More news from Liberia

I need to give people some background information about the country of Liberia, and how it is that I find myself here in Monrovia.

First, some background on the country.  Liberia suffered through a disastrous civil war from 1989 – 2003, which destroyed much of the country’s medical infrastructure, medical workforce and medical training programs.   The war has also taken its toll on the children of Liberia:

• Nearly 50 % of the population is <15 years of age
• Neonatal and under 5 mortality rate is among the top 5 highest in the world
• 40% of children suffer from stunting due to malnutrition
• Malaria and measles are among the leading causes of death
• HIV prevalence rate is 5.9%  (many believe it to be higher)
• Only about 50 physicians are presently practicing in country
• There is only one pediatrician in Liberia

A non-governmental organization called HEARTT (Heath Education and Relief Through Teaching) was created in 2005 by Dr. James Sirleaf, son of President Ellen Johnson-Sirleaf, to address the critical shortage in medical workforce capacity in Liberia.  The goals of this organization are 1) to provide interim direct patient care   2) To aid in capacity building through education and training of medical students, interns, residents and mid level health care providers (NPs and PAs).

To give people a flavor of what type of patients we are seeing here in Liberia I have listed the diagnoses that I have seen on the floor on my service.  The pediatric floor has approximately 30 beds and we have divided the service into 2 teams.  We work closely with the Dr Emmanuel Okoh, the only pediatrician on staff here at the JFK Hospital in Monrovia to provide care for the approximately 30 inpatients as well as seeing patients in the outpatient pediatric clinic and the emergency room.

The bed census for today includes the following diagnoses…

1. 5 yo boy with a large infectious neck mass of one week duration
2. 6 wk old girl with malaria
3. 1 ½ yo girl with severe malnutrition (admission weight – 5.5kg)
4. 2 yo girl with malaria, pneumonia and malnutrition
5. 11 mo old girl with diarrhea and severe malnutrition (admission weight – 4.2kg)
6. 4 mo old girl with pneumonia
7. 5 yo boy with osteomyelitis
8. 11 mo old boy with diarrhea, severe malaria and malnutrition
9. 6 yo girl with headaches, vomiting and tremor for 7 months and papilledema on eye exam from a presumed CNS tumor or tuberculoma
10. 7 yo boy with miliary TB
11. 6 mo old female with angioedema
12. 13 yo girl with pericardial effusion caused by TB (did well after pericardiocentesis now on TB treatment protocol)
13. 12 mo old female with AIDS and possible TB
14. 2 ½ yo boy with Burkits Lymphoma responding well to chemotherapy
15. 2 yo girl with severe malaria

That is the patient list in a nutshell.  A rather different list of typical diagnoses from what I usually see in the office on an average day.  It has been a privilege to be involved in this work and I look forward to the opportunity to come back in the future…