NOTES FROM LIBERIA
Published December 2016
ANNA DU
A Chinese clinic located in Oldest Congo Town, Monrovia
Decorating the wedding car in Monrovia
The Liberian nurse next to me continues to talk,
but all I can think about is the nauseating smell—a mixture of sweat, damp precipitation, and sour bodily fluids—that permeates Redemption Hospital’s OB/GYN Ward. I glance at the doors to the delivery room and find myself, a twenty-year-old woman, wondering about the mysteries of childbirth. For now, I can only hear the cries of someone in labor.
I arrived in Monrovia, Liberia shortly after West Africa was declared free of active Ebola virus transmission in June 2016. Liberia—one of the top five poorest places in the world—suffered more damage and death due to Ebola than any other country. During the outbreak, the few health facilities that remained open had to streamline resources, accepting those with Ebola while turning away others (e.g. pregnant women). Fear and distrust further corroded relationships between families, communities, and health providers.
“What happens when a woman dies?” I ask the nurse. To my surprise, she pulls out a stack of death certificates, forms, and record books. I’m amazed by this treasure trove of information. I’ve been mapping the pathways of pregnant women, starting from their arrival at triage. I thought I was close to the end. My fingers trace the ledger lines filled with handwritten details on women who have passed through this ward. I stop at the last column, which reveals the ultimate outcome: life or death.
Liberia’s Ministry of Health classifies maternal death as an immediately-reportable event under the country’s Integrated Disease Surveillance and Response (IDSR) strategy. Through IDSR, health personnel at all levels are expected to report, investigate, and respond to any occurrence of maternal death. In this way, a patient’s story continues beyond death. Her case will be investigated by district and county health officials before it is entered into databases and reported to Liberia’s Ministry of Health.
During my second week in country, the Minister of Health declared maternal mortality a national public health emergency. Numbers alone are compelling, since Liberia has one of the highest maternal mortality ratios in the world. I was tasked with figuring out how to close the gaps on chronic problems facing Liberian women after Ebola. For two and half months, I assessed Liberia’s maternal mortality surveillance and response system. I learned that preventing maternal death can be more complicated than fighting infectious diseases due to diverse factors—cultural practices, supply chains, trained workforce, integrated services—that must be considered at every level of the health care system. By addressing issues in this comprehensive manner, stakeholders can thus create sustainable public health systems that actively engage women throughout all stages of their lives.
The bridesmaids taking a selfie
Moments before the wedding ceremony
Starting the bridal shower with introductions
For Dr. Cynthia, the bride’s maid of honor,
I felt so grateful, not only inviting me but driving me out to the New Georgia Estate area past New Kru Town. I’d say it’s the equivalent of the suburbs, since it is ~40-50 minutes driving from Sinkor (without traffic, which can get really bad with all the work being done on the roads). I got to see a very different part of Monrovia, which Dr. Cynthia kept insisting was the ugly part, but to me it’s all about the kinds of people living in a place. I met Cynthia on Friday, when I was at Redemption Hospital. I was walking around with an OB ward nurse, who was showing me around the area. Cynthia said 你好 (hello!) in very good Mandarin as I was passing by. She introduced herself as a doctor in the medical ward and wrote out her Chinese name, then gave me her phone number, telling me to call.
Later that same night, she seemed excited over the phone and immediately invited me to the bridal shower on Saturday. I went to Benson Street to pick up tailored clothes, just in time for the event. Cynthia met me there and drove me around with her on some errands. I met her daughter and went with her to buy a large flat screen TV as a gift for the bride and groom. The bride, her best friend, had waited for Cynthia to come back from studying medicine in Wuhan (China) to have the wedding. They grew up together.
Dr. Cynthia took me to an Indian grocery store and spoke to me in Chinese the whole time, wanting to make sure that I was comfortable. She is a large and very tall woman who talks a lot, and she is my first real Liberian friend-mother. We drove to the bridal shower compound to drop off the many many drinks. People were there setting up blue chairs and blowing up red and white balloons, the bride’s favorite colors. There was a gazebo with a bar and a DJ, and a large green tree growing nearby.
Afterwards, Cynthia took me to her house, which had a gate and also a separate area for the business that she runs, selling miscellaneous objects as far as I could tell. I learned a bit about her and her family. She wouldn’t say how old she was but I learned that her husband is a banker and a naturalized US citizen who lives with the rest of her children in Iowa and comes to Liberia to visit her. Cynthia had a lot of shoes, no air conditioner, and a circular mattress. The bathrooms in her house do not have running water. I changed into the new dress I had picked up earlier and it fit just right. As a bridesmaid, Cynthia had to wear a red and white collared t-shirt with a picture of the bride and groom on the front and gold shorts to the bridal shower.
When we got there, we hung around and helped the other bridesmaids get ready. I got the sense that Cynthia and the bride were either upper middle class or upper class Liberians. The bridal shower started off with introductions and games. Cynthia bought the bride’s red and gold dress for her in China. The bridesmaids sat behind the bride while the rest of the guests were dispersed across the space. Children were running around and two photographers documented the party. We had to introduce ourselves by singing and dancing our names. The atmosphere felt very funny, relaxed, and centered around women.
The games that we played included some kind of Simon-says variation involving shoes, telling a story for as long as you are wrapping a string around your finger, musical chairs, and answering anonymous questions written on strips of paper. The women who went before me asked a lot of sexual questions — how long it lasts, where they like doing it, their first time. I thought I received the most normal question: what is your favorite style? When I stood up to speak, I started talking about long dresses, when I was interrupted by laughing women who told me that “favorite style” referred to sex positions. All I could say was that I did not know. Cynthia’s mom pitched in with her suggestions. Nobody answered the questions they were asked seriously, and instead a lot of joking and dancing. Cynthia and some of the other bridesmaids made brief speeches, and some of the older women gave the bride advice. The bride gave a speech and everyone ate.
As the party continued, Cynthia acted as the bartender and people grouped together, talking and dancing. Sometimes it’s hard for me to understand Liberian English, but at this event I felt like I improved. I felt a little anxious about not knowing anyone and being far away from the city, but still I had a great time. After the party, Cynthia drove me and some other guests all the way to Sinkor. The police stopped us and asked for her license — apparently the roads are very dangerous. On the way home, I was invited to the wedding and decided I would go.
Along the Liberian coast
The remnants of Ducor Hotel’s swimming pool