A Walk with the Curran Hospital Mobile Team
The following are my experiences as I walked with the Curran Hospital Mobile Team on a trip to visit Wolmai and Balaqwaluz, villages deep in the Lofa county forest. The purpose of the trip was to vaccinate children under five years of age, and women of childbearing age, to provide prenatal care, health education, to treat the sick, to distribute clothes and quilts provided by Lutheran World Service, and to visit and evaluate the newly reestablished clinic in Balaqwaluz.

--- Edna Johnson, volunteer at Curran Hospital with the Evangelical Lutheran Church in America

December 6
Mid afternoon we are on our way to Wolmai in the little green truck. The group includes Moore, the driver, also part of the vaccination team, Joeka, the head of the team, Morris, tuberculosis and leprosy supervisor, Mary, midwife, Kollie, vaccinator, James, vaccinator, and Moses, vaccinator, plus all the material and our gear. Wolmai is about an hour drive over very bad roads. We spent the night in Wolmai so we could begin the clinics early in the morning. The entire team is concerned about crossing the “monkey bridge” over a large river. This bridge is about a 30 minute walk from Wolmai so the entire team walked down to the river and the bridge for an inspection. To approach the bridge you must climb up a steep ladder made out of logs. The bridge itself is made out of vines and about 30 feet above the water. We climbed up the ladder and decided that it was not dangerous. After supper, a meeting of the chiefs from the various towns was held to determine how many bales of clothes each village will get and to talk about the activities of the next day.

December 7
After much discussion in the morning, the bales of clothes were finally given out and we were able to start our clinics. Mary and I saw the pregnant women with the Trained Traditional Midwives (TTA) of the village. The rest of the team vaccinated the children and women of child bearing age. In the afternoon, the mobile team divided into two, one team walking to Balaqwaluz and the other to Boloma, Massawio and Walema. Mary, the village chief of Balaqwaluz and I started walking at about 3 pm. We met the advance carriers ahead of us at the “monkey bridge”. It was quite a feat carrying the large cool box for the vaccine up the steep ladder to the bridge. Two poles had been attached to the box with one man was at the front and one in the back. I have no idea how heavy the box was, but to carry it through the forest on the rough path must have been difficult. After the first hour we had climbed the highest hill. We continued walking through the shady but humid forest. In places it was very rough with rocks and tree roots and I had to keep my eyes on the path for fear of stumbling. We were hurrying to get as far as possible before dark, crossing at least six other streams (some you could jump across, others had log crossings). By 6:30 pm it was already very dark and Mary helped guide me over the rough places on the path. About 20 minutes before we reached the village, men appeared with flashlights making the way significantly easier. Then as we neared the village, we could hear singing. A large group of people had gathered around kerosene lanterns and were waiting for us. The entire walk had taken 4.5 hours.

December 8
Mary, Joeka, the chairman of the village health committee and I toured the village before the clinic started. I would estimate there were 30 or 40 houses either built or in the process of being built. We stopped to see the church, a building in the middle of the village. We visited the well, which before the war was in good condition with a pump. Now the handle of the pump is broken and the area around the well breeched to the point of contamination. The village water supply is a small stream about one eighth of a mile away. There are two latrines in the village -- mud and stick structure but quite adequate. The clinic is a large building. During the war it must have been the headquarters for some rebel group as there was graffiti on the walls. The roof was covered with old zinc with many holes. There was a large area which I think was the waiting room and a central hallway with at least six rooms on each side. One of the rooms was equipped with a wooden delivery table; another had rough shelves which they said would be their dispensary. At the far end of the building was a room the width of the building. A scale was the only piece of equipment in this area. The balance mechanism on the scale needed some repair but otherwise it is functional. The concrete floor seemed in good shape. There were no screens on the windows. There were doors for every room. Outside the front door of the clinic was a sign stated the building was started April 6, 1969 and completed August 7, 1969.

As with the Wolmai clinic we started to vaccinate children under the age of five, pregnant women and women of child bearing age. The vaccination registration procedure takes a very long time because new “Road to Health” cards had to be made out for each child. The mothers had to wait a long time with their children. Tarpaulins had been set up in front of the clinic to provide shelter; even so, the line was long and many were standing in the sun. Registration took place outside after which the mothers and children sat inside on low bamboo benches waiting to be vaccinated. Mary and I started to see the prenatal patients in the room with the wooden delivery table. With an afternoon break for a meal, we continued the clinic continued until 5 pm. We ran out of DPT and measles vaccine. It was hoped that Team B, which had gone to other villages would returning the next day with more vaccine.

After supper we were sitting in our rooms when outside the door we could hear singing and gourd playing. Joeka came and said we must go out to dance with the people. The singing and dancing was because they were glad to have us as guests in their village. The whole village seemed to be there, with people sitting or standing in a wide circle. Various individuals would get up to dance. Mary led me out to dance, saying “Follow my feet,” which of course I could not do. As the expert dancers danced they were given money for their effort. I do not know how long this went on but for quite some time until we went in and the singer and dancers made there way back to their homes.

