Liberia Time, Liberia Pace

We are now into our 3rd week in Liberia and gathering experiences with new friends, as well at places we frequent or visit.
The hospital here is John F Kennedy Memorial Hospital, the main public hospital in Monrovia the capital, as well as the country. It is fairly old and portions are under renovation. We visit the Pediatric ward here which is where Meg and GG play with children who are inpatients. They color, read books and play games with them. JFK also has the Pediatric outpatient clinic, which is pretty crazy and busy each time I go in there, but I have been spending most of my time in the NICU and with those patients, their families, and nursing staff.
There is a newly renovated hospital next to JFK - "The Liberian-Japanese Friendship Maternity Hospital" and it does look nice inside and out. Each time I walk in on the first floor - I am impressed by the large number of pregnant women waiting to be served - they wait in a non air-conditioned assembly area and sit on benches for what seems to me to be a long time. The same center serves for prenatal care, prenatal labs, Gyn. surgery, admission for Labor and Delivery, post-delivery care.
The NICU is on the 2d floor, and the actual patient care area is much too small. 2 babies are often in the one incubator (not twins) and today there were 3 small babies in one incubator (each between 2 and 2.5 pounds). There is just not enough equipment such as incubators and warmers in the place - it is a matter of resources to purchase it, to pay for nurses so that with enough staff more rooms could be open for patient care. But bless their hearts, the Nurses and others try hard and want to do a good job.
There are many little roadblocks and hiccups that make the day and patient care anything but smooth. Lack of the simplest items such as gloves, paper towels, hand cleaning gel, soap, trash cans, alcohol wipes - constantly looking for these things, asking for them, searching for them, buying them at local stores. It is sometimes the easiest way out. And my little list of sundry items just scratches the surface.
There have been several interesting cases coming through the door since I was awarded my Liberian Medical License, and began to practice, help in the NICU. This has been challenging given the absence of some core items such as respiratory support, only rudimentary labs, minimal Xray support. We can get most basic medications, but many other supply items are in short supply or absent. There is one Pediatrician practicing full time in Liberia and he is from Nigeria. So he and we do it all with no specialty support.
Way too many babies for my taste are born outside of the hospital - most at home, fewer at small clinics or outlying general hospitals. Today a 1.09 Kg baby (this is a small baby!) came to us through the Emergency Room - 5 or 6 days old, spent a few nights at the birth hospital, WENT HOME (aaaaaaggghh) and per the parents was not feeding well and had a fever (a sure comment to get a baby admitted). Well this kid is tiny by standards of any US NICU and would NEVER have gone home in such condition. THis is one of many stories for me in only a few weeks! Many are admitted to be treated for suspected infection; some are truly infected with something, get very ill and pass away because they came to late and we have so much less to offer for care. Some babies born at home come in with pretty severe effects of birth asphyxia and again are too bad off for us to do much that is good for them. And in more than a few cases the family waits 12 to 48 hours until they come to the hospital.
Survival of the fit has true meaning here in more than a few ways. It is a very different scene in so many ways - hospital care for mothers and babies; when we walk through the communities and neighborhoods (and we walk a lot), when you drive or shop at markets.
Well I have rambled quite a bit - I must say babies are just as cute here as they are in USA; so are the children and when they smile it warms your heart. But when you also lay eyes on a child who is very ill from malaria, or a diarrhea illness, or severe malnutrition, this is heart-wrenching. I have not lost that sense of hurt when I see suffering, nor have Kim or the kids.
We are well, we are together, we are having experiences that lead to stories, and we are fond of the Liberian people (except for Abraham who scared Kim and the kids! :) ) We remain fond of each other as well and we are all growing.
We miss you, our family and friends. All the best - John (aka Dad)