Following Christina

When I was living in Freetown, one day one of the watchmen came to me, exasperated, telling me that his son had had an accident and was in a nearby hospital (not an MSF facility). Sahr, aged 15 months, had stumbled into a pot full of boiling water that was bubbling away on a charcoal stove on the floor of his mother’s kitchen. It was the first time I had seen a black person with severe burns. I remember thinking how one of his little hands looked like it had been dipped in dark chocolate, because only the tips of his fingers were still brown – the rest of the hand and arm was raw, pink flesh, as was most of one side of his body. Sahr spent weeks in hospital, when he was discharged I drove the family back to their house, armed with bandages, lotions & instructions on how to take care of him. A few weeks later, Sahr died. The news came as a complete shock to me because I thought he was over the worst of it. To this day, I don’t know why he wasn’t taken back to the hospital when his condition started to deteriorate.

At that time I thought that this was a freak accident, little did I know. In the paediatric unit at Benson Hospital, we have little mummies wandering the corridors every day of the year. Their story is always the same: they were scalded by hot water. Often the victims are toddlers – practising their first steps and curious at the same time – a worrisome combination in all societies. In Africa, where food is commonly prepared on fires at ground level, it is unsurprising that this is such a frequent injury.

Photo: Emily Bell, MSF | Emmanuel

Emmanuel, pictured above, is four. He was admitted to Benson on 29th January with 2nd degree burns on the left side of his body. On that day, he had been playing with his homemade toy truck (the kind often seen in Africa, ingeniously crafted together using scrap metal, wire and bottle tops for wheels) – chasing around his house and compound using a stick to push it forward. At one point the car flew forward further than normal and Emmanuel & his friend sprinted after it. Emmanuel reached it first but his friend collided into him and sent him flying into a pot of boiling water that was on a coal fire in the hall. Emmanuel’s mother was not in Monrovia at the time, his aunt was taking care of him, but she was not at home when the accident happened. A local pastor took Emmanuel to Benson Hospital from his home in ZayZay Community, fortunately not too far from us. Emmanuel remembers a neighbour removing the clothes that were stuck to his body and the painful motorbike journey.

Emmanuel has now been in the hospital over 3 weeks. He’s become a familiar face, as he likes to lounge around the reception area of the hospital – a breezier choice than the crowded room he shares with 2 other burns patients and their caretakers. He knows my name, which, like most Liberians, he pronounces ‘Emly’, and we often have a little chat. One morning last week I went to watch him have his bandages changed, which for him is a traumatic daily ritual. He told me that the part he dislikes most about the dressing is the injection he receives, this being Ketamine for pain management. The fact that this is the worst part for him must indicate that it at least works – if he was fully conscious during the change of dressings he would surely be in excruciating pain. Apart from the injections though, Emmanuel likes the hospital, in his own words – ‘Benson mek ma sore to die’ (loosely translated: ‘Benson is making my sores die’).

From our expat house in Congo Town, eastern Monrovia, it’s possible to see the sea from the first floor terrace, and to hear the waves crashing on the sand. The beach can be accessed on foot in a couple of minutes, and according to our security rules we are allowed to reach as far as the Chinese Embassy – a large, modern complex which looks incongruous in the surroundings and at night is lit up like a football stadium. This evening I jogged to the Embassy & back with 2 colleagues. It was a beautiful evening and the beach was flat and smooth which was perfect for the occasion. On nearing the Embassy, I saw a man sitting in a squatting position in the sand. I blinked twice: was he defecating? When I returned in the other direction, I discreetly had another look. He was definitely defecating, and he didn’t seem to mind that people could see him. A colleague had warned me that the beach near our house wasn’t clean, but I thought he was exaggerating when he said that people actually defecate on the beach. Clearly he wasn’t. Despite this, I was so hot at the end of my jog that I still ran straight into the sea and splashed around for a few minutes. On emerging, I saw not one but two more people defecating on the sand. One of them was a young lad in his early 20s who had taken a quick break from a game of football which was engaging around ten Liberians and now also my colleague Oriol. He was beaming at me, so I couldn’t resist.
 
‘Why do you make pupu on the beach?’
 
