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by Gary Myers MD
Although I often felt alone
in my work overseas, when I found Friends of Liberia, it seemed I
may be among 'friends' with similar experiences and perspectives. I
am a fifty year old General Surgeon from Oklahoma. My last five
years have been devoted to work overseas. I gravitated to Medecins
Sans Frontieres (Doctors without Borders) in 2002 and my first
assignment was working in Sri Lanka.
My introduction to Liberia was through MSF when in June of
2003 I was offered a chance to work in Monrovia, Liberia. The
circumstances and environment in Monrovia at that time have been
recounted many times in many places by many people. My time as a
physician in Monrovia was almost exclusively in and around Mamba
Point, with very limited work done in Tubmanburg and New Georgia.
I was not an educator but a practitioner of surgery—in
2003. I was fortunate to be in Monrovia when peace came and I began
to contemplate how I might help Liberians in a more sustainable
fashion. I saw a need to support a ‘very fragile’ medical education
system. I did not know how I might do that, but I seized the
opportunity to ‘see for myself’ what activities were actually taking
place during these more peaceful times.
After
a year working in and studying at home in Oklahoma, I generated an
opportunity to return to Liberia from June through August of this
year. I took a leave of absence from my employer, the Oklahoma
State Department of Health, and convinced my professors that I would
be able to gain knowledge in ‘Applied Epidemiology’ with a return
trip to Liberia.
This
trip was for a different purpose than the one in 2003. I was, and
am, convinced that a sustainable and less dependent health care
delivery system requires supporting a system of ‘professional health
care education’. From my perspective I believe that ‘replacing’ a
‘non-existent’ functioning health care system is very necessary at
this time, but Liberia and Liberians will
eventually need to move toward independent or ‘free-standing’
systems.
My
immediate goal this summer was to provide some specific ‘surgical
education’ to medical students at the AM Dogliotti Medical College,
the only medical school in Liberia. My more general goal was to
discover if it would be possible/feasible/practical to establish a
direct relationship between the ‘Medical Education System’ in
Monrovia and a collection of American and ex-patriot Liberians who
would be willing to ‘support’ rather than ‘supplant’ efforts to
train Liberian physicians.
This
summer I developed an arrangement with MSF, the ELWA Hospital, the
Medical College and the Ministry of Health to operate as a physician
and surgeon - there was no compensation involved. I was given a
place to live, hospitals to teach in, a medical license and about
200 medical students to ‘teach’. I lived at ELWA Hospital (near SKD
stadium). I worked there and at Redemption Hospital in New Kru
Town. I taught medical students at AM Dogliotti Medical College
(behind St. Joseph's Catholic Hospital) in Congo Town. I spent one
day a week at JFK Hospital with the students.
We at MSF spend some time extolling the virtue of
'proximity' with the populations that we serve. I imagine that the
Peace Corps and other organizations do as well. Because I was
'independent' and more separated from formal organizations, I
believe that I got a new perspective of the indigenous Liberian
medical community. Of course, during this short time and limited to
Monrovia my impressions are of one place at one time.
It was clear and obvious that things were very different
from the summer of 2003. People moved freely and frequently. Food
was available, adequate and diverse. Unfortunately the price of a
'cup of rice' (remaining the 'coin of the realm') seemed to be at
the same levels as during those dire circumstances of the
previous summer.
People were occupied; apparently many involved in an
'informal economy'. I am reluctant to quote 'numbers heard', but I
seem to recall that 80,000 people were employed (75% were working
for the government). If that is true, surely 20,000 Liberians
worked for NGOs, the UN, and these 'strange/foreign' groups (like
MSF) that interject themselves into Liberia.
That seems to leave ‘0’ other people working in the general
economy. My impression was that many other people are ‘working’,
obviously many ‘working’ people are not listed as ‘employed’. Many
people provide for their families, in commerce and carrying on a
peaceful, albeit difficult life.
Besides discussions of not “making enough money”, a major
topic of conversation among my Liberian colleagues often centered
around the frustrations concerning a “failed health care delivery
system”. I don't want to be too cynical, but these are often 'the
topics of discussion' here in the US as well. Please understand I
am certainly not discounting the difficulties and tremendous
challenges that the Liberians have. I have been fortunate to
'practice' this human art of medicine in several countries. The
circumstances of this type of work lend themselves to some
artificial relations between people. With each assignment I develop
not only an affinity and affection, but also an admiration, for the
people I work with. Liberia is not unique. I have concluded that
Liberia is a place where an American can readily and effectively add
to the rebuilding of a country. (Of course, 'readily and
effectively' are very relative terms).
Permit me some recent anecdotes. I suspect that most of
you have a much longer time of reference frame than I do. I have no
personal observations outside of Monrovia. Of course, I have
impressions, but these are second hand at best. The people of
Monrovia overall are in a much improved state, compared to the
summer of 2003. I recall a
'three-day front page Newspaper story' that concerned a man found
dead and apparently murdered. This demonstrated to me a vigorous
press, but more importantly showed me just how 'quiet' things had
become. Conditions remain austere. Liberians certainly
struggle to exist. My friends feel relief and genuine hope. I feel
that the 'disconnect' between authority and the populace is not
quite so great. I am afraid that these 'interim' band-aids (UNMIL,
NGOs, MSF) sustain Liberia in this terrible time, but I hope for a
time of stable autonomy. That time surely is a long way off. I
have to believe that it is past my lifetime. In the meantime, I
would like to 'add' to Liberia and the Liberians.
Thank you for indulging me. I know
that these topics and Liberia deserve continuing personal and
thoughtful discussion.
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