Well here I am. I finally made it.
All my ophthalmic life I have wanted to work for / with Medecins Sans Frontieres ( MSF ) / Doctors Without Borders. Recently MSF, NYC told me I was the first ophthalmologist they have ever recruited. Currently I’m here in Monrovia, Liberia seeing post-Ebola survival patients with eye signs or symptoms. In Monrovia, MSF has a 90 bed pediatric hospital ( < age 8 ) they manage / staff / administer. There are about 20 MSF ex-pats here but obviously most of the staff are nationals who are doing great work. Some of the local ( Liberian ) health care workers were earlier staffing the various Ebola Treatment Units scattered about Monrovia during the active outbreak ( Dec 2013 – Nov 2014 ). About 20% of all Liberian health workers died with Ebola. About 80% of all infected local health workers ( Liberian ) died. In a country recently devastated by two civil wars, they didn’t need Ebola.
It is their country and we ( MSF ) are just here to give support / knowledge / training. The ex-patriot MSF staff in Liberia are from all over --- France, Italy, Germany, USA, Denmark, Kenya, Nigeria, , Australia, N.Z., etc. We all have various skills to help run / support the MSF hospital ( pharmacy, logistics, nursing, administration, inventory, maintenance, etc.).
Part of my mission here is training / teaching. I recently gave a basic eye talk ( “ Is the white, white; Is the black, black? “ ) to the P.A.’s that are on the various wards actually running the hospital. Most of the MSF staff are in their 20’s or 30’s. Many have been in several different countries ( assignments ) with MSF --- south Sudan , DRC, etc. Since this is my first assignment, I’m the new boy. There are two ex-pat pediatricians here that are both excellent. I have had good conversations with both about providing realistic health care in the developing world. ( no CT / no MRI, no culture possibility, etc. ). Many kids present with cardiomegaly, TB, HIV+, malnutrition, etc. Apparently the health situation is more desperate in the rural ( eastern ) part of the country. During the rainy season ( just starting ) the roads to the east become impassable.
The traffic situation in Monrovia ( 1.2-1.5 million persons ) is quite bad. You can spend over one hour trying to get to or back from our housing compound or the pediatric hospital. The MSF ex-pat staff leaves for the hospital at 7:00 AM to try to beat some of the traffic. There are some restrictions where we can go, etc. No one ( MSF ) is allowed to use a taxi or motorcycle for their transportation needs. As elsewhere in the developing world, the leading cause of death for health care ex-pats / tourists is road accidents not malaria, etc. Our living compound is on the beach with a great view of the ocean with impressive waves and strong undertows There is a tall fence around our compound with security guards in watch towers at night.
There are places to wash your hands ( chlorine 0.5% water ) scattered all over the hospital and compound. If you are going on the ward you must first change into scrubs and boots. Change your gloves between each patient. There is a malnourished ward but I have not find any children with xerophthalmia. For the kids that are fortunate enough to make it onto the nutrition ward, they usually do quite well. Amazing how enough food will promote growth, good health, etc.
There is a heavy-duty isolated tent unit for any patient / family member who might show up with suspected Ebola. Except for the mothers, other family members are not permitted on the wards. Monrovia has had three separate isolated Ebola cases since the main outbreak which also involved Sierra Leone and Guinea. So everyone is still on alert. When we enter the compound, everyone washes their hands and have the soles of their shoes sprayed.
The survival clinic has been set up by MSF to treat / monitor / support these post -Ebola patients . There are other places in Monrovia seeing survivals as well. Initially there was a lot of fear / hostility / prejudice against the survivals by the general population. Sort of like what happened to HIV + patients early on, in the 1980’S. That apparently has gotten better with time as the initial Ebola fear has resolve somewhat. There are billboards around encouraging the public to accept the Ebola survivals. The three major health issues that survivals are experiencing are #1. mental stress, depression, anxiety, etc. #2. arthalgia myalgia, sort of vague generalized muscular - skeletal complaints #3. eye concerns --- tearing, ocular pain, burning, decreased vision, etc.
Well I wanted to give you a brief overview of MSF activities in Liberia. In my next blog I will describe some of the Ebola eye findings I have seen in Liberia.
Baxter McLendon, MD