Aneri Pattani, a freshly minted graduate of Northeastern University, is the winner of Nicholas Kristof’s annual win-a-trip contest. She previously wrote about a fierce investigative journalist in Liberia.
I considered leaving my suitcase at a government hospital in Liberia last week. It seemed the hospital needed its contents more than I did.
My suitcase had antimalarials. The hospital did not. My suitcase had ibuprofen. The hospital did not. My suitcase had acetaminophen. The hospital did not.
Granted, I am an overzealous packer, but St. Francis is the only hospital in Rivercess County, serving 75,000 people. How could it lack what I had packed for a 10-day trip?
“The simplest things we don’t have,” said Dr. Mamady Conde, the only full-time practicing doctor in the county.
One reason for the paucity of supplies is that most health care in Liberia is free. From prenatal checkups to surgeries and even birth control, the majority of services are offered at no cost. (Yes, it’s strange to realize that birth control, which can be expensive without insurance in America, is actually free in Liberia!) But it’s difficult to support a free system in a low-income country where the tax base is so small. As a result, medications are often rationed.
Take antimalarials. Malaria is the second leading cause of death in Liberia, killing thousands of children and pregnant women each year. Yet the hospital only had drugs to reduce fevers, and nothing to treat the disease itself. On the other hand, I had plenty of antimalarials in my bag, even though the chances that I would get malaria were slim, given my constant application of bug spray and the opportunities to sleep in air-conditioned rooms or under mosquito nets.
Despite such limited resources, the work Dr. Conde and his colleagues are able to do is inspiring. When a nurse anesthetist wasn’t available during a recent operation, Dr. Conde stepped in to act as both the surgeon and the anesthesiologist. When pregnant women arrive at the hospital with a risk of preeclampsia – a complication characterized by high blood pressure that can lead to fatal consequences – he takes their vital signs regularly throughout the day and will even sleep at the hospital to make sure he can care for his patients overnight.
But even a remarkable staff cannot make up for a lack of medication or equipment.
At the time we visited, the hospital couldn’t run blood tests, malaria tests or HIV tests. It had three ambulances in various states of disrepair. Dr. Conde said they used one, but often worried it would breakdown en route.
The lack of these faculties is not just a matter of being unprepared for emergencies. It affects the hospital’s ability to save Liberians from everyday threats.
It’s difficult to diagnose tuberculosis when the X-ray room functions as a museum for a broken machine. Hygiene is challenging when most rooms, including the operating theater, have no running water.
C-sections have to be postponed when the generator runs out of gas and the hospital is left without power. Postoperative care is compromised when the dispensary is out of antibiotics to treat infection.
These shortcomings have devastating effects. Patients can be left to suffer in the village if an ambulance can’t bring them to the hospital. Children can die of pneumonia for want of antibiotics.
Dr. Conde does have a small stash of antibiotics in his office – medications donated by nonprofits – that can be used in emergencies. But that’s not always reliable.
The real solution has to come from addressing core problems in infrastructure and governance – a perpetual difficulty in low-income countries.
The Liberian government is the sole supplier of medications and equipment for St. Francis, and it does not follow any set restocking schedule, Dr. Conde said. Sometimes supplies are delivered three times a month. Other times they may not come at all.
Many vehicles can’t weather the approximately six-hour drive on bumpy, pothole-ridden dirt roads from Monrovia, the nation’s capital, to the more rural town of Cestos, where the hospital is located. Even trucks with tires several feet tall can get stuck in the muddy roads, and steel plates can fall out of bridges, leaving travelers stranded on either side. (I can attest to both from personal experience.)
In some places, corruption is also an issue. Medicines intended for a government clinic mysteriously end up being sold in the markets.
The last time the hospital received antibiotics was months ago when President Ellen Johnson Sirleaf brought a bottle of amoxicillin during her visit. By the time we visited, the bottle was almost empty.
That’s when I was tempted to raid my own suitcase and hand over my personal supply.