Liberia’s desperate need for anaesthetists

It has been seven years since the end of a civil war which wrecked Liberia. During the fighting half a million people fled – including thousands of hospital staff.

One of the most critical absences is anaesthetists. There are less than two dozen left for the whole country. It’s one of the reasons maternal deaths have doubled in the last decade.

Jane Deith has been to Liberia to meet one man who’s trying to train the anaesthetists Liberia needs to save the lives of its mothers and babies:

Anaesthetist Wilmot Fassah is 57. He has diabetes and cataracts and would dearly love to retire and get some rest. But he has to keep going, because he is trying to train enough anaesthetists for Liberia.

At the moment there isn’t enough for one for each hospital. There are just 22 anaesthetists across the whole country – most of them old men now, working 24 hours a day. They are the anaesthetists who weren’t killed – or didn’t flee – during Liberia’s long civil war.

They’re so few, that in most hospitals anaesthetic is given by people who’re not qualified. Wilmot Fassah says he knows they are making mistakes and it is killing people.

“Before you give anaesthetic, you have to know what you’re doing. If you don’t know what drugs to give people, or you don’t know when something’s going wrong in theatre, patients die.”

Wilmot Fassah has created a school of anaesthesia at Phebe Hospital, five hours north of the capital Monrovia. But he says he’s chronically underfunded. He has to rely on visiting American doctors to bring the drugs he needs. He often runs out of oxygen, and he and his students have to operate without it – which is very dangerous.

He’s managing to turn out a few newly trained anaesthetists each year. But some of graduates are giving up after only a few months – scared by the risks they’re forced to take in hospitals which can’t afford to buy drugs.

While we were filming at Phebe Hospital, we heard that one of Wilmot’s former students had just resigned from his first job at Saniquelle in the north of the country.

We tracked down Prince Julutoe and he told us why he quit. He said he couldn’t cope with working alone in a busy hospital, without supervision or help. He said he had to leave – before someone died.

“It was like crucifying yourself. You go to work in the morning, you don’t stop. You don’t eat all day. There were a lot of emergencies and I was the only anaesthetist – working day and night.

“Some days your brain just freezes and you make mistakes. I was just fortunate not to have caused any deaths. It was a very difficult decision to walk out, because I went into anaesthesia to save lives and I know my absence will cost someone’s life.”

Liberia’s health system can’t afford to lose people like Prince Julutoe, because so many were killed during the civil war – when fighters tore through hospitals. In one attack at Phebe Hospital in 1994, 160 staff and patients were murdered.

Liberia’s Minister of Health Waltyer Gwenigale used to be a surgeon at Phebe and is frank about the problem:

“It was like crucifying yourself. You go to work in the morning, you don’t stop. You don’t eat all day. There were a lot of emergencies and I was the only anaesthetist – working day and night.”

“The country is trying to come back from the war. Before, our health budget was $500 million. Now it’s $80 million. We don’t have the money for a lot of things. We don’t have enough anaesthetists, but we are training some. But the reality is, is you have one anaesthetist in a hospital, you are lucky.

“There are many hospitals that don’t have any anaesthetists at all.”

The shortage of anaesthetists, not to mention surgeons and nurses, is one of the reasons why operations like caesareans are so rare in Liberia. The country has one of the worst rates of maternal death in the world. In Labour, when women go into labour, they don’t know if they’ll come out of it alive.

The war has destroyed so many of even the most basic health clinics, that women have been left even further away from medical help. During the second period of the war, the number of women dying in childbirth doubled.

We heard about the loss felt when a mother dies, when we travelled to the village of Gillipa in the remote interior of the country. It used to have a health clinic, but it was destroyed in the war. Now they live five hours walk from the nearest road – and the chance of a lift to a hospital an hour away We sat down with the women of the village, while mother after mother told us with devastating composure – that their daughters had died giving birth.

Yemen Bomo is grieving for her daughter Patience.

“My eldest daughter Nowai gave birth to a baby girl. But the placenta didn’t come out …and she died. My second daughter Nemah died before her baby came”

“Patience, was five months pregnant with twins when she started getting terrible pains. We put her in a hammock and carried her as far as the next village – where someone gave her some glucose – but she miscarried on the way back. We carried her to the hospital the next day, but she died there.”

Dinga Belai had watched both her daughters die in childbirth.

“My eldest daughter Nowai gave birth to a baby girl. But the placenta didn’t come out …and she died. My second daughter Nemah died before her baby came. She was suffering great pain, so we carried her towards the road…but she died before we got there.”

In Ganta hospital two hours away, Rebecca Saye is having the life saving surgery the women in Gillipa don’t get. An isolated project run with $1 million from US AID has paid for an ambulance which can get out to women in some targeted villages. Rebecca has been brought to Ganta for an emergency caesarean. This is a rare event in Liberia. Having a qualified anaesthetist is even rarer. But Rebecca’s anaesthetist, Wanleye Wilyam, was trained by Wilmot Fassah, and the surgeons are able to safely deliver her baby – a boy, weighing 10 pounds.

The anaesthetist was only one part of Rebecca and her baby’s survival…and the shortage of them in Liberia is only one of the problems making giving birth here so dangerous.

But 22 ageing anaesthetists is not enough – if Liberia is going to rebuild its health service from the wreckage of war.