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!

Weekend in Liberia

Saturday – Sunday 13th May

It's the weekend and so operations are a bit slow. Saturday I was invited at a wedding. Two members of the staff were getting married. One British girl with an Ethiopian man. In the morning Céline, Sofie and I went to chill out on the beach and get a tan. Well at least for Céline and Sofie. I just get either red or stay completely white. As I want some colour, I just stay in the sun. Result: I am red and have some spots on my face. Hopefully it will go away before I get back.

Talking about getting back… This is going to be difficult. I really like it here. The staff is great, expats and nationals, they made me feel more than welcome. I am not counting the days when Wednesday comes and I will have to catch the plane to Brussels. I am happy to see my friends and family back but also really like my job here. I hope I'll get the chance to go back on the field soon.

The wedding was set on Golden Beach in the centre of Monrovia. The sea there is completely different from the one that we usually go to (Cece beach). It's impossible to swim there as it's rough and dangerous. It was a really nice buffet and it was a good opportunity to speak to the staff in a different setting than just plain work.

I also had the chance to speak more extensively with the national staff. I wanted to know how they live, how they spend their days outside the NGO, how they saw the future, if things had changed since the war. They wanted to what Belgium was, like how I live and why white women are so scared of spiders .

Blackie, one of the national staff, invited me for the next morning to his church as I wanted to know how an African mass is celebrated.

The next morning I took the car downtown to an area where probably it's rare for "white" people to go. Blackie was waiting for me, all dressed up and proud that I would do the honour to visit his church. He had even warned the pastor that I was coming. African mass is very different from what we know. First you get the pastor to preach and then they basically sing and dance for nearly two hours. What's not different is that they have to give money to the pastor. For a population that's living on less than 1 dollar a day, they surely give a lot to the church. Blackie explains to me later that it's only because they actually don't have a church. It's kind of a small house with bullet holes (probably a leftover from the war in 2003) and a metal roof. No more than 15 people can sit in it but the community is growing so they need to move, hence the money… Hum

Houses are as scarce in Liberia as is clean water. They're a few from the glory days before the war and rarely inhabited by Liberians. Most "houses" are either ship containers that European companies just dumped, in "full" wood or "small" wood. Don't really know how the explain it correctly but some houses are entirely in wood, others just have four wood sticks and a metal roof.

Apart from being extremely hot, Liberia is one of the most humid countries in Africa, if not the most. It rains here regularly and when we complain in Belgium about a heavy rain shower, just come here and see hell break in the sky. It's amazing. But not for the people living in the wooden houses. After a rainy night you can see that it has rained inside their houses. You also have to imagine that they haven't got a running water system (nor toilet system) and no electricity (some have generators). The morning after the rain the smell inside the city is quite indescribable.

Cars are also a big issue. People have no money to buy a car and mostly take the cab. You have to imagine that yellow cabs are not taking one person but several people. They just hop in along the way, mostly four people cramped in the back, three in the front.

Africa can be considered as Europe's dustbin. Well at least Liberia, I haven't been to all the other countries and wouldn't call myself and African connoisseur. They get the t-shirts we can't sell anymore, the toys we wouldn't give to our children etc. The worst are the cars. If you ever wondered were your 13 year-old car is, well now you have the answer: it's in Africa polluting the atmosphere. I saw a car with a smap (Belgium insurance company now called something else) sticker on the back and one with a Kortrijk (a city in Belgium) sticker. A vast majority of the cars (used as cabs, Liberians rarely have a car) also have stickers at the back showing what country they're from (B for Belgium, CH for Switzerland, NL for the Netherlands are the most popular).

As a result, Monrovia is extremely polluted and it's sometimes hard to breathe when stuck in traffic. All this time we are lobbying for the environment and at the same time we dump our old, polluting cars on the poorest.

For those who are interested in reading more about Liberia and the NGO's, an actual writer has actually written a very good piece in the Observer. "Letter from Liberia", Zadie Smith, 29 April 2007. Go and check it, it's brilliant.

