Mike’s Liberia Journal
June 5th, 2021
This trip to Liberia is my shortest (and most focused) to date. Twelve days (minus a few hours), able to be summarized in a single journal! We needed to upgrade the laboratory and operating rooms, so a huge purpose of the trip was me delivering supplies. I landed very late on a Monday night with 320 pounds of luggage.
Yup, 320 pounds. Of that 320, approximately 30 are for me. Then there are 100 pounds of surgical equipment, 150 pounds of laboratory equipment/supplies, and 40 pounds of random hospital supplies. It is a lot to handle while trying to navigate an airport alone. Luckily, I found the only skycap working at pandemic-times Dulles as soon as I arrived.
Our laboratory needed an upgrade – our new hematology system we installed last trip is going so well we already need more supplies and to update the unit itself. Same with our chemistry device. While the logistics of getting the supplies there are suboptimal, it’s a “good problem” to have. Especially while flights are so cheap that it is much cheaper and easier to fly them there personally than to ship. And it justifies me coming back to Liberia, which is always fun. This equipment would otherwise have cost several thousand dollars to ship securely and would likely have taken weeks to arrive.
I started off the trip on a fairly unpleasant note. I had been warned that hassles at the airport (and roadstop checkpoints…and just about everywhere) were extraordinarily prevalent…and that proved to be true. After two hours of hassling over extra “fees” and “duties”, I finally got out of the airport with all of my belongings and those of the hospital. After 30 hours of travel, those last two hours were even more frustrating than usual. Luckily, my ride was there with some friends to help with the luggage; I was in bed within an hour of leaving the airport.
First project, updating the hematology device:
As I mentioned in the last trip, the hematology machine we use is quite novel. The Olo™ machine is made by Sight DX and is, in theory, ideal for the Liberian healthcare environment. It requires no reagents, its kits do not require refrigeration, and its results (and any errors) can be accessed remotely from anywhere in the world. It is really, really cool.
Sight DX was eager to partner with us as a “trial run” of their device in this environment. This is the first Olo™ on the continent and, due to its austere conditions, Liberia is a great test site. This trip, they have provided us with a new Olo™ to swap out with the one we installed in February; I will bring back the old one for them to evaluate for effects from a few months of life in Liberia.
Along with swapping out the device, I delivered 450 new test kits, which should last until my next trip over (September). If we keep increasing our services, they may not (another “good problem”)…in which case, Sight DX has pledged to find a way to get more here in the interim.
Our lab staff, Ibrahim and Theo, were thrilled to get the new wonder-tool. We managed to have it fully installed and working within one week of arriving in country.
Once I had the Olo™ up and running, I started the process of unpacking, sorting, and inventorying our new surgical tools.
This was a huge donation from our friends at Brother’s Brother Foundation (BBF). We have worked together for almost a decade on healthcare and solar power projects. A few years ago, they donated all of our hospital exam tables and enough medical monitors and other equipment to fill a shipping container. Our hospital would not be open without their generosity.
Last year, a surgeon starting performing small surgical procedures at our hospital. He made a shopping list of surgical tools he needed that he could not find in country. I turned the list over to BBF and they responded with 100 pounds of very high quality surgical tools: multiple copies of everything on the list, jam-packed into three surgical trays to minimize space since they knew I had to carry it all over. After a few hours of unpacking and inventorying, we have a very well-stocked operating theater.
After setting up the laboratory and OR, I spent the rest of the trip treating patients and expanding our respiratory care unit at the hospital. We were fortunate to receive a donation to double our oxygen capacity at the hospital and also to have a few of our broken oxygen concentrators (previously donated by BBF) serviced by a biomedical engineer training seminar. This was perfect timing as COVID-19 numbers were (and still are) rapidly increasing in Liberia.
Liberia largely dodged the COVID-19 pandemic of 2020. In March of 2020, when the first COVID-19 patients were noticed in Liberia, the government closed the borders. No airlines, no land crossings, nothing. Schools were closed, mask mandates were put in place. Expats in the country were offered chartered flights from the Embassy every few weeks to get home. The country really shut down from March until the end of July. Although they had a small wave of COVID-19 in the Spring, it did not overwhelm the system.
When the borders reopened, the rest of the world had stopped travelling so there wasn’t much of an opportunity for COVID-19 to come into Liberia. They also had implemented testing requirements to enter the country. Even when I came back in February, the flights were pretty empty and the government was being quite serious about testing upon arrival. But, by March, the world had started travelling more frequently. Most international agencies in Liberia had brought their staff back, “necessary” business travel had resumed, general activity was increasing. However, vaccination rates in Liberia remain quite low and very little of the population have been exposed to COVID-19. Liberia is quite vulnerable to this pandemic that has already beaten upon so many other countries. Combining increased international travel with the onset of rainy season for the Summer (during which people tend to congregate indoors) could cause a significant uptick in COVID-19 infections. In preparation of this, we increased our capacity in our respiratory care unit at the hospital. Luckily, the largest oxygen plant in the country is only a few miles from our facility.
Unfortunately, there was a significant spike in COVID-19-positive cases arriving at the airport in the days before I left (108 new cases on the 6 flights before mine, and “many” that exited the plane on which I departed the country). I flew out on Friday and the Minister of Health called us on Monday to ask for our facility to serve as the overflow site for the national COVID-19 treatment center as it was becoming overwhelmed. I’m glad we prepared for this, but, I’m very concerned about what the next few months in Liberia will look like. I’m currently scheduled to go back in September but may go sooner (and bring some colleagues) if the pandemic gets too bad there. In the meantime, I will hope not.