Anders Berglund traveled through India and Africa on behalf of the Enova Mission Program and documented his experiences along with Enova President and CEO, Roger Heegaard. They recently spent time in Liberia assessing the state of the nation’s healthcare system and Anders shares their touching and inspiring experience below.
For people my age (mid-20s) in Liberia, war was not seen on the screen. For the people who live here, war was lived. It only ended 15 years ago, and the wounds are still fresh. A country on the rise, the long-lasting conflict threw everything into chaos, leaving few pieces to pick up at its end.
It started with a military coup in 1980, and for the next 24 years grew more and more dire. The number of warring factions fluctuated, with each of Liberia’s 16 tribes joining one side at some point or other. The recruitment of child soldiers was more than common, with countless young men handed guns and pitted against each other.
All told, the war claimed an estimated 250,000 lives and put Liberia’s economy and healthcare system at the bottom of the world. Where there once was investment and progress, there remained only pain. But the Liberians have taken back peace from the throes of death, and today hope and smiles prevail.
Liberia is exceedingly rural, with paved roads ending before Monrovia does. But in the modes of transportation, the recovery shows its progress. At the end of the war, the children who fought were given money if they turned in their guns; With it they bought motorcycles. On every uneven dirt road, men in their 20s zoom past on two wheels, with friends and painful memories as their passengers. It’s a newfound culture of perseverance. They have formed motorcycle labor unions and protect each other in a way only those who share the same trauma could understand.
It was here in Monrovia – in the section where pavement does exist – where we finally met Dr. Mosoka P. Fallah. Dr. Fallah grew up in West Point, the largest slum in Monrovia. Tucked between the freight harbor and the strategic Ducor Intercontinental Hotel overlooking the city, West Point saw the horrors of war in everyday life. After the 1980 military coup, Dr. Fallah’s family moved to the Chicken Soup Factory community as a survival mechanism. His father hoped that he could give them education, as Dr. Fallah had not gone to school for an entire year as his parents tried to eke out a living in West Point. He and his friends would scavenge garbage sites for empty bottles and rice bags to sell and find food to eat. Here Dr. Fallah was almost raped by an adult gang and survived due only to the miraculous interventions of a plainclothes policeman. Moving away from West Point was a decision necessary for survival.
When his family moved to Chicken Soup Factory, it was only trees. As the situation post-coup deteriorated, more and more people fled to the area, and the community – named for the main local economy – grew to a thriving and bustling neighborhood. Here his family found refuge and a place to call home. Almost forty years later, Dr. Fallah’s mother refuses to leave the home that she has created.
Despite the vibrancy of the crowded streets and winding paths, access to healthcare remains only marginally better than during the war. But there are many dedicated to changing this, which is where Dr. Fallah comes in.
As a result of the civil war, Dr. Fallah’s dream of becoming a doctor was stalled and it took him 10 years to obtain his Bachelor of Science (BSc) degree from the war-ravaged University of Liberia. Unperturbed by the massive destruction of the medical school in Liberia, he enrolled to become a medical doctor in 2002. But the ugly head of the civil war again hunted them as the war raged in Monrovia between 2003 and 2004. He found solace as a first-year medical student volunteering with Doctors Without Borders on
the makeshift hospital at the frontline of the conflict. In late 2004, his close friend and brother found him a scholarship to study at Kent State University. He completed his master in a record 12 months and was given a full ride scholarship to pursue his Ph.D. in biomedical sciences at the University of Kentucky.
After his Ph.D., he was accepted at the Harvard School of Public Health to study Global Health where he focused on Infectious Disease Epidemiology. He eventually returned to Monrovia and planned to split his time between the US and Liberia. But during the West African Ebola outbreak of 2014, he felt an overwhelming sense of duty to his country, and he has been here ever since.
Within minutes of meeting Dr. Fallah, he was talking about hope. Despite the struggles and the pain and the crumbling remnants of war, he sees only room for progress. “You can look behind and see the suffering, or you can turn your eyes around and see the path to a better life.” With his strong optimism and dedication, he has begun to build health clinics in the places most in need.
