Changing the Odds

After years of civil war and Ebola that decimated the health care system in Liberia, Partners In Health is committed to changing the odds for the Liberian people.

Story and photos by LuAnne Cadd

When 28-year-old Elizabeth Sieh gave birth to healthy triplet boys at J.J. Dossen Hospital in Harper, Liberia, it was cause for celebration on several levels. Just two years ago, the outcome would likely have been very different.

Elizabeth received an ultrasound that alerted the doctors to a triplet birth – a difficult delivery in any country, let alone Liberia. She was started on steroids prior to the cesarean section to accelerate the growth of the babies’ lungs; surgical instruments were sterilized in the new autoclave; the newly installed generator ran the operating room’s air conditioner in the newly refurbished operating theater (where surgeons can suffer from heat exhaustion in the 32+ ºC heat); the supply chain team located the required special sutures in the capital of Monrovia and MAF flew them southeast to Harper in time for the operation. Fourteen staff stood ready to enable a safe delivery for Elizabeth and her babies, including experienced local and international doctors, nurse anesthetists and midwives. Three teams stood by, one per baby, ready to resuscitate if required.

The successful triplet birth demonstrated a new level of care at the only hospital in Maryland County, the beginning of change that Partners In Health is committed to bring to Liberia’s health care system.

Changing the Odds

The odds have never been in a Liberian’s favor. Prior to 2014 the country had fewer than 200 doctors for the entire population of 4.3 million, due in part to back-to-back civil wars. In the US and most European countries, 10,000 or more doctors serve the same number. If you were a pregnant woman in Liberia, you had a 1 in 28 lifetime risk of maternal death. Compare this to 1 in 8,400 for European Union countries.

It’s difficult to imagine it could get much worse, but it did. In 2014, the Ebola epidemic struck, shattering the already weak health care system. At the invitation of the Ministry of Health (MOH) in late 2014, Partners In Health (PIH), an American NGO, came to Liberia to respond to the Ebola crisis in southeastern Maryland County, a 16-plus hour drive from the capital of Monrovia on brutal dirt roads.

After Ebola came under control, PIH stayed to focus on a long-term plan for rebuilding the broken health care system. It could take decades, but PIH is committed to changing the odds for Liberians.

The Decades Solution

In July 2016, PIH doctors Jason and Sara Beste arrived in Liberia to work in Harper where PIH is based in Maryland County. Jason is an Internal Medicine and Infectious Disease specialist and the Director of Clinical Services for PIH Liberia. Sara is a Pediatrician.

“We had worked in Malawi and thought the system had challenges but they were nothing compared to here,” Sara says. “Even the most basic systems have been so difficult to get working. Everything is hard but also a lot more rewarding because you see change so quickly when you start from very little.”

In just two years, PIH has worked to significantly refurbish two major facilities in Maryland County: J.J. Dossen Hospital in Harper, and the New Pleebo Health Center in Pleebo which serves a city population of approximately 23,000 plus outlying areas. They are working hand in hand with MOH colleagues to staff and oversee the two facilities and supply necessary equipment such as the first X-ray machine since before the civil war, new generators, building the first Oxygen Plant in the southeast of Liberia, and considerably improving the supply chain for medical drugs.

‘Quickly’ is relative, however, when the need is for permanent and stable change, but with time and commitment it is possible as PIH has proven in Haiti and Rwanda. In 2000, Rwanda’s maternal mortality rate matched Liberia’s: 1,071 deaths per 100,000 live births. Through the hard work of local leaders and partners, including PIH, the number of Rwandan women who die from pregnancy or delivery has decreased 80%. PIH is working toward the same kind of transformation in PIH-supported facilities in Liberia, with a five-year goal of zero maternal deaths.

“PIH believes in the ‘accompaniment’ approach which is to support the Ministry of Health,” Jason explains. “We will build or refurbish hospitals and clinics, but we hand it over to the Ministry. We’ll hire physicians and nurses to work side-by-side with the Ministry, but we don’t take over their jobs. If you want real change, you don’t build your own clinic, staff it, then leave in 10 years. There are only 40-50 Liberian doctors actively working in the public system in the country now. If you can build up all the medical education programs, then maybe 10 years from now there will be 300 doctors in Liberia. The goal is to work yourself out of a job, but it can take decades.”

Minnie Horace is a Liberian working with PIH as Clinical Lead Nurse. She received her nurse training in Canada and gained experience working at a hospital in Texas before returning to Liberia in 2014 to work with PIH during the Ebola crisis. Now Minnie mentors Liberian nurses working in PIH-supported facilities, an important part of strengthening their skills now and for the long term.

“I love mentoring the nurses. In my perception from back in the day, it was completely different from our new nurses now. I think after the war the basic knowledge, the foundation, was really lacking. I see the gap is great. It’s challenging but I like it. It gives me the greatest joy.”

A Partnership with MAF

Getting to and from the capital of Monrovia and Harper by road is nothing short of torture, particularly in the rainy season. PIH requires constant travel between the two cities for staff movement, emergency and cold chain medicine deliveries, transferring patients, bringing in technicians to service equipment and a host of other needs. Most of this transport is done by MAF and the gratitude from PIH is overwhelming, due in small part to the personal experiences of those who have taken the dreaded road trip.

Minnie pulls out her phone with pictures, a common response when the subject of ‘the road’ comes up. It’s a sea of mud like a storm of frozen waves, at times peaking higher than the cars. “Sometimes if MAF is too full, I take the road. We got stuck for two hours last time. That’s a good day. Sometimes you get stuck for days.” Once on a trip from Zwedru to Harper with a car full of 13 nurses for HIV training, the six-hour drive lasted 17 hours.

At the beginning of the year Jason boarded a car instead of a plane when the MAF aircraft was down for maintenance. “It took 16.5 hours. Everyone vomited multiple times. I was taking chemo-therapy-doses of anti-nausea meds, and giving it to every passenger. That’s how terrible the roads are, and this was the dry season.” In the rainy season, the road often becomes impassable.

Ask any of the staff with PIH or the hospital how MAF helps and you will hear stories.

For Dr. Sara Beste, who deals with malnutrition in children, it’s getting supplies of Plumpy’Nut via MAF.

For Katie Letheren, PIH Clinical Operations Officer, it’s flying in X-ray technicians or preventing drug ‘stock-outs’ (running out of a drug) by transporting program meds for HIV, tuberculosis, malaria, leprosy, and reproductive health on a weekly basis.

For Dr. Methodius George, Liberia’s Medical Director of J.J. Dossen Hospital, it’s being able to transfer seriously ill patients to a referral hospital by plane rather than by car for a full day on extremely rough roads, plus MAF’s response to emergency requests such as the sutures for the triplet birth – all to save patients’ lives.

Ian Mountjoy, PIH Director of Operations for Liberia, summarizes it best. “Our partnership with MAF has really made it possible for us to be able to work as extensively as we do here in the southeast given how remote it is and how unreliable it is getting vehicles back and forth. If we didn’t have MAF, we’d really struggle to do work this far out.”

Building Trust

The successful birth of Elizabeth’s three baby boys represents the change that is already taking place in Maryland County and that is cause for celebration.

“It’s amazing to be involved in the rebuilding process and already see change in the short time that I’ve been here, working hand-in-hand with the Ministry of Health in Maryland County which is very open and supportive,” Jason says. “This was the hospital for the dying. Now the community is starting to trust again.”

In the end, it’s all about giving Liberians more than just a chance at surviving an illness, accident, pregnancy, or birth. Partners In Health, working with the Ministry of Health and supported by MAF, are changing the odds.