Liberia: Nimba Public Health Centers in Crisis

Public health centers of all sizes in Nimba, including George Way Harley Hospital in Sanniquellie and the Jackson Fiah Doe Memorial Hospital (pictured), are facing a major shortage of drugs to treat patients.  

.... … As public clinics and hospitals run out of drugs, leaving the poor to suffer.

It is 9 a.m. and Mercy is responding to the needs of patients at the Dorgbor Town Clinic. But as she opens the clinic’s medicine cabinet, a drawer slides open and there she finds very few drugs that will hardly meet the patients’ needs.

Mercy, who works as a nurse at the clinic, which is located in Gbi and Doru administrative district, Nimba County, tried three other compartments that would normally contain vials of essential and basic medicines, and the results were all the same: low supply of stock.

The low stock of medicines means that Mercy and other nurses at the clinic had to ration — leaving some patients going home without medication.

“Here, we are facing a critical shortage of basic medicines and urgently need medicines to replenish stocks. This is a real problem. We do not have enough medicines for the needs of the population,” Mercy, whose name has been changed to protect her identity, explained. “A patient today will have to seek most of the medicines he or she needs privately, where prices are far higher than in government health facilities.”

According to Mercy, basic essential medicines ranging from anesthetics, preoperative medicines, and medical gasses, as well as medicines for pain and palliative care, are all in low supply. 

But despite the shortage of drugs at the Dorgbor Town Clinic, Mercy and other staff members of the clinic have to always brace themselves for a busy Monday, the day of the week which sees a higher number of patients at the clinic than other days. Most of the clinic patients are women and children.

Gbi and Doru Administrative District is located in the southern part of Nimba, with Grand Gedeh to the East and Rivercess to the Southwest. The biggest medical facility is the Jackson Fiah Doe Referral Hospital in Tappita, which is about 100km away from Gbi and Doru. The district also happens to be the home of President George Weah’s late mother, who  hailed from the area.

And as Mercy responded to her patients, people in Yarwin Mensonnoh, another remote district in Nimba County, were also complaining of drug shortages — a situation which has weakened healthcare delivery service in that part of the county.

 In Yarwin Mensonnoh and Gbi and Doru, two of Nimba poorest administrative districts, doctors and nurses working there have for weeks been struggling to lay hands on crucial drugs like penicillin and some other antibiotics — needed to treat infections and other diseases as well as antimalarials.

But it seems that the shortages are not just for people in the poorest part of Nimba as most public clinics and key hospitals are also being affected. For example, the Esther & Jerelyn Medical Centre in an urban city like Ganta is among some of the public hospitals that are low on stock to serve their patients.  Other public health centers, including George Way Harley Hospital in Sanniquellie and the Jackson Fiah Doe Memorial Hospital, are also facing a similar problem.

In the end, patients are mostly receiving prescriptions on random sheets of paper to purchase their medicines from any nearby pharmacy or drugstore. Or in some cases, they have to purchase their own medical gloves or battery for thermometers before they can be checked.

The shortages now mean hospitals, small and large, are now left with the task of scrambling to come up with alternatives in responding to their patients’ needs, with doctors and nurses dismayed to find that some patients must suffer through pain, or risk unusual reactions to alternative drugs that are not the best option. 

The situation, according to chiefs and district commissioners in Nimba, needs urgent attention from the government as it is becoming increasingly difficult for people throughout the county — particularly the most vulnerable — to access basic medicines.

“This lack of medicines in public health centers and hospitals is part of a broader problem of the Nimba health system. But we cannot allow this to go on for a long period. We need to ensure that basic medicines are within reach for all Namibians,” said James Karr, who is the District Commissioner of Gbi and Doru.

Commissioner James added that at Dorgbor Town Clinic, nurses there are now giving their patients prescriptions after diagnosing their illness, “because the required medicine to treat the problem is available within the clinic.”

He said it is very difficult to get medicines in any part of his district to be purchased and, as a result, the patient seeks another remedy for the illness, which sometimes leads to complications or death.

“You cannot even find a drug store in the district to buy medicine, so giving patients a prescription means nothing. Simply, you are telling them, ‘no drug, go home’,” he said.

Also in Kparblee, the District Commissioner complained that while his people have clinics, they do not have medicines, hitting the poorest people hardest.

According to Commissioner Henry Korso, the situation in his district is serious with the most vulnerable people in the poorest zones severely affected, because there are no medicines in the public hospitals and health centers.

“We have clinics in our district but no medicines,” Korso said. These clinics are in need of urgent medical supplies and drugs to proficiently cater to the health needs of people. We have well-trained doctors, and nurses here, but what we now lack is sufficient drugs and other medical equipment to smoothly run the facilities.

Kparblee, which is one of Nimba’s seventeen administrative districts, is located in Tappita, Statutory District and situated along the Cestos River which borders Liberia with the Republic of Côte d'Ivoire.

Back in Ganta, at the E and J hospital, nurses who spoke on the condition of anonymity disclosed that while the hospital offers treatment free of charge, the shortages of drugs and other equipment means patients are asked to not just to buy their own drugs, but any other materials required for them to be treated; at the same time paying for surgical and laboratory tests.

“Even though most of the services, including bed fees and doctor consultation, are free, patients will now have to buy medical gloves and battery for thermometer and pay for lab tests,” the nurses said.

Meanwhile, local authorities like Korso and James have disclosed that while private pharmacies have medicines in stock, rural populations have difficulty getting to the pharmacies and most cannot afford the prices. Therefore, more and more patients are left to fend themselves – indulging the risks of counterfeit medicines.

They fear that shortages will turn more people towards questionable medicines sold by unregulated vendors since Liberia is one of many African countries where counterfeit pharmaceuticals pose a health problem.

And with Nimba being a county with several external borders, the risk, according to them, is high.  The county shares borders with the Republic of Côte d'Ivoire in the East and the Republic of Guinea in the Northwest. With the county's area measuring 11,551 square kilometers (4,460 sq mi), Nimba is the largest of Liberia's 15 counties

“If there are no medicines in public health centers, the first place people turn to is the local market, because they cannot afford to buy in pharmacies,” the commissioners added. Meanwhile, efforts to get a response from the local health authority did not materialize as their phone kept ringing perpetually.