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ICRC supports bush clinics in Liberia

10-01-2005 Feature

A horrific civil war bled this country dry, virtually eliminating access to medical care. Since peace returned a year ago, the ICRC has been supporting small bush clinics in the north-eastern county of Lofa. ICRC communication delegate in Liberia Jean-Yves Clémenzo reports.

It is seven o'clock in the morning on a late October day. The sun rises timidly over Voinjama, the biggest town in Lofa, where the last war against former Liberian president Charles Taylor began. Marcelle Baltzinger, who has been working as an ICRC delegate for the past 20 years, is getting ready to take to the road and drive to the clinic in John's Town, about 30 kilometres away. She hasn't been there for a month. " Usually we go once a week, " she says. " But this past month the rains have made the road impassible. "

We're accompanied on the trip by two officials from the Ministry of Health and Social Welfare. Though supported by the ICRC, the John's Town clinic is run under the ministry's responsibility. Marcelle explains that the ICRC wants the Liberians to be fully involved so that the facility will continue to function once the organization leaves. The ICRC has been working to revive a number of health-care centres paralysed during the war. In addition to the John's Town clinic, the ICRC is also helping two other health-care facilities in the area, in Voinjama and Velezale. The gutted buildings have been renovated, medical supplies have been furnished and salary bonuses paid. " The Health Ministry recruits the staff and the clinic director, " explains Marcelle. " We’re consultants of a sort. "

After half an hour on the road, during which we see women walking nonchalantly with large bowls of vegetables perched on their heads, our four-wheel-drive vehicle suddenly plunges into a mud hole from which it’s unable to exit. Marc elle merely smiles, for her 10 years of humanitarian work in Africa have taught her not to get upset by this type of incident. The driver and two ICRC employees get down from the vehicle to shovel mud away from under the wheels. This process takes 20 minutes, but the vehicle finally frees itself. The passengers discuss the latest childbirths and the polio-vaccination campaign under way in Lofa. There then comes a long straight stretch – actually no more than an endless succession of muddy puddles. " This is the notorious Kilometre 28, the bane of our existence, " remarks Marcelle with mock sourness. This time the vehicle is truly unable to negotiate the obstacles and everyone ends up walking the final to kilometres to the town.

 Situation slowly improving  

At the roadside we find the clinic, its walls painted white and green. It contains a waiting room, a consultation room, a delivery room, a pharmacy and a bedroom for short stays. Most of the patients suffer from malaria or diarrhea. " We’re delighted to once again be able to do our work in a purpose-built facility, " explains Edwin Seba, the clinic director. Fortyish, fine-featured and distinguished-looking, Mr Seba received paramedical training before the civil war that devastated Liberia. Today he is in charge of a staff of nine. He estimates that they treat about 50 persons per week.

©ICRC/J-Y. Clémenzo ref LR-E-00208 
People have regain access to basic health care in some areas. 

Before the war, Lofa county had 44 bush clinics. Since hostilities ceased last year, 10 have been put back into operation. But these medical facilities are still far from enough to meet the needs of a population estimated by the ICRC to be 100,000. When ICRC staff returned in October 2003, the county had been virtually emptied of its population. Robert Gaygay, the local official in charge of public health, relates the health-care difficulties faced: ambulances are lacking, it is not possible to treat serious cases in the county, and even patients requiring more sophisticated care than the John's Town clinic can provide have to go home after treatment there since the nearest hospital is in Gbanga, over 300 kilometres away.

" Despite these problems, the situation is slowly improving thanks to aid from international humanitarian organizations, " says Mr. Gaygay. " But still it is not really enough. "

By the time the salary bonuses, medicine, hygiene items and clothing for newborns have been distributed, it is already noon. There is no time to lose if the ICRC team wishes to get back to Voinjama by nightfall, since the trip – which usually takes one hour – can easily last three at this time of year. Marcelle and the others return to the vehicle satisfied that the clinic has been functioning well during their absence. They are nevertheless mindful of the immense needs that remain unmet. A great deal must still be done in the realm of public health in a country whose citizens have a life expectancy of 45 years and one of the highest infant-mortality rates in the world. Far too many Liberians die of an otherwise treatable bout of malaria or diarrhea simply because they have no access to adequate care.

In 2005, the ICRC is planning to support 10 bush clinics in Lofa county and seven others in south-eastern Liberia. " We're concentrating on the areas hardest hit by the war, " explains Päivi Laurila, the organization's medical coordinator in the country. Though she does not have statistical proof that the health-care facilities are improving people's well-being, Päivi points out that the bush clinics afford renewed access to basic care after years during which the area had no medical infrastructure at all. In addition, she stresses that this care is being given by professionals. " That's progress. "

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