When 28-year-old Elizabeth Sieh gave birth to healthy triplet boys at J.J. Dossen Hospital in Harper, Liberia, it was cause for celebration.
Just two years ago, the outcome would likely have been very different.
Elizabeth received an ultrasound that alerted the doctors to a triplet birth – a difficult delivery in any country, let alone Liberia.
She was started on steroids prior to the cesarean section to accelerate the growth of the babies’ lungs; surgical instruments were sterilized in the new autoclave; the newly installed generator ran the operating room’s air conditioner in the newly refurbished operating theatre (usually 32ºC or above); the supply chain team located the required special sutures in the capital of Monrovia and MAF flew them southeast to Harper in time for the operation.
Fourteen staff stood ready to enable a safe delivery for Elizabeth and her babies, including experienced local and international doctors, nurse anesthetists and midwives.
Three teams stood by, one per baby, ready to resuscitate if required.
The successful triplet birth demonstrated a new level of care at the only hospital in Maryland County, the beginning of change that Partners In Health (PIH) is committed to bring to Liberia’s healthcare system.
Changing the odds
The odds have never been in a Liberian’s favor.
Prior to 2014, the country had fewer than 200 doctors for the entire population of 4.3 million, due in part to back-to-back civil wars.
In the US and most European countries, 10,000 or more doctors serve the same number.
If you were a pregnant woman in Liberia, you had a 1 in 28 lifetime risk of maternal death.
Compare this to 1 in 8,400 for European Union countries.
It’s difficult to imagine it could get much worse, but it did.
In 2014, the Ebola epidemic struck, shattering the already weak healthcare system.
At the invitation of the Ministry of Health (MOH) in late 2014, Partners In Health, an American NGO, came to Liberia to respond to the Ebola crisis in southeastern Maryland County, a 16-plus hour drive from the capital of Monrovia on brutal dirt roads.
After Ebola came under control, PIH stayed to focus on a long-term plan for rebuilding the broken health care system.
In 2016, PIH doctors Jason and Sara Beste arrived in Liberia to work in Harper where PIH is based.
'Even the most basic systems have been so difficult to get working. Everything is hard but also a lot more rewarding because you see change so quickly when you start from very little.' Sara says.
In just two years, PIH has worked to significantly refurbish two major facilities in Maryland County: J.J. Dossen Hospital in Harper, and the New Pleebo Health Center in Pleebo, which serves a city population of over 23,000.
They are working with MOH to staff and oversee the two facilities and supply necessary equipment including the first X-ray machine since before the civil war, generators, and considerably improving the supply chain for medical drugs.
Minnie Horace, a Liberian working with PIH as Clinical Lead Nurse, trained in Canada and worked in Texas before returning to Liberia in 2014 to work with PIH during the Ebola crisis.
Now Minnie mentors nurses working in PIH-supported facilities, strengthening their skills now for the long-term.
'I love mentoring the nurses. In my perception from back in the day, it was completely different from our new nurses now. I think after the war the basic knowledge was really lacking. I see the gap is great. It’s challenging but I like it. It gives me the greatest joy.'
Zero maternal deaths
‘Quickly’ is relative, however, when the need is for permanent and stable change, but with time and commitment it is possible as PIH has proven in Rwanda.
Since 2000, through hard work of local leaders and partners including PIH, the number of Rwandan women who die from pregnancy or delivery has decreased 80%.
PIH is working toward the same transformation in their facilities in Liberia, with a five-year goal of zero maternal deaths.
If we didn’t have MAF, we’d really struggle to do work this far out.
Ian Mountjoy, PIH Director of Operations for Liberia
The successful birth of Elizabeth’s three baby boys represents the change that is already taking place in Maryland County, and that is cause for celebration!
'It’s amazing to be involved in the rebuilding process and already see change in the short time that I’ve been here, working hand-in-hand with the Ministry of Health in Maryland County which is very open and supportive,' Jason says.
'This was the hospital for the dying. Now the community is starting to trust again.'
In the end, it’s all about giving Liberians more than just a chance at surviving an illness, accident, pregnancy or birth.
Partners In Health, working with the Ministry of Health and supported by MAF, are changing the odds.
A partnership with MAF
PIH requires constant travel between the two cities and most of this transport is done by MAF; the gratitude from PIH is overwhelming.
'Sometimes if MAF is too full, I take the road,' Minnie recalls. 'We got stuck for two hours last time. Sometimes you get stuck for days.'
Ask any of the staff with PIH or the hospital how MAF helps and you will hear stories.
Ian Mountjoy, PIH Director of Operations for Liberia, summarizes it best: 'Our partnership with MAF has really made it possible for us to be able to work as extensively as we do here in the southeast given how remote it is and how unreliable it is getting vehicles back and forth. If we didn’t have MAF, we’d really struggle to do work this far out.'