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Doctors
without Borders
in Liberia
Doctors without Borders
in Harper, Liberia |
| Medecins Sans Frontieres (MSF, Doctors
without Borders) has been working in Harper, Liberia since 1997
supporting J.J. Dossen Memorial Hospital, the only hospital in
Southeastern Liberia. The infrastructure in the country of
Liberia has been destroyed by more than 10 years of civil
war. The trip from Harper to the capital on rough dirt roads
takes 15 hours. Towns which previously had electricity,
running water, and sewerage systems, including the capital, now
have nothing. There is no investment, economic development
or business. Unemployment rates approach 80%. People
farm small plots of land to eke out an existence. Doctors
and other educated or well-off people left the country years ago
for their own safety and for better economic opportunities.
It is estimated that there are fewer than 30 doctors remaining in
the entire country to serve a population of more than 3 million
people. Most people have no access to health care whatsoever
due to poverty and poor transportation.
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Click the Photos
for Larger Photos
A fire hydrant's only use
is in supporting a
clothesline since
the war in 1994 destroyed the
community's water system. |
| J.J. Dossen Memorial Hospital is based
in Maryland county. The three counties have
neither doctors nor hospitals. Outside of JJ Dossen, there
are a few health clinics
staffed by nurses or physician assistants but they have few medications
or supplies. Those who are able try to come to our hospital
which is one of only four functioning hospitals in Liberia.
J.J. Dossen has about ninety beds including wards for pediatrics,
medicine, surgery, obstetrics, and tuberculosis. There is an
operating theater, a therapeutic feeding center for malnourished
children and an active outpatient clinic. The hospital has
more than 100 Liberian staff including a surgeon, eight physician
assistants, and nine nurses. The hospital is managed in
cooperation between the Liberian Ministry of Health and MSF.
|
Malnourished patient in
feeding center gets NG
feeds until
their appetite returns. |
| Our current MSF expatriate team
consists of four expatriates including myself. Julia, a
German doctor, is in charge of the tuberculosis program and
supervises the medical ward and the lab. Marianne, a French
nurse, runs the therapeutic feeding center (TFC) where we treat
anywhere between ten and forty kids at a time for severe
malnutrition. Mika is our Bulgarian/French
logistician. He keeps everything running making it possible
for us medical folks to do our work. He keeps our
generator working so we can have electricity for 6 hours per night
and ensures the water pump and chlorination are being done
properly so we have safe drinking water. He also keeps the
cars running and pays our local staff, among his numerous other
responsibilities. I am the field coordinator and lead
doctor. My responsibilities include the supervision of the
surgical, obstetrics, and pediatrics wards, the operating theater,
and the outpatient department. I am also responsible for
maintaining our security/evacuation plans and for keeping ties
with the local authorities and security personnel.
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Most people get their
water from uncapped
wells or open water
sources. |
| I started my six month mission working
in Harper in August 2002. I am posting this info on the
website during a brief break back in the U.S. during the month of
March. In April, I'll be going back to Harper for another
six months. To say the work has been rewarding is a gross
understatement. In the past six months, in addition to the
things which have now become routine such as cerebral malaria,
elephantiasis, and kwashiorkor, I've seen something new almost
every day. I've treated patients with rabies, tetanus,
meningococcal meningitis, Burkitt's lymphoma, measles, Ludwig's
angina, and gunshot wounds. In my first week in Harper, I
took care of a 10 year old boy who was hit on the head with a
coconut, became comatose, and died from his injuries the following
day. Infections and abscesses spread aggressively during
weeks without treatment as patients who can't easily access the
hospital choose to use traditional medicines instead. I've
drained more than a couple of abscesses that each contained enough
pus to fill a two-liter Coke bottle. The medicine is
fascinating!
|
A recovering child with
malaria on the pediatric
ward.
The white paint
is a traditional remedy. |
| When the hospital's Liberian surgeon left
town for six weeks without arranging for coverage, I found myself
as the only option for the patients who needed emergency
surgery. I was doing surgeries I hadn't done since residency
and some I'd never even seen before. There were no options
for transferring the patients. We were the referral
hospital. I operated on patients with ectopic pregnancies,
obstructed labor, appendicitis, torsed ovarian cysts, and gunshot
wounds. Most of the time I was scared to death and drenched
with sweat hoping I didn't run into a situation that my modest
surgical skills couldn't get me out of. Did I do a good job? I don't know. I did the best I
could and the patients all survived so I guess most would say that I did
do a good job. Could a traumatologist, OB/Gyn, or general
surgeon have done better? I sure hope so! But the
thing is, none of them were
around.
