By Evelyn Kpadeh Seagbeh and Siatta Scott Johnson
The survival of Daddy Kerkulah Willie and his spouse Helena Tamba from the Ebola Virus Disease (EVD) in 2015 was like a miracle. But, like many other survivors, the couple still struggles with the aftermath of the virus. They were hopeful when they learnt that a USAID-funded project promised to deliver free medical treatment to survivors. However, they were turned back without medicines. Nineteen (19)out of the 22 survivors we interviewed were not able to get the promised comprehensive care.
“Many people died in this country from Ebola,” Kerkulah explained, “but we survived, and not being able to get real healthcare for our present health condition puts fear in me and I think our lives are at risk even after Ebola.” Kerkulah lost two members of his family while his spouse, Helena, lost all of hers.
The USAID-funded Ebola Transmission Prevention & Survivors Services Project aims to help survivors like Kerkulah and Helena. It is a US$9 million project started in August 2016 to strengthen the capacity of the health system and provide free comprehensive specialty healthcare services needed by Ebola survivors.
Over eight months ago, Kerkulah and Helena were informed through the National Ebola Survivors Network’s leadership about USAID’s free healthcare services for survivors at 11 health facilities, including the local government Hospital C.H. Rennie in Kakata. The couple decided to take advantage of the opportunity since they could not afford to pay for their treatment.
“We were told that we will get treatment for any condition,” Kerkula told us. However, at the Catholic Hospital, the medicine he needed was not available. Instead, he was given a prescription. At the St. Joseph Catholic Hospital in Congo Town, Monrovia, Dr. Ahmad Aljawish recommended that he buys the medicine at a pharmacy on Mechlin Street in central Monrovia, whose name he does not remember.
“The pharmacy agreed to treat me for 3 months and my bill was $US120; but they said when the medicine arrives in the country they would contact me, and since September 2017 I have been waiting.
“It’s about my health so I have been taking in country medicine (traditional medicine) because I want to get well,” Kerkulah told us.
His spouse, Helena, experienced the same situation, as did most of the survivors we interviewed in three of the four counties covered by the project. The USAID-funded project raised the hopes of Ebola survivors but has failed to deliver.
The USAID’s Ebola survivors project
Liberia’s fragile healthcare system coming out of 14 years of civil war was badly affected by the outbreak of the Ebola Virus Disease in 2014, killing over 4 thousand people, leaving behind over 8 thousand Ebola orphans and about 5 thousand survivors in Liberia alone.
The virus ravaged the country’s entire healthcare delivery system, killing some of the country’s few good doctors and creating a serious gap in the sector.
On January 14, 2016, Liberia was declared Ebola free by the World Health Organization (WHO). However, three years on, about 80% of the survivors of the outbreak still have medical complications as the aftermath of the disease. Their conditions range from liver infections, impotency, and problems with their eyesight, heart diseases, body and joint pains.
The USAID project aims to help those survivors get on with their lives. The project’s healthcare pillar, according to the project’s document, is implemented by John Snow Incorporated (JSI), an American company. The firm is charged with providing specialized clinical health services needed to care for common complications faced by Ebola survivors, with particular focus on mental health and sub-specialty services such as neurology, rheumatology and ophthalmology.
According to Dr. Rose McCaulay, the Chief of Party (COP) for JSI in Liberia, the project targets survivors in 4 of Liberia’s 15 counties: Montserrado, Bong, Lofa and Margibi. The free healthcare is given in two private faith-based hospitals, ELWA and St. Joseph Catholic, as well as several government facilities, such as C.H. Rennie Hospital, Redemption Hospital, JFK Hospital, Dolo Town Health Center and Phebe Hospital. Others are Tellewoyan Hospital, Du-Port Road Health Center, Foya and Kolahun hospitals.
“Ebola survivors who can prove that they are survivors can go to ELWA and Catholic hospitals in Monrovia for any condition that they have and they will be treated free of charge,” Dr. McCauley told us.
“The complaints survivors have had with the government facilities, which is not the case with the two private faith-based facilities, is that when they go to the government facilities they are given prescriptions, but when they go to these two private facilities, they are not given prescriptions, they are given comprehensive care free of charge for any condition,” the JSI chief of party claimed.
But 19 out of the 22 survivors who visited both the private and government facilities have complained that they cannot access drugs and were made to purchase their drugs elsewhere at their own expense. This includes 6 survivors who visited the private hospitals and were not able to get drugs for free.
In a second interview on January 17, 2018 contradicting her earlier comment that JSI was not responsible for drugs at government facilities, Dr. McCauley admitted that the newly-arrived drugs will be distributed to government facilities in conjunction with the Ministry of Health.
Contacted by email, USAID has refused to comment. They’ve also declined to provide the specific cost of the project in Liberia, including the price and quantity of the drugs that arrived in country.
