Mike’s Liberia Journal
June 19, 2023
I recently returned to Liberia and am excited to write my first journal in two years. Shortly after my last journal, a devastating wave of COVID-19 hit Liberia and I was urgently called back to Liberia to aid their government. I could not really talk about a lot of what I was doing during that time, and then fell out of habit of journals. But, thank you all so much for your care and support in these years, and I can summarize most of the gap in this prologue to my current trip!
Third Wave of COVID-19 in Liberia –
About two weeks after my May 2021 trip to Liberia, I received a call from the Minister of Health of Liberia. COVID-19 had spiked in a huge way since I had left and the COVID-19 Treatment Units (CTUs) were overwhelmed. More concerning, the mortality rates were through the roof (greater than 80% for folks requiring oxygen the week that I arrived). She asked me to come serve as her consultant for the national COVID-19 response and sent a letter requesting my assistance to my boss and also my department Chair at Indiana University. They fully supported this and within a few days I was on a one-way flight to Liberia. I spent several months in Liberia in daily meetings with the Incident Management System (IMS) which is their sort of “national catastrophe management group”. It was founded during the Ebola epidemic and had been dormant since then. It consists of the Ministry of Health, the CEO of JFK Hospital (the national hospital), some other members of Cabinet, the regional heads of the CDC/WHO/USAID, the National Public Health Institute of Liberia, and various other high-level folks.
An IMS team member working in the National CTU during the Third Wave.
I ended up recommending a three-tiered plan for handing the Wave. Immediately, we needed to optimize oxygen delivery at the CTUs and minimize waste. This would both improve outcomes of those current patients receiving oxygen and also allow us to treat more patients by conserving oxygen (the CTU stayed at 100% capacity even as we increased the available oxygen, meaning there was really a line out of the door of critically ill patients). This could also be done within a matter of weeks. Second, we needed to scale up training for managing patients with COVID-19 for healthcare providers to increase the workforce able to effectively work at the CTUs. This would allow us to open and staff more facilities and therefore treat more patients. This could potentially be done in a couple of months. Finally, we needed to increase the production of oxygen in Liberia quickly by installing oxygen generation plants. This, at best, would take six months.
My recommendations were accepted by the IMS and we went to work. We had updated the treatment protocol at the CTUs within two weeks, which was great because outpatient numbers were not decreasing. Just a few changes allowed us to treat about 25% more patients with the same oxygen capacity. Clinton Health Access Initiative (CHAI) generously offered to fund and staff urgent trainings for treating patients with COVID-19 in every county in Liberia. Thanks to CHAI’s amazing efforts, healthcare workers from all 15 counties were able to be trained (in part by our respiratory therapist (RT) graduates from the Liberian Respiratory Care Institute (LRCI)!) and complete competencies on COVID-19 treatment protocols within 60 days. Our co-founder, Scott Dwyer, even flew over to help with those trainings as well. Shortly thereafter, I was notified that USAID approved one million USD to urgently install oxygen generation facilities in Liberia. Fortunately, around this time the incidence of COVID-19 had started to decline. Within 3 months, the “Third Wave” was ending and I was able to head home feeling that Liberia was in much better shape for whenever the “Fourth Wave” would arrive.
Attendees practice respiratory assessment on one another in the second multi-county COVID-19 training
session.
Partner Liberia assisting the MOH and CHAI with training local medical professionals in the application and administration of oxygen to help improve COVID-19 outcomes
Liberia Respiratory Care Institute –
The LRCI is still going strong. We saw an uptick in enrollment after the Third Wave, due in large part to the role of our RTs at the CTUs and in the nationwide trainings. We have graduated another two RTs in the past two years who have entered the workforce and have fourteen students currently enrolled. We have moved our campus to another site that is more conveniently located due to reasons listed in the next heading.
The CHAI COVID-19 training team and a multi-county cohort of students (and me).
Oniyama Specialist Health Center –
Unfortunately, a casualty of COVID-19 was the Specialty Health Center. It might seem counterintuitive that a respiratory specialty center would not thrive during a respiratory pandemic, but, that was the case. This health center is located within a mile of the main CTU. During the pandemic, all suspected cases had to go to the CTU for screening before they could receive treatment anywhere else. We were unable to become a CTU, and instead sat mostly empty after the Third Wave. After meeting with our partners and the Ministry of Health, we decided it just was not sustainable in its current location (especially with the CTU being able to serve the same community as our Center after the Third Wave passed). We have since moved to another campus in another underserved area on the outskirts of Monrovia where we maintain a respiratory clinic and house the LRCI. We are still able to treat respiratory patients here and it serves as a clinical training site for our students. More on that in the journals from this trip.
I think that pretty much sums up the gap. My focus for this trip is on three projects: 1. Checking in on the LRCI and seeing what is needed there; 2. Establishing a pediatric respiratory treatment program at JFK hospital with some of my partners from Indiana University; and 3. I have been invited to help establish a PhD program in Biomedical Science at the University of Liberia. I will be in country for three weeks, hopefully able to devote a week to each of these projects.
Thank you so much for your encouragement and support in this work--your generous gifts help make all of this happen! As always, feel free to share these journals with anyone you think will enjoy this. This posting is available on our social media and website (www.partnerliberia.org).
Thanks,
Mike