more surgery back on the ship. It was a repair of a club foot on a 15 year old boy. In about 60 minutes time the surgeon skilfully put scalpel to tendon and stretched the foot to be reset in the pot. It was just amazing to witness this.
On Monday, the ship’s chief surgeon said something that has stuck with me. He said, " there are developed countries, there are developing countries and then there are surviving countries. Liberia is just trying to be a surviving country." It is impossible to be part of this, even in some small way, and not be completely affected by the experience. It is just unbelievable to see so first hand what man has done to man through violence and neglect and at the same time see how people are helping people in the most selfless way as the people on this ship and folks like Denise Walsh are doing every day. It is frightening to see just how large the challenge is even in this one small country, but inspiring to know that people here supported by esg and others are really making a difference.
I am grateful for the opportunity to see Mercy Ships in action. On Friday I was ready to leave, but the memories of this visit will long remain.
esg is making a financial contribution that will finalise the restoration of the 10 bed clinic in Tenegar is complete.