Liberia - last days

Monday – Tuesday - Wednesday 14th – 15th – 16th May

Tuesday morning in our clinic at New Kru Town. The waiting room is packed. It's very hot, smelly, noisy and about 200 patients want to see a doctor. Around 11 women gave birth during the night or in the early hours and therefore have to share their beds. At least two women per bed with their newborn baby. And we complain when we can't have a bed in a single room back home! Another 5 women are in labour in the other room.

Monday is usually the busiest day of the week. Liberians don't like to come on a Friday I am told. Work, looking food, lack of money, ignorance about the severity of their condition and probably the idea of the weekend puts them off of going to the hospital. However Monday 14th was Independence Day and the clinic was closed. So now Tuesday it's even worse than any other Monday.

Sofie and I decided to follow a patient. Theresa is 27 years old and suffers from high fever and acute headache. She arrived around 7.30 in the morning to get a number to see the doctor. By noon she's still in the waiting room. I have trouble staying there and I am not the one with an excruciating headache. It's noisy because the nurses keep on shouting numbers, babies are crying, people are talking loudly, it's even hotter than in the morning and the air is missing. Theresa is a typical malaria case, or at least that's what we suspect. Malaria is more and more frequent around this time of the year. Most people who come to the clinic are treated for this condition that is life threatening. Symptoms are a very high fever, chills and headache. If you leave it untreated, you can start convulsing, fall in a coma and die.

While Theresa is waiting just to see a doctor, Sofie and I go to the family planning. This is a program that is working very well. Women who have just given labour are advised to rest a little before they have a new baby. This is good for the mum but also for the newborn as it will breastfeed longer. Teenage girls who don't want to become pregnant also come here to get their free pill. One girl, 16 years old, came just to get her pill but during the consult we realise that she is shivering. I put my hand on her forehead, she is burning. Probably malaria. The nurse tells us where she needs to go and probably because Sofie and I were with her she is treated immediately. Well immediately is a vast conception. The result for the simple malaria test is negative and so they have to do a smear. Christiana will have to wait another 3 hours before it's confirmed she's indeed suffering from malaria and receive proper medication.

It's not the staff's fault. They are highly qualified, do a really good job, but they're just too many people. The corridors, the benches, the waiting rooms, the floors, everywhere it's packed with people waiting. Most of them wait for hours.

Theresa is still in triage. It's now 2.30 and she still hasn't seen a doctor. She's got number 108 and they're not there yet. I could have found a patient with a smaller number but I want to know I long it takes to see a doctor here. So far Theresa has had to wait for 6 and a half hours!

Theresa has nothing to read, she basically can't read anyway. She is staring quietly , not moving as she is scared she might lose her seat. Interviewing people in Liberia is not easy. They're friendly and very happy to talk to you but their English is so different from mine. They don't really understand my English and I have trouble with theirs. Somehow over the last week it's easier cos I am getting used to it but still. Here they call it pidgin English. Antenatal care is called "belly check", "passing poopoo" is diarrhoea, titty water is breast milk etc… Another difficult thing is that most people actually have no idea how old they are and how old their children are. For me, Western girl, absolutely obsessed by time it's the most difficult thing to grasp. They're usually in between ages. "I am in between 25 and 30 years old, my baby girl is about 5 to 6 months". Sometimes you definitively see that the baby girl is closer to one than to 7 months but most of the time it's hard to say.

This is a major problem when it comes to vaccination. Some vaccines can only be given after 5 months. Doctors therefore usually ask questions regarding the season, the sun and determine if the baby is old enough. You have to find a solution to everything here.

With the rape victims I have interviewed today, it's the same problem. They usually don't know when they have been raped. You have to kind of guess according to historic events. The woman today was raped somewhere during the first world war so probably around 1990-1992. As she told us she was married at that time we also determined her age: around 35 (and not 27 as she thought she was). Time is a different conception around here.

Theresa will finally see a doctor around 2.45 (yes I have a watch). Her malaria test is negative but her urine test is positive. She's got a urinary infection. She should have come on Friday when she had the first symptoms. That's why today (4 days later) she's got fever, pain in her lower back (due to the kidneys). But the main thing is that with strong antibiotics she'll be ok. So back to another waiting line: the pharmacy. About 25 people are before her in the queue. It will probably take another 30 to 45 minutes.

I can't stick around cos we have an emergency. A little boy with malaria is unconscious and needs to be transferred by ambulance to our other hospital. The mum is crying in despair, we rush to the hospital with An the midwife.
In Island hospital, doctors are immediately attending to him, I'm taking the mum to registration and trying to calm her down, reassuring her a bit. A few minutes later a nurse and I are putting the boy in a tub and put cold water on him to get the fever down and get him conscious. The boy will be fine but again it proves that sadly people wait too long before coming to hospital. Of course it's not their fault. They don't know, have no money. They're just trying to survive.


On a more personal note, I have been running a little bit in Monrovia. Never thought it to be possible as security is very tight but it is as long as you have a guy with you. So I have been running twice: once to Africa hotel (in the pre-war glory day the most beautiful hotel in the city) and to the beach. It's quite surreal to run here but it was nice. Also, Sam, the watsan (water and sanitation) specialist has taken us for dinner last night. We went to New Jack's, local bar/restaurant in downtown Monrovia run by Myriam, a Liberian woman married to an Oxfam employee. Her mum was there and told us about Liberia's history, the wars and the problem this country is facing today. It was nice to get an "inside" perspective. And if you ever go on holiday here, and hopefully one day it will be possible, it's the best food in town!