Three is Company

25 August 2009 Comments

“I were happy”, says Esther, 25, when I asked her how she felt when she gave birth to triplets instead of the expected single baby. Esther and her husband, Wilson, 23, call the multiple births on 3rd March “a gift from God”. They named the girls Nancy, Rita and Ellen. Nancy after the traditional midwife in their community who delivered the babies at their house, Rita after Wilson’s sister with the same name, and Ellen after Liberia’s President – Ellen Johnson Sirleaf.

Emily Bell

 

Esther, Wilson and Angie (expat Nurse) with the triplets, outside their house in Lakpazee, Monrovia. | Photo: Emily Bell

11 days after the triplets were born, Wilson and Esther took them to Benson Hospital because “they went off…they were getting darker”. After a helpful consultation with the Paediatrician who took care of the triplets, I learn that the triplets were suffering from neonatal sepsis and malnutrition; they were lethargic, feverish and not feeding well. They weighed 1 kg (2.2 pounds) a piece and Esther was struggling to satisfy their hunger with breast milk alone. When they
arrived, they were kept warm and closely monitored in our intensive care unit (ICU), and fed on a diet of antibiotics, breast milk and infant formula through a syringe. Mum was provided with three meals a day by Benson’s kitchen (porridge and bulghar wheat), and allowed to catch up on much needed sleep. When the babies were stronger, they were moved upstairs to the Paediatric Ward, and on 8th May – each weighing 2.5 kg (5.5 pounds) – they were finally allowed to go home.

I first met Wilson when the triplets were still admitted at Benson. With an open, innocent face, and an infectious smile, he approached me and asked if MSF could continue to help the family, even after the triplets were discharged. They already had an 18-month old to take care of and, like many of the families who bring their children to Benson, they were desperately struggling to make ends meet. Unable to find any other organization that could provide them with assistance, and in view of the exceptional circumstances, we agreed to provide them with formula milk until the triplets are nine months old (while at Benson, Esther had been given proper instructions on formula milk use while continuing to breast feed).

Last week I visited Wilson, Esther, the triplets and their extended family at their home in Lakpazee, not too far from where I live in Monrovia. Approaching their community at dusk, I pass the ubiquitous plywood shacks painted in bright colours, home to ‘entertainment centres’ (if you want to see a Nigerian movie on a television), barber services or small shops selling daily essentials such as eggs, sugar, soap and telephone scratch cards. At this time of the evening, the average Monrovian is in a hurry to complete the day's last task before darkness descends. Young girls and boys balance buckets of water precariously on their head and steady themselves before beginning the walk home. Barefoot boys who have escaped their chores play impromptu football games with a ball if there is one, if not then a handmade equivalent. Women and girls sit in front of their houses and take turns to fix each other’s hair – the victim usually looking bored and uncomfortable, not to mention faintly ridiculous if the job is only half-finished – one side of her head displaying neat, orderly cornrows, and the other a wild, untamed afro.

Wilson tells me that he dreams of living in a ‘professional house’, meaning one made from concrete. The house he lives in currently is cobbled together from traditional matting and corrugated zinc sheeting – the latter a popular low-cost building material in urban Africa, and a deafening one in a country with rainfall as heavy as Liberia’s. In one of only two rooms in the house, Wilson sleeps on the floor with his wife, the triplets, and no less than four boys who are all somehow related to Wilson. There is barely room to move without stepping on the sleeping area, which is covered by a giant mosquito net. Rita, Wilson’s sister, sleeps with her husband in the small room opposite.

Cooking, eating, washing and socializing all happen outside. Rice and gari (fermented cassava) are prepared on a 'coal pot' at ground level. The community water pump is conveniently located across the street from the family’s house. In the midst of the rainy season, water supply is rarely a problem, although the quality occasionally results in a 'running' stomach. In the height of the dry season, however, families like Wilson’s are forced to buy drinking water – sold at 50 Liberian Dollars or ‘Liberties’ (70 US cents) for 5 gallons. The ‘shower’ that Esther emerges from as we arrive at the house is a patch of ground barely enclosed by some zinc sheeting; this same patch of ground serves as a toilet; ‘pupu’ is put in a plastic bag and thrown over the fence.

Esther wishes for a generator, and as we sit on the small porch at the front of her house with the natural light rapidly fading, it’s easy to understand why. It’s only 7 pm and the triplets are all wide awake, although I seem to be more worried about this fact than Esther, who exudes serenity at all times. Wilson rummages around to find the household’s only torch, which doesn’t function with his first attempt. He takes the batteries out, rubs them on his trousers and gives them a blow, which seems to do the trick. The only income the household has comes from selling drinking water for 5 Liberties (7 US cents) per sachet, and coal at 10 Liberties per bag; they are lucky to have 15 customers per day which is a maximum of 150 Liberties, equivalent to about 2 US dollars. 2 USD for 9 people for one day! Even purchasing candles is beyond the means of Wilson and Esther, a generator is but a pipe dream. I think to myself that I must email my friend Charlie, who is coming to visit me in September. If she could bring Esther a head torch, that might at least make the nights a little brighter for her.

This post is dedicated to Professor David Morley, who died on 2nd July 2009, aged 86. Morley was a Paediatrician and an Emeritus Professor of Tropical Child Health, and he inspired my interest in health in developing countries when I was studying English Literature & French at the University of Manchester over ten years ago. He supported and encouraged me to develop my career in this field, and it is largely thanks to his mentorship that I am working for MSF today. Before my blog went live, I emailed him the first two posts in order to have his valued opinion. Fortunately for me, he approved, and one of his comments was: ‘Yes I think you should (go ahead)…we do not hear enough about people’s ‘pupu problems’…please enroll me’. This very down to earth and no nonsense statement was typical of a man who dedicated his life’s work to improving the health conditions in underprivileged communities. His obituary can be read free of charge on The Lancet website here:

http://www.thelancet.com/journals/lancet/article/PIIS0140673609614410/fulltext?rss=yes

And an article about him in his local newspaper:

http://www.hertsad.co.uk/search/story.aspx?brand=HADOnline&category=News_Harpenden&itemid=WEED09%20Jul%202009%2016:34:18:990&tBrand=HADOnline&tCategory=search