Tanya Haj-Hassan is an MSF paediatrician and worked in Liberia where MSF set up the Bardnesville Junction Hospital (BJH) in 2015 to provide urgently needed care for children during the Ebola epidemic.BJH admits about 100 children per week for conditions including malaria, severe acute malnutrition, non-bloody diarrhoea and respiratory tract infections. It includes an emergency room, intensive care unit, pediatric ward and nutrition ward, as well as Liberia's only pediatric surgery program.
Before I left for Liberia, I got a lot of briefings about the situation there and I was told that the mortality rate was quite high and that I should expect that when I arrive. But I think nothing could have prepared me for what happened my third week there.
When I first arrived in Liberia, I assumed that most of the deaths would have been a consequence of tropical diseases. But then, after I started working there I realized a lot of the reasons they were dying were things, generally diagnoses that kids survive in a high-resource setting. But they were presenting very, very late. They would often present at the point where they were in organ failure for instance and also, in the interim, they were at home receiving local remedies that were often very toxic.
Another huge contributing factor is malnutrition. You can have a healthy child develop pneumonia or, a gastroenteritis, like a vomiting illness, and they'll recover quite quickly from it. But when you have a child who's severely malnourished, you end up with kids that are very, very ill and are often hard to treat.
It was a normal start to the week on Monday morning and then I got in and it just all started at once and kids were coming in really, really sick. We were resuscitating kids outside in triage, and by the end of the week we lost 23 kids in total, in one week.
The mortality rate had been high already, but that week was especially bad. And so, we all got together, and we started discussing what we could do stop this
We decided to start with communication. We worked on basic communication techniques that would help people convey information about patients in a clearer manner, and help you formulate your ideas about the patient better so you can make better plans. We worked on structured training most days and more informal training. We worked on better 24-hour care. We decided to round twice a day rather than once.
We noticed that the majority of patients that were dying, were dying in the evening hours, so we started thinking about ways that we can address that. So we advocated and worked with the administrative team to hire an extra physician’s assistant that could help cover the nighttime hours so that they were less overwhelmed and had more time to care for the patients.
There was a lot of hard work that went into those six months, and most of that hard work was done by the local staff. We certainly saw a correlating trend in the mortality rate. And it dropped drastically over the period of those quality improvement projects
And it was always really exciting to see the staff celebrate drops in the mortality rate. And then just when you think it couldn't get better, two weeks later it dropped a little bit more. It's a good reminder that there are things that we can make better.