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The mobile clinics of Nimba in Liberia Do the elections recently held in Liberia in October signal positive and stable features of a country on the mend, or could they also be seen as a catalyst for new and emerging tensions? At the moment signs are positive thanks to the presence of the United Nations Mission to Liberia (UNMIL) with its 15,000 peacekeepers. However many factors still hang in the balance and especially in Nimba County in the north, where MSF Switzerland (CH) is providing essential health services. Walking on a tightrope
Continuous threat of violence in Côte d’Ivoire The failure of the peace process in Cote d'Ivoire, with a recurrence of violent incidents, has destabilised the fledgling progress towards rebuilding infrastructure in Liberia. The MSF-CH run rural hospital at Saclapea in central Nimba, is adjacent to a UNHCR camp that is home to both refugees from Cote d'Ivoire and displaced Liberians. Situated about eight hours drive from the Liberian capital, Monrovia, Saclapea Hospital is the region’s only 2nd level health care facility, and provides free medical care to people living in the camp and to the surrounding local population.The hospital has 75 inpatient beds, with ICU, maternity and paediatric departments, a malaria unit and a therapeutic feeding centre (TFC). Outpatient consultations average around 120 per day. Following a cholera outbreak earlier this year a separate isolation unit was set up to manage the situation. Surgical referrals are made to hospitals in cities three hours drive away ( Ganta, Phebe or Saniquellie), or to Monrovia There is a fledgling program for Sexual and Gender Based Violence (SGBV) and a TB unit is also being established. In addition, MSF mobile clinics tour the region and offer weekly consultations in eight separate locations. Approximately 30,000 people live in Saclapea while around 200,000 people live in surrounding districts. It’s principally here that MSF CH’s mobile clinics conduct essential health services.
Plans for 2006 include closing the TFC (most cases of malnutrition now have underlying social factors or co-morbidities), and building a permanent 45 bed structure to replace the present “poles and plastic” hospital. Now that Liberia enjoys “post emergency” status it’s likely that the mobile clinics will be phased out as more fixed health posts are established in the more remote locations of South and East Nimba.
On the road in Nimba County Nimba is where New Zealand nurse Adam Walter has just returned from after six months in the bush conducting mobile clinics. Adam, who was recruited in Sydney by MSF Australia, would go with a local team of health workers another two to three hours drive into remote areas to set up mobile clinics for populations who had no access to health care facilities at all, sometimes travelling as far as the Cote d'Ivoire border. The clinics offered antenatal care as well as providing general consultations. Predominant morbidities were malaria (30%), STDs (15%) and acute respiratory infections (12%).
“In Nimba the main hurdles to access to health care are lack of infrastructure, lack of funding, and lack of human resources. Some ethnic groups have been marginalised, and along with the large population of ex-combatants these people must be reintegrated into the community to provide a stable environment,” says Adam. Reintegration started with the ex-combatants handing in their arms in exchange for money and educational opportunities in mid 2004. ”As long as this process does not cease and there is the creation of work or training, then Nimba is relatively safe. Road clearing, bridge reconstruction and farm work are examples of UN subsidised work schemes that are assisting the reintegration. Unfortunately, a second promised payment to the former militias in 2005 was not forthcoming” says Adam. “Furthermore, the recruitment of disenchanted Liberian fighters for the current Ivorian conflict also runs counter to this process.” Meanwhile the everyday work continues for MSF which means delivering free health care to a population traumatised by 15 years of civil war. Adam explains some of the health issues in the Nimba region: “Malaria remains the number one cause of death, especially among young children with low resistance to the prevalent falciparum infection. HIV is an emerging problem, with already an estimated prevalence rate of 10%. There are numerous factors for this: there is a huge population of ex-combatants or young men who have been at war for 14 years, so they have no employment, no education and their social skills and attitudes to women are appalling given the context of HIV.”
“I was particularly pleased to have a midwife added to our mobile team. This allowed us to address more effectively a range of mother and child health issues as well as providing antenatal care. For example, family planning, SGBV sensitisation, sexual health education and programs for local traditional birth attendants.” During Adam’s tenure MSF Switzerland had four international staff based at Saclapea, including a doctor and a nurse in the hospital, a field coordinator for the project, and one nurse responsible for mobile clinics and health posts. There are six people currently in the team including a logistician and a community health educator establishing the SGBV program. MSF-Ch employs about 120 national staff in Nimba including nurses, physician’s assistants, lab technicians and many non-medical personnel. “The strength and resilience of the Liberian people and their generous hospitality was a real encouragement in what sometimes seemed an insurmountable task,” Adam said. “It’s like they’ve been walking a tightrope, for 15 years. They must be strong and make sure this current post-election process can bring a durable peace and a real change in their living and health conditions. If the election can provide a stable government committed to rebuilding Liberia’s infrastructure with a sound program of economic development, there is no doubt that the Liberian people have the fortitude, desire and humour to enjoy life again in this beautiful West African Nation. But MSF must remain vigilant.” By James Nichols and Philippe Tanguy, MSF Australia » Read about other featured projects
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