Editor’s note: This report was filed during the author’s mid-July visit to Liberia.
I’m writing this from Monrovia, the capital of Liberia, a West African country in which we are trying to start a national clubfoot program. This is my first visit to Liberia, but it’s been 13 months in the making. Most of the countries in which we have clubfoot programs in Africa don’t also have a CURE Hospital. That results in an entirely different dynamic, and starting those programs is a lot more challenging.
For example, with Liberia, I started planning in June 2011. Essentially, we had funding; however, it’s always a challenge to know exactly how to proceed, and it involves a lot of fact finding to begin with. Who are the health providers in the country we could or should be working with? What exactly is the role of the Ministry of Health, and how will that affect our program? How do people view a child with clubfoot or other disability? What is the general infrastructure like in the country, such as roads and power, and how will that impact us in starting clinics in a number of towns? What range of health professionals does the country have? Are there orthopedic surgeons and physiotherapists or only general surgeons and technical level paramedical staff? Is there any government funding devoted to the disability / rehabilitation end of the healthcare spectrum, or is the country still grappling with funding treatment of acute trauma, malaria, HIV, tuberculosis, etc.?
Usually, to make a first visit, we need to have some key contacts established and some prior discussion about the project. Often this is challenging in Africa. At home in Australia, we usually expect to develop a relationship with people and start to understand them as we start working together. In Africa, people want to know you before you start working together. There is a reluctance to communicate at all via email or phone before you are known in a face-to-face capacity. That one dynamic makes it hard setting up a first country visit and meetings, even from my base within Africa in Nairobi, Kenya.
My first attempt at visiting Liberia was in October 2011. The presidential elections had taken place about a month earlier, and all seemed calm. In the absence of any firm meeting commitments (again, it’s all about that face to face contact!) or even confirmation that someone was meeting me at the airport or had booked accommodation for me, I figured I just needed to jump on a plane and hope for the best. I had a week booked in Togo en route and was hoping some of these “minor” details would come together before I arrived. As it happened, two days before I was due to travel to Liberia, post-election protests started in Monrovia. As often happens in Africa, one of the opposition leaders was challenging the election result, and potential for significant unrest was high. A friend in Nairobi advised that their NGO had banned all visitor travel to Liberia. That was enough for me, so I headed “home” to Nairobi, resigned to the fact that it would have to happen another time.
One more failed attempt later, finally things came together for this current trip. I traveled with a Kenyan colleague, Christine Kalondu, and we arrived Wednesday night after a 15-hour journey door to door (Africa is a HUGE continent!). The two days since have been a whirlwind of meetings and getting to know and understand Liberia a bit. I always find I’m incredibly tired on these trips, trying to get my head around the country I’m in, making a plan for the program, and continuing to re-cut that plan over and over as the hours go on and more meetings ensue, as well as keeping up with emails and happenings in 13 other countries in Africa.
I find that yet again I’ve been amazed by an African country. I’m not sure exactly what I was expecting, but I’m somewhat taken back by the gentleness and good humor of the people I’m meeting and their resilience and determination to move forward after a military coup in 1980 ushered in almost continuous civil war until 2003. I’ve been intrigued by the high value placed on women, with women having been instrumental in realizing peace in Liberia after pressuring the then-president Charles Taylor with peaceful protests, and now occupying many high-level positions in Liberia including the President, Nobel-peace award winner Ellen Johnson Sirleaf. I’ve been surprised by the link with the USA, with Liberia the only country in Africa without a history of European colonial rule, but instead having been colonized in 1820 by freed slaves from America. There is obvious affection for the US and a clear American lilt to the accent. Clearly, before the wars, Liberia was a progressive country, experiencing the second highest rate of growth in the world in the 1950s and being a founding member of the United Nations in 1945. And finally, coming from beach-obsessed Queensland, I’ve loved hearing the crashing waves and feeling the ocean breezes.
Having said all this, the war is still palpable here. It peppers every conversation. The effects are visible on every street. The President won’t occupy the official presidential palace because of the bloodshed that occurred there. There is still absolutely no electricity in the entire country, with every bit of power coming from generators. 85% of people now officially live below the international poverty line, which is evident in children of all ages doing all manner of work.
These things make me more determined to get the program started. With a miniscule health budget and a nominally functioning health system, programs like CURE’s clubfoot program are essential for these children and their families to receive the help they need. So far, so good on this trip! With the incredible support of Amlib, a local company with a strong program of corporate social responsibility, we have had many helpful meetings with various hospitals and health professionals. I’m excited that we will continue to work with Amlib to get the program established, using CURE’s expertise in establishing clubfoot programs and Amlib’s obvious expertise in operating within the Liberian political, economic, and socio-cultural contexts. Hopefully we will have an advertisement in the local papers by next week for a Country Coordinator (program manager). This is a crucial step! My next trip back should be on 15th August, to provide orientation for our new Country Coordinator. Such a full on, fascinating, overwhelming, but exciting few days for CURE’s clubfoot programs in Africa!!