What the lack of healthcare looks like

Before I came to Liberia, I liked to complain about our healthcare system, our insurance companies and our hospitals. I complained every year when I had to choose a healthcare plan - that it didn't fit my needs, it was too expensive, it didn't cover my meds and on and on and on. And I know I'm not the only one with these complaints.

We are an unbelievably spoiled and privileged society - and we don't know it. This is what it looks like in one of the poorest countries in the entire world where there is no healthcare. We have a 19 year old patient named Gbah (pronounced jeeba) - we just met him for the first time on Wednesday morning. He has Burkitts lymphoma and was so weak on Wednesday that a family member had to carry him on his back to our car. Gbah is skin and bones and couldn't hold his head up. It didn't take a medical degree to tell he is critically ill.

We took Gbah and his parents to a local hospital here so that he could get chemotherapy and maybe have a chance to live. We always take our patients because you have to know what you are doing or they will not admit you to the hospital and no one will help you. So it took awhile but they finally took him up to the ward where we left him with his parents.

Late Wednesday night, Jean got a phone call from the father saying no one had seen Gbah that day and no one had started any treatment. We have no authority over the hospital so there was nothing Jean could do. Thursday morning we went to the hospital to admit another patient so I went up to the ward to talk to the nurse before talking to the father. She told me that Gbah was going to get a blood transfusion before starting chemo. I went to the father and Gbah and tried to reassure them that the doctor had reviewed his chart and that he would be getting a blood transfusion that day and that he needed to be stronger before starting the chemo. I noticed that Gbah did not have an IV started. This young man had critically low sodium levels (a level lower than any I have ever seen before) - he should have had IV fluids started the minute he was put on the ward. 24 hours later he'd not had any kind of treatment. I know his lab values were critical because we did the blood tests on the ship so that the hospital wouldn't have to do them.

Early Friday afternoon, we received a phone call from the father. He had taken his son out of the hospital and was now trying to find another hospital to give his son a blood transfusion. The phone service here is horrible and we couldn't get the whole story but we couldn't meet the father until 4:00 pm. So we finally got to the father and found out the whole story.

The lab that takes care of the blood said that the father needed to pay 1025 LD (about $17.00) up front for the blood. He only had the $5.00 we had given him for food (food here only costs about $.75 for a meal). But if a family member donated the blood, they would only have to pay for the bag the blood goes in. They tested the mother and an aunt and they didn't match. They wouldn't let the father give blood because they said he was too old (he's 50). When he realized the family couldn't give blood, he went back to the lab and then they told him they had no blood for him to buy. So he told the doctor he was taking him from the hospital since they couldn't give him a blood transfusion. The doctor told him to bring Gbah back on Monday if he could find another hospital to give him a blood transfusion. Yes, the doctor let a critically ill person leave without doing a single thing to stabilize him.

So now the father was in our car at 5pm on a Friday asking us for help and we had no way to help. None of the hospitals have labs that are open after 4 pm. None of them are open on the weekends (even though they technically have emergency rooms). None of them will transfuse blood over the weekend. Jean actually has the type of blood Gbah needs but there isn't a hospital for us to take him to. The father also told us that Gbah has had constant diarrhea for two days which means that the critically low sodium levels from Wednesday have to now be extremely critical. The father was actually giving Gbah ORS (a sodium replacement drink) himself in the hospital.

We told the father we couldn't come up with any options. So I told him that he must tell us what he wanted to do. The father said he wanted to take him to the pediatric hospital to see if they will help. His son is 19 but he was going to say he is 15. The pediatric hospital here is run by MSF (also known as Doctors Without Borders), it's free and they actually have a real emergency room.

A family member carried Gbah to our car and all I could think of is that he is going to die in the car. He was obviously in critical condition. We drove as fast as we could to the pediatric hospital and stopped out front. You can't actually park by the hospital - there are gates and you can only walk to the hospital. So the family got Gbah out of the car and carried him to the ER. Jean followed to find out if they will admit him. She met the ER doc who said they will only tranfuse blood over the weekend if he is in critical need of it and the family must donate blood to replace the blood that is used.

We left the family there to deal with the nightmare. I fully expect to receive a phone call this weekend from the father to tell us Gbah has died. I'm not hopeful at all. If they can stabilize Gbah, he will have to be returned to the original hospital because it is the only one who can give the chemotherapy he needs.

As a nurse, there are so many things that occurred with Gbah that I can't even comprehend: a hospital that doesn't rehydrate a critically dehydrated patient while in their care for two days, a hospital that doesn't have blood because people here don't donate blood, a doctor who allows a critically ill patient to leave (in a taxi, no less), hospitals with ERs that can't treat emergencies after 4 pm or on weekends, nurses who won't tell a worried father a single thing that is going on, a hospital that doesn't give a single pain medication to a patient in serious pain.

This is what it looks like in a country without a healthcare system. This is what it looks like when the people of a nation live in extreme poverty. The only reason Gbah even has a chance is because Mercy Ships has made chemo available to people with Burkitts and that Gbah came to Mercy Ships to even know that there was chemo available. Everyone else in this country with cancer just dies a painful death at home.

This whole situation is not an isolated incident. We have a little patient, Survivor, who is also receiving chemotherapy. His father is critically ill with cardiomyopathy. His family took him to 2 different hospitals for help and was turned away because he didn't have the money to pay up front. The second hospital sent him home after he sat outside the hospital all day waiting to see if someone would help. They gave him some meds without even evaluating him or doing labs (3 of the 4 drugs have nothing to do with helping cardiomyopathy and the one that could actually help is such a low dose every other day, it will have no affect). We haven't gotten a phone call but I expect we will get one saying he has died.

We live in a privileged and wealthy country with our own problems. But the amount of injustice here is horrendous. Some days I feel like there is no hope and this is one of those days. But the more injustice I see, the more I want to be part of the solution that brings hope. I think the more injustices I see, the greater my desire is to continue to serve here.

I'm ending with my favorite Bible verse and my philosophy of life, Micah 6:8 - 'He has told you, O man, what is good; and what does the LORD require of you but to do justice, to love kindness, and to walk humbly with your God? (NASB).

Peace,
Michele