Coming home.

I am mostly packed to leave.  I have my colorful fabric walls folded and packed away.  I am just waiting for my clothes to dry one last time in the African sun.  I ate my last meal of potato greens and white rice.  Tonight I will have my last club beer.  I am sure I have yet to have my last ARC hassle, but there can't be many more of even those. 

This has not been a regrettable experience.  I met Jonathan who I will cherish forever.  I would expect we will keep in very sparse touch for a long time.  This community I know like the back of my hand.  I can walk down the street and see several people I know any day I want to.  I can't do that in Minneapolis.  

My understanding of the NGO world has increased from zero to enough that it makes me question instead of giving blindly.  I will no longer be a staunch USAID supporter.  We have lots to give but it turns out giving in a way that doesn't do damage is a tricky thing.  The book Blue Clay People supports my experience and I want to read more about this bizarre and mostly well meaning phenomenon.

Tomorrow morning as early as we can get the Liberian drivers up we will hit the road.  It is a bumpy, miserable road, but it heads toward the airport and we are all ready to get out of here.  The good news is we won't be parboiling in our tents or baking in the sun tomorrow.  We will be traveling in blessed AC.  The exact plans are uncertain in our view as we would just as soon bull through all the way to Monrovia over the 14 hours of road as long as we can leave early enough.  Contrary to the beliefs of our management the road is unpredictable, and we DO NOT want to miss our flight on Friday.  I personally will breathe several sighs of relief over the next few days- one on each of the planes in Monrovia, Brussels, and Chicago.  

Thank you to all who have taken the time to communicate with me.  Your support has been more valuable than I can say.

Dedicated to 34th and DuPont

"Hey white woman!"  I hear that cry a lot from the kids of Fish Town as I walk their streets either for exercise or transportation. "Give me money."  "Give me bottle."  I feel the hand of an adorable child join mine uninvited as I walk along only to hear from the little voice at my side, "Give me peppermint."  I am white.  No matter where I go or what I am doing I am a spectacle.  At any one time there are only four white people in Fish Town and they all work for ARC.   There is an albino Liberian here but he is well known and been here since birth so in a discussion of race he is black to these folks.  We are decidedly white.  A group of kids posed yesterday so I could take their picture.  They love having their picture taken, and as they gathered around in a tight huddle straining to see themselves in the image I noticed a small boy on the edge of the scrum running his finger along the skin of my forearm daring to touch such an odd colored appendage.  

The first time Jonathan and I walked to Jayproken the OIC asked a couple of the workers there to take us on a tour of the village.  Everyone was very friendly, but the kids were fascinated.  Some hid, some braved a wave, and many followed us as we walked around the village.  We played with them a bit and laughed at their antics.  Kingston, a man with dark black skin, turned and explained, "It is the color of your skin.  The same would happen if I walked down your streets."

Race is a fascinating issue and after being the minority for 3 months I have come to the conclusion that white skin is always the trump card.  While having white skin In a black culture can be annoying (who wants to be conspicuous 24/7?) white skin signals dominance and power whether it is in a white culture or black.  I can only wish that if Kingston walked the streets of Minneapolis the worst he would face would be fascination.  But we know that is not how it is.  In our country black skin is not presumed to contain the brightest and most successful, the kindest or most approachable.  Too often the the default assumption is just the opposite.

Perhaps even more wrenching than the American scenario is the Liberian situation.  This is a black country.  The only white people are NGO "humanitarian" workers. One can't even run for president here unless her or she is black.   Still the people who are looked at as the saviors, the rich, the solvers are white.  When we walk down the street people see money, they see help, they see a way they can gain.  Only the small children who can't figure out how someone can be such a different color are afraid.  Everyone else sees wealth and smarts and success.  It is a far cry from what black Americans face on our white streets.

So next time you walk down a street and see skin different color from yours take a second, be courageous, and honestly examine what your preconceived notions are about the human being within.  You might be surprised. 

