By: Eddie Miaway Farngalo MPH, RN, BSN
Lives of citizens seem to be at deeper risk with most county hospitals covered with darkness due to fuel shortages. Residents, who have no means of travelling overseas for treatment like the privileged are in yawning trouble if they fall at sick-since the already insufficient hospitals serving catchment communities lack fuel to run generators, ambulances, as well as suffering from severe drugs shortages. Hence, diagnostic equipment is useless. Consequently, actual lab tests for sound clinical judgements are compromised (effective treatment plans).
Clients who have been attending some health facilities that lack those basic and essential logistics, have turned out to avoid seeking health at health centers or hospitals that are in WHO’s standard 5km distances that are doubtfully followed. As a result, traditional healers are most likely expected to regain their relevance. That is, herbalists (country medicine men) have become more accessible to them as compared with health facilities or centers that have become just an empty structure-no drugs to treat patients while turning out as areas where patients are given prescriptions that are usually disregarded after she/he (client) leaves the facility due to self-buying inability.
“This clinic here is empty today because no drugs. If drugs were here, this place was going to be packed. Normally, when we get drugs, I can treat about forty patients every day. We can only give them prescriptions that they can misplace every time because they don’t have money to buy it” (OIC who requested not to be named).
“Me pa, I can go to country medicine man this time because any time you go to the hospital, they will say no medicine, only paper they will give you to go buy and me, I na get money.” (Patient).
“Even the big hospital sef, le doctor them can be selling medicine to us because they say medicine finish so that their own medicine they bring to sell so they can get food money to eat. They say that the government can’t pay them plenty months, na.” (Patient).
Government facilities in Liberia are believed to be “free of charge” but patients are buying fuel for ambulances and drugs for treatment. Thanks to the international communities for donating ambulances with the latest being three ambulances donated to Grand Cape Mount, Bomi, and Gbarpolu counties. Those ambulances are parked at the County Health Teams waiting for patients to buy fuel before they can move. With this, the intended purpose for which those ambulances were donated is less likely to be accomplished.
“Since three months, the ambulances we have here have no fuel. Patients or people who call for their sick relatives are told to buy fuel before we go for them. Most often, they (patients’ relatives) will say no money to buy fuel for the ambulance” (Ambulance driver).
“No fuel for the hospital so the whole CHT is off. All our offices are not working besides the EOC that can help us to work because they have 24 hours current”.
“Me pa, I thought the government say we mon na pay money when we go for treatment but every time someone sick for you to call the ambulance, they will say no fuel so we must buy it before they come for the sick person and we na have money sef, for ourselves.” (Stakeholder).
With high level of poverty in the country versus the relatively poor health seeking behaviour coupled with lack of basic life-saving materials (drugs etc.), there is a contradiction that “health is a fundamental human right.”
Most issues or challenges (lack of incentives for over 3 months etc.) raised or faced by the local health authorities and the health care workforce have been handled with no due diligence by policy makers.
Why the headquarters are relaxed in the midst of issues threatening the Public’s health?
Most serious health issues died natural death few days after they have been uncovered. Is it that health system is most peaceful than other entities? Or the health work force continues to be under threat/ has been intimidated by an oath given upon graduation? Is the Ministry so favoured by the central government for which no wrong is noticed? Or the Ministry is not fully supported despite the presence of several Non-Governmental Organizations?
There are lot of unanswered questions imminent in people’s minds about the way issues of importance like the health of citizens is overlooked in many ways by those who are charged with the responsibilities to “make things happen”.
Well, as we head for the national presidential and representative elections, it is most likely that people in charge of allotments to local offices or hospitals have been adamant in terms of equitable allocation of materials essential for the smooth operation of the County Health Teams and its auxiliaries (clinics etc.). Moreover, it is not a secret that those who are privileged are uncertain about what the next regime will bring for them. Therefore, they might highly be egocentric when it comes to efficient and effective usage and distribution of life-saving logistics and supplies at both central and local levels.
It must be clear that in terms of system, changing the head/management has no influence over traditional management (taking portion of materials for personal use or sale) of resources that are already gravely limited. Until the functions of those in charge can be executed independently, replacing those in charge will yield no fruitful result but to rather picture good leaders as ineffective while the very behaviours or practices become more prevalent even when the individual has been replaced.
Lastly, much easier way for the system to compete with international standard is that the entire system must be overhauled from the least (cleaners) to the highest, with people who will own it, while putting the public’s health as priority. But when changes continue to be made at the top, management’s/ leaders’ minds are highly vulnerable to be poised by people at the operational level who have become accustomed to traditional practices that, if not bowed to, will definitely lead to character damage that will also lead to dismissal based on no cooperation from resident/old staff.
The Author: Eddie Miaway Farngalo is the Head of Research at the Center for Liberia’s Future which is currently conducting a national study on community perceptions about Ebola and the reintegration of Ebola survivors, orphans and caregivers. Contact: 0886484351/0777590035: email address:[email protected]