Dr. McCauley confirmed that the project started two years ago, and was nearly finished, but the drugs only arrived in Liberia in January 2018. She blamed the delay in the arrival of the drugs on procedural issues in the procurement processes by Chemonics, the company responsible to procure the drugs under a USAID arrangement.
Chemonics is a US-based international development organization operating in about 70 countries and manages project in developing countries, fronting for bids and mainly contracts from the United States Agency for International Development (USAID).
Chemonic’s Herbert Rwabugahya, who is the country Director as well as Contractor for USAID Global Health Supply Chain Program Procurement and Supply Chain Management in Monrovia, promised to get back to us but we have not heard back since February 1, 2018.
From saving Ebola victims to becoming one
50-year-old Konah Massaquoi is an ambulance driver for the Ministry of Health. He contracted the Ebola virus while driving infected persons to treatment centers. Despite risking his life to save others, he is still struggling with his health condition while caring for his daughter.
Konah’s daughter was infected by the Ebola virus, which has impeded her mobility. At almost 4 years old, she’s just started walking, but very slowly and does not talk yet.
Konah told us that he suffers severe pains in his lower abdomen as a result of his Ebola infection.
So he visited Catholic Hospital but there again he did not get free treatment. “I did all the tests and I was told to buy drugs, because I had sore on my liver, so the doctor told me they never had the medicine there, I should pay for it. I was forced to buy the medicine from the same doctor that directed me to the clinic here in Clara Town called Mawah or what. I went to that clinic and paid him US$35 for the medicine.” He added that at both the government and private hospitals he visits, Redemption and Catholic, he always has to pay for his drugs.
His drugs were given him in a dispenser bag without the drug’s name, but only the dosage and was issued no receipt.
Dr. Amad Aljawish works in three health facilities : Mawah Clinic, the Catholic Hospital, and now his newly-established Syriana Medical Center.
Dr. Aljawish confirmed to us that he does refer patients that meet him at Catholic Hospital to Mawah and sometimes to Syriana to purchase medication that best suits their situation.
He said, “We bring most of our medicine from outside, some from Europe, we have good medicines, and we have medicine for many conditions here at Syriana.
“We can help them, I have medicine for enlarged heart, infection in the liver,” Dr. Aljawish confirmed.
Syriana and Mawah are two of the many private health facilities where survivors spend their own money to access adequate care despite the USAID project that is supposed to provide care at no expense to survivors.
Moreover, Syriana is not registered with the Liberia Business Registry, a legal body responsible to grant legal operating licenses to businesses operating in Liberia. According to section 4.5 of the Liberia Business Registry act, a business registry certificate is required to operate legally in the country.
The then Director General of the Liberia Business Registry Mr. Abu Kamara said, “As far as we are concerned, the Syriana Medical Clinic does not exist— meaning that it is not registered with us.” Despite the lack of registration, the Liberia Medical and Dental Council on January 1, 2018 licensed Syriana under the proprietorship of Ahmad A. A. Aljawish and Angie Griffith.
Rural survivors fare the worse
In the rural area, the situation is even worse for survivors who have to walk several miles to get to healthcare facilities.
32-year-old Bebe Tamba, living in a village in Lofa County, has survived Ebola. She is now expecting a baby, but she’s worried about the child’s safety and her life. She feels excruciating pains in her joints and body that often causes weakness in her back and waist.
In September, October and November 2017, she visited the Telewoyan Hospital, a leading government health center in Lofa, but could not get drugs for her prenatal care. She travels 52 kilometers or 1 hour 30 minutes riding on a motorbike from Foya to Voinjama to the hospital.
Bebe Tamba laments, “When we heard that JSI will be giving us free medical care, I was happy, but three times now I went to Telewoyan Hospital and they told me no drugs.”
The sales of drugs in polythene bags or in plastic buckets under the hot weather is common in rural communities. The government had cracked down on this mode of drugs circulation in the past. But without alternatives, survivors have resorted to consuming drugs from “black –baggers,” the illegal drug suppliers, and private medicine stores.
Frustration among survivors
Patrick Farley, the president of the survivors’ Network which is responsible to coordinate activities of Ebola survivors in the country, said that the secretariat estimates that only 310 survivors got clinical care across the country since the start of the project and out of 1,210 visits.
He explained that the USAID-funded treatment centers “are on paper, but in reality they are not functioning well. We are frustrated; there was no need for the JSI project to come to Liberia because survivors are not getting the comprehensive clinical care as stipulated in the project.
“Where is the comprehensive care when survivors are asked to purchase their own drugs,” he asked. “The comprehensive healthcare for survivors is cosmetic.”
Farley told us that the Network would file a lawsuit against JSI for its failure to deliver on the clinical care for survivors and engage the donor of the USAID project about the situation.
“I challenge the JSI family to come and tell me that the clinical care met its objectives,” he said.
This story was written as part of ‘Reporting after the epidemic’ journalism programme run by the Thomson Reuters Foundation.