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Medical References for the Doctor on the Go
and the Home of the Series


Doctors without Borders
in Liberia


Doctors without Borders
in Harper, Liberia

Medecins Sans Frontieres (MSF, Doctors without Borders) has been working in Harper, Liberia since 1997 supporting J.J. Dossen Memorial Hospital, the only hospital in Southeastern Liberia.  The infrastructure in the country of Liberia has been destroyed by more than 10 years of civil war.  The trip from Harper to the capital on rough dirt roads takes 15 hours.  Towns which previously had electricity, running water, and sewerage systems, including the capital, now have nothing.  There is no investment, economic development or business.  Unemployment rates approach 80%.  People farm small plots of land to eke out an existence.  Doctors and other educated or well-off people left the country years ago for their own safety and for better economic opportunities.  It is estimated that there are fewer than 30 doctors remaining in the entire country to serve a population of more than 3 million people.  Most people have no access to health care whatsoever due to poverty and poor transportation.


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A fire hydrant's only use is in supporting a  clothesline since the war in 1994 destroyed the  community's water system.

J.J. Dossen Memorial Hospital is based in Maryland county.  The three counties have neither doctors nor hospitals.  Outside of JJ Dossen, there are a few health clinics staffed by nurses or physician assistants but they have few medications or supplies.  Those who are able try to come to our hospital which is one of only four functioning hospitals in Liberia.  J.J. Dossen has about ninety beds including wards for pediatrics, medicine, surgery, obstetrics, and tuberculosis.  There is an operating theater, a therapeutic feeding center for malnourished children and an active outpatient clinic.  The hospital has more than 100 Liberian staff including a surgeon, eight physician assistants, and nine nurses.  The hospital is managed in cooperation between the Liberian Ministry of Health and MSF.


Malnourished patient in feeding center gets NG feeds until their appetite returns.

Our current MSF expatriate team consists of four expatriates including myself.  Julia, a German doctor, is in charge of the tuberculosis program and supervises the medical ward and the lab.  Marianne, a French nurse, runs the therapeutic feeding center (TFC) where we treat anywhere between ten and forty kids at a time for severe malnutrition.  Mika is our Bulgarian/French logistician.  He keeps everything running making it possible for us medical folks to do our work.  He keeps our generator working so we can have electricity for 6 hours per night and ensures the water pump and chlorination are being done properly so we have safe drinking water.  He also keeps the cars running and pays our local staff, among his numerous other responsibilities.  I am the field coordinator and lead doctor.  My responsibilities include the supervision of the surgical, obstetrics, and pediatrics wards, the operating theater, and the outpatient department.  I am also responsible for maintaining our security/evacuation plans and for keeping ties with the local authorities and security personnel.


Most people get their water from uncapped wells or open water sources.

I started my six month mission working in Harper in August 2002.  I am posting this info on the website during a brief break back in the U.S. during the month of March.  In April, I'll be going back to Harper for another six months.  To say the work has been rewarding is a gross understatement.  In the past six months, in addition to the things which have now become routine such as cerebral malaria, elephantiasis, and kwashiorkor, I've seen something new almost every day.  I've treated patients with rabies, tetanus, meningococcal meningitis, Burkitt's lymphoma, measles, Ludwig's angina, and gunshot wounds.  In my first week in Harper, I took care of a 10 year old boy who was hit on the head with a coconut, became comatose, and died from his injuries the following day.  Infections and abscesses spread aggressively during weeks without treatment as patients who can't easily access the hospital choose to use traditional medicines instead.  I've drained more than a couple of abscesses that each contained enough pus to fill a two-liter Coke bottle.  The medicine is fascinating!


A recovering child with malaria on the pediatric ward.  The white paint is a traditional remedy.

When the hospital's Liberian surgeon left town for six weeks without arranging for coverage, I found myself as the only option for the patients who needed emergency surgery.  I was doing surgeries I hadn't done since residency and some I'd never even seen before.  There were no options for transferring the patients.  We were the referral hospital.  I operated on patients with ectopic pregnancies, obstructed labor, appendicitis, torsed ovarian cysts, and gunshot wounds.  Most of the time I was scared to death and drenched with sweat hoping I didn't run into a situation that my modest surgical skills couldn't get me out of.  

