Leaving Liberia

After a month in the sweltering heat of Monrovia, Liberia I’m bundled in my fleece watching jumbo jets rise into the gray sky over Brussels.  Monrovia seems a distant, ethereal memory already.

Sometimes over meals at home, we go around the table sharing “highs and lows” of the day.  That seems a reasonable way to structure a few reflections on this past month:

Highs:

- To the best of my knowledge, I did not ever touch a patient with Ebola.  While I did have the opportunity to tour the largest Ebola Treatment Unit (ETU) in Liberia - “ELWA-3” managed by Medicins Sans Frontiers —  I did not go to Liberia to work in an ETU.  I went to support the transitioning weak medical system with general obstetric care. I also ended up covering the whole hospital for general medicine and pediatrics on my call days.  We know from experience that the hidden collateral damage of every Ebola epidemic arises from the fact that hospitals just shut down in order to protect their staff.  The result is that children die from malaria and women die in childbirth.  I did quite a few C-sections - all good outcomes - to that end.

One of the OB wards

- I relished the opportunity to work at ELWA Hospital.  Jennifer visited ELWA way back in 1982, when she was in Liberia for the summer with InterVarsity’s Summer Mission Program.  As mission hospitals go, it’s been around a long time (1965).  It’s a shadow of its former glory though.  The Liberian Civil War of the early 1990s took a devastating toll on the facility.  It’s in pretty bad shape.  The good news, though, is that Franklin Graham, the head of Samaritan’s Purse International Relief came for a visit, was completely appalled at the condition of the place, and committed SP to building a new hospital.  They are 75% of the way into a $3.5M hospital construction project.  It’s going to dramatically transform ELWA into a new era.  But the real treasure of ELWA Hospital is the spiritual heart of the hospital.  The whole staff meets daily for a half hour of singing, Bible study, and prayer.  Their bedrock and strength is God’s Grace and Love.

With Dr. Jerry Brown, TIME Magazine Cover Star

- Working with some of the most courageous people on the planet…the Ebola Fighters.    ELWA Hospital was among the first hospitals to establish an isolation ward for Ebola patients (an ETU).  The hospital closed for a brief two weeks in August after three American missionaries were infected with Ebola, but Dr. Jerry Brown insisted on re-opening the hospital because pregnant women were going to the personal homes of ELWA’s midwives in order to deliver their babies.  Dr. Jerry Brown appeared on the cover of TIME magazine regaled in his Tyvex suit and goggles because he bravely treated Ebola patients when no one else would.  But there are many many others.  Nurses , midwives, lab techs, janitorial staff all came to work at significant personal risk, because they believed it was the right thing to do.  So far close to a billion dollars has flowed into Liberia from outside donors.  The ELWA staff have been promised “hazardous duty bonuses” by the government (approx $300/mo x 6 months for the midwives), but as of this writing, not one dollar has been received by any ELWA staff.  Are they on strike?  No they just keep working.  

With my team of midwives

Lows:

- The heat.  

- The poverty.  Liberia is a hard place.  The soil is sandy and there isn’t much that grows there except palm and rubber trees.  It’s billiard-table-flat so the country has no ability to generate it’s own power from hydroelectric.  When we flew in over the capital, Monrovia, I was shocked at the darkness.  A capital city immersed in darkness?  No grid electricity.  The country runs on generators.  Liberia also has the poorest physician-to-population ratio in the world. (50 Liberian doctors for 3.6 million people before Ebola).  Doctors fled in the civil war - and of those that remained, some died in the fight against Ebola.  Life was a struggle before the war, before Ebola, and now everything is broken.

- The threat of Ebola.  While I feel confident that I didn’t actually come into contact with any Ebola patients, every patient we saw was screened for the possibility (temperature taken, symptom checklist reviewed).  Everything we did was viewed through the lens of Ebola.  Almost everyone has malaria which means that many, many patients arrive with fever.  We tested many for Ebola.  We worried about Ebola.  We wore impermeable gowns and gloves for every patient encounter.  Thankfully the NIH Ebola Lab was actually on the ELWA campus so the wait for an Ebola test was never more than 24 hours.  In the last week of my work, there was only one new confirmed Ebola patient in the whole country.  That was encouraging, but the fact that in that same week, Sierra Leone had 65 and Guinea had 33, was disconcerting.  Until all three countries are Ebola-free, none of these severely affected countries can really relax.

- The deaths.  I saw a lot of people die this month.  Most heart-breaking were the preventable deaths.  A newborn developed tetanus four days after birth because his mother was not properly vaccinated and died a horrible death of spasms and respiratory paralysis.  (Did the mother fail to understand the need for vaccination—or was she afraid to come to the hospital because of Ebola?) An 8-year old died of rabies after being bitten by a stray dog.  I poured myself into the care of a 16 year girl who had severe and protracted menstrual bleeding for over two years.  After hormonal therapy failed, we began to think she might have had an inborn blood clotting disorder.  She was in-and-out of the hospital over three weeks of February during which time she received twenty units of blood.  We finally decided that it would be life-saving to remove her uterus - but the father refused.  She died the next day.  I went to my room to weep alone.  The incomprehensible senseless deaths just weigh you down.  The death of a healthy 16 year old girl.  The death of a healthy newborn for lack of a tetanus immunization.  Doctors who die from Ebola.  Our dear friend Dr. Jonah died from Ebola back in 2007 leaving five girls and his wife pregnant with their first boy.  In our human understanding, there is no way to justify these things.  While there can be beauty from ashes and fruit from the seed which dies, the fact remains that Death steals Life that it does not own.  We have six new doctors in training in Bundibugyo who were sponsored in the aftermath of Jonah’s death—but Melen is still a widow and his only son is still fatherless.  While I have been freshly struggling with the tragedy of such pointless, inexplicably wasteful deaths, I suppose that is some small way I must admit that is only in this suffering, in wading through this wilderness, that I seek and search and cry to understand the Mystery.  And as I ponder the Infinite, squinting through the tears, God is there.  And He defies Explanation.  Here is where the Psalms of Lamentation abruptly switch from wailing to worship, from agony to faith. The alternative is bitterness and despair—and I refuse to go down that path.

It’s been a long road, this path to Ebola-Land.  Jennifer has paid a high price, keeping all the balls of our Kijabe Life in the air in my absence.  Doing all the cooking, hosting house guests, taking extra hospital call, caring for the dogs, teaching our Senior Boys Sunday School, handling a bevy of crises among our Serge East Africa Teams.  She’s been burning the candle at both ends and in-between.  I’m thankful for her and miss her desperately.

Now I’m putting even more distance between me and Jennifer as I head for California to hole up and wait 21 days to make sure I don’t develop Ebola.  I never did go “skinny dipping in Ebola juice” as one of our oh-so-compassionate blog commenters suggested that I do — so I doubt it will be a problem.  I will be taking my temperature twice a day and calling it in to the California State Health Department.  I’ve not missed a dose of my malaria medicine, so I’m hoping that I don’t get any fevers at all.

Thanks so much to all who prayed and continue to pray.  And give.  We are your hands and feet.  Thanks for your partnership.