Liberia 4

Friday 11th May

I already told you that Liberia has a high number of rape victims. For this my NGO has set up a special sexual violence program. One of the key person in this program is Angie, the psychologist. She's training 3 social workers who counsel the rape victims. Two for the adults and one for the children. Raping children is quite common here as well.

The 2003 civil war but also before (they refer it has world war I&II – between 1989 and 1997) has made rape a "natural" thing. Many women, children were raped by the rebels and the army. Today, the perpetrators have still not been punished and rape is still very much part of their daily life. We also went to see the Female Lawyers association ,which is helping to change the rape and gender based violence law. Slowly the country is changing but it will take years before the rape stops altogether.

Interviewing rape victims, especially children is extremely hard. I begin to get the impression that I am this white girl coming to Liberia to hear all the miseries of the world and then is going to go back home to my comfortable daily life and routine. And worst part is: it's true. Next Wednesday I'll be back home. These people still have to live in terrible conditions. I'll just worry about what to wear on my next date. I have these extremely mixed feelings: I feel guilty and at the same time I can't take all the misery of the world on me. Already I am helping a little bit by raising awareness of what is happening here. A beautiful country with very capable people that have sadly been living in a country destroyed by 20 years of civil war. They have to start everything back from scratch.

Despite all that, there is hope. This morning we went to the delivery room of the hospital we work at. A lot of women were in labour but as I have learnt over the last few days, it can sometimes take hours before they actually have their baby. But this morning we were lucky: 4 babies were born. And all boys! One woman even had twins. All perfectly healthy babies. So good to see this especially after the last few days.

I was a bit apprehensive with the labour. Probably I'll go through it one day and somehow I thought that seeing a delivery would put me of the idea. But it was great. Ok, it's very impressive and the first one is not scary, not gross but at the same time scary and gross (if you get what I mean). But by the second one (very quick one) and then the twins it was totally natural. The women don't really make a big deal out of it. They don't scream their lungs off (and we don't give pain killers), they just moan a little and some sing. In general it's a silent business. Very reassuring for the day I'll go through this myself :-)

Liberia 3

Thursday 10th May

This morning, when I went to the hospital, I already knew just by seeing Foday's face that something was wrong. Foday is a Liberian doctor who works in the ICU. He's really great, caring and great with the patients. He told me he had to talk to me but preferred to do it later and outside. In the meantime I saw Kristina, one of the expat doctor, who told me the ad news: B. died during the night. Although I knew the chances of survival were very slim and that without a mother and also with the probable mental problems following his malnutrition he's better off, it's still a shock. I really hoped he would make it. Kristina explained to me that the first 3 days were critical. Tonight, it would have been three days. I am just grateful that I didn't see him die.

Liberia and our project is not only about death. So many children come here every day at the hospital to get free treatment and the vast majority come out of this hospital cured. This little girl for example who had malaria is better and will be released tomorrow. Another one who has a bad cough has gone home today smiling. The doctors are saving the lives of so many children. But sadly sometimes you have a case like B. and even though they tried the best they could it wasn't enough to save his life. In Belgium he would have been fine. First of all he wouldn't have been 3,7kg at 7 months and second he would have been hooked on so many machines that would have helped him. In Liberia, one in 5 children dies before the age of 5.

This afternoon, we went with An the midwife to see some deliveries and to check on the new born babies. When we arrived, the nurse told us that a young mm had given birth to a 500gr baby, probably 26 weeks old. The mum was very anaemic and needed to be transported to the hospital next door. We couldn't really wait anymore and carried her as quickly as possible. Once in the hospital, An gave me the baby, that was still alive, for a few minutes to help the mum. I have never seen anything like this before (and I probably already wrote this sentence in this blog but this time I mean it), he was tiny, weighing nothing, looking more like a foetus than a baby.