December 8
On the second day there was a morning meeting to welcome us and to make requests for help. Mothers and babies from other villages were beginning to come for vaccination. Everyone had gathered under the tarpaulin. The village administration, the church staff, the town chiefs from Wolomeh and Lehama and the clinic committee and staff were present. The program was opened with a prayer and a reading from II Corinthians 1:3-7, comfort in time of sorrow. The village staff, the church staff and town chiefs from Wolomeh and Lehama were introduced. There were welcome remarks and the traditional presentation of Kola nuts, $150 Liberian dollars (LD) and a white hen. Henry Sumo, nursing assistant gave a history of the clinic. In the late sixties the people of the Bluyema clan gathered together to discuss the need for a clinic. A site was selected in Balaqwalzu. The people donated the materials and the labor for the construction of the clinic. Construction was started April 6, 1969 and completed five months later. Over the years assistance for the clinic had come from the government. Curran Lutheran Hospital Community Health Department was responsible for the supervision of the health service. Before the war the clinic was a source of primary health care for thirteen remote villages deep within the forest. During the war the clinic was damaged and services discontinued. In May 2004 the Monrovia Balaqwalzu Association sent the chief and elders a letter stating they would purchase medicine for the clinic if a clinic committee could be formed and staff hired. The town chief and elders agreed, the committee was formed and two health workers and four trained birth attendants were hired. The clinic has been renovated as best it could be.

After the brief history the clinic staff was introduced and three problems were identified by the chairman. First, a poorly located, inadequate clinic building. Second, lack of medical equipment and essential drugs. Third, the clinic is understaffed. The request was followed by the Sassa group singing several Lorma songs. Next was a brief history of the Lutheran church and school. Samuel Lutheran Church began in 1962. Over the years it has produced many evangelists. When missionary pastors visited the church they were flown in by air taxi. The building suffered damage during the war, so they are requesting a new building and school. They asked that their requests be extended to all Lutheran Churches in the United States. Joeka and I made a few remarks and gave words of thanks. The church choir sang and the meeting was concluded with a thank you from the chief. It was now after 12 noon. Mothers and children from other villages were waiting to be seen. The mothers were told to get their children something to eat and return later for the vaccines. Team B was expected later in the day with more vaccines. The mothers and children registered and we start seeing sick people. Team B arrived but they also have used up all their DPT and measles vaccine. Children were vaccinated for polio only and given Vitamin A.

December 9
We finished vaccinating the few children that had not been vaccinated the day before and also treated other people. Morris saw a seven year old girl with leprosy lesions. He treated her with a one month supply of medication and instructed the parents to bring her back in one month for evaluation and more treatment. Joeka, Harry Sumo, and I discussed the operations of the clinic. We learned the Monrovia group sent guidelines for the operation of the clinic, which started services June 1. Clinic charges were to be a one time registration fee of $5 LD per child and $10 LD per adult. There was a charge of $5 LD to $10 LD for oral medications and $15 LD per child and $25 LD per adult for injections. Each prenatal registration was $50 LD. The TBA received $200 LD per delivery. The clinic manager is paid $350 LD per month. The Monrovia group had wanted the clinic only to serve the village, but the committee decided it should be for all the 13 towns as it was before. Fees for service are sent to the group in Monrovia. Joeka encouraged the clinic staff to keep morbidity data. The clinic staff requested the following: copy books, stethoscope, and blood pressure cuff. The plan is to revisit the clinic in one month. While we were discussing the clinic, the clothes we had brought with were distributed. At about 5pm a soccer game between Curran Staff and the Balaqwalzu group had been scheduled so we all walked down to the field. Before the game we were taken to the area where the airstrip had been and the school, both very overgrown. You would never know there was an airstrip there if you had not been told. The leader of the youth group requested a soccer ball because the two balls they were playing with were in very sad shape. About 20 minutes into the game one of the prenatal women we had seen early came walking back with her husband. A few minutes later Harry came to get Mary, the woman was in labor. We found the woman on the hard, uncomfortable table which had been covered with a plastic sheet. Mary examined her and determined the woman was in early labor. All four TTA’s were in attendance. The woman was told to get up and walk around. She went to one of the TTA’s houses for her labor. Joeka used this opportunity to discuss the need for beds in the clinic. He called all the elders, the chief and the health committee together for a meeting. He asked them to make beds for the clinic for the maternity cases. He was very persuasive. Later that evening the women gave birth to a little boy; delivered by one of the TTAs supervised by Mary. After the delivery one of the older TTAs held the baby while the others attended the women. During the delivery there were nine women in the room including me. When the baby was put to breast and began to suck you could here an audible sigh of relief from everyone.

December 10
Early the next morning we said our goodbyes and started the walk to Wolmai. The following is a brief summary of the five days clinic activities: 84 patients treated, 43 prenatal women examined, 692 people treated for river blindness, 131 children under the age of five vaccinated, 239 women of childbearing age vaccinated against tetanus and distribution of clothes donated by Lutheran World Service. It was my privilege to walk with my Liberian brothers and sister for these six days.