ELCA Liberia Support Network

PHEBE HOSPITAL & SCHOOL OF NURSING
Suakoko, Bong County, Liberia, West Africa
Post Office Box 10-1046 1000 Monrovia 10, Liberia
E-Mail Phebe@phebehospital.uuplus.com

2003 ANNUAL REPORT

Memo to the Board of Trustees

To the President and Members of the Board of Trustees

To the Supporting Agencies

The Lutheran Church in Liberia
The Episcopal Church in Liberia
The United Methodist Church in Liberia
Government of Liberia (GOL)

To Phebe's many supporters in Liberia and overseas

From:
Emmanuel M. Sandoe, MD, DOphth, (WACS)
Medical Director/County Health Officer

Subject: SUBMISSION OF 2003 ANNUAL REPORT

After a rather unstable period of civil crisis in Liberia, the Phebe Hospital employees and the Bong County Health workers join me in extending our sincere thanks to each of you for the opportunity given us again to serve the health care needs of our people during the year 2003. We also thank all of you for your prayers and support. We are please to report on our activities during the year.

Reporting Format
Our operation in 2003 is divided into two aspects. Part of this report will be on our services on base, which was from January to March 16 2003, and the second half is on our work at the field hospital in Salala. Each Department/Unit head has submitted a report on the activities in his/her department to the Medical Director. These reports have been summarized to make them easier and shorter for the convenience of the readers. Departments that were not fully functional due to the civil crisis were more or less just mentioned in this report. The Medical Director reported for departments that were run without a department head. One of such department is Medical Staff.

The three primary operation areas of the hospital (patient care, community health and training) are adequately covered in this report.

Patient Care
Curative service: In the absence of Chief of Medical Staff, the Medical Director or his appointee oversees the curative services of the hospital. The section on Medical Services and reports of other departments providing patient care, adequately describe the activities in 2003.

Phebe Nursing Training Programs
The Training Program received continuous support from DEM Project, which ended December 2003. We have received assurance from DEM for further support in 2005 including rehabilitation of the buildings, but Phebe needs to sponsor the remaining 16 RN Students who have 3 more semesters to graduate. From the report of the Training Director, many young people have been trained and are now working in many parts of Liberia. Many more young people (78 persons) have applied to be trained in various areas. Our appeal is that other donors could come in to augment the effort of DEM so that many people will be admitted into the Training program. The Directorís report covers the schoolís activities in 2003.

Community Health Department (CHD)
The CHD is responsible for carrying out the preventive services of Phebe Hospital. It also supervises the work of the county clinics/health centers. Despite the war they have continued to train traditional Birth Attendants in the county.

The aging of their only vehicle which is heavily subsidize for repair work have hampered or reduce their activities substantially. There is a need to replace this vehicle. The report from this department includes both preventive and curative care.

ADMINISTRATIVE ISSUES

Financial:
The Audited Financial Statement is a part of the report. Like the previous years, the major sources of income for the hospital were external grants & donations. The EU & ELCA were the major donors. ELCA and its associated agencies continue to provide personnel (long/short term) and containers of medical equipment & supplies to Phebe Hospital. The personnel cost and the values of the medical equipments & supplies will show a much higher expenditure than is shown in the financial statements. Many thanks to GHM, the Upper Susquehanna Synod and the people of First Lutheran in Cedar Rapids for sending us these containers.

The Servants of Christ Lutheran Church, a congregation of the ELCA, has continue to assist Phebe Hospital with an annual grant of US$50,000 to pay incentive to the Liberian members of the medical staff, supporting the hands that heal. We thank the pastor and the members of Servant of Christ for this assistance and most of all, their prayers.

Christoffel BlindenMission (CBM) made cash, Material and food donations to Phebe Hospital during the critical time of war in 2003. They donated cash to buy local food for patients and employees; also other malnourished food and milk were air-lifted to Liberia by CBM for the hungry people of Liberia. These food items were distributed among IDPs, Patients and Employees of Central Liberia. This was in addition to their support to the eye unit of the hospital. They are also assisting with salary top-up for the Ophthalmologist. We want to thank CBMI for their meaningful assistance to Phebe Hospital and the people of Liberia. We always welcome their prayers and support.

Personnel
The year 2003 started with the preparation of change in staffing via a turning over program. Dr. Walter T. Gwenigale who served the institution for over 30 years, offered to step down from his position of Medical Director on February 1, 2003. He offered to stay on as head of Surgery, and he was requested to serve as adviser and consultant on health and administrative issues. The Phebe Hospital Board of Directors appointed me Medical Director/CEO of Phebe Hospital and County Health Officer for Bong County to succeed Dr. Gwenigale. I was mandated by the Board to work in a team with the Chief of Medical Staff, the Administrator and the Department Heads to revitalize the institution. A month after the turning over, we were forced to evacuate the hospital due to the rebel advancement. The Administrator, the Acting Chief of Medical Staff and the Chief of Surgery were evacuated to Monrovia and later left the country due to the escalation of the civil crisis.

