The Liberia “Light Up a Life” project was formally launched this week when three WE CARE Solar members flew to Liberia to join Dr. Fatorma Bolay of the Liberian Institute of Biomedical Research (LIBR) and Dr. Musu Duworka, of the Liberian Ministry of Health. Our objective was to provide Solar Suitcase trainings and installations in selected clinics in two counties in Liberia, as part of an 18 month LIBR research project examining the impact of providing sustainable electricity in rural maternal health clinics. This initiative is funded by an UBS Optimus Foundation “innovation grant.”
To be honest, I knew little about Liberia, its unique history or its brutal civil war, before the World Health Organization suggested that we collaborate with the LIBR. I hadn’t realized that the American Colonization Society arranged for freed American slaves to relocate to this country beginning in 1820; nor that the Americo-Liberians settlers became an elite class that dominated the indigenous peoples, remaining in power until a vicious coup in 1980. I knew little about the vast destruction caused by the recent 14 year civil war. In addition to the hardships sustained and atrocities that occurred within Liberia during those years, the war destroyed much of the country’s physical infrastructure. It resulted in the exodus of scores of well educated professionals, unraveling the medical system and depleting the country of doctors and nurses.
I also hadn’t known of the natural beauty of this country, which sits on the coast of West Africa, with a landscape characterized by lush foliage, deep jungles, reddened earth, and a rich variety of wildlife. I had no idea how warm, open, trusting and hopeful Liberians were – especially remarkable in light of the pain and suffering sustained in recent years. And I knew all too little about the history and outstanding accomplishments of Liberia’s (and Africa’s only) female president – Ellen Johnson Sirleaf – a woman devoted to improving the health, wealth and literacy of the four million who live here.
I did know that the majority of Liberia’s four million inhabitants were poor; most live below the poverty line of $1 per day. I also knew that the maternal mortality ratio was high; recent reports suggested that the maternal death rate was climbing during the last decade. So I felt that anything we could do to support safe motherhood in this region was of value.
We had the privilege of visiting 25 health facilities; a considerable accomplishment once you realize that there are few paved roads outside of the major cities. We traveled over dirt roads requiring a four-wheel drive, and the confidence of drivers willing to cross ditches and bridges barely held together by logs, sometimes passing vehicles that had fallen off of the road, or had become lodged in muddy creeks along the way. The areas to which we traveled had no electricity (there is no grid outside of the capital of Monrovia), no land lines for phone, no running water, no centralized plumbing, and few stores.
With all of these challenges, I was surprised to see how well-thought out the rural medical system is in Liberia. The country is dotted with health clinics, well-organized in order to provide the frontline medical care for the surrounding communities. President Sirleaf has called for an end to home births as part of her “Roadmap to the Reduction of Maternal Mortality.” The traditional village midwives have received training on recognizing pregnancy danger signals and now work in concert with the formal health care system. The trained traditional midwives support women during their pregnancies, and allow patients to conduct their early labor at home. Once labor is active, they bring their patients to the clinics, are partner with clinic-based certified midwives, who can conduct clean deliveries and provide essential drugs and treatment for childbirth complications. The certified midwives, in turn, are backed up by referral hospitals that can conduct cesarean sections and blood transfusions. As evidence of Liberia’s commitment to safe motherhood, they provide ambulances in hospitals that retrieve mothers needing acute care for obstetric emergencies. What hasn’t been assured in these facilities is reliable lighting. In most of the facilities we encountered, the midwives rely on their own flashlights, or kerosene lanterns, or their infamous battery-operated “Chinese lanterns” (which were broken in several cases), or as a last resort – candles. Some of the facilities have generators, but unless their impoverished patients are willing to provide the fuel, these lay dormant.
We provided formal trainings in two counties during this trip, educating approximately forty health providers, technicians and county officials about solar energy and the use, maintenance and repair of our solar suitcases. We then fanned out across the countryside, visiting remote areas over bumpy roads. We were joined by a Liberian engineer named Thomas Kpoto, an early pioneer of solar electricity, who was eager to volunteer his services to help power up rural clinics. We were able to install solar suitcases in fourteen facilities, which included a detailed educational program for the medical staff at each facility. After introducing the principles of solar electricity and the parts of the solar suitcase, we engaged the staff with games that reinforced how to utilize the power provided by the suitcase, and how to trouble-shoot when problems occur. The games usually resulted in lots of laughter, as I tried to stump the staff by disconnecting lights and switches to test their new knowledge.
But the most wonderful part of the trip was showing the health providers the new lights. These specially designed lights included 9 or 18 LEDs embedded in a waterproof plastic brick that was impervious to water and could survive being dropped. The lights not only illuminated the clinic rooms, they excited the staff and boosted clinic pride and morale. The clinicians told me how much strain they had been under without overhead light. They showed me how they had struggled to prop flashlights between their neck and shoulder during deliveries, or held lights in their mouth. They told me of the difficulties of starting intravenous lines, or examining newborn babies in the shadows of the night. In many cases, I was told our magical suitcases were an answer to their dreams.