Liberia: Where You Live Should Not Determine How Long You Live!

Daniel Cardwell, PhD

There are about 195 countries in the world. Of those countries, the International Monetary Fund (IMF) established a ranking based on their per capita GDP or financial stability from the richest to the poorest. According to that ranking, 20 of the poorest countries in the world are in Africa. That data also ranks Liberia #9 from the bottom. As a result, one might consider Liberia unable to compete with countries on the other end of the ‘poorest to richest world chart’.  

Can Liberia compete with ‘richer’ developed countries in the treatment of stroke?  Before you answer “NO,” read this article about Lisa, A 36 year old black Liberian female who experienced a hemorrhagic stroke (ICH) in her brain and was extremely close to death in 2019. Oddly there exists a similar case approximately 8,000 miles away involving Deborah, a black professional woman, 57 years old, who suffered the same illness in the U.S. close to the same date.

Data from the Health Improvement Network in 2013 indicates that “more than ⅓” of the persons that suffer hemorrhagic stroke die in the first month. Those “younger than 50 years” suffering the same condition die in greater numbers. So, Lisa’s chances of recovery from IHC were far less than Deborah’s.

According to the WHO, mortality (death) due to hemorrhagic stroke in poorer countries of the world was over 85% in 2001. In other words, chances of surviving this type of stroke was about 15 out of 100 in 2001. Etiology or causes of stroke includes risk factors affected by gender, ethnicity, diet, general health, heredity, access to timely healthcare, and age. Oddly, younger patients do worse. Additionally, they state that patients “younger than 50 years are more likely to die” of hemorrhagic stroke.

Liberians often state that “when you take someone to the hospital in Monrovia, don’t expect them to live.”  While money or wealth can play a part in a persons’ access to good healthcare, money alone can’t cure your cancer, stop your bleeding, mend your broken bones, or save you from sudden death. When it comes to complex health emergencies, if the proper medical intervention is not employed at the right time by the right doctor, death is almost certain. As a result, most people consider that if you are stricken with a disease or ailment that can kill you, flying to a richer country for treatment may increase your chances of survival, but in these cases, involving hemorrhagic stroke, I beg to differ!          

It was Sunday morning and Lisa had prepared herself for church. However, she was running late because Mya, the young child living with her, overslept and seemed irritable while Lisa was attempting to get her dressed quickly. Rushing to leave for church, Lisa slipped and fell on the tile floor and became unconscious.

Mya called out for help from the 2 older boys that lived on the property, Mike & Meleto. Once in the house, they found Lisa semi-conscious and confused with garbled speech, on the floor and attempting to move but in distress. Mark & Meleto quickly lifted her onto a wheelbarrow taking her to a taxi on the road and on to the nearest clinic in Mt. Barclay.  That clinic took one look at her and stated she needed to go to a hospital as their services were limited.

Lisa was now unconscious and getting worse, so they quickly moved her to Benson Hospital. There, they met Lisa’s niece, Jessica, who heard the news and just arrived from Kakata.  Lisa’s husband was on travel in the U.S. and was phoned with the news by Jessica. Trained as a registered midwife in Liberia, Jessica works in Kakata.  A few hours after Lisa arrived at the Benson Hospital there seemed to be no change in Lisa’s status so Jessica called her husband in the U.S. again and made a recommendation that would save Lisa’s life.

After explaining to Lisa’s husband that her condition was not improving, and upon Jessica’s recommendation, Lisa’s husband in the U.S. gave an “ok” to sign Lisa out of Benson Hospital AMA (Against Medical Advice). She was immediately transferred to Fidelity Hospital. Within an hour Lisa was admitted, and although unresponsive, began needing diagnostics.

Shortly after her CT scan, she was diagnosed with a hemorrhagic stroke by Dr. Alvin Doe, “the only neurosurgeon in Liberia”. Lisa’s blood pressure was dangerously high on admission and throughout that night. Lisa had never been treated for high blood pressure before. It is likely this was the reason her father died suddenly a few years ago. Hereditarily they may have shared the same disease.

