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08 from emergency to recovery As Liberia has gradually moved from conflict to relative stability, Merlin has taken advantage of the opportunities that the post-conflict environment offers, and has forged a reputation for its commitment to sustainable development. “After a major crisis, Merlin stays in place long enough to rebuild lasting health care systems. It’s one of our fundamental principles,” says Andrew Martin, Merlin’s Operations Co-ordinator in Liberia. “There can often be huge gaps left when agencies leave a country, but Merlin is trying to ensure that, through increased capacity building, this does not happen in Liberia. This is why we work very closely with the Ministry of Health and Social Welfare to ensure that when we do leave, things don't just collapse.” A mother and child at the Merlin-supported Well Baby Clinic in Buchanan. Staff profile Sarah Hodge, an experienced certified midwife, is one of Merlin’s longest serving employees. In 1998 she joined Merlin’s inaugural programme in Nimba County, where she co-ordinated a traditional midwife training project. At the height of the 2003 conflict, Sarah was assigned to camps for displaced people in Monrovia. She recalls an incident at a football stadium, where an estimated 50,000 people were seeking shelter: “There was a pregnant lady who came in with cholera. I was trying to find a vein to get some fluids into her, but she was so dehydrated that we couldn’t find one. “I had to cut the flesh in her feet and find a vein. I had never done that before, but I did it. I was so happy because I knew I had managed to save her life.” Now, as Reproductive Health Manager, Sarah is responsible for planning and implementing various training initiatives that are part of Merlin’s overall reproductive health programme. She believes Merlin’s continued efforts to build the capacity of local health staff will be vital to ensure sustainable improvements. “We’re trying to introduce activities in such a way that they remain, even when we are not here. We need to make sure that whatever we leave behind is sustainable.”
09 10 years of health care in Liberia Transforming a hospital devastated by war Nurse Lawrence Jallah attends to a patient on the surgical ward at Liberian Government Hospital in Buchanan. Liberian Government Hospital in Buchanan, which serves an estimated 600,000 people, has been transformed over the last four years thanks to the direct support of Merlin and its donors. The hospital, which had been severely looted and damaged during the war, underwent major renovation in 2003 and 2004. Electrical and plumbing work was carried out; furniture, equipment and medicines were supplied; and clinical staff were recruited to get the war-battered facility back up and running. “Before, the condition of the hospital was very bad indeed. We didn't have the workforce or the equipment and support needed for proper clinical work," says longstanding employee Albert Saykpa, a former Nursing Director of the hospital. “When Merlin came we really noticed things changing.” 2005 saw the construction of a new outpatients department (OPD). Previously, outpatient services had been conducted in the main hospital building, which led to overcrowding and made it difficult to maintain an organised service. The new wing was officially opened by Liberia's president, Ellen Johnson-Sirleaf, in April 2006. “It has become easier to see more outpatients in any given day,” says Stanley Otunga, Merlin's hospital matron. “We have a good emergency room, and a short stay area where we can observe people. It is making a big difference to patients and to the operation of the hospital as a whole.” In 2005, the OPD saw an average of 4,496 patients every month. Last year, this figure had risen to 5,008– more than 500 extra patients per month. Better organised wards, staff training initiatives and an incentive scheme have also led to an improvement in clinical standards over the years. “In-patient care has definitely got better. Now we have a lot more nurses who are properly qualified and who are benefiting from Merlin's incentive payments,” says Otunga. “I would also say that because of regular training sessions we have given to staff – especially on the management of medical conditions – the physicians and nurses are becoming much more accurate in their diagnoses and treatment.” President Ellen Johnson-Sirleaf officially opened the new outpatients department at the hospital in Buchanan in 2006. In a country where many public sector employees are still not on the government payroll, Merlin’s payment of monthly incentives is helping to attract and retain skilled health workers who might otherwise relocate to Monrovia. “As well as the regular supply of medicines, one of the great things that Merlin has done is to offer incentives to staff here,” says Dr Jerry Brown, the hospital's doctor and the County Health Officer for Grand Bassa. “If it hadn't been for Merlin, some of the qualified staff would not be here.” There are several other challenges for this rural hospital to overcome. Perhaps the most immediate concern is the lack of qualified medical specialists, particularly doctors. “Currently I'm the only Liberian doctor here at the hospital, and I also act as County Health Officer,” says Dr Brown. “It can be a real headache when I have to leave the hospital to attend meetings.” Merlin has secured funding to support the hospital until February 2008 but further donor support will be vital to ensure that the significant improvements to health care provision are maintained.
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