It is a pleasure to work in a place where doing your
best is always good enough. Everyday I was forced to stretch my
knowledge and my skills to do my best for these patients who have
no other source of medical care.
|
Closing after a
Cesarean section |
| The medical challenges might have been
enough to keep me working there longer but it isn't the main reason
I chose to return for another six months starting in April.
Please pardon me
if I'm sounding melodramatic but I've only been back in the
country for a week now and haven't fully returned to myself.
|
Mobile clinic for Liberian
returnees and Ivorian
refugees. Saw 39
patients in two hours. |
| Let me start by saying that I am an
American. I believe that anyone can succeed through hard
work and diligence. I believe that people who are less well
off should be able to pull themselves up by their own
bootstraps. So why am I volunteering my time to help provide
health care for people in Liberia? The situation is very
simple. Liberia is filled with people just like you and
me. They are good people. They love their
families. They are trying to work hard to get ahead in the
world, to build a better life for themselves and their
children. They laugh, eat, sleep, play, and love just like
we do. They are not lazy.
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 |
| The problem is that they are in a very
hostile environment. The schools have been destroyed.
Education is expensive and often of low quality. Job
opportunities are few. Most people earn less than $1 per
day. There are no banks for saving money or borrowing
money. The police and the army are more feared than
valued. Roads are poor and civilians must pay bribes to pass
through the many military checkpoints blocking their way. Unsafe
drinking water is the only option for most. Malaria kills
the children and diseases like filariasis (causing elephantiasis)
and onchocerciasis (causing river blindness) disable the
adults. Falling back on the bootstrap analogy, it is
impossible to pull yourself up by your own bootstraps unless you
are standing on solid ground. The Liberians are standing on
quicksand. Insecurity, disease, and limited education and
economic opportunities stand as roadblocks on their road to
prosperity and success. I see the work that MSF is doing,
providing health care, as one way to help eliminate some of those
roadblocks that are preventing the Liberians from pulling
themselves out of their current situation.
|
"Now that I'm eating well
and gaining weight will
you
stop putting that
thing in my butt every
eight hours?" |
| I am proud of what I have accomplished
so far professionally. Through hard work I've done well in
school, gotten into and completed medical school, practiced
medicine in a variety of settings, and I've even set up this cool
little website. But after working in a place like Liberia I
find myself asking how much would I have been able to have done if
I'd faced all the obstacles that the Liberians face
everyday. If fate had led me to be born in Liberia instead
of in California, would I have been able to have done the same
things, achieved the same things? The answer is
no. I see my work with Doctors without
Borders in Liberia as being a way to help people who have very
little
get just the smallest solid foundation so that they have something
to push off of as they try to get ahead amidst difficult
circumstances, as they try to rebuild their country. Like most of us in the United States (maybe more
than most), I was blessed with the basics that made it
possible for me to work towards achieving my potential. I
want the people of Liberia, many of whom I now consider to be my
friends, to be able to achieve their potentials
as well. |
 |
| So why go into all of this
here? What does any of this have to do with
MeisterMed? Ummh . . not much really. Most people when
they hear about my work say things like "How heroic your work
is!" or "Can I give some money to support MSF's
work?" Well, everyone likes a little positive
affirmation and MSF couldn't do such good work if it wasn't well
funded but neither of these things get to the root of why I like
talking about this work. I speak passionately about my work
because I want to motivate others to do similar things.
There is plenty of need to go around. But in addition to
helping others, I have been enriched in so many ways by my work
with MSF. It's made me a better doctor. It's given me
insight into the challenges faced by the people in the
"two-thirds" world. It's given me the opportunity
to live within and get to know a very different and exciting
culture. The rewards are many. MSF has volunteer
positions for doctors, nurses, lab technicians, and a few
non-medical positions. There are hundreds of other
organizations that also do humanitarian work in the developing
world. Take a break from the rat race and give one of them a
call. Like me, you may find it to be one of the best things
you've ever done. Andrew Schechtman, M.D.
Comments? Questions?
Visit the MSF
website or send me
your comments |
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