According to relatives present at the hospital, when Lisa regained consciousness days later, “she didn’t recognize her own mother” and could not speak or walk. A few weeks later Lisa’s blood pressure returned to normal (120/70), and she was discharged from Fidelity Hospital, walking out of that hospital without assistance. She received an appointment to return for follow-up care at their outpatient clinic the following week.

Far away in Washington, D.C. near the same date, Deborah was frantic and driving late for work one morning and experienced a sudden headache with blurred vision. Deborah was 57 years old and in good general health but had been undergoing treatment for high blood pressure for years. Before her vision went completely, she was able to dial 911 on her cell phone.

She was met by an ambulance in minutes and taken to the famous Georgetown University Hospital. She was admitted to ICU and managed by a team of doctors specializing in Neurology. Shortly after her CT Scan, she was diagnosed with a hemorrhagic stroke.  Some unique emergency interventional procedures were attempted to stop the intracranial bleeding (in her brain), but they were unsuccessful. After the bleeding clotted and her blood pressure returned to normal, she was discharged from the hospital about  2 weeks later and was able to walk out on her own.                

In comparison, these two black females were about 20 years apart in age, and both with some history of high blood pressure. One rushed to work and the other to church, both had increased stress leading to a spike in blood pressure at or beyond 250/140. However, with similar risk factors, the analysis of the overall timely healthcare they both received in Liberia and in Washington D.C. seems remarkable. 

Therefore, these are good cases of female patients for comparison involving hemorrhagic stroke. One, living in one of the poorest countries, Liberia, and the other, living in one of the richest countries, the U.S.A. While both of these women may have had other medical issues unrelated to hemorrhagic stroke, for the purpose of this true illustration, I am only mentioning symptoms that may be related to risk factors for this illness and admission. 

Conclusively, both women are living today and neither has extended disabilities beyond the wearing of eyeglasses to correct changes to their eyesight since their hemorrhagic stroke. One should not forget that the statistical odds were mostly against Lisa for her younger age and for living in Liberia, one of the poorer countries in the world.

However, unlike other illnesses, her younger age increased her risk of death. Both females had hereditary links with fathers that died of high blood pressure-related illnesses. Therefore, I can say that Lisa’s continued life resulted from the will of God, quick decision-making by Jessica Kortu, her niece and a Liberian-trained registered midwife, who got Lisa moved to a place where she received excellent care from Dr. Alvin Nah Doe, Neurologist at Fidelity Hospital, who made the needed treatment decisions resulting in a successful outcome.

According to a recent interview by “Face2Face” online, Dr. Alvin Doe is the only doctor “qualified” to do brain surgery in all of Liberia. So, don’t underestimate your access to good healthcare in Liberia for stroke. While we are thankful to God for sparing Lisa, Liberians should be proud of the care she and others can receive in Liberia from Dr. Doe for this deadly condition. Compared to America, the results you just read are unexpectedly remarkable and unique on a world scale! 

If you have high blood pressure and want to live longer in Liberia, consider a visit to your doctor. With minimal lifestyle changes in consideration of your risk factors, monitoring your blood pressure,  lowering your salt intake and stress, drinking plenty of water, and getting in the habit of regular exercise, may keep you away from a stroke.  Where you live should not determine how long you live! 

Editor’s note: The views expressed in this commentary are solely of the author and do not necessarily represent that of the Daily Observer newspaper.

About the author:

Daniel Cardwell, Ph.D. has worked in association with healthcare administration & technical management for over 50 years professionally in Radiological Health. A graduate of Howard University in Washington D.C., he has lectured Liberian students & nurses at Cuttington University, and Tubman National Institute of Medical Arts (TNIMA) on Radiological Sciences. He has also made presentations to the medical staff at the JFK Hospital, on Radiation Safety applied to healthcare. He is the only living team member responsible for building and opening the first Cobalt 60 Cancer Treatment Suite at JFK Hospital in Liberia for West Africa and similarly in Haiti, Tanzania, with other developing countries. In 1975 Mr. Cardwell, with his team received the distinction “Knight of Redemption…” which was presented by the deceased former President, William R. Tolbert in 1976.  He was responsible for the first SEER Tumor Registry in Liberia also serving as the President of the American Cancer Society in the U.S. Virgin Islands raising over $200,000 USD toward the completion of the Charlotte Kimelman Cancer Institute.