September 27

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You can learn to surf…

Life in Liberia

So I’m three months in and only just making the time to write again. It feels like it has gone so quick and yet day 1 feels like a lifetime ago.

My team at the Clinton Health Access Initiative, Inc. (CHAI) sits in the Ministry of Health (MoH) building, which is outside central Monrovia in Congo Town. The office is about an 80:20 split of national and international colleagues. This split has been great for getting insight into local customs, food and seeing glimpses of Liberia’s captivating history, whilst having people in the office who understand the adjustment of packing up and moving to another country has also been reassuring. I feel like my PULSE family is growing, even if they don’t realise I’ve adopted them!

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The Context

Over the last 30 years, Liberia has experienced 2 civil wars spanning 14 years[i], voted for the first elected female head of state in Africa, survived but has been left scarred by a deadly outbreak of Ebola in 2014-16, and started to rebuild Mama Liberia.  It is extremely hard to comprehend living through some of these times, but the war & Ebola explain a lot about the infrastructure and resource constraints that the health system faces daily.  However, I have been inspired by the strong men & women that I’ve met, who are passionate about the field of oncology and are not willing to let the geography of their birth define the fate of cancer sufferers here.

[i] For more insight into life in (and out) of Liberia during the civil wars, I would recommend “The House on Sugar Beach” by Helene Cooper.

When I first arrived, I thought that the focus of my assignment might be pulling together chemotherapy forecasts from different hospitals that were not already collaborating and then helping to prepare for a national tender for chemotherapies that leveraged the combined volumes. However, with every meeting and health facility visit, my perception of the task and what was achievable has changed…

The Challenges

I believe that there are three main barriers to overcome, before a successful cancer care program can be launched: systems, awareness & resource.

As a starting point, and probably the most relevant for my role, the lack of systems and process for forecasting the required drugs, health commodities and human resources mean that it is very difficult to build a business case for support from potential donors or the Ministry of Health.

There are currently no chemotherapy forecasts at any level of the health system. Many doctors and/or patients attempt to purchase on an adhoc basis when the need is identified. Additionally, all records are paper based and far from standardised or consistent. So rather than collecting the forecasted demand from each health facility, I am trying to decipher individual patient records to quantify the size of the cancer burden. This has meant reviewing a few thousand patient records so far…my medical awareness is certainly increasing! #changeme

Secondly, there is a severe lack of awareness about cancer within Liberia. Cancer is still seen by many as a bewitchment, and so not something to be dealt with by a hospital but by a witch doctor or a local healer with herbal remedies. Furthemore, there is still a lot of stigma attached with cancer and so sufferers will often try to hide the disease from their communities until they cannot bear the pain any longer. This results in cancer sufferers presenting to hospitals as a last resort, when they are already in the advanced stages of disease and it is often untreatable.

Finally, the resource dedicated to cancer is very limited, both from a funding and a human resources perspective. This further exacerbates patients presenting with such advanced cancer, for even when there is awareness, the majority know that there is no free treatment across the country and the cost is inaccessible to fund themselves. One doctor shared with me that the course of treatment for a recent 14-year old patient, with Burkitt’s Lymphoma, cost $1800. Luckily for this child, he had a sponsor in the US who was able to fund his treatment. However, when the GDP per capita is just $456 per annum, the heart-breaking reality is that this is not an option for the vast majority of the population.

In light of these challenges it can sometimes feel like I’m swimming against an overwhelming tide. However, hearing encouragingly similar stories from other PULSE10 buddies and reminding myself of the strength and resilience of so many friends and colleagues here, helps me to focus on finding ways to ‘surf’ the crashing waves. Liberia has some incredible waves and not just in the figurative sense…when dry season finally arrives I am hoping to learn to surf the actual waves. Liberia’s children are already doing so…

https://www.bbc.com/news/av/world-africa-45147431/teaching-children-to-surf-liberia-s-wild-waves

Photo by delfi de la Rua on Unsplash

The Hope

Two weeks ago, we helped facilitate the validation workshop for the first National Cancer Control Strategy in Liberia. With inputs from doctors across the different counties, civil society groups, private sector organisations, NGOs, the MoH & more, the day felt like a huge success that was subsequently reported in the national news channels. #awareness1cancer0

The strategy takes the first step in addressing the challenges highlighted above. It sets out the plan to increase awareness, access and availability of cancer services. From the levels of energy and participation in the room during the workshop, it certainly feels like we’re edging closer to a more robust Cancer Care Program in Liberia that is owned and embraced by all sectors of society.

This, combined with the work that CHAI are doing to validate the cancer burden in country will form a platform to advocate for resources to support the program.

Daily reminders that anything is truly possible…

#PULSE10 #learntosurf #changeme #awareness1cancer0  #nothingisimpossible

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Views expressed in this post are those of the author and not of GSK or CHAI