A Day in the Life of an Epidemiologist in Liberia

This is a small depiction of my daily life in Liberia.  It takes into account my professional work and my everyday activities.

The sun rises and a rooster crows.  The sound of life outside my window wakes me before my alarm does.  The air is crisp from the running air conditioner which kick starts at 6am when the power returns to the house.  The room smells dank which comes from the mould that takes over every corner when the temperature is not hyper-managed.  The air conditioner beeps to alert me that it will begin a day of relentless conditioning – then my alarm goes off and my day starts. 

The light in the bathroom blinks on and off and I feel like I am brushing my teeth in a strobe lighted club.  The housekeeper rings the doorbell and I unlock the main door and the steel cage door to let her in.  Packing up my laptop and my notes, I head downstairs where my driver is waiting for me. 

The moment I walk out the door, the humidity slaps me in the face.

Below are some photos of where I live:

Notice the fine tinsel of razor wire that surrounds the two foot high concrete walls.  Everywhere is like this in Monrovia.

This video is the drive I take from my home to the office.  My fingers are in the field of view as I am trying to prevent anyone from seeing the camera.  As well, there is a short moment where I block out the view of the camera.  Video and photography are prohibited outside the US Embassy and so I hid the camera from view at that point.

I will post this video when I get to an internet connection that can upload reliably.

I get to work and I set up my laptop.  My day can vary enormously from crunching down on a hospital database to meeting high level ministers listening in on policy change to meeting hospital staff to discuss how their hospital is run.  When I get the time, I am sitting in front of an Excel spreadsheet creating a database which is intended to optimize the intake of hospital data and output various indicators specific to malaria.  Right now we are using a tallying system to count the number of times the outpatients, inpatients and emergency department see malaria cases.  The nurses tally their daily count of cases from a summarized ledger and bring this information to a data entry clerk.  Everything is done on paper as a computerized system is not feasible in a resource poor hospital that deals with the most impoverished people.  The paper system right now is clunky with patients shifting around, duplication of effort and  unnecessary documentation.  Two hospitals are being used as sentinel sites for malaria.  I attended the first hospital in Zwedru in my first week in Liberia but was a passive observer to the hospital operations.  Zwedru, located about 12 hours from Monrovia, is a government run hospital which offers free services to the public.  The second hospital, ELWA, is a privately run organization which charges for service and is located in the outskirts of the capital.  My job is to see how the hospital is running and try to improve the way data flows through the hospital and to the Ministry and MENTOR (the NGO I work for) so that we can see how malaria is changing month after month.  This is not such as easy task.

It would be great if I could simply install computer kiosks with open source medical records software and train the staff to keep high quality medical records but this option is not feasible.  Not only is there no money to start this up but the staff are not computer savvy enough to use a computer and the barrier to entry would be enormous.  Right now, there are no medical records stored in the hospital which means that each patient is seen as if it was their first time except for a yellow card which the doctor writes their conditions and treatment on.  Interestingly, the patient takes this home and brings it back each time they come to the hospital.  What makes this so interesting is that these patients in Liberia have better access to their medical history than Canadian do.  I can’t see my medical record nor does it move around with me as I move to different doctors.  More like France which has a centralized medical records system, Liberia and their yellow cards provides much more access for the patient to their medical history than in Canada – though using a low tech solution.

I have come up with some solutions by changing the hospital forms.  It will centralize their information and streamline their work.  My forms have tick boxes for common illness and integrate into their natural workflow.  It is all very low tech – good thing I use Occam’s razor to shave each morning.

At 1pm, the power ends.  The generators are turned off and there is no power at work.  Since there is no power grid, there is no reason to have power when everyone is at lunch and so, the lights go out.  My laptop, with about one millisecond of battery life, gets shut down and I head back home for lunch.  Home, as well, has no power and won’t until 6pm. 

I can’t eat a classic Liberian lunch.  Liberian food is really limited for me.  Each Liberian meal has at least three meats in it: chicken, cow meat (not called beef here) and fish.  It is because of the fish that I don’t eat the meal.  Fish has never really appealed to me and this fish is really fishy.  Also, the vegetables here are of poor quality and it is difficult to find the right variety to be satisfied. 

I head back to the office at 2pm.  The road is bumpy and full of potholes.  My glasses fog up as I exit the air conditioned car.  At this point, I could be either working on the hospital database, going to a National Malaria Control Board meeting or heading to the US Embassy to talk to people about how to properly run a hospital sentinel site.  Meeting on policy are not my favourite but I have learned a lot about how things are run here.  Healthcare in Liberia is very interesting.

My work ends pretty close after 5pm.  I head back home in a 4×4 truck with a driver.  The driver sits at my house which we, the other expats, call “the guesthouse”.  Sometimes I go out but most of the time I have spent inside either continuing to work or just watching TV. We get cable here but unfortunately, only CNN is stable enough to watch without it scrambling.  The few times I have gone out it has been with the Filipino community.  These are a fun group of people some of whom have been here for a while.  Other times, I head to a bbq, or go to someone’s house.  The curfew here is midnight on weekdays and 2am on weekends. After that, it isn’t safe to wander the streets and it puts both you and your driver at risk. 

So, that’s it.  The average day in the life of an epidemiologist in Liberia.  My time here is short as I head back to France on Dec 23rd.  There is a good possibility that I will return after the six week period that I am in France so at this point, I will start establishing myself more but, for now, I am just passing through…

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