The Director of the Training Programs was dismissed by the Phebe Administration in close consultation with the Board of Trustees for misappropriation of funds. He was replaced by his deputy as acting Director.

Phebe Hospital started the year 2003 with 173 staff members. Again, due to all the uncertainties and force evacuation, the year ended with 136 staff members.

Phebe is operated by both Liberians and Americans. There are certain positions that need to be filled by expatriates sent by the ELCA. These positions include, but are not limited to the following: Administrator, Engineer, Physician, Pharmacist and Chaplain are much needed at present. All of these positions are presently not occupied. We would want these positions filled earlier in order to speed up the rehabilitation process as these posts are key areas in the running of the hospital. We are very grateful to our American colleagues who struggle side by side with us in operating Phebe Hospital during these critical times.

Support Services
The hospital administrator usually reports on the activities of the support services. In the absence of the Administrator, a Chief Financial Officer and the Engineer, the Accountant who is carrying out some of the duties of the Administrator in consultation with the Medical Director has reported on these services in this report.

Situation Report
Phebe Hospital is located in Central Liberia, Bong County and is about 123 miles from Monrovia. She serves as the only referral county and a major Regional Hospital in Rural Liberia prior to the escalation of the war and now the only Regional Hospital in Rural Liberia.

The Phebe Hospital Provides basic Primary, Secondary and tertiary health care services to more than 500,000 to 600,000 population of Bong County, in addition to responding to the health needs of 30,000 to 40,000 IDPs who fled the war from Lofa and Nimba Counties.

In March 2003, just as it was in may 2002, following series of rebel attacks in Bong County, an estimated 30 - 40,000 IDPs originally from Lofa County voluntarily relocated to Totota and Salala in search of safety. Seeing the growing insecurity and based on its experience of the wanton destruction of lives and its properties in the past, the Phebe administration found it necessary to relocate its services to Salala and housed itself in one of the 28 clinics she supervises. The Administration was wise to have done so because their properties on base were subsequently looted and some heartlessly destroyed.

Though displaced like many of the users of its services, Phebe in exile is still providing 1st, 2nd and 3^rd degree health care services to an estimated 600,000 ñ 700,000 IDPs and host population.

We are thankful to the civil authority of Salala, who willingly accepted the employees of Phebe and provided housing for some of them. We are especially thankful to Ma Gorma-lon, Paramount Chief of Salala District and the commissioner of Salala.

The civil crisis left Phebe Compound lying in ruin due to the systematic looting that was carried out by the fighters. Every part of the hospital compound was affected, every movable item removed and others destroyed. Total rehabilitation is needed to get Phebe back to function.

Transition
Phebe was forced to bid farewell to one member of her staff, Ms. Caroline Fania, who died during the year. Our sympathies are extended to the family of our beloved employee. May her soul rest in perfect peace.

Constraints
The major constraint in this year was the forced evacuation of the hospital on March 16, 2003. This was followed by systematic looting and destruction of the entire hospital compound, which has put an additional load on our already scarce financial resources.

As the institution is still entirely dependant on outside support, the repeated looting and destruction of facilities has caused some level of reluctance in decision by donors to continue to give us financial support. Until peace comes to Liberia, which we are very hopeful, Phebeís problems will continue to exist. The individual department head will give constraints in their areas.

With the return of sanity to Liberia, many International and National NGOs have resumed operation in the Country. These organizations have much attractive salary scale thus causing some of our staff to leave us for greener pasture. This has caused reduction in our staff and exerted extra workload on the remaining staff.

We are very grateful to most of our donors who even with the repeated looting continue to stand by us.

Recommendations

With some semblance of peace and disarmament soon to take place, we recommend that the government of Liberia, the supporting churches, and the many supporters of Phebe in Liberia and overseas physically and financially take part in the rehabilitation of the hospital.
Ministry of Health of the Republic of Liberia to assign doctors and Health Workers to Phebe Hospital to help run the only regional referral hospital in Central Liberia.
The Government assist Phebe employees with special resettlement benefits as the only hospital who has never closed her doors during the 14 years of civil crisis in the country.

Conclusion
We thank God for providing the needs of Phebe Hospital during these critical days of 2003. I also thank the hospital employees and the Bong County Health Workers for their patience, faithfulness and their unwavering dedication to their work.