Best day in Liberia

Today I took my final walk to Jayproken.  I went by myself because I was going there only to check on the construction project funded by my very generous friend, Chrissy.  She wired me some money and I was able to get a solar panel for their vaccine refrigerator, refurbishing of the latrines, new construction of a bathing stall for women who have just had a baby, and new welded lids for their incinerators.  Remember this is a village accessible only on foot or by motorbike.  Even the welding machine had to be hauled in by motorbike.  I left them last week with the money and asked (and was assured) all would be done by today.  As I walked in 100+ degree heat over 8 miles to check on the work doubt crept into my mind and by the time I dragged myself up the hill to the clinic I fully expected to see a marginally progressed project.  WRONG!  The latrines were done complete with locking doors, the bathing stall was constructed only missing some paint, the incinerator doors were fixed making it possible again for them to properly dispose of medical waste, and the solar panel was up (they could buy that right here in Fish Town) and the frig was cold.  Here are some pictures-

Latrines in brown on the left, bathing stall in gray on the right.  Two employees of the clinic in blue, the construction guys in civilian clothing.  They were very proud of their hand written signs on paper on each latrine door.  They will last no further than the next rain.  Of note, for the first time since I have been going to Jayproken people are actually using the latrines.  

The incinerators with new welded covers.

James, the officer in charge (OIC) proudly presented me an itemized report of where the money went.  I have no doubt it was padded in spots but he was so enthusiastic and proud I threw in money to cover the $62 over and another $20 for more paint.

Solar panel not visible from any angle, but this is the vaccine frig which they already owned.

The walk back was hell except I was able to pause from my misery to notice that there were very few people and motorbikes along the way.  As I walked I drank over 4 liters of water but the heat still got to me.  Then this loveliness occurred.

6 miles into the return trip I decided it was serving no one for me to bull through so I called Isaac, the motorbike driver.  He took me the last two miles then downtown to get something to drink then back to camp.  I arrived a mess, but after some time In front of the fan, a shower, and more liquid I began to return to closer to normal.  

Here is a bonus round from the day.

Positives

This morning I was sitting in front of my fan when I overheard a conversation between George, our WASH coordinator, and the group of young, local girls who haul out water.  They are a hard-working, young, strong, upbeat group.  George is in his 30's and has done WASH professionally for 13 years.  He is a tall man from Uganda with a distinctive British accent.  He was telling the girls that they are making small money but they should save it.  "If you save it and use it for school fees it will turn to big money.  These men here, he continued, are no good.  They want to you to have your baby and disappear.  They cannot support you.  If you go to school you will find a man who values you for your brains.  A man who will stay with you."  OK so he is still somewhat sexist, but at least he was trying to steer them toward advancement and independence.  If even one of these fabulous women take him up on his advice it will have been time well spent.  Then George left for a 3 weeks vacation to reconnect with his kids and professional wife in Uganda.

Yesterday on our walk back from Jayproken Karnie gave me nature lessons.  This is a fruit we ate the inside of.  It is sweet and makes you thirsty.  Karnie said employers will buy a whole bunch of them and feed the workers then supply water.  That way the workers stomach is always full and they never want to eat.  Much cheaper for the employer. 

He also showed me a plant used during the civil war to brush teeth, a plant you can boil to make a thrush medicine, a leaf that can be used as a skin anti fungal, and a tuber that is filled with water.  Very fun way to pass the 2 1/2 hours walking in the blazing sun.

Finally U-bor

About a month ago (or a year in perceived time) Jonathan and I worked hard to get a trip to U-bor, a little town in the north east corner of the county.  The attraction was that has is one of the two health facilities in River Gee that requires a water crossing to access.  That trip got squashed by the county health team and by our own local management.  Since ARCs mission is changing in the absence of ebola they are exploring school and WASH work for their next phase.  Preliminary to that work is assessing the schools on a short list they were assigned.  Lucky for us U-bor was on that list.  We were asked to go by the response manager and told we couldn't by the medical director.  Rogue behavior after a controlled logical chat became the tie breaker.  Yesterday we went!

The distance to the river crossing was 88 km which took every minute of four hours.  The main highway was an interstate compared to the smaller road that was the majority of the distance.  The road was overgrown with brush from the shoulders to the point that motorbike riders would get filleted by the sticker bushes without long sleeves and long pants.  We drove forward largely on faith at some points brush and branches obscuring the road completely.

We got stuck one when the ruts were so deep we got high centered.  Some careful jacking and judiciously placed planks got us free.

At bridges we decided to only endanger the driver's life by all bailing out using weight as an excuse.  As the car traversed them creaking and cracking planks were heard as a rule.  

Finally after the back and neck jarring ride we came to the river.  