The first clinic is in Dr. Fallah’s home community of Chicken Soup Factory. When we arrived, the evidence of growth was overwhelming in the sounds of generators and hammers and saws. This clinic is currently under expansion, adding dedicated maternity wards and recovery rooms. In the small and rustic microscope lab and unfurnished rooms, it is clear there is much work to be done, but the impact will be huge. “Usually at least one in one hundred women who give birth in Liberia will die during labor,” Dr. Fallah Says, “last year we delivered 425 babies here with no child or mother deaths.”
Called simply Refuge Place Clinic – as it was the first for Dr. Fallah’s team – the Chicken Soup Factory structure represents the first success in Dr. Fallah’s grand plan. Already the clinic serves over one thousand patients each month, covering wide-ranging needs from eye exams, to malaria treatment, to births. And all of it is at minimal cost to the patient.
Dr. Fallah knows that in one of the world’s poorest countries, cost is the most urgent limiting factor to health. At this clinic, the cost of delivery is free. Expecting mothers pay just a couple dollars for bimonthly checkups before the birth, and new mothers pay only around 5 USD for post-birth drugs and medication. “The government gives free care, but it is not really free,” he says, “they don’t have drugs at many government hospitals.”
The model for Dr. Fallah and his team is based on community involvement. “If the community helps build and support the clinics, they are more likely to use them and care for them.” The Chicken Soup Factory branch was built – and is being upgraded – by local labor forces. Bricks and other materials are created on-site or nearby, and the labor force is working as volunteers or at very low rates. The original Refuge Place Clinic is a model for community involvement – and it’s just the first.
Despite the undulating dirt roads and slum-style housing of Chicken Soup Factory, this neighborhood is considered urban compared to the other two clinics in progress. The other two lie less than 30 miles from downtown Monrovia but take well over an hour to reach, a bumpy journey down narrow jungle roads.
The most complete of the two rural clinics are in Low-Cost Town. The village was named as such because of a pre-war government program by the slain President William R. Tolbert to create low-cost housing for working-class families. But over time refugees from Sierra Leone that have naturalized, and their fellow Liberians came to occupy these buildings. The remnants of such projects are clear, with wide and beautiful boulevards crumbling and pock-marked.
The town itself consists mainly of cement or mud construction houses, but the clinic is sturdy and nearing completion. Construction is finished, with colorfully painted cement walls, and rooms laid out for all the future healthcare needs of the community. There are recovery rooms, operation rooms, restrooms, and a placenta pit for the leftovers from birth. Yet as of now, there is no equipment. Awaiting some final financial contributions, the clinic is mere steps away from full function. The hope is that it will be operational in no more than a few months.
A few slow miles farther down the road lies the foundation for the third clinic, in a town called Nyemah. Nyemah has a population of around 320 people, almost all of whom live in mud-huts. It is part of a clan consisting of 32 villages and 10,200 people. There is no electricity and the young children walk two hours to school if they go. Yet, within the walls of the village homes lie physical manifestations of the hope that Dr. Fallah so optimistically follows: building materials. In the huts, there are bags of cement,
timber beams, and bricks. While this outpost still lacks a roof and finished walls, the realization of a local healthcare clinic remains firmly in sight. This building, which will be called Nyemah Refuge Place Clinic, will someday soon provide support for a community with almost nothing.
Liberia’s healthcare system remains one of the worst in the world. With little economy to speak of and never-ending recovery from a brutal war, the residents are taking it into their own hands to create spaces for health. A brief but poignant story from Nyemah summed it up in a way only an anecdote can: Earlier in the morning of the day we visited the town, a young woman had gone into labor. With no place to deliver the baby in Nyemah, they called the jeep from the nearby town that functioned as the ambulance. The jeep had no gas. The people from the town gathered bags to carry gas into the next
town so that the jeep could take the pregnant mother to the nearest clinic, many miles away.
What is clear from stories such as this one, which is not infrequent occurrences, is that Dr. Fallah’s unending hope is both optimistic and necessary. As he put it himself, there is not much lower to go, so if you turn your eyes around the path forward is a bright one. And most importantly, the people care. They have built and continue to build clinics with their own hands. They make mud bricks from the ground beneath their feet. They carry gas down jungle roads so that the ambulance has fuel. They dream of a better world, and they know that it is up to them if they want to reach it.