This trip to Liberia is life changing, at least to me. It's a big cliché, but I won't come back the same person as I was before. Too many things happened. Africa has revealed itself in all its beauty and despair. This trip makes my job worthwhile.

Liberia 2

Tuesday 8th May

His name is B... I looked for him everywhere all morning but he had been taken to the ICU (Intensive Care Unit). He's 7 months old and only 3,8kg. Most babies weigh more when they are born. He's in bad shape but at least he pulled through the night. B… has become "my patient". Not that I can help, by any means, but he is a symbol for all those acute malnourished patients we have. His mum died a few weeks after giving birth to him. We suspect HIV but are not sure. It's the mum's sister who has brought him to the hospital. She wakes over him like he is her own. B… is suspected to have TB has well. He is probably suffering from secondary malnutrition: malnutrition following an infection or disease like malaria or TB. He's grasping every breath he can and is looking more and more distraught by the hour. A fever is also coming up. I am really upset. Not in front of the doctors nor the sister but this is really difficult. I like this kid. I whish I could just take him in my arms and tell him everything will be fine but that would just be a lie. No-one at this stage can guarantee that he will survive.

B… is one of many patients that come here suffering from acute malnutrition. When we arrived after lunch time in our hospital with Kristina, the Swedish doctor, a baby boy was receiving CPR. For 25 minutes, the doctors tried to save him but it was already too late. Seeing a little baby aged not more than a few months been given CPR is something I wish on no-one. It's hard. It looks like they're going to break the baby in two. The mum, a girl that didn't look more than twenty, was crying in a corner. She just came to the hospital too late. Many mums come to the hospital or clinics when sometimes it's too late to help the children. Not because they don't care but because they can't do otherwise. They either don't know that we provide free care, live too far away, have to work to provide for the other children or can't afford a cab to drive them to the hospital. 75% of the Liberian population lives on less than 1 dollar per day. Taking a cab is just not an option.

I have spent the entire afternoon in the ICU. Not only for B… but also to see how other children were taken care off. The good news is that some were stable and could leave the unit to go to a "normal" ward. It's certainly not only about death, it's about hope for a great majority amongst them.

Outside, mothers are waiting with their children to go home. It's good to see how well some children leave the hospital. A boy runs to me with a big smile on his face. He's just so cute, bubbly and full of life. I play with him for a little while: he tries to push me but he's probably not even two years old. It gives me confidence: this incredible team is achieving so much. It's not only about hope but about concrete results and this little boy is the living proof of that. I just wish B… will come out of the hospital with a big grin on his face. Long way to go though.

Liberia - First two days

Sunday 6th May

I wish I could start this blog with the same sentence Ryszard Kapuscinski wrote in his book Ebène. "Premier choc: la lumière. De la lumière partout. Hier encore, Londres dégoulinant sous une pluie d'automne, un avion ruisselant d'eau, un vent froid et les ténèbres. Ici, dès le matin, l'aéroport baigne dans le soleil, nous baignons tous dans le soleil." Sadly I am not as lyric and well written as he is and also it wasn't the case. We arrived In Liberia around 5 o'clock and the weather was surprisingly good. Although very humid, the temperature was around 25 degrees. Night is falling quickly in this part of Africa. From the plane you could see how green Liberia is. Huge area's of green trees surrounded by rivers and swamps. This is beautiful and I have never seen anything like this. It's truly like in the movies or like a postcard.

I am travelling with a journalist to Monrovia, the capital of Liberia and this for work. We will visit several projects my NGO has in this country, mainly focusing on women: maternal health, sexual violence, tuberculosis, malaria, …
I have always wanted to come here. In August 2003, in the middle of the civil war that destroyed Liberia, I started working as a trainee-journalist for a newspaper in Brussels. My ever first article was about this country I had never heard about. It was an article explaining the history and creation of Liberia, the first country to gain independence in Africa.

