I had an incredible experience this week that I wanted to remember, and since this is the closest thing that I have to a journal, this is where it goes. I’ve been in Grand Bassa, Liberia since Sunday, visiting health facilities. The idea is to survey hospitals and clinics in the area to get a good sense of what difficulties they are facing in receiving and maintaining their stocks of malaria medicines, so that we can make recommendations about how to address the problems. As an outsider, I am fairly reliant on my local counterparts to come up with an appropriate sample of health facilities which will be somewhat representative. I was feeling frustrated after the first day of visits, as we had been to three facilities that were all within a ten minute walk of one another in the largest city in the region. A good portion of the population in Liberia live in rural areas, and visit their local clinics rather than come into the city to receive health treatment. These rural clinics are more likely to face difficulties in maintaining adequate provisions to service their patients. With this in mind, I felt justified pulling the obnoxious American attitude on my Liberian teammates (a woman from the National Drug Service named Suwah, and Kollie, the Head Pharmacist for the county) Tuesday morning, and asked that we cancel our visit to yet another hospital, and instead drive out of town a ways to go visit a clinic.
Our visit to Compound 3 Clinic proceeded normally, and I was just finishing up my review of the storage room when Suwah came in to mention that a child had come in that was really anemic. I didn’t pay much attention to what she said, finishing up my entries so that we could move on to the next facility, when she brought up the anemic child again. Now keep in mind, Suwah wasn’t actually telling me much about the child, nor asking me to do anything, but the fact that she brought it up twice finally got through to me – she was trying to get me to do something, but was being too polite to ask. This is a tactic I have noticed in other countries, and have been stymied by before. Americans are so direct, that it’s easy to miss the subtle gestures in other cultures. I stopped what I was doing, and asked about the child. She told me that he was a 2 year old boy that likely had severe malaria, and he needed to be transferred immediately to a hospital where they could provide better treatment. Of course, the clinic we were at was an hour or more outside of town over some pretty terrible dirt roads with very little traffic. The only other vehicles we had seen that day were motorcycles that function as taxis, carrying one or two passengers behind the driver on little 500 cc 1987 Hondas. Not ideal for patient transport. Finally I got it.
“Can’t we take him to the hospital back in Buchanan?” I asked.
“Sure, we can do that,” Suwah replied, obviously relieved, feeling that she needed my permission since my project had rented our vehicle.
When I saw the boy, I was shocked. He was naked, his eyes were open but not moving, and he was drooling down his chest. I was angry with myself for taking so long to react. His uncle hurriedly carried him into the back of our Landcruiser, and his mother climbed in with a 9 month old baby girl, and we were off. Much of the drive was spent with Suwah and Kollie harassing the mother and uncle for waiting so long to bring the little boy into the clinic. Malaria kills a million people every year, most of them under the age of 5, because until a person has lived in a malarious region long enough to build up some immunity to the parasite that causes it, the body has a more rapid and severe progression of the disease. Coupled with the fact that many kids in Africa are malnourished anyway vastly increases the chance that children under 5 will develop anemia and other complications very quickly once a fever kicks in. If the kid can get into a clinic within 24 hours of the onset of fever, the prognosis is really good. Looking into the back of the Landcruiser, I could see what the effects could be if the parent waited much longer than that.
Our driver pushed it as fast as he could over the roads, splattering mud up my arm from the open window, and we probably shaved off 15 minutes of the journey. Still, I was not feeling very optimistic. I have never seen a person look so close to death. We rushed him into the emergency room, pushing past a large crowd of people waiting for their turn with a physician, and squeezed into a 50 foot square space that housed maybe 7 beds. There was no room for goofy Americans with degrees in political science, so I stepped out, and with not much else we could do to help, we decided to go visit the other health facility on our list and come back to check on the boy when we were done.
Throughout the long drive to the next facility, and during our survey there, I couldn’t stop thinking about it. Henry is two years old, and it was just devastating to me to think that that mother was going to lose her little boy. She had been unable to reach her husband to let him know, and the uncle couldn’t remain with her at the hospital for some reason. All I could think about was Kim and Henry being in that situation. The mother was obviously exhausted and struggling to juggle her sick child and her baby. I worried that her son would die and no one would be there with her, or even know where she was.
When we got back to town, we went back to the emergency room, but the staff there didn’t know which boy we were asking about. They showed us a little boy laying on a table, but I knew it wasn’t our child because he was wearing a shirt. Kollie, Suwah and I decided to head over to the pediatric ward to see if he had been moved there. On the way, Kollie told me matter of factly that the emergency room staff had told him that the boy we had just seen on the table, that I had presumed was sleeping, had just “expired” from malaria. I paused for a minute to try to cope with that, and then we entered the saddest place that I have ever been.
Over the last year and a half I have seen a lot of health clinics in Africa. I think today marked my 43rd visit, in 4 different countries. However, I’ve never before been in the pediatric ward of a major hospital over here, and everywhere I turned I encountered something else that made me well up in tears. I don’t think I want to even write the details of what I saw. Surrounded by children in pain and in visibly bad condition, having just seen a dead child and being very worried for the boy I had brought in, I was feeling pretty overwhelmed.
Down at the end of the pediatric ward, we found our boy. He was still naked, laid out on a bed receiving a blood transfusion. His eyes were closed, but other than that there didn’t seem to be much improvement. We asked a harried looking nurse for some details, and she confirmed that he had malaria, and that they were doing everything they could. The mother (Ruby) gave us the phone number for her husband (Robert) so that we could continue to try and call him. We left, and I went back to my hotel room thinking that it was pretty likely that our boy was going to end up like the other little boy that I had seen in the emergency room. I called and talked to Kim about it, and spent most of the night thinking about him.
This morning I dragged my team back to the hospital one more time as we headed out of town. I wanted to check on him again, but I really didn’t want to get bad news, so it was with some trepidation that I walked back toward the pediatric ward. I was greeted by this.
This is Maurice. He was sitting up and playing with the boy on the bed next to him. He looked totally fine. I was so happy, I thought I might just fall apart. I gave him and the other boy each a pack of smarties, and ran back out to my vehicle to get the bed net that I had been sleeping under. I gave it to the mother, but refrained from reiterating any instructions to her after the berating that she had received on the drive the day before. Mothers here know that their kids are supposed to sleep under bed nets. I also gave her some of my Clif bars, because I can’t imagine that she’d had anything to eat since before our car ride the day before. There is no food at the hospital, and she had no one else to stay with her boy and watch her daughter while she went to get something to eat.
We had work to do, so we left the hospital and finished our survey this afternoon, and I just got back to Monrovia tonight. Even though the whole point of the project I work for is to deliver malaria medicines and bed nets to Africa, this was something really tangible that I got to be involved with. I really don’t think Maurice would have made it if we hadn’t chosen to visit that particular clinic on Tuesday.
I’m so glad we did.