Did I do a good job?  I don't know.  I did the best I could and the patients all survived so I guess most would say that I did do a good job.  Could a traumatologist, OB/Gyn, or general surgeon have done better?  I sure hope so!  But the thing is, none of them were around.  

It is a pleasure to work in a place where doing your best is always good enough.  Everyday I was forced to stretch my knowledge and my skills to do my best for these patients who have no other source of medical care.


Closing after a
Cesarean section

The medical challenges might have been enough to keep me working there longer but it isn't the main reason I chose to return for another six months starting in April.  

Please pardon me if I'm sounding melodramatic but I've only been back in the country for a week now and haven't fully returned to myself.


Mobile clinic for Liberian returnees and Ivorian refugees.  Saw 39 patients in two hours.

Let me start by saying that I am an American.  I believe that anyone can succeed through hard work and diligence.  I believe that people who are less well off should be able to pull themselves up by their own bootstraps.  So why am I volunteering my time to help provide health care for people in Liberia?  The situation is very simple.  Liberia is filled with people just like you and me.  They are good people.  They love their families.  They are trying to work hard to get ahead in the world, to build a better life for themselves and their children.  They laugh, eat, sleep, play, and love just like we do.  They are not lazy.


The problem is that they are in a very hostile environment.  The schools have been destroyed.  Education is expensive and often of low quality.  Job opportunities are few.  Most people earn less than $1 per day.  There are no banks for saving money or borrowing money.  The police and the army are more feared than valued.  Roads are poor and civilians must pay bribes to pass through the many military checkpoints blocking their way. Unsafe drinking water is the only option for most.  Malaria kills the children and diseases like filariasis (causing elephantiasis) and onchocerciasis (causing river blindness) disable the adults.  Falling back on the bootstrap analogy, it is impossible to pull yourself up by your own bootstraps unless you are standing on solid ground.  The Liberians are standing on quicksand.  Insecurity, disease, and limited education and economic opportunities stand as roadblocks on their road to prosperity and success.  I see the work that MSF is doing, providing health care, as one way to help eliminate some of those roadblocks that are preventing the Liberians from pulling themselves out of their current situation.


"Now that I'm eating well and gaining weight will you stop putting that thing in my butt every eight hours?"

I am proud of what I have accomplished so far professionally.  Through hard work I've done well in school, gotten into and completed medical school, practiced medicine in a variety of settings, and I've even set up this cool little website.  But after working in a place like Liberia I find myself asking how much would I have been able to have done if I'd faced all the obstacles that the Liberians face everyday.  If fate had led me to be born in Liberia instead of in California, would I have been able to have done the same things, achieved the same things?  The answer is no.

I see my work with Doctors without Borders in Liberia as being a way to help people who have very little get just the smallest solid foundation so that they have something to push off of as they try to get ahead amidst difficult circumstances, as they try to rebuild their country.  Like most of us in the United States (maybe more than most), I was blessed with the basics that made it possible for me to work towards achieving my potential.  I want the people of Liberia, many of whom I now consider to be my friends, to be able to achieve their potentials as well.


So why go into all of this here?  What does any of this have to do with MeisterMed?  Ummh . . not much really.  Most people when they hear about my work say things like "How heroic your work is!" or "Can I give some money to support MSF's work?"  Well, everyone likes a little positive affirmation and MSF couldn't do such good work if it wasn't well funded but neither of these things get to the root of why I like talking about this work.  I speak passionately about my work because I want to motivate others to do similar things.  There is plenty of need to go around.  But in addition to helping others, I have been enriched in so many ways by my work with MSF.  It's made me a better doctor.  It's given me insight into the challenges faced by the people in the "two-thirds" world.  It's given me the opportunity to live within and get to know a very different and exciting culture.  The rewards are many.  MSF has volunteer positions for doctors, nurses, lab technicians, and a few non-medical positions.  There are hundreds of other organizations that also do humanitarian work in the developing world.  Take a break from the rat race and give one of them a call.  Like me, you may find it to be one of the best things you've ever done.

Andrew Schechtman, M.D.

Comments?  Questions?
Visit the MSF website or send me your comments

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