The civil war here was pretty awful: extreme violence, systematic rape, child soldiers and even reports of cannibalism. This has left deep marks and we are trying to help the best we can. About 8 women out of ten were raped.

The driver takes us to a welcome barbecue in one of our compounds. Nothing extremely fancy but it's really nice. We have a view on the sea. The expats and locals that work with us are great and make us feel very welcome.

After a good meal, Céline, the journalist and the people we stay with bring us back to our place: a really nice house.

And here comes a dreadful confession: I am totally arachnophobic. Once in my room, I just check everything. In the bathroom also. I close every bag, put socks in my shoes and try to sleep. I try to convince myself that the mosquito net will probably save me from any encounter with a big black fury spider but still: what if I wake up one morning and there's a spider above me on the mosquito net….

Shouldn't think about that, close my eyes and get some sleep….What's that noise?

Monday 7th May

I kind of got some sleep last night. The noise is probably lizards running around on the roof. I checked everywhere and couldn't find my 8 legged enemy. Should be ok now…

Today the sentence of Kapuscinski is revealing the awful truth: I am melting :-). Took a very quick cold shower (water is scares her and should be treated with respect) and I am already sweating… The good thing is that everyone is suffering so no one actually minds. Work starts early here: we are in the office at 7.30… Quick briefing and then we get to meet the team. The national staff pays us a compliment: they introduce us as "the two lovely and beautiful ladies from Belgium". After that we leave for one of the clinics we work at.

I have never been to Africa. I have only seen films and read books that described this incredible country. Last night I was too dark to see anything but this morning I am finally seeing it all. Walking on the famous African sand, smelling African food, hearing people sing or playing music, bargaining on the market. It's all there and I love it.

On the other hand, I am seeing real poverty. Not the first time cos I have been to some very poor countries before, but never so obvious and in such number. People have literally nothing. They live on less than 1 dollar a month, 85% is unemployed, more than 70% cannot read or write, leftovers from a civil war that is still making victims 4 years later. Things are not cheap here either so don't think that 1 dollar can get you anywhere.

The hospital is an MoH hospital (Ministry of Health) but we help with the staff training, the logistics, a doctor is visiting the most serious cases and a midwife is training future midwives and helping with deliveries.

First impressions when I arrive is that the waiting room is packed. About 400 women are there. Either pregnant or accompanied with their child/children, many seek treatment for various sicknesses like malaria, a good family planning or come to have their antenatal check-up or even give labour.

We start the day with an antenatal check-up of a woman named Lucy. She's 33 and expecting her second child which is quite late here. She'll deliver beginning of June. An antenatal check-up is different from those we know in Europe and then they're not so different. It's back to basic. The baby's heart is checked by using a tube put on the woman's belly, the midwife just count the heartbeat to see if it's fine. To see how far away the pregnancy is, they measure with a tape measurer the belly. To see if the baby is in the right position before birth they use their hands. Here you'll find no scan, no ultrasound, no vaginal check-up. The midwives use their five senses. A student explains it well: you only need your hands, your eyes and your common sense!

After that we go to the delivery room. A young girl is suffering from pre-eclampsia and is referred to a bigger hospital where she might get a c-section. Others are waiting to deliver. No drugs, all alone (men are not there during the birth), and in insufferable heat. I have great respect for these women, especially since most of them are actually young girls: 15, 16 years old is no exception. The national midwives are extraordinary, they help these women the best they can, give courage for those who are facing giving birth for the first time.

Sadly one baby will die. It's only my first day here and one didn't make it. He had an abnormality so it's probably for the best, but it's a shock. The mum will stay in the same room as the others who gave birth successfully, no making one sound.

In the afternoon, we visit our hospital. The NGO hospital. It's specialised in paediatrics and has various sections. I am especially worried about the malnutrition section. I don't want those mums to see how distraught I will be the first time I'll see a little baby in really bad shape.

We start visiting the malaria patients, the TB patients. A little boy runs to us: he has just been given a cast for his leg. He smiles, grabs my leg, gives me "five". He's just great.

