Liberia: First Impressions

Paediatrician Mark is working at the MSF children's hospital in Liberia, providing care in a country where the health system was devastated by the 2014 ebola outbreak. 

It’s been two weeks since I first arrived in Monrovia.

I’ve joined an international team from France, Sweden, Nigeria, Rwanda, Ivory Coast, Uganda, Cameroon, Australia and USA. They form the coordination team and two project teams; one working on mental health, the other is my project – Bardnesville Junction Hospital (BJH).

In 2015, MSF converted an old accommodation block into a paediatric hospital with the aim of delivering general paediatric care that had largely been neglected during and post ebola. There are currently a total of 82 beds with 15 beds in Intensive Care Unit (ICU), 10 in the Emergency Room (ER), 31 on the paediatric ward and 26 on the malnutrition ward. There are a total of 12 physician assistants (PAs) that cover all the areas of the hospital, day and night, seven days a week. Along with the nurses, they have considerable experience, with some having worked with MSF in previous projects.

The hospital is a four story brick building, with a colourful mural on one side, and brightly coloured stairwells

Bardnesville Junction Hospital. Photo: Mark Lee / MSF.

If I had to use three words to describe my first impressions: wet, confusing and relentless.


The humidity is stifling, with simple tasks such as walking up three flights of stairs becoming embarrassingly exhausting. My glasses are constantly fogging up and I’m perpetually apologising to the Liberian staff as I pause to wipe my face dry, only for it to perspire profusely again after two minutes. I expect it will be a couple of weeks before I acclimatise.

The long rainy season is showing signs of beginning to ease up - a blessing as there should be a reduction in malaria cases. However, I’ve been reliably informed that it will only get hotter – fantastic!

Rain pours off the roof of the hospital. The sky is grey, the palm trees and everything else is soaked with rain.

View from the hospital: #rainyseason. Photo: Mark Lee / MSF


I naively thought that communication with national staff and patients would be a breeze in English-speaking Liberia until I was greeted by the MSF driver at the airport, my first encounter with ‘Liberian English’. It would be optimistic to say I understood maybe 50% of the conversation on the way back to base. Morning handovers and medical discussions at the hospital have been just as challenging. I’m glad to discover that some of the international staff who have been here for months still struggle with it, though some (of the French variety) admit that they find the Australian accent equally incomprehensible…


The workload is intense, with a high number of patients with severe, life-threatening conditions that require a lot of attention and support. Last week was particularly harrowing, with seven children dying in a 24-hour period. Sometimes, I feel like we are treading water – trying to free up space on the wards and in ICU for what seems like an endless conveyor belt of sick children that turn up in the ER.

The patient list typically consists of comatose infants with cerebral malaria, convulsing babies with suspected meningitis, children with severe pneumonia, children with gastroenteritis with shock, tragic cases of malnutrition, and sickle cell sufferers requiring blood transfusions.  Unusually, we had two DKAs (Diabetic ketoacidosis - newly diagnosed diabetics that had become seriously unwell with dangerously high blood sugar levels), a condition difficult to manage in the UK, but especially challenging here given the lack of resources and absence of quality long-term outpatient care.

The hours will take some getting used to – we leave base at 7am and aim to leave the hospital at 5pm, usually getting back to base around 6pm. Occasionally, emergencies in the hospital or the traffic will mean a later finish. I split the weekends with the medical referent - my boss, a French intensive care specialist and MSF veteran, whose role is more managerial and administrative, but who is a great source of support, both medically and emotionally.

A team of health care staff in green scrubs resuscitate a baby

Resuscitation of an infant in cardiac arrest. Photo: Mark Lee / MSF

It’s a steep learning curve in terms of adapting to a different living environment, familiarising myself with MSF treatment guidelines and getting to know the huge numbers of Liberian staff at the hospital. But it’s still early days, and as they say in Liberia ‘slow, slow’.