I pray for a stable and peaceful Liberia so that Phebe as “THE HANDS THAT HEAL” can once more take her rightful place in our Country, Liberia

= = e n d = =

BOARD OF TRUSTEES

Representing The Lutheran Church in Liberia
Hon. John K. Fania
Mr. G. Pewu Subah, President

Representing The United Methodist Church in Liberia
Rev. Anna S. Kpaan
Rev. Herbert Zigbuo

Representing The Episcopal Church in Liberia
Mr. Roosevelt Jayjay
Mrs. Elizabeth Sele-Mulbah, Secretary

Representing The Ministry of Health & Social Welfare
Dr. Nathaniel Bartee
Dr. Emmanuel M. Sandoe (Medical Director/CEO)
Mrs. Dede Jones

Representing the Evangelical Lutheran Church in America
Mr. William E. Martin

Representing The Bong County Community
Hon. K. G. S. Karpue

Dr. Henrique Tokpa, President, Cuttington University College
Hon. Charles Rennie
Hon. Amelia Ward
Representing The Catholic Diocese of Gbarnga
Sr. Ludwika Korona, F.M.M.

Representing The Phebe Employees
Mr. Saturday G. Quellie

Observers
Christian Health Association of Liberia
Mrs. Ellen George-Williams

Lutheran World Federation/World Service (LWF/WS-Liberia Programme)
Charles Pitchford, Resident Representative

Aministrative Staff
Emmanuel M. Sandoe, MD,DOphth (WACS), .....Medical Director/CEO & CHO
William E. Martin          Administrator
Walter T. Gwenigale, MD         Advisor & Chief Surgeon
Mary W. Tiah, CM, BSN, RN Nursing Director
Francis T. Kambo, PA Supervisor        Director, C.H.D.
Saturday Quellie, MT, acting   Director of Training Programs
Ms. Cecelia A. Morris, RN, BSN, MSN          Director Phebe/CUC Nursing Program
Wilmot M. Fassah, LPN, BSN, RNA   Chief Anesthetist
Saturday G. Quellie, MT (ASCP)         Director, Laboratory Services
Robert B. Wraynee      Pharmacy Supervisor
Harrison P. Sarblee      Accountant
Joe M. Curllie   Acting Maintenance Engineer
Pastor G. Victor Padmore        Acting Chaplain

REPORT ON MEDICAL SERVICE
Dr. E. Sandoe, Medical Director

Introduction
Another year has passed again. God has guided Phebe and her staff to provide care for people of Bong County, the IDPs from Lofa, and other people of Liberia through daily clinics and inpatient medical surgical, pediatrics and obstetrical care. We give thanks and praises to Him for the year 2003.

The services of Phebe were rendered in two phases due to the civil crisis. On base in Phebe compound which ran from January to March 2003 and in the field hospital in Salala, which is from April to December 2003. On Phebe Compound as well as in the field hospital, Phebe team continue to provide care for Pediatric Patients, women with normal deliveries incomplete abortion, Obstructed Labor, ruptured ectopic pregnancy, Patients with gunshot wounds, Road traffic accident, major and minor surgeries and the usual pattern of diseases seen in Bong County.

Patient Care

OUTPATIENT/EMERGENCY CARE DEPARTMENT
In 2003, a total of 16,624 patients were seen in Phebe Hospital. This represented an average 1,385 visits monthly. The OPD & ER were jointly seen together in the field hospital. The most frequent single diagnosis in 2003 was a replica of 2002. The number of patients seen at the OPD/ER were tabulated as follows:

PATIENTS	# of patients	Percentage
Adult	10,454	63%
Children	6,170	37%
Male	7,931	48%
Female	8,693	52%
TOTAL	16,624	100%

INPATIENT DEPARTMENT
In 2003, a total of 3,002 patients were admitted in Phebe Hospital. This represented an average 250 admissions monthly. The number of patients admitted was tabulated as follows:

PATIENTS	# of patients	Percentage
Adult	1618	54%
Children	1384	46%
Male	1241	41%
Female	1761	59%
TOTAL	3,002	100%

Usually, the most cases treated at Phebe Hospital and Bong County as a whole show that Malaria, Anemia, Respiratory Infection and Diarrhea ranking from highest. But for this rather difficult reporting period, our attention is focused on the following specific cases, which was mostly tracked at the field hospital at Salala. The below table reflects our findings for these cases:

DIAGNOSIS	MORBIDITY
Watery Diarrhea	435
Road Traffic Accident (RTA)	253
Gun Shot Wound (GSW)	118
Bloody Diarrhea	28

OBSTETRICS
The Phebe midwifery staff delivered 586 babies in the past year. The number of normal deliveries in the hospital were 296 while the number of C-Section were 290. The amount of 498 babies was alive while 88 were dead on delivery. Substantial amount of the infant mortality in this category came from premature babies and late arrival of patients at the referral center (intra Uterine Fetal Death, IUFD