Tuesday, March 18, 2008

Project HOPE Volunteers Arrive in Liberia

After two days aboard the HSV Swift we were finally arriving in Monrovia, Liberia. I and two volunteers woke up really early to attempt to see the sunrise from the ship. It is quite an inspiring view to look stand out on the flight deck of the ship and see nothing but ocean and feel the breeze blowing while you look out. It was cloudy today so didn't see the sunrise but we could see lights because we could the see the shore of Liberia.

We were getting off the boat at 9:00 am along with the Africa Partnership Station dentist, Seabees, veterinarians and the environmental and preventative medicine team. As we got closer the military sent two of its small boats out with men. This was done for security. One boat covered the front of the Swift and the other the back. Gradually we pulled into port were we were told that a tug boat had to guide us in because there are 11 shipwrecks in the port of Monrovia. There was actually a ship that had been wrecked that was washed ashore onto a little peninsula as we came in and we were suppose to dock next to another shipwreck. The shipwreck we were suppose to dock next to looked to be a cargo or oil ship and its middle was submerged in the water. Its hull was completely rusted while on its bridge you could still see remnants of while paint. On our other side was the Mercy Africa. The Mercy is actually a boat that belongs to non-governmental organization Mercy Ships. My understanding is they come in to port on this giant ship with volunteer families who live on board and provide humanitarian aid to different countries. I read somewhere they were inspired by the SS HOPE—the first peace time hospital ship—that Project HOPE retired in 1974. The Mercy Africa looks like a cruise liner and some of its inhabitants came out watch as we pulled in. I'm hoping we get to visit with the Mercy Ship volunteers at some point.

Media was waiting for us on pier ready to interview some of us as we came off the boat and possibly get a tour of the boat but after a while the Swift began to go backwards. We then realized that we were not getting off the boat as we had originally planned. Because of reasons unbeknownst to me it was decided the Swift would not dock but that the tugboat that was guiding us through the harbor would ferry us to shore. That meant we had to gather all our belongings and bring them to the back to the back of the hull so that it could be placed on the tug boat after we boarded. To board the tugboat we had to tie the tugboat as tightly as possible to the Swift which still left a gap between the two ships of about three feet that we had to jump over to get onto the tugboat. This is something I had to also do when I visited the USNS Comfort in Nicaragua last year. After everyone was on the tugboat a line formed so that we could pass everything we needed down to the tugboat. After everything was loaded we untied ourselves from the Swift and headed for shore while the Swift headed to its next destination. We waved from the tugboat and they all waved back.

When we arrived on shore we again had to jump to get off the boat. Dr. Polifka, Cornel Mortiz and me got off the tugboat first so that we could greet the media. Everyone else got off the boat after and again formed a line to get all the luggage and boxes off the ship. We were met ashore by half a dozen reporters. Dr. Polifka did a good job again addressing the reporters' questions. After we were done we headed to out of port in vans with an escort as the lead car (side note: the van I was in was playing Kenny Roger's greatest hits, I wonder if the driver really likes Kenny Rogers or thought we would) and to the hotel that would be our home for the next two weeks. I wasn't feeling well but thought I was just tired from being up so early.

In Liberia we were again met with lots of traffic. As we drove down the road there were buildings that were not whole anymore because they were destroyed. We drove past a staircase that led to what looked to be the foundation of a building that was no longer there. The people as Marley put it "looked burned out." You didn't see many children around and the ones I saw were digging in a trash pile. There wasn't much trash on the street because it seemed everything was taken to that pile. Like in Ghana were met on the road by folks trying to sell us stuff but they weren't as aggressive. I noticed there were lots of tire shops but I am assuming it's because the roads are so bad. I also saw a couple holding hands which is something I didn't ever see in Ghana. The van also passed a very large illustrated sign about rape counseling for women to get help. In Liberia most women have been raped.

We finally arrived at our hotel. While here we are doubling up on rooms to save money. My roommate is Christella. Our room is nice. It has two twin beds a mini fridge, a desk, TV and standing shower. There are no elevators in this hotel so we had to haul our entire luggage upstairs. According to the other folks staying with us the higher you go up in the building the worse the rooms get so Christella and I got lucky with first floor rooms.

After we settled in we went downstairs to have lunch. There is a cute little café owned by the hotel. This is where we are having breakfast and dinner every day but we are still having MREs for lunch. The food seems to be pretty good. Liberia still has power surges so while we were at lunch the power went out for about 5 minutes. When lunch ended we headed over to the JFK hospital where most of our work will be done.