Many babies cry before and during the vaccination. They're scared and don't really know what happens to them. Many also cry when I enter the room and try to come closer to them. I just merely want to reassure them but they cry because I look so different. For the first time I realise that I look different and probably scary to them.

The malnutrition section is hard. Especially acute malnutrition. The children are tiny, thin and it's scares the shit out of me. However, I realise that I am stronger than I thought. I don't give a peep. And more importantly those children are so strong. The malnutrition is due to the quantity of food but also to the quality of food. Always eating rise is making them lack essential supplements. Malnutrition exists in two forms: the first one is the one we know most: children are tiny. The circumference of their upper arm can go down to 85mm. The other form is known as kwashiorkor. The baby is actually not thin but swollen. His body is full of oedemas and the skin is bursting. He basically looks like a burn victim. One of the babies in the clinic is suffering from that probably painful condition but with proper treatment he'll be ok. The worst form of malnutrition is a combination of both: a tiny body with oedemas on the feet. Again, the clinic has one patient : she's 1 year old. Looks about 6 months. The doctor says she'll probably be alright.

The last patient of the day is the worst. He is 7 months and according to the MUAC (a device that able you to measure the degree of malnutrition) he's in the red. He is dangerously malnourished. His eyes are convulsing, he suffers from acute diarrhoea and I honestly think for one moment he's going to die in front of me. He doesn't. The doctor suspects a TB infection as well and wants to start the TB treatment immediately. The next three days will be critical. I just hope that he'll be there tomorrow.

Decadent week

Last week was crazy week... So crazy that I didn’t really have any time to write anything on this blog. And now all the sensations, jokes and funny things I wanted to write have disappeared from my mind. So bear with me...

Last Wednesday I went to the Chine Collection runway. I am fortunate enough to count journalists among my friends and therefore I was able to attend the fashion highlight of the month. It was very interesting to see how a fashion show works and to see how the ‘high society’ lives in Belgium. I spent the first few hours backstage amongst the models. First: they are gorgeous, thin but not anorexic and worst: they eat! They live on tiny sandwiches and diet coke. Didn’t see any (real) coke or champagne. Their faces all look the same (but then they were chosen for those particular features), their figure is extremely boyish but not frightenly thin. Simple reason for that: they were 14 to 16-year-old. After the show (price ticket: about twice the price of my apartment just for 45 minutes and that’s only for a ‘small’ Belgian fashion designer so imagine the Chanel shows ), there was a huge buffet or walking dinner has they call it. Kilo’s of foie gras, tuffels, salmon, red tuna, asparagus, champagne etc to ease the appetite of the rich.

Thursday I went to the UNFPA launch of the “end the fistula campaign’. Obstetric fistula is a hole in the birth canal caused by prolonged labour without prompt medical intervention, usually a Caesarean section. The woman is left with chronic incontinence and, in most cases, a stillborn baby. For more info check the website: www.endfistula.org.

The spokesperson for this campaign is Natalie Imbruglia. She was very moving and spoke really well about this very difficult and stigmatising issue. Their campaign is really good and normally you should have seen some posters in the metro, tram, busses and Eurostar. And for those interested, Natalie Imbruglia is as stunning in real life as on picture. Not good for us common mortals.

My London flatmate Mike came over this weekend so it was so good to see him after nearly two years! Obviously he had to taste all the Belgian beers (don’t think he managed them all) and taste our great food I missed so much when I lived with him in London.

Work is the same as usual except my boss is leaving for another position and that means that I will probably have to do his job as well as mine during the summer....

The good news is that I am leaving for Liberia and Sierra Leone on Sunday. Well hopefully cos I will only believe it went my plane leaves on Sunday morning. We have problems with visas and stuff so keeping my fingers crossed. So normally next time I’ll write from Liberia if the internet connection is working :-) If not you’ll hear from me after the 21th!
Wish me luck!