Building access to care in Liberia

By Dr. Mark Farha

I recently had the privilege of joining the IVUmed team on a trip to Tappita, Liberia. We

were received at the airport by the hospital chief of staff and transported to our

accommodation where a small reception was being held. The premier hospitality of the

Liberian people was on full display as we were made to feel very welcome. We heard from

various health ministers during the reception who reinforced the importance of the trip to

the people we are serving and the country as a whole.

The journey to Tappita was about 6-7 hours with a stop in Ganta, the largest town in Nimba

county for lunch. As we were completing the last leg of our journey, the pickup truck that

was part of our caravan sustained a flat tire. Again we were able to see the selfless

collaborative nature of the Liberian people on display as people flooded from the local

village to help us with the tire jack and tire change. They even offered us bananas as we

were waiting for the tire to be changed, which were sweet and delicious. We were quickly

back on our way and arrived at the Jackson Doe Memorial Hospital at dusk.

We made rounds on the ~30 patients who were preadmitted for the campaign to identify

the most suitable candidates for surgery as we would not be able to get to everyone in the

short time we were there. The lack of resources in this setting taught me valuable lessons. I

understood the privileged environment we are coming from in the US more deeply and I

saw that it is still possible to provide compassion and care despite not having every little

tool or test. After rounding on the patients, we had a priority list and went to get some rest

in preparation for the first day.

Each surgical day in Tappita proceeded in a very similar fashion. We would generally wake

up around 6:30 and make our way to the conference room for breakfast. We were

incredibly lucky to be well fed during the whole trip, as the director of nursing took on

juggling her nursing role with ensuring that we were fed three meals a day, a truly

Herculean effort. During breakfast, we would touch base with the general surgery residents

who were helping take care of the patients to ensure there were no major issues with their

post operative course. After a quick breakfast we would make our way to the operating

theater, where we would have two rooms to do our cases. As Dr Smith outlined to our team

at the onset of our trip, our primary responsibilities were 1. To take care of the patients to

the best of our abilities 2. To train the Liberian urologists and ensure they were comfortable

performing the surgeries. We were joined by the three practicing urologists in all of Liberia,

Drs. Kottima, Cassell, Kone, who are responsible for providing urologic care to the >4

million people in the country.

For each of the cases, myself or my American counterpart Delaney would join Dr Smith

(prostatectomies) or Dr Johnson (strictures) in their rooms with one of the Liberian

urologists. For both the American trainees and the Liberian doctors, the surgical experience

was incredibly robust and educational. Open retropubic prostatectomies and complex

stricture management are cases that I had not been previously exposed to during my

residency training, and I appreciated the opportunity to see several complex cases in such

a short window of time. The multiple repetitions enabled me to learn steps of the cases

quite well and be able to work together with the Liberian doctors on certain steps like

urethral exposure and mobilization or fascial closure. Although the cases were difficult, the

teams worked very hard to ensure things went as smoothly as possible. I was quite

impressed by the quality of the scrub nurses and the anesthesiologist who gracefully dealt

with a volume and complexity of cases they rarely see.

By the end of the week, we performed 21 cases encompassing both urethroplasties and

simple prostatectomies. All the patients were doing well post-op up until the day we left

and some were even starting to go home. Most importantly, as the hospital leadership said

in our closing meeting, we instilled confidence in the local doctors to be able to take care

of the patients in our absence and restored the hope and dignity of the patients we served.

As my first global surgery experience, this was a truly life changing opportunity that will

shape the remainder of my career. I left with a renewed passion for urology and am

incredibly grateful to have had this transformative experience.