Morris Earle Jr reflects on his work with Doctors Without Borders.
I first went to Liberia in 2008 to work at the JFK Hospital in Monrovia. The city sits on the rainy coast of West Africa, where it is usually 90 degrees, with 250 inches of rain a year. I arrived there by flying to Ghana first, and then taking Kenya airways to Monrovia. They had an in flight magazine full of pictures of giraffes and lions, but wildlife was not in evidence when I arrived at the tiny Roberts Airport. The airport lay at the end of a red clay road, full of potholes. I was met at the airport, fortunately, because there were no taxis. We bounced through a countryside of scrub brush, with occasional mud or plywood huts and swept dirt yards with a few banana trees and goats. We drove into a city where burned out, bombed out buildings, with visible bullet holes, were being reclaimed by the bush. There was no electricity, the power plants having been destroyed in the Civil Wars of the 1990s. There was no running water, ATM’s or credit cards, although the local Lebanese store where foreigners shopped had Ben and Jerry’s ice cream.
It was an eerie feeling to drive around Monrovia in the evening, a city of a million people lit up only by the flicker of firelight from street vendors’ stalls, where clutches of people would gather. Most people live on less than 50 cents a day. There are 34 tribal languages, but Liberian English, a dialect, allows people to communicate across tribal lines. The most popular food is foo-foo, a gelatinous glop of beaten cassava root in a pool of palm oil, topped by bushmeat. How they ever get past the age of 50 without having a heart attack I’m not sure.
The child soldiers, as young as 7 years old, who fought in the war until recently, had grown up and were now driving motor scooter taxis but they still had their automatic rifles at home. A UN force of 10,000 soldiers in blue helmets maintained peace. They roamed the streets by day and visited brothels at night.
The JFK hospital, named after John F Kennedy, was once the best hospital in West Africa, but was stripped of everything in the war, including equipment, copper pipes, wiring, doors, and windows. Most doctors left then, and the ones who remained had to carry guns with them on their rounds for protection.
When I arrived, there were lots of children at the hospital, but no pediatricians anywhere in the country. Mothers would take a crowded truck for 10 cents to bring their sick babies to the hospital with malnutrition, malaria or both. Mosquito nets were distributed by the World Health Organization to limit the spread of malaria, but were apt to be used for fishing nets or clothing or sold. Families had to supply food and milk to the babies because the hospital didn’t have any food. Sometimes I would go out on my lunch break and buy powdered milk for the ones who were especially malnourished.
The hospital often had no electricity, water, paper, soap, medicines, x-rays, or bedsheets. On one occasion, there were so many babies in emergency that we had them lined up on a stainless steel counter, at which point the hospital generator shut down. In the darkness that followed, a baby started having convulsions, so the doctor working with me, a woman named Alex Vinograd, had the child’s mother pin down the shaking arms and hold Alex’s cell phone flashlight in her mouth. The mother aimed the phone light well, and Alex got an IV started and stopped the seizure with the medicine that I had drawn up.
Missionaries donated small bibles to the pediatric ward and the nurses would set them on each bed, turned to the 23rd Psalm. It cheered me up on my rounds to be reminded that “the Lord is my shepherd I shall not want,” even though most mothers were illiterate.
A few Liberian resident doctors would round with us, working long hours for little or no pay. They scolded the Liberian mothers, and considered them superstitious and uneducated. When I would ask if a baby was eating the mother would stare at me blankly, and the Liberian doctor would yell, “Da baby eat?!!” The mothers would say yes, whether the baby was eating or not. My mastery of Liberian English was weak.
If I said, “How are you?” the families would just stare at me. You had to say “How be de body?” and they would reply “I trying small small.” There were many cultural taboos. If a baby had HIV infection, you couldn’t come right out and say so. If you did, the father would throw the mother out on the street and blame her, even if it was his fault.
On my second trip I worked with an American resident named Caitlin Neri, who was very persistent. Children died every day, sometimes four or five of them, and they would get wrapped in a dirty sheet and carried off to the morgue, while the mothers cried quietly. I got discouraged by this, but Caitlin insisted that we do something to make it better.
“Morris,” she said, “This place is a death star. We have to do something.”
“Caitlin, there is nothing we can do.”
“But why are they dying? We are treating their malaria.”
“They are dying of malnutrition”, I replied. “We tried to get the hospital to follow the UNICEF guidelines for malnutrition, but they can’t. They have no food, no fridge, no one to feed the babies at night. The babies refuse what food there is, and nasogastric tubes make them throw up.”
But Caitlin would not be stopped. “Someone in this country must be able to treat malnutrition, and I’m going to find out who.”
Two days later we were in a hospital jeep, en route to the national UNICEF feeding station. Dede, a Liberian physician’s assistant, kept up a running commentary as we weaved along hot dusty roads, through crowds of women with huge bags of market goods on their heads; bananas, sugar cane, cassava, soap, salad greens, and always a baby tied to their back. There were hawkers and herds of children and goats, and UN peace keepers with blue helmets and rifles, looking hot and unhappy. We passed thousands of huts made from palm fronds or galvanized tin.
“These moms”, Dede said, “They lock their children in the huts at night and go out on the street.”
“What do they do on the street?” I asked.
Dede looked mildly amused. “They are streetwalkers. It is the only way they can feed their children. Last week a hut burned and the children were locked inside.”
“What happened?” I asked.
Dede thought I was a little slow on the uptake. She shook her head in reply and sighed deeply. “These huts are here because people poured in from the country during the war. Then they never went back. They were too scared. It is still not safe in the country. But there are no jobs here.”
I stared out at the shantytowns passing by; huts only four or five feet high. They provided little more than a place to stoop, out of the rain, sort of.