The JFK hospital is actually a big campus but most of its buildings are now useless because of the 20+ years of neglect and civil war and it some of its entrances are surrounded by barbed wire. At JFK we first stopped at the conference room in the administration building where we were briefed by Project HOPE's in country director for Liberia—Caroline Teeter—about the current situation in Liberia and security measures. Below are some highlights:

· This is a post conflict country with UN peace keepers in it. We saw a lot on the road as we drove in.
· The infrastructure is poor. The water and electricity grids are just beginning to function but most of the sewage still winds up in the ocean.
· Because of the war it took physicians 10 years to complete medical school.
· There are only two functional operating rooms in the hospital.
· Before the war there was a population of 300,000 in the Monrovia area now there are 1 million. Around JFK hospital there are 20,000 squatters.
· Physicians are old and want to retire but they can't because there is no one to take their place.
· There are suppose to be 1,000 doctors for the amount of people in Monrovia but there are only 51.
· There are no pediatricians in the country or anesthesiologists.
· 27 buildings at JFK have been destroyed.

As for security there is a curfew. No one is allowed to be out between two and six AM. We were told not to walk alone especially if you are a woman. And we are not allowed to take cabs because they can be very dangerous. We are also supposed to get a security briefing from the UN at some point this week.

At this point in the day I am starting to get pretty congested but don't think anything of it as we are off to tour the rest of the hospital. We first stopped in the maternity ward. The building was hot and dark because there weren't any lights. The areas with lights and AC were kept closed because the AC was running. These areas were the critical areas of the hospital like the OR. We got to see some new babies in the nursery which in was just a room with different types of cribs in it. We visited the fistula ward. If you don't know what a fistula is look it up, it's caused by prolonged labor and isn't pretty. I am not going to go into detail here but most of the women in this ward will stay until they can be operated on which can take months and most of them have been abandoned by their family. As we walked from ward to ward I couldn't help but notice all the old hospital furniture lined up in the hallways. It seemed to be a grave yard of old equipment.

We then headed to the ER. As we walked up we noticed a stretcher that had been turned on its side in and sat in front of no parking sign. We walked and again it was hot and dark. There was a child in the ER that had been abandoned and in the hospital since August. Apparently most traumas are seen due to burns or automotive accidents. We saw one woman whose thighs had been burned. They were all shades of pink and she had been in the hospital since October of 2007.

The pharmacy was our next stop. Project HOPE has built some shelves in the pharmacy for all the medications that have been donated to the hospital. There are some medications they offer for free to their patients.

After the pharmacy we headed to the physical therapy wing. It had a couple of pieces of equipment and also an obstacle course for patients. We were told they are trying to encourage people who need physical therapy to come in but that it's hard because most people don't have the transportation to get there. We also got to see the prosthetics work shop they have on campus. While we were there a woman was making a prosthetic from the knee down. It was like walking into shop class but they were making limbs.

Next we saw the cholera unit. On our way there we walked past the remains of a building as I got closer I saw a plaque. It was a community health center built in 1990 that had been completely destroyed. All that sat was its empty shell. The rainy season in Liberia brings cholera. At the height of the cholera epidemic the hospital will see up to 500 patients a week. The cholera wing is small building with again no AC or electricity. As you walk into the different rooms you have to step in some padding that contains chlorine so you don't get cholera because anything you touch can carry cholera. The beds in this wing all have one hole in them that the patients can use the bathroom into bed pans. Cholera gives you what they call rice water diarrhea which is incontrollable. These patients are then hooked up to IVs for dehydration.

Project HOPE just donated IVs for the upcoming cholera season in May. They are expecting 2,000 patients with cholera. There is even an overflow are which is just a tent with the beds set up. As we left the cholera wing we had to wash our hands in a chlorine solution.

That was the end of our tour and we loaded up the vans to head back to hotel. It turns out this part of this mission will be very different. We have a physical therapist and bio medical technology engineer—to fix the equipment that has been burned out— with us. Also, the nurse educators will be and primary care team will be doing hands on teaching on Mondays and Fridays, going up to the different wards to work with the nurses and medical students.

At this point I am feeling pretty ill. I went to dinner and left with headache and cold. This sucks because this is not the place to get sick, there is no one who can fill in for me and the media is going to be at JFK Tuesday. It's been an eventful day and hopefully I can get to work tomorrow.
--Marisol Euceda

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