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Field notes from Liberia
In January 2006 Ellen Sirleaf-Johnson was elected Liberian President and in doing so became Africa's first elected woman head of state. One of the biggest challenges ahead is healthcare, as Sydney nurse and Médecins Sans Frontières (MSF) field coordinator Susan Thomas writes in her Letter Home. As you drive through the towns and villages of Liberia all seems peaceful and calm with the children wearing shoes, as it should be. People smile and wave and go about their business selling cigarettes or bananas at the side of the road while chickens scratch in the dirt. It’s hard to picture the scene just three years ago when militia groups dressed in wigs and makeup and even wedding dresses, committed crimes against humanity any day of the week. Some of the soldiers were mere children themselves, others just there for the salary, not really knowing what it was all about. I wonder about the experiences of the people, including our national staff, and how they manage to pick up and go on. MSF recently set up a 50-bed hospital in a refugee camp in Saclepea, in the north of the country, where it has over 150 staff. It’s a plastic sheeting affair but it works. Just next to this we are constructing a new health centre and hope to move into it next year. This health centre provides out-patient consultations, in-patient facilities, a tuberculosis (TB) annex, and a Therapeutic Feeding Centre. We also provide vaccinations, dressings, blood transfusions and have a decent laboratory. It’s a pretty busy place, with about 3000 consultations in the out-patient department (OPD) every month and about 70 in-patients. There is no operating theatre however. Another key part of the health centre is the Women’s Health Unit which provides maternity care, family planning, sexually transmitted infection screening and treatment, and a facility to treat victims of sexual gender based violence. Among the many victims treated here was a seven year-old girl who was raped by a man staying in the family home. Her grandmother brought her to us with multiple lacerations, but it was too late for her to receive HIV prevention medications (these must be started within 72 hours). Despite this, we treated her for sexually transmitted infections (STIs) and arranged counselling and follow-up by the International Rescue Committee. We also provide a medical certificate for legal purposes that the family can choose to pursue. The man ran away but at least he will be caught since he is known to the family. This little girl seems to have what it takes to survive as she got up after a few days and wandered around the paediatric ward and the therapeutic feeding centre, looking at the other children, smiling and carrying the teddy bear I gave her. Of course it will take a lot more than this to heal the damage done. Her grandmother is a very caring and protective woman, and like many African grandmothers, is taking care of her children’s children. Unfortunately this is just one case among many in Liberia. Apart from this service, we are rehabilitating four health posts in the remote area near the border with Côte d’Ivoire where the security can be precarious. In these health posts we offer very basic maternal care, out patient care and vaccinations. We have an ambulance that can transfer patients from these posts to our hospital but even from there we refer serious cases to the regional hospital. There are many obstetrics and orthopaedic cases as well as strangulated hernias. The prevalence of HIV in Liberia is, not surprisingly, unknown. Some put the figure as high as 10% while others say it is more like 5% so we are all looking forward to adding another component to our project: HIV counselling and testing with treatment of opportunistic infections, such as TB. After that we will begin antiretroviral treatment (ART) for HIV/AIDS infection. I’m enjoying the work, the team and village life. Saclepea has a market every Tuesday where you can buy lovely African fabrics, plastic cups, batteries from China and onions; not to mention some black magic potions and various cures from the bush. There is not much food here so we have to get most of it from Monrovia which is six hours by car. The roads and bridges are in a deplorable condition and the rainy season has started. The health posts are a bumpy two to three hours’ away. We have to repair some bridges as we cannot get to one of our health posts now and they need their drug supplies for this month. When driving over bridges you don’t look down, you just put your faith in the driver. In town there is a broken down truck and painted on the rear bumper are the words “Relax, God is in Control”. I think this will be the defining slogan for my time in Liberia. » Read, listen and watch more updates and reports from Liberia
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