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A Health Perspective from Liberia: Part 1

  • August 23, 2017
  • Health Initiatives, Communicable Disease, Africa and Middle East, Ebola Outbreak, Disease Outbreak, Global Health Blog
Jed Selkowitz

Jed Selkowitz

Friday, July 14, 2017: Stamford, Conn., U.S.:

The countdown is on for our trip to Liberia to capture in-depth stories of Americares work there. What began as a response to the Ebola crisis just a couple of years ago has now evolved into a field office doing deeply programmatic work to support the country’s health system. I am excited about the trip ahead, but there is much work to do to prepare, including getting a yellow fever vaccine booster and medication for typhoid and malaria prevention.

Liberia is a small country on the coast of West Africa, bordered by Sierra Leone, Guinea and Ivory Coast. It’s about the same size as Virginia, with about half the population — 4.5 million. The climate is tropical with a heavy rainy season between May and October (of course, we’re going right in the middle). The official language is English, as it was founded in the mid-1800s by freed slaves from the United States. Liberia is one of the single largest producers of rubber in the world.

From a health perspective, keep this in mind: Out of a population of 4.5 million people, it has been reported that there were 45 registered doctors in Liberia at the time of the Ebola outbreak — 45.

My visit to the travel health clinic went smoothly. Just a little pinch, and I’m now vaccinated against yellow fever. I will begin taking the typhoid medicine tomorrow. You must take it at least 10 days prior to departure–it must remain refrigerated at all times to maximize effectiveness and there are food and alcohol restrictions. One vaccine I did not know was even available, but the Center for Disease Control now recommends for certain regions, is for cholera. While a fully approved cholera vaccine is still in the works, there is an oral vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) available now, so I scheduled another visit to take it. I will be the first employee of Americares to take this new vaccine. Not sure how I feel about that distinction!

Tuesday, July 18, 2017: Stamford, Conn., U.S.:

I went back to the travel health clinic today to get the cholera vaccine. I’ve worked at Americares for a little over two years now and definitely am no expert on global health, but I’ve heard and read enough about cholera to know it’s a horrible disease nobody deserves to get, and I want to avoid it at all costs. I’ve heard devastating stories and seen photos of cholera patients from our response to Haiti in the aftermath of Hurricane Matthew that are too distressing to share.

As far as public health issues go, while cholera can be a devastating disease, it’s also something the global health community has figured out. With proper resources, we can stop it from spreading. At Americares, we have often said that there are a lot of complicated health issues in the world today–cholera is not one of them.

The cholera vaccine (brand name Vaxchora) is a liquid the nurse stirs and serves in a little Dixie cup. The nurse is wearing latex gloves and keeps a huge vat of sanitizer under her arm. I drink the vaccine — it tastes like a salt water smoothie (not in a good way). I now have cholera in my system. Frightening, really, but not nearly as frightening as contracting the full-blown disease.

Because the vaccine has live cholera in it, you have to be very careful not to get any of the vaccine on your hands, which is why the nurse immediately pumps two gobs of hand sanitizer onto my palms. It takes two minutes to rub it all in. For the next few days, I’ll have to be even more sanitary than usual after using the toilet. I’ll have cholera in my system, so my waste will have particles of the disease that could spread to my wife if I don’t immediately wash my hands thoroughly after each trip to the bathroom.

So, yeah. I now have particles of cholera in my system. That’s new!

Tuesday, July 24, 2017: 2:02 p.m., Stamford, Conn., U.S.:

Just got off a video chat meeting with the Americares Liberia team: Louis York, acting Liberia country director; Magdalene Gbatoe, community liaison officer and registered nurse and Serawit Kassa, Grand Bassa program manager. Louis and Magdalene were born in Liberia; Serawit is Ethiopian.

It takes a great deal of time and effort by the Liberia team to plan a trip like this. The group has been and will continue to work on our daily itinerary, including lining up community leaders, patients, nurses and midwives with whom we can meet, so that we can capture their stories on video. I should mention that I will be traveling to Liberia with Americares head of multimedia, Marc, who is a superb photographer and videographer and also a fun travel companion.

We have a very talented team, and I’m very grateful for all of the work they’ve done to set this trip up for success.

Friday, August 4, 2017: 10:00 a.m. (somewhere over Europe)

I’m in flight from Amsterdam to Liberia, re-reading Americares program summaries and reports on our work there. Americares most recent intervention in Liberia started during the Ebola crisis in 2014, but, as is often the case after we respond to a disaster, Americares has stayed in Liberia to develop innovative health programs to strengthen the health system and improve overall health. Besides improving health every day, these programs will help ensure the health system is resilient in the event of another infectious disease outbreak.

Ebola ravaged Liberia more than any other nation. Limited stockpiles of medical supplies like gloves and masks, misunderstanding and/or mistrust of health facilities and a delayed global humanitarian response made the country particularly at-risk.

Still recovering from civil war that took anywhere from 250,000–600,000 lives, Liberia’s vulnerable communities suffered enormous casualties during the Ebola crisis. Of the approximately 28,000 people who contracted Ebola, 11,000 were in Liberia. According to the WHO, 4,809 Liberians died from Ebola — more than in any other country. Its effects will be felt for many years to come.

Friday, August 4, 2017: 9:30 p.m., Roberts International Airport, Harbel, Liberia:

We deplane at 9:30 p.m. in Harbel, Liberia, a town about 35 miles from the capital, Monrovia, into what feels like a steam shower. Fortunately, it wasn’t raining (yet), but I got the feeling storms had just stopped. The air hit me like an August night in Atlanta. We cleared through two passport checks and waited for our bags from the single belt in the tiny airport.

One of Americares staff, Gibson, was waiting for us outside. It had started to rain. “Welcome to Liberia!” he exclaimed with a big smile. We set off for our hotel in Buchanan–about an hour drive that meandered through the Firestone rubber plantation, a source of much controversy during the civil war.

Because there is limited electricity and few, if any, streetlights in Liberia, our drive is in almost total darkness. A little over an hour later, still in darkness, we’re in Buchanan.

Depending on your source, you’ll find Buchanan listed as being between the third to the seventh largest city in Liberia, with population ranges between 25,000 and 34,000. Monrovia, Liberia’s largest city, has about 940,000 residents.