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Typically, Sundays are my favorite day of the week in Liberia. The streets of Monrovia are alive with families walking to and from church wearing their meticulous, vibrantly colored Sunday best.
In a country of dirt yards, and often dirt floors, I’m continually amazed at the brightness and pressed cleanliness of Liberians’ dress. On Sundays, there’s also relative quiet in the hospital; the craziness of weekday demands nearly becomes manageable on weekends.
However, this Sunday wasn’t typical. The peace in the emergency room was suddenly interrupted by the arrival of yet another young toddler with a chemical ingestion. Joshua is the second such ingestion we’ve seen this week; another came in just four days ago. Unfortunately, these types of poisonings are a common phenomenon and reflect the desperate conditions Liberian families face. With the extreme poverty in the country (most people live on less than $1 per day), families have been forced to seek any option to supplement household income—even to the point of bringing harmful chemicals like lye into their homes to produce soap to either use or sell. Meanwhile, thirsty toddlers mistake the clear chemical for water and drink the tissue-destroying liquid. With anything but a minor ingestion, immediate airway management is essential, and breathing tubes are often required to prevent the swelling and complete closure of their chemically burned airways.
Until recently, patients like Joshua would most certainly die as a result of these poisonings, even if they were immediately brought to the hospital. Fortunately, the medical staff at JFK Medical Center in Monrovia are becoming much more comfortable with and adept at the life-saving airway management techniques that I’ve helped teach them. After recently completing pediatric training at Children’s Hospital Boston, I spend half my time working in Boston and the other half serving in Liberia as the pediatric consultant to the Liberian Ministry of Health. With the support of local Liberian colleagues and visiting pediatric residents and faculty from Children’s and Massachusetts General Hospital, I’ve been asked to help develop pediatric training and clinical care for Liberia.
After more than a decade of armed conflict and civil unrest, Liberia’s childhood mortality rate is among the world’s worst, with nearly one out of every four children dying before age 5. And the vast majority of these childhood deaths are due to preventable diseases, such as malaria, respiratory infections and malnutrition. The country’s health care system can’t address children’s huge health needs, and many international non-governmental organizations with emergency aid mandates are transitioning out of the country, leaving fewer physicians and fewer hospital beds. In fact, aside from me, there is currently not a single fully trained pediatrician in this country of more than three million people—more than half of whom are under the age of 18.
My interest in caring for children and other vulnerable populations started far from Boston—and far from any hospital—in the war-torn Balkans during the early 1990s, where I volunteered for two years alongside other humanitarian workers. My interests continued to grow through subsequent service in Haiti, the Middle East and a half dozen regions of Africa, as I worked with organizations like the Centers for Disease Control and Prevention, the Red Cross, International Rescue Committee and Doctors Without Borders.
There’s always been a dichotomy in my interest in pediatric care. On one end of the spectrum is my training and work at Children’s, with all of its world-leading pediatric care and technology. At the other end is working as a pediatrician among some of the world’s most vulnerable children in the most resource-limited settings. Unfortunately, there are significant differences in outcomes between these extremes. For example, we lost two otherwise healthy newborn babies to asphyxia last week here in Liberia. What was most difficult about these deaths is that they shouldn’t have happened. But what shouldn’t happen is happening in Liberia on a daily basis. Despite the dedication and best efforts of the Liberian medical community, death is an all-too-common occurrence. And lack of pediatric training and lack of resources are among the largest reasons why.
I knew that it would be difficult to work in a post-conflict setting like Liberia. And, while I’m already a bit exhausted after being back here for just a few weeks, I’m buoyed by the fortitude and dedication I witness daily among the local physicians, nurses and staff who have been doing this difficult, yet essential, work for years. I quickly realized that their energy stems from their remarkable hope that things will get much better.
With the experience of working in dozens of settings similar to Liberia, I can confidently say that this is the most optimistic I’ve ever been. With the right training and the right equipment, I’m convinced we can reverse Liberia’s child health tragedy. Hopefully, in the near future, conditions for families will greatly improve. Hopefully, they won’t be so desperate that they feel they must bring dangerous chemicals into their homes just to survive. Hopefully, future Sundays will be full of more vibrant colors and fewer innocent young victims. But, in the meantime, while the public health crisis continues, we’ll continue our collaboration with the medical center to save lives in Liberia.
Resident Julie Herlihy, MD, MPH, treats HIV/AIDS in Zambia
Kim Wilson, MD, PhD, improves newborn and maternal care in the Dominican Republic
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