Hi to everyone - a little further discussion on the state of Pediatric care at hospitals in Liberia.

Today was a good and busy day. Arrived early to find no babies were admitted that were born at home, or rushed into the Emergency room and then up to us in the NICU. But it seems often now, that I turn my back or leave the unit for 10-15 minutes, and when I return they tell me a baby has shown up from the ER -" born at home 6 days ago, had a fever, not feeding well, came to the ER" and they just zip them over to the NICU (mostly without asking - it is just their routine). Some who read this know it is not good policy to readmit patients who have been home, are possibly infected with something contagious, and could infect preemie or sick babies in a Neonatal ICU. However here there is not much choice - the Pediatric ward already wages many battles against disease.

Have had my first baby with congenital malaria (born with the protozoan that causes malaria in his blood) - Mother and baby both looked surprisingly okay. Baby started treatment in the hospital and will complete his quinine syrup at home, as will mother get re-treated.

I was able to hitch a ride to another busy inner-city hospital today, after I finished my rounds.. It is called "Redemption Hospital" and is on Bushrod Island, pretty much part of Monrovia proper.

The drive through the neighborhoods was quite interesting - busy, busy with people.

The hospital looked little like a hospital from the front facade; as I found my way to the Pediatric ward, and to Dr. Sankoh the senior Pediatrician, I was impressed by the sheer number of patients, and family members. Empty beds were rare.

About the beds: they were made of wood, and not like Children's furniture as you see at IKEA or Selden's. Crude bed platforms, with vertical posts looking like they were planks nailed together. The bassinets for babies were like square boxes made of wood raised up on legs. Each was covered by a mosquito net.

Dr Sankoh I put at early to mid 60s. He was fit and healthy, but serene and in control. He showed me 5 different rooms, mostly large - each as open bays, in essence. The first was the Pediatric ER and "Concern Room". This functioned as ER, urgent care, same day observation etc., and was busy.
Right next to the ER was his "critical, intensive care area" - newborns with breathing problems were mixed in with older infants and children that needed higher level care. This was also a busy room - maybe 2 or 3 nurses i noted here.

Out of this building to the North was a large 12-15 bed "Malnutrition Ward" - when they make it here they are out of trouble but in serious need of special nutritional formulas, such as F-50, F-75, F-100 - high protein milk products I am told. These children varied from sadly undernourished to a reassuring appearance. Some children I noted had a reddish hue to their hair - Dr Sankoh told me this is due to Vitamin B deficiency.

Measles and polio are still real diseases here in Liberia; as are tetanus, HIV and Tuberculosis. The next ward was a typical Pediatric Ward - many children with various maladies. This was in another building to the south of the first building. There was still an infectious disease ward where the children with HIV are managed, which we did not visit.

In each case - each child or baby had a family member at their side; that person is needed to give care, feed, change, comfort and console their child since the docs and nurses are crazy busy! And generally it was fairly peaceful, with the children placid and the family members lounging or sitting with them on their beds, etc.

Lastly, and it just seemed to keep on coming - we went to the OB and Labor Ward. The post-delivery mothers and babies were in 2 large, long rooms. Each room (every room I saw - no A/C) had 8-10 mothers along the 2 walls, just lined up on their beds - sleeping, nursing, caring for their baby etc. 30-40 mothers and babies all out there in an open bay setting - the sights, the smells!

Through it all Dr Sankoh seemed calm, he walked and talked with authority - yet seemed to express concern and was clearly respected. I only spent 45 minutes with the man, seeing his operation, talking about clinical issues in a tropical and developing nation arena - yet I felt as if I was in the presence of someone great. He is assisted by one other Pediatrician, a young guy from Uganda. Two pediatricians - the entire operation looked like all of our children's hospital, with about half of our NICU and half of our Pediatric ICU thrown in, along with a whole bunch of newborn babies, and an emergency care area! 2 doctors.......

It was humbling to see this, and I cannot get Dr Sankoh off of my mind.

Sincere best wishes to you all -

John, the Dad