December brings not only Christmas, but also the Harmattan, a dry, dusty wind that sweeps in from the Sahara through West Africa at this time of year. The humidity is slightly lower and the temperature has dropped to a relatively chilly 25 degrees Celsius during the day. The most noticeable impact of the Harmattan is the clouds of dust that turn the skies to a thick haze and leave a fine layer over everything. Blowing my nose results in a black tissue – if you live in London, you’ll know what I mean.
Mark and MSF's supply manager celebrating Christmas with some friends from other organisations, wearing matching Lapa [shirts]. Photo: Mark Lee/MSF
After three months in Liberia, I feel more comfortable with the job, the hospital and the team. However, mortality rates continue to be high and the daily sound of bereaved mothers wailing after the death of their child is always upsetting and something I will never get used to.
It is natural to question ourselves and think that perhaps we are not doing as much as we could to prevent all these deaths. Certainly, a large part of my job is to make sure we are providing the best possible treatment with the resources we have. But, one clear contributing factor to the high mortality is the difference in health-seeking behaviour.
Files documenting deaths on the ward during December. Mark Lee/MSF
Challenging health-seeking behaviours
Traditional or ‘country’ medicine seems to be the first port of call for parents. Traditional healers use a combination of cutting/marking the skin and the application of herbs (both orally and through other orifices, depending on the complaint). These herbs cause vomiting and diarrhoea, and can sometimes lead to infections and toxic effects. It is only when all else has failed and the child is extremely unwell that they then decide to come to the hospital. Often it is too late.
When mothers experience difficulty with breast feeding their babies, they resort to giving them water rather than seeking medical advice. Not only does this make the baby malnourished, but there’s also a risk of gastroenteritis, as the water is often contaminated, and frequently the babies choke as the water is forced into their mouths.
There are many delays that contribute to children dying here: the delay in recognising when their child is unwell; the delay in seeking help from a skilled healthcare worker; and the delay in reaching a high-level care facility, particularly as the distances involved, on terrible roads, can take many hours. When a child or baby has died while on their way to our hospital, they are recorded as ‘dead before arrival’ (DBA). Sadly, we receive so many DBAs that we have a specific area in our emergency room for these cases.
Changing cultural practices is never easy or quick, but we have an excellent health promotion team who regularly engage with the local communities. They are gradually building trust in MSF as shown by the increase in patients coming to the hospital.
A public health campaign poster encouraging mothers to breast-feed. Mark Lee/MSF