Pam Gordon is a Merlin intern working in Liberia. She joined a week-long assessment to the rural heart of the country – the remote Grand Kru county, close to the border with Ivory Coast. Visiting clinics that have never received international aid and are so inaccessible the Liberian government struggles to get vital drugs and staff to the area, here is her account of what she found.
The road to knowledge
Dickson is both our skilled driver and passionate professor as we explore his home county of Grand Kru. Steering the Land Cruiser carefully over the broken bridges and muddy roads of southeast Liberia, he is eager to express his views on the complex history of this remote, abandoned area. Over hours of bumpy miles, listening to looped tracks of Bob Marley and Marvin Gaye, Dickson tells stories of Liberia’s 14-year war that ended in 2003.
Still-fresh scars of conflict
The scars of conflict are still easy to spot, from empty schools to fallow fields, but Dickson points out others that I don’t notice from the backseat of the car. The beautiful grass plains, he says, used to be full of cows, until a corrupt government official had thousands slaughtered so that she could easily land her private plane. Dickson also reminds me that ex-combatants from the war’s many factions are not just the muscular men who intimidate on the streets of Monrovia. They are also the teenagers (children during the war); mothers who’ve been raped; and fathers forced to fight to feed their families.
Dying to live
I’m reminded that war is complex and confusing, but one thing I’m sure of is the damage it has inflicted on Liberia’s health system. People die in Grand Kru county because they can’t get drugs and basic health education. They die of preventable illnesses like diarrhea and malaria. They die because they can’t get a caesarian section. That’s why we’re here: to see if Grand Kru could become the sixth county Merlin supports in this slowly recovering country.
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Nyankunkpo village - a rural haven?
This tiny community of thatch mud huts is nestled in a shallow jungle valley that is alight with stars at midnight, blanketed by pink mist at dawn, and refreshed by afternoon showers during the rainy season. A small river winds through the village, quenching the thirst of cassava, rice and palm fields.
Yet many of the people we met during the week tell a more sombre story about the seemingly tranquil ‘seclusion’ of Nyankunkpo and other villages.
A clinic with no drugs and no qualified health worker
Mr. Habakku runs the clinic here. He must be close to seventy years old and speaks slowly as he patiently answers our questions for over two hours. I watch raindrops sink into the mud floor of his three-room clinic, as he tells me that he sees an average of 15 patients a day, but has no medical qualification or training whatsoever.
Habakku treats malaria, but often prescribes the wrong medication. He assists with deliveries, but can’t manage complicated ones. He provides family planning, but believes HIV can be transmitted through stepping in another person’s urine. Habakku refers many of his patients to more equipped facilities, but Nyankunkpo is a three-hour walk from the nearest road, and a two-day walk from the nearest hospital. The only ambulance is a stretcher or hammock carried through the forest by village volunteers. Across Liberia, Grand Kru County is known as ‘Grand Walking County’, and now I know why.
Distance from qualified care
I recall how much I enjoyed the three-hour hike to Nyankupo earlier that morning, when I was healthy, hydrated and slathered in sunscreen. I can’t imagine the same walk, through muddy forests, for a woman in labour, a man with tuberculosis, or a child with severe diarrhea.
Just as patients struggle to leave Nyankunkpo, Liberia’s Ministry of Health struggles to get drugs and supplies into it. The clinic has no vaccinations, no vitamins, no painkillers and no delivery bed; it has shelves of unused condoms, surgical gloves, and expired drugs.
Meeting the only doctor in the county
Doctor Camara is young, energetic and originally from neighbouring Guinea. I didn’t warm to him when I first met him in Rally Time Hospital. He answered our questions on behalf of his less qualified colleagues, particularly the women, and insisted that Merlin should furnish his house. My initial disregard for Dr. Camara swiftly changed to deep respect, when I learned that he is the only medical doctor in all of Grand Kru, with a population of over 58,000. He has left his home country to live in one of the most remote parts of Liberia and accept a workload that is humanly impossible: I would request chairs for my house too.
After one short week in ‘Grand Walking County’, learning from people like Mr. Habakku, Dr. Camara, and Dickson, I am convinced that Merlin also has a vital role to play here. Our plan to help the Ministry of Health supply seven clinics in Grand Kru with drugs, supplies and staff training is a small but significant step towards rebuilding a war-torn health system. By helping these remote communities access essential health care, Merlin may also give them one more reason to hope for change, and indeed to pursue it themselves.
Dickson tells me that dogs chase cars because they paid the drivers too much and owe the dogs change; that goats run from cars because they didn’t pay enough, and that sheep don’t notice cars because they paid the right amount. I respect Dickson’s choice not to chase the future or run from the past. He drives over the bumpy roads of Grand Kru at a pace that matches the steady recovery of his country, Liberia.
Find out more about our work in Liberia