Hospitals in Liberia

I have now had opportunity to visit 2 hospitals in Liberia. One wsa the 'JFK' hospital in Monrovia, which one of our dayworkers invited us to look around. the other was this weekend when we took a day trip on an open train to a place called Bong Mines (up country, and somewhat out of the way at the iron ore mines). Both had quite a similar atmosphere.
The JFK hospital is HUGE! I was surprised at how big it was, and in it's former glory before the war it must have been quite impressive. It was quite a shock to see how much the war has impacted the hospital. They are gradually restoring it floor by floor, but the areas open are by no means at full capacity.
The wards are fairly open with anything from 8 to 20 beds. No curtains, often no sheets on the mattresses. No piped oxygen except for in intensive care. Resources seemed scarce, yet there were labs for testing, and xray area, operating theatres. The accident and emergency department was a little small, but had cubicles as we do back home. The corridors were wide and full of queues of people, the 'checking in' system was intense, with you having to line up in at least 3 different areas to just get your notes and your name on the list, then you just had to wait, potentially all day.
We had arrived thinking our day worker had preorganised our visit, not the case! He just used to work there and asked on the spot if we could be shown round. 2 of the directors were pulled from whatever they were doing to show us around, something that would never happen back home!! We were shown in everywhere, no questions asked...again, not exactly something that would happen at home. There were a few odd things that stuck out for example; the childrens immunisation clinic shared the same waiting area as the kids 'clinic' so basically new babies without immunity, mixed with sick ones, slightly vulnerable situation! The JFK hospital is also linked in some way to China and Japan. We were introduced to several doctors from Japan who did not speak a word of English, they appeared to write in their own language, and their assistants evidently did not speak their language. How on earth any examinations etc took place I will never know.
The hospital up in 'Bong Mines' was smaller but still quite extensive. Be fore the war, you could imagine it being a very busy place, right now it was virtually desolate apart from a few patients. When the mine was running to full capacity, the community was more extensive. Now the staff that work there work for free, not having been payed for months and months. Our Mercy Ministry teams have been out to the hospital to work with the education team to assist in awareness of HIV and Aids as well as nutrition. Again, there was a similar feeling of space but dinginess. There is a generator for the hospital but this only works for a few hours a day, so otherwise no electricity. The systems to sterilise equipment for the operating room were crude but obviously did the job.
I think what was most upsetting about both places, was that there was huge potential for both to have a real impact on the community if they were running and staffed effectively. So many people in the community can't afford their healthcare so just do not go to hospital. As I understand it, a few days to pay for food/general nursing care before even purchasing medicine like antibiotics that might be needed, a weeks wages would be needed. Another problem I discovered was that with reagrd to antibiotics, people are often told the one they need, but because they have to pay for them , they will ask for whichever one is cheapest, or on occasions some donated drugs will be free. Obviously this causes problems of resistance developing, and also prevents illnesses being treated effectively.
This is why our work here is so heavily involved in education. When our patients leave the ships ward, we spend a considreable length of time explaining medicines, why and how they should be taken, and to never share them with others.
Hopefully you can have a look at the photos I've attached to give you a bit of an idea about Bong Mines hospital (this is run by christians I believe, whereas JFK is a government building so we couldn't take pictures).