How to transport goats?

On a pen-pen, naturally! Duh!!

Over the weekend I traveled to Buchanan - capital of Grand Bassa County - to assess the state of the county health services and system. It is only a 2.5 hour drive from Monrovia, so I left on a Sunday afternoon (after a great buffet lunch at the Royal Hotel...something to talk about another time) around 3PM to arrive in time. On our way we discover that a road construction company is blasting a hill to make way for the road. We stopped and waited for the blasting to be finished so we can keep driving without being hit by flying rocks. While waiting for the blasting to be finished, I got out of the vehicle to walk around (there was a river nearby). Many people were waiting with us and I noticed a lot of motorbikes and some cars behind us.

While walking towards the river I hear sounds. I immediately recognize it is a goat, and I was excited to see one out in the wild. I was disappointed to see that the goats were actually being transported on a pen-pen (Liberian word for motorbike).

Goat mobile

As cruel as it looks in the pics, I have to tip my hat to whoever came up with that contraption to hold the goats. It fits perfectly on the back of a pen-pen and it had THREE goats in that small contraption. Notice the guy grinning wide while I am taking pictures. He seems to be proud of this invention.

Three goats on the back of a pen-pen

While some guys are innovative in transporting animals, others are just plain lazy. The following picture shows a goat with its legs tied and transported on the back of a pen-pen by two guys. It seems to be happy sitting in the back seat in between two people.

Lazy goat mobile

After a short drive we arrive in Buchanan only to realize that the situation in town is tense. Allow me to explain. There was a maternal death in the county hospital few days before our visit. The woman's family claims it is due to medical error, the county hospital claims the woman died because her family did not bring her to the hospital in time. My understanding - with the limited information I received on site - is that it was a case of obstructed labor due to breech presentation that was not attended promptly. Regardless of who is at fault, the woman and fetus did not survive. The family is now up in arms against the hospital and issued a threat to kill all doctors and health workers at the county hospital. And here I am, a physician, arriving at the county hospital in a vehicle that a has a huge logo of our project. Its like saying "look at me, look at me, I am a doctor". The County Health Officer and most of the health workers fled town fearing for their life. Needless to say I got back in the vehicle and requested my driver to take me back to Monrovia immediately. We have a policy of not driving after dark, but I didn't feel safe staying in that town for an extra minute considering the tense situation. We got back to Monrovia safely around 9PM.

So, that's my dramatic trip to Buchanan. Even though I didn't get to do my work, I am happy to have witnessed the "goat mobile".

Service delivery in the bush

Two weeks ago I visited some of our health facilities in the Grand Cape Mount county to observe service delivery and organizational structure. Our project supports many health facilities across the country, I am trying to visit as many as I can. As part of this mission, I visited one health center and two clinics - Sinje health center,  Bo-Waterside Clinic, and Tieni Clinic. Terminology is important because a health center is different from a clinic - type of services, number of staff, catchment population, and other factors play a role in deciding if a particular facility is a health center vs. clinic.

Sinje is a health center. They have a maternal and child health ward, provide family planning and reproductive health services, and even have an in-patient section. Fairly well run. I found a few issues here and there, but what health facility does not have issues, especially in the developing world? Even though I am not their supervisor, I found some areas in health records maintenance that I advised. I noticed that the newly appointed child survival officer was not adequately trained on recording patient data, therefore I took it upon myself to show her what individual columns mean in the ledger and how to record patient data. She was more than happy to listen because she has been looking for someone to show her how to record some of the data. If you look at the size of the book (see pic below), you will realize why training is needed to fill in the data. Our County Coordinator was quick to capture Dr. V in action, resulting in this picture.

Me explaining data collection to the child survival officer. Look at the size of that book!

After visiting the children's ward and talking to various staff, I wanted to visit the maternal health section. Reproductive and family planning services are top priority when it comes to improving Liberian health system. As such, it is very important for us to understand and improve service delivery in these areas. I was greeted by the Certified Midwife, who just finished delivering twins. I had the privilege to visit the children and delivery room. Neatly maintained. I even spoke to a few pregnant women who were waiting for their antenatal care checkup. I inquired patients about their satisfaction with services and the type of services they are receiving. While services are delivered as planned, there is still a lot of room for improvement. That is why I am here, to strengthen service delivery as a part of strengthening the system.

Avoid sex?

One of the posters I noticed on the wall in the maternal section caught my eye. It is a message aimed towards youth. Teenage pregnancy is a big problem in Liberia and there are different campaigns - from USAID, EU, WHO, etc - aimed towards family planning of both youth and adults. This particular poster is not from our project. What particularly caught my attention on the poster is "avoid sex". Technically speaking, the poster is absolutely correct. Abstinence is part of comprehensive family planning. I appreciate the "protect yourself at all times" message.

Following Sinje, I visited Bo-Waterside clinic. Also known as Bo-H2O (waterside = H2O, get it?), the town borders Sierra Leone. We ate lunch at a restaurant situated right at the border. In fact, we waved at the border patrol while eating lunch. Bo-H2O delivers a limited range of services compared to Sinje health center. We talked for an hour with the Officer in charge (OIC), who is a young guy working there for about 6 months. I discovered a lot of issues with the way the system is currently set up and I plan to address them during our interventions. Tieni clinic was the same as Bo-H2O, with limited service delivery and an even smaller facility. 

Pink delivery table

Besides these facilities, I also visited the Gbanway clinic in Lofa County. One of the best clinics I've visited so far, very clean, neatly organized, and all staff were present and busy working on the day I went (I didn't inform them ahead of time of my visit). The major attraction at Gbanway clinic is the pink delivery table. It put a smile on my face. Child birth is a tedious process, a little color in the delivery room might add some pleasant visual. I am so tired of seeing the hospital green and grey delivery tables, pink is a welcome change. I think every clinic should get a pink delivery table.

I can write about each one of the clinics in great detail, but I do not want to bore my non-public health friends with additional details. I have more trips planned and I will post pictures of my visits. I am in the bush all week doing assessments, so I hope to come back with more stories and pictures.