5 minutes and an amusing conversation later, I learnt that people pupu on the beach because the government doesn’t provide any facilities on the beach. The lad, who is currently enrolled at university in Monrovia, knows that defecating on the beach is not nice behaviour, but there are no latrines at the beach, and he had a natural urge, so what else can he do?
 
He has a point, however I don’t think I’ll be joining him next time I need the toilet at the beach.
 
Of course pupu on the beach is nothing. Liberia is recovering from 14 years of civil war, which left a broken society and the country on its knees. My days are full of contrast. One minute I am relishing every moment of being back in west Africa (I spent 18 months in Sierra Leone in 2005-6) – the colours, the music, the natural openness and fun of Liberian people. But the next I feel like pulling my hair out when something happens which makes me wonder how and when Liberian society will manage to rally together and rebuild its land. Children under the age of 10 are regularly brought into MSF facilities in Monrovia for medical attention and counselling after being raped. In my first week we received a 5-year old rape victim, who was so ashamed of what had happened to her that she told the doctor that she had fallen off a seesaw. On Friday, I was alerted that we had an abandoned infant on our hands; a girl aged 1 ½ who was malnourished & suffering from malaria. Her mother had left on Thursday afternoon and had not reappeared. The frightened child started to cry every time someone went near her. The mother reappeared briefly on Sunday, but left again, so when she turned up on Monday I asked to talk to her. She was very young and looked afraid as she explained that she had a small baby from a different father at home. The father of the second child didn’t care for the first child; therefore it was difficult for her to stay at the hospital. We asked her to bring her baby to the hospital so she could be with both of her children, she agreed but it’s very possible she will not return. Abandoned babies and children are by no means common, but they are common enough that we have a procedure in place for dealing with these types of situations.
 
The war lives on in the minds of the people, and the impact of the war undoubtedly affects our everyday activities: which patients come, why they come, how they react to new life, death and everything in-between. I know already that my experience in Liberia will be very different to the time I spent in Sierra Leone – Liberia’s neighbour & also a very poor country recovering from a long and brutal conflict. I was not working for MSF in Sierra Leone but a development-oriented organization running projects in agriculture and construction. While the physical scars of the war were visible for all to see, my day-to-day activities and experiences were not a constant reminder of the less tangible consequences – those inherited by the people who experienced a generation of brutality.

My mother has warned me not to become too attached to the children in the paediatric wards at MSF Spain’s Benson Hospital or I will become, in her words, ‘emotionally bankrupt’. I fear she may be right, but it will not be easy. My office for the next 9 months is situated in Benson Hospital, in the same building as the ‘paeds’ wards – so even before I enter my office and switch on my computer I am inevitably distracted by the likes of Fred, pictured below with his 19-year old mother. Fred is malnourished, like many of the children in our hospital, however in order to be admitted into our facility he must have presented with other symptoms – probably malaria. Of the approximately 250 Liberian staff who keeps Benson Hospital operating, I have not yet located the individual who takes care of Fred. When I see him he is not being weighed, poked or prodded, he is simply wobbling around the building on unsteady legs, holding tightly onto his mother’s hand and smiling suspiciously at any white folk who cross his path.

Photo: Emily Bell, MSF | Fred and his mother.

I have just completed my 5th day in Liberia, however as always with MSF I do not feel as if I am in an unfamiliar land surrounded by strangers. Undoubtedly it will sound cheesy, but I feel I have been welcomed back into the home of my second family. Cristina, who I am replacing, left Liberia yesterday and today I made it through my first day on the job as ‘Field Coordinator’ for the MSF Benson Hospital project in Liberia’s capital city, Monrovia. The organigram that Cristina printed for me on my first day fills 3 horizontal A4 pages, and above 6 expatriate and 250 Liberian staff was my name, Emily Bell. Even though I knew that’s why I was here, seeing my name presented in such a way made my heart beat loud and fast. At the end of Day 1, seemingly everyone knew my name already and I was still struggling to remember the names of the expats who I live with, who come from as far a field as Japan, Greece and Argentina and have equally exotic names to match. 4 days later I’m doing somewhat better, however as the saying goes in Liberia, it is definitely ‘no easy’.

Emily Bell is originally from Oxford, UK. She is currently in Monrovia, Liberia, working as a Field Coordinator in MSF’s project supporting the Benson Hospital.

Photo: Emily Bell