While waiting for the boat to come over we conversed with a woman waiting with her two children.  The children were holding lengths of vine tied to large beetles.  As the kids walked the beetles flew and the kids walked around guiding their tethered and tortured insects.  

The kids had also captured a monkey.  This little guy was leashed to a stick so they could take him with them.  They swore they would not eat it since they were wary of ebola.  Hopefully the little guy gets away eventually.

The boat was amazing.  It was probably 20+ feet long (though I am terrible with estimated measurements like this) and was made of a huge hollowed out tree.  As I grabbed the gunwale I could feel the heft of the craft.  I bet it weighs upwards of 500 pounds.  One guy is assigned each day to be the ferryman.  We squatted or knelt as he rowed us skillfully across. 

The village was not one of the ones oozing civic pride, but the people were friendly.  The clinic has the same problems as they all do- no supplies, and no patient exams or vitals ostensibly due to fear in the time of Ebola.  The schools were supposed to open yesterday but they haven't.  The school in U-bor is still full of goat and other animal feces and the desks and tables are all in disrepair.

The village has one operational well for over 1000 people and their latrines are all full.  An NGO supplied all of it and for some reason the towns folks can't see it to dig a few latrines themselves.  No idea why except the mentality that has been pervasive here.  Namely, NGOs should do it for us.  

The kids loved getting their picture taken.

Here is a sign you read upon leaving the village.

It was another four hours of jostling to get back.  It was worth every bump!

One gone

One of us finally threw in the towel.  Dr. Joe gave his notice and, in one of the most efficient acts that has taken place since we have been here, he was in a truck headed for Monrovia the next morning.  He flies back to Texas today.  His leaving had me asking myself and others what makes me not go too?  Every day here is like wack a mole.  Something good happens, we get excited, and it gets squashed.  This happens over and over again.  Why keep going through that?  Because we came as a team and I can't even imagine getting on that plane in Monrovia and leaving everyone behind.  I can't imagine missing the triumph of boarding all together knowing we made it together.  There are some great people here, people I will never forget.  The adversity here could have made us a nonfunctional mess, but instead we have bonded tightly.  We have handled this very, very well.

Thanks to my friend, Chrissy, I have some money to help someone here.  I asked the folks at Jayproken what would help them most.  They said fixing the latrines was a project that needed doing that would make a difference.  The estimate was $2500.  I am not a Liberian contractor, but NOT!  He said the. How much would you pay for the work?  $500.  OK he said give me the money.  I told him I would give him half and I needed to see the rest completed before he got the balance.  He agreed.  My guess is he will find free labor from the village, get the materials dirt cheap or free and be that much richer.  Sigh.  At least they will have respectable latrines.  We will see if he can pull it off.  Trust is at a premium here.

Beautiful moon last night.  Nearly full.  I believe it was the same moon as shines over Minneapolis. 😉

Two more weeks of Fish Town.

Many tears

This blog may very well have reached its end.  Even the relatively rosy representations here scare those close to me into silence.  I wonder if people in comfy America really want to hear how it is here.  I wonder if I were truly honest instead optimistic if the people reading would get it or if they would still think I was "doing great work" or doing some noble learning exercise.  Would social studies teachers still use the blog to enhance their classes?  

This society is corrupt beyond comprehension.  Jonathan is working at a clinic on the highway, a horrible dirt road the government doesn't care enough to fix.  Just repairing that road would change Liberia forever.  It would improve the economy, the health care system, education, everything.  But I digress.  At Jonathan's clinic a 30 yo woman with six kids came in for a birth control implant.  Reasonable and responsible.  The midwife who is also the officer in charge at the clinic told the woman the implant is free but the procedure to put it in is not.  Total lie.  He found out she had $250 LD but that wasn't enough for him.  To get more he said the lidocaine at the clinic was expired so she had to pay for the gas for him to go get some.  She didn't have the money.  Jonathan took him outside and offered to pay the gas money.  Jonathan figured the man had to go to the next town so he prepared to continue to see patients while the guy was gone.  Five minutes later he returned.  Turns out he went 200 yards to his own home to retrieve lidocaine he had stolen from the clinic to resell to women who are just trying to keep from breeding like rabbits in a society in which men satisfying their sexual drive is a right but women trying to support a family in which many of the men don't work is a complete struggle.  So one could say what could the guy do?  His pay is not always delivered on time and when it is he gets only 180 USD per month.  All well and good until you do the math.  His housing cost is about 3% of his pay.  That's it.  The man has money relatively speaking.  So why the stealing, the conniving for more money?  This is just one such story.  There are many.