Eventually we got off the road and bounced along a single dirt track through tall grass, passing the occasional cow or goat. I couldn’t believe Dede had any idea where we were, but I sat quietly, until we pulled up near a few low huts, in the middle of nowhere. A blue sign identified the UNICEF feeding station, and we got out and were welcomed by several friendly young men who gave us a tour.
I remarked that we were certainly way out in the country. The tourguide said that it made it harder for the young mothers to abandon their babies and run away to the nightclubs. There were two long huts, each with a hundred mothers in it. Every mother had a mattress and a mosquito net. The babies were fed milk on a three hour schedule and given vitamins and worm medicine and antibiotics. The mothers were taught to make food from complimentary proteins; corn and beans or peanuts and rice. Best of all, almost all the children lived and got better. Caitlin and I were ecstatic. There was a place in Liberia where we could send our starving patients and they would live!
We looked for appropriate children to send to the UNICEF station. One girl, a two year old named Susanna, arrived at JFK with cerebral malaria, in a coma. She recovered, but wouldn’t eat and had arms as thin as a stick. She looked at us with large, listless eyes, while wrapped in a sheet in her mother’s arms, and picked at the string on the hem of the sheet. We couldn’t get the nurses to give her milk, so we called the UNICEF center and they came to get her. The day they came, she stood up and walked on her spindly legs, wearing only underpants, with a small parade of mothers and children following her. She was wobbly but seemed pleased to be the center of attention. It was the first time she had seemed anything. It was the first time I had seen her walk. When the UNICEF worker arrived, he measured her upper arm with a tape, and it was only as big around as a hard boiled egg. It was skinny enough that she made the cut; she was allowed to go. She and her mother piled into a small Toyota with their bags and six UNICEF workers. The doors were wedged shut and off they went down the dusty street.
The picture I have presented may sound like it contains the important details, but it is just a surface view. What was it really like to be there and see children in the hospital or clinic with their families? Mothers would hold their babies in their laps and clean their faces with a cloth. They would be nervous, worried and answered my questions quickly, politely and in detail. How was the baby breathing, going to the bathroom, eating and sleeping or playing? Sometimes they laughed and so did the children. They prepared cornmeal mush at the bedside. Up close, from a distance of about 2 inches, which is how close pediatricians have to get to their patients and families, they appeared very much like the people of Middlebury. They had the same expressions, worries and body language.
Even though I have lived more than a year in tropical countries, that first trip to Liberia represented the hardest two weeks of my life. I felt as though everything I had known up to then was misguided; my lofty notions of morality and idealism from the viewpoint of a comfortable life. I asked the hospital driver Mark how he fared during the war.
“I did ok”, he said.
“Did anyone in your family die?” I asked.
“Only my son” Mark said. “He was seven and we didn’t have any food. We ate roots from the forest and we drank out of puddles. There was no food in Monrovia. The bullets were not the most dangerous things. There were times when the streets were stacked up with bodies. But starvation was the big problem. It is better now. There is food.”
“What about your house?” I asked.
“”My house was destroyed. I lost everything I had.” He said this in a quiet and matter of fact tone. If this was his idea of making out ok, I wondered about the people who had fared less well.
Who was I to say what honesty is and how much it means when most of these people survived the war by drinking out of puddles and digging up roots from the forest because there was no food? Seventy five percent of the women were raped and everyone lost family members. What would I have done in these circumstances? I felt less on a high horse and more like a common member of humanity when I returned.
I made more trips to Liberia, but Monrovia is much the same today, except for the arrival of Ebola. It is difficult to keep hospitals clean when you have no running water and hard to wear proper protective clothing without even enough paper for writing. It is hard to convince people to believe government warnings when there are few newspapers or those who can read them, and the rumor mill is the main show in town. Bad spirits and kharma have more influence than science. It’s hard to build trust in government when the previous president’s campaign slogan was ‘I killed your Ma, I killed your Pa, but you will vote for me anyway.”
Over 50 health workers have died there, including the medical director I worked with, Dr. Bisbee, and the assistant director. I had a sense of dissociation a few days ago when I was rounding on my patients at Porter Hospital, and everywhere I looked, at the newspapers and the TVs in the mothers’ rooms, the news was about Liberia. The man who brought Ebola virus to Texas had helped carry a young woman to the JFK hospital in Monrovia only to be turned away because they had no beds. She died. Now he is in intensive care in Dallas, being discussed on TV by well dressed, smiling talk show hosts. Liberia on TV was some other place, or on some other planet. Pictures showed mud walled huts, the family of the deceased sitting in the dirt under a tree. Why were they sitting on the dirt? The answer is simple. They didn’t have chairs.
CVUUS Raised over $700, an especially large collection, to send protective clothing for the healthcare workers at the JFK Hospital so they would not die of Ebola virus. It was done through the UMass medical center where I work and which has partnered with the JFK hospital for eight years. I am very appreciative of your help, as is everyone involved.
People get overwhelmed by humanitarian crises. How much can you feel someone’s pain, if you have never met them? What good has foreign aid done in places like Africa? It helps me to remember that places like Africa are not all that different from places like Addison County .
An archbishop from Brazil, Dom Helder Camara, once said
“When I give food to the poor they call me a saint. When I ask why the poor have no food they call me a communist.”
Foreign aid providers and governments are reluctant to ask why the poor have no food, because they are funded by the rich.
There are no easy solutions to these problems. We can listen to the voices of Africans, like Chinua Achebe in his novel “Things Fall Apart”.
We can ask our legislators not to support corrupt governments, to reign in corporate interests that exploit the poor, to help the UN in its’ work for peace.
I have no answers but I want to ask the right questions.
We are a species that survived by living in community.
For the wellbeing of our souls and our species, we could heed the advice of St. Francis of Assisi, eight hundred years ago;
“It is in giving that we receive.”