The chief's son was never brought in for medical help.  He will die of malnutrition.  He doesn't have a chance.  Maybe he has a wasting disease that can't be treated here, but he was never given a chance.  The chief's wife brought him to town on market day.  She brought me a chicken, but she didn't bother to bring him to the clinc or the hospital.  His bones looked like fish bones poking through his skin.  He had sores in his mouth.  He was listless.  He was almost two but didn't have the strength to stand.  His mother is pregnant agan.  Maybe he has HIV.  Maybe he has something else.  Apparently it is possible the family just doesn't feed him enough.  The rest of the family eats.  The boy will die.  Maybe he would die anyway but I am deeply saddened by the fact that no one in his family cares enough to give him a chance.  What kind of society does that?  

The PA at the hospital was seen ducking out the back door to avoid having to that a patient brought in by ambulance.  A child in severe respiratory distress was brought to the hospital and not treated until morning.  

There is one doctor in the county.  He is the only one who can do a C section.  He was called in the morning about a pregnant patient at the hospital who had been in labor for over 15 hours and the baby had not dropped at all.  One of our docs looked at her and thought probably the pregnancy was ok, certainly the fetus was alive with good heart tones, but she had a tiny pelvis.  The doctor was called again and he did not want the patient transferred or to leave.  He wanted to see her.  He never came.  A dead baby was delivered the next morning.  I was at the health center where he works while the patient was waiting at the hospital.  That doctor was in his air conditioned office all day.  

These are just a few of the stories.  There are many more.  These are not rumors but are witnessed accounts.   We all have stories like them, so to say we are doing good work?  No we aren't.  Maybe one or two patients will get more treatment than they otherwise would.  Maybe one or two won't die from pneumonia because Dr. Joe brought some antibiotics from home and gives them freely.  Maybe a solar panel bought by Chrissy will allow vaccines to be chilled in a clnic 2 1/2 hours away, but that will be the extent of it.  Everything else is just pissing in a cold, corrupt ocean.  There will be no sustainable change made.  None. 

Hail on the chief!

My walk to Jayproken kicked my butt, but it was an interesting day.  

Karnie, the CRNA from Fish Town, is one of our local ETU nurses.  He is an amazing person who has done a lot in his 27 years.  He has many opinions about his country.  Walking with him is fascinating and humbling.  He is half my age and, thus, walks way faster than I do.  He is kind enough to accommodate my speed.  We have the 3 1/2 hour walk down to a solid 2 1/2.  Turns out even I walk much faster than the average liberian.

Ebola triage where everyone gets screened even though ebola has never been seen here.

The dispenser in his dispensary.  Notice the empty spots on the shelves.

Kingston, the registrar.

Henry, the nurse.  He's been nursing for 40 some years!

James Quayee, PA, and me examining an OB patient in for her weekly check.  She should pop any minute.

On the right are the incinerators for trash burning and the cover on the ground on the left is for the placenta pit.  All birth products compost in there.

Dilapidated latrines.  These are squatty potties- pits with a hole you squat over.

After clinic Henry was kind enought to show us inside his house.  His is really nice compared to most.  

Karnie holding the welcome gift from Henry's mother in law.  They were delish!

This is a bed frame made of reeds (bamboo).  It is surprisingly springy.  They asked if I would buy them a mattress for it.  Not are how we'd get it there, but maybe a brave motorbikes would somehow load it on their bike and transport it.

Huge bamboo.  The men climb up in them and cut the reeds with machetes.

Termite nests are all over.  Thus no wooden buildings.

Jerry and me.  He was a patient today in the clinic.  I wowed him with my iPad then and he climbed up for more at the Chiefs house.  The chief is not a favorite of mine.  He has another grandson who is dying of malnutrition.  I saw that boy in the clinic as well this afternoon.  Hopefully the grandma will show up tomorrow in Fish Town to have more tests run and begin some sort of nutrition program.  We will see.  The chief had us over after out town tour and insisted on giving us a chicken.  Ironically they couldn't catch it.  The chief said he would send the chicken with is wife and the boy tomorrow.  Wish he'd keep his damned chicken and stew it up for the boy.  I may have to figure out what to do with a live chicken in a health center.  Stay tuned.......

Hospital?

Really?  That was a hospital?  Don't get me wrong the building was pretty nice for here and there were IV's hanging on a couple people, but that was about it.  They are so hurting for meds, equipment, and energy it was almost unbearable.  I was supposed to go to a far out clinic along the main road today, but I just couldn't stomach the ride.   It would have been 1 1/2 hours bumping along in a packed Land Rover type car, 3 hours of work and the same bumpy ride back.  So not worth it so I said no, and went to the hospital with Cher, a retired ER doc from Hennepin County.  She knows her stuff that's for sure.  We saw some interesting patient we could do nothing for.  One was an HIV positive 20 something with probable TB.  She'd had TB a few months ago and never finished her meds.  She was gurgling and hacking up a storm.  She was without a mask and in the women's ward with another HIV positive woman with typhoid who was 19 and looked 10.  When I heard the diagnosis I backed way away from the woman and made sure she coughed only into her piece of cloth she was holding.  First thing was to explain infection control to the workers and get her isolated.  From there we could talk treatment but in an environment in which there is little testing and few meds and one in which the clinics don't know what the hospital has or is doing and vice versa, there is little hope for this woman.  

The other patient worth mentioning was a man in his 20s or 30s who was referred to the hospital by one of our team who was working at another clinic.  The man had stolen a pack of cigarettes and as a vigilante punishment been heated on his head an back.  He was sitting on the ground when someon poured a bucket of "caustic water" on his upper back.  The chemical ran down his back into his pants and he sat in it.  He had third degree burns on his buttocks and upper thighs and second degree burns on his face, arms, legs, scrotum and penis.  He was a mess.  The ambulance ride was torturous over these roads.  We had Tylenol for pain and 10 mg of of diazepam.  Cher decided to de ride the scrotum and perineal burns while leaving the scarred buttock burns alone.  The man was understandably agitated so we decided to give him half of the available diazepam IV.  The hospital staff was laughing and chatting so the administration of the med was leisurely to the point Imalmost took over.  I did become somewhat drill sergeant like.  The IV was useless and by the time that was discovered they only had a tiny bit left.  Needless to say the man suffered all the way through.  Harper is a more affluent city south in Maryland county.  The man is from Maryland and has family there.  He should be getting his treatment there because family members can go buy supplies and bring them to the hospital if they are needed.  Turns out the man is a criminal wanted in Maryland County and is afraid to go back.  He is going to need months of care if he doesn't get septic and die.  He, like many others, is in a real pickle.

My day was exhausting and interesting.  Cher and I worked well together.  The glacial pace of the place and the lack of knowledge of what supplies they had drove me nuts.  There is a super complacent attitude born out of chronic deprivation that has almost completely killed creative thought. I get it.  I would probably have the same problem, but it is very frustrating and very, very sad.

Happy birthday, Dr. Joe

Today is the birthday of a very gracious and dedicated man.  Dr. Joe has made the very best of this ride.  Since he first set foot in the Fish Town Medical Clinic he has been the happiest, most fulfilled man imaginable.  He has met people and treated patients and had his world rocked not only by the poverty and resource shortage but also by the amazing people he has met.  One is Rose.  Rose is a certified midwife who runs the maternal health program at the clinic.  She's been there about 4 years and has delivered 1000 babies.  She is also the leader of the local Planned Parenthood and a person of authority at her church.  Like Dr. Joe, Rose takes life by the horns.  

Today four of us went down the hill to play frisbee.  We couldn't use the town soccer field as there was a game going on, so we took the disc to another open space and befor we had thrown it to each other even once there were 50 kids gathered trying to join.  It became an exercise in crowd control as the kids piled on top of each other for a chance to throw.  Then all 50 walked and ran back up the hill with us.  We organized them in a rough semblance of a line and had them wash their hands.  Why not?  We had to wash to get back in the gate and they wanted to wash as well.  Never too many hand washings.  We bid them good bye and disappeared in the gate.

Tomorrow we officially start going to the clinics.  Freelancing stops and we are now scheduled.  It should be interesting.  

Dr. Joe at Christmas.

Jayproken

This morning I made the walk with Karnie, a very talkative, outgoing, intelligent nurse anesthetist who was hired by ARC to be a nurse in the ETU.  We made it in 2 1/2 hours.  It is great having young legs pull me along.  We arrived at the clinic before the first patient was seem though after they had begun to gather.  We got another tour of the clinic which included a lot of detail of what they need.  Solar panel for the frig and other electricity, new covers for the incinerator, latrine upgrade, and a well.  All were real needs.  Then they showed us how inadequate their baby scale was.  They have the actual scale mechanism which is suspended from a wooden tripod.  The baby sits in a canvas seat like a kids swing.  I was with them on everything else but when I saw the scale situation I couldn't believe they would ask for that.  A new one could easily be contracted in a short time with almost no resources.  I should have taken a picture.  I will next visit.  It was a ludicrous request- such an easy fix for anyone there.  We may actually be able to get some of the other things done.  AND....the USAID said they have a portable bore hole digger they may bring here for our water.  Now my simple, hopeful and naive brain sees an incredible opportunity here.  The road to Jayproken is not passable for anything much bigger than a motorbike and certainly not for a well drilling machine, but there is a soccer field right next to the clinic that a helicopter could surely land on.  Why not drill two?  I know, I know....pipe dreams.  Still no one can say yes if the question isn't asked.  

The PA didn't show up until after 11, so, after the clinic was opened with a reading from Galatians and a prayer, Karnie and I began to see patients.  I am becoming a master at the rapid malaria test and the Depo shot.  The two big issues with providers here so far is the gross over use of amoxicillin and the gross underuse of physical examinations.  Those are my two educational goals for this clinic.  We go back Wednesday which is a busy day- tons of pregnant women.  I will be a master at measuring fundal height very soon.  One crazy frustrating thing today- a teacher at the school came in with headache.  His BP was 170/100.  This was a consistent reading with his past history.  In the past he had been given a short course of methldopa and followed up in a month.  No surprise that his BP was up at each visit.  Karnie and I agreed the man needed chronic meds but the only hypertension med the clinic ever has is hydrochlorathizide and they were all out.  We gave him Tylenol for the headache and aspirin for th blood thinning properties.  Such a cheap, simple treatment unavailable.  Sad.

I look forward to returning on Wednesday.  Tomorrow we head to a clinic on the road about 1 1/2 hours away.  I do not look forward to bumping up and down that road.  

Exercised AND useful

Today Mark, Jonathan and I walked to Jayproken again.  For those that forgot this is a clinc accessible by foot and motorbike.  Jonathan and I have been there two times before and last week promised to come again this week.  We finally did.  When we arrived I sat down with the OIC (officer in charge), a PA who has been there for 4 years.  4 years is forever in these clinics.  There is a lot of problem staffing the rural clinics so 2 years is about the longest you usually see.  I asked him point blank if our coming was a help or a hindrance.  His enthusiastic response made it clear that he would love our help.  Mark dispensed medication, Jonathan worked in a room with Henry, an RN who has been a nurse for 40 years and at this clinic for 20+.  I worked with James.  We saw all or almost all pregnant women from ages 19 to 41.  The 41 yo was on her 10th child.  I gave a lot of Depo shots to the rest of the patients. Here is the scary thing.  Wth just a little study I will be able to do the pregnancy checks on these woman with the same degree of efficacy as James.  Frightening.  The options and kills are so limited I May actually be able to teach them something in Jayproken.  Craziness.  

We came back and had a demonstration on how to put out a fire with an extinguisher.  The fire never went out.  That is until a bucket of water was brought out and doused it.  It was funnier than funny, but I will be keeping my wallet and passport on me just in case there I a fire 'cause this whole place is going up in flames is something ignites!

Here is my favorite wildlife to date.  Butterfly or two snakes?

Half way done.

My day began with water hauling.  Why not?  It has every morning for a long time.  We need water and I am willing to help.  We have a system to get it out of the river that works great- if everyone shows up.  

Today they did not.  Bright side?  I got good exercise.  Dark side?  I was very crabby at those who refuse to pitch in.  We are at a common point in communal living.  A few do the majority of the work.  We show up for meetings, we participate in fire drills.  In short, we carry the group.  My experience in this type of dynamic is that hard feelings now will even out and most of the non participants will end up contributing.  That is really hard to believe now, but usual history does not lie.  

Water crew.

After water Cher, Mark, and I walked an hour to Teajiliken, a little village an hour walk from here.  We knew there was no medical clinic but since some are assessing schools I volunteered to do that.

We met with the assistant principal of the school.  He declared right away that they needed a new building.  There are 127 students in nursery to sixth grade.  They have 5 teachers, all men.  They said they need a female teacher "to take care of the kids."  He admitted the men have tempers.  He claims they should have supplies though admitted he was not sure when the government would provide.  Here are pictures of the school.  My assessment?  They need a building!

School kitchen.  The kids get bulgar wheat at 1030 am.  They begin at 815 and are done by 1245 Monday through Friday.

After our walk we came back to afternoon electricity which was a real treat.

This evening I went down to Joes patio to talk with folks and catch up on our days.  The conversations were curt and snippy and snarky.  Again, we are at the midway point.  One conversation was about female circumcision.  One member of our team is older and from one of the tribes around Bong County.  He has a lot of pride in his heritage and culture.  He believes female circumcision is an important part of that heritage.  He particularly values the education that goes along with the surgery- education teaching women to be subservient to their men and holding very particular roles in society and the household.  Well you can imagine what was swirling around in the brains of the women gathered.  Everyone was determined to sway him which was not possible.  He is a strongly principled man and he has carefully sorted out his life in a way that makes sense to him.  It was a recipe for horrible and uncomfortable communication and was compounded by that fact that, yes, we are half way done.  I went back after everyone had left.  He explained that the women of Liberia don't know sexual pleasure anyway and the practice of female circumcision has kept teenage pregnancy almost nonexistent in his tribe.  He denies any knowledge of adverse side effects of the procedure in his tribe.  In his social structure women are respected and revered but should be educated in the traditional ways.  At the same time he values school education for women.  His daughters have advanced degrees and white collar jobs.  It is the new meeting the old and he values both and has decided for himself how to reconcile the two.  He also acknowledged the fact that I am not crazy.  He said most definitely the men I meet defer to any man which accompanies me.  It is part of the culture.  Wow.  I really really don't want to live here.  

This evening we had a meeting that was poorly attended and a fire drill that was not taken seriously.  Our leadership is weak and it really shows.  AND.......we are half way done. 

Good stuff

Nothing and lots has happened since my last post.  We have done little toward any health related stuff but we have talked a lot and gotten some parameters ironed out.  Keith, the country director has been in town.  He has talked and he has listened.  He is a mild mannered man on the surface at least and he speaks as one who knows the NGO world, Liberia, and world economics.  He has been able to put this mistimed ebola response in some perspective that those of us who want to can hear.  Some cannot hear it for their intense disappointment in this mission.  The biggest thing he did was make it clear that we can start really thinking of ways to reach into the community and design a project outside of ebola.  We are clinicians and not public health people or policy people and most of us will be gone in less than six weeks.  Add to that the inability to research anything on the Internet and the task becomes daunting.  Still we feel freed.  At least we can get some equipment to help those who want to work in the clinic and we can attempt to educate the health workers here.  Dr. Chessor was also helpful last night in illustrating some of the gaps in knowledge that exist here.  

The morning was again spend fetching water.  Many of the pumps have dried up or have owners that feel like they will dry up so we scouted the cleanest river farthest from garbage or homes and accessible and we have been dipping that water for showers and toilets.  The water is brown, but the WASH guys treat it and it doesn't even stink and they say it is safe.  We have an incredible system down which not only supplies water, but also money for the hired Liberian women and exercise for us.  Esther is the leader.  She makes $45 per week for her 4 hours of work per day including supervising the other women.  She is kick ass.  Her girls show up on time and work hard.  They are strong and happy and enthusiastic.  I have pics but no way to transmit them now.  Maybe in a later post.  

Yesterday we were sitting around discussing how to make the world better when a huge truck arrived at the gate.  It was either the bore hole digger or the second generator.  We were hoping for bore hole, but it was the generator.  Our disappointment was quickly turned to elation as we processed that we would have 24 hour electricity.  Sounds non essential, but the afternoon is the hottest and 24 hour power would mean afternoon fans.  EXCITING!!  As they unloaded the generator it was quickly noticed that the packing for transport had been shoddy enough that the engine had broken from the casing and was sitting akimbo.  Epic fail.  No generator.  No 24 hour electricity.  No afternoon fans.  Damn.

Today it was rumored the bore hole driller was at the ETU site.  As of this minute this is unconfirmed.  I will not believe it unless there is an eyewitness account.  If it is true and it doesn't break while drilling there maybe, just maybe we will have better water without all the hauling within a week.  There goes one source of exercise.  But like I say, nothing is assumed.  All must be confirmed by eyewitness to be believed.

Jonathan gave a lecture tonight on the origin of the phrase "I heard it through the grapevine."  It was the most entertaining part of the day!

Eyes forced open

Today I was assigned to work at the county health center.  I showed up at 8am and as is typical here there was no one to greet us for about a half hour.  Turns out they wanted me to take over one of the RNs office and see people all day.  The RNs here see patients order labs and prescribe meds.  If a PA is available the RN does more traditional nursing work but for today we were to take over their place entirely.  One of our staff is a PA from Monrovia so he and I worked together.  He did most of it because 1) he can understand what people are saying and 2) he is used to prescribing for the maladies here.  He had almost everyone tested for malaria.  All but one were negative.  I will have to read up on that.  Was he over testing or is the prevalence that high that testing most is reasonable?  Our RN who was working the pediatric room said almost all of his kids were positive.  All STD suspected patients get a rapid HIV.  Luckily the were all negative.  

The clinic is run like an urgent care- first come first served.  They show up with a paper chart without a cover that miraculously survives several years of use.  They state their complaint and a history is solicited.  No exam is done unless the case is "dire" which is not defined.  The only vital sign done is temperature.  Here is one blood pressure cuff in the clinic and it is not used for fear of transmitting disease.  These rules are the result of ebola and are limitations handed down from the ministry of health.  The labs possible are malaria, HIV, and hemoglobin if the case is "dire."  The panel of meds is limited as well.  One patient treated for gonnorhea could get the penicillin from the pharmacy but had to go to the hospital for the needle and syringe.  

One woman showed up with chest pain, back pain, and numb legs.  She was in her 50's which is no spring chicken around here.  There are no tests available anywhere, so we gave her an aspirin a day and some Tylenol.  It was the best she could get without going to Monrovia.  No exam was done.  Not sure we did no harm.  Another heart breaker was a 12 yo child with an enlarged liver and spleen.  He had been seen 2 weeks previous and referred to the doctor but was never taken.  According to the RN who saw him last he was deteriorating.  His spleen was massive.  We did examine him as the PA decided he was "dire."  He was referred again to the doctor, but who knows what the odds of him getting treatment is.  It was heart breaking.  

If I work there again I plan to disregard the crazy no touch rules and do more.  It just didn't make good sense.  What is clear, though, is that Americans are crazy lucky with the quality of our health care.  Now we need to take a page from Liberia and make it free and available to all.

Strong like a local.

This morning we went to the other end of town to pump water from the well of the HANDS NGO.  We had twenty 5 gallon jugs plus 3 fifty five gallon barrels to fill.  We did the jugs three times and the barrels twice.  We had some local liberian day workers with us who are hired for the task and we just go along to feel useful.  The leader of the Liberian troupe is Esther.  She has a mammoth smile, talks a mile a minute and readily makes jokes.  I can understand about 2/3 of what she says.  She is entertained by the Americans, but has Liberian pride.  I was honored today when she called me "strong like a Liberian" after I pumped 55 gallons without stopping.  Somewhere during the few hours we were working she went on a tirade about how the women in River Gee are so much stronger than the men.  What we have noticed in this land of incredible unemployment is that it is the women who show up at the gate each morning to see if there is any work.  None of the young men who come up to us daily wanting money to "get to America" show up to lift a finger.  We often see families coming in from the forest after cutting wood.  The woman will have a huge bundle of wood on her head and the men will have a machete balanced on theirs.  The gender roles here are crazy.  Men who I met first and have talked to most focus away from me and totally on the male I am with.  It is maddening.  In a country with a woman president and a workforce in which the women are so prominent it is amazing that they are still seemingly the second class citizens.  

I tried a machete today.  The security guard at HANDS was cutting the grass and I asked him if I could try it.  I was not very good at it.  It was amusing enough to the Liberians the ARC Liberians took pictures of me.  I am thinking mowing the "grass" at the cabin would be much more fun with a machete!

Fish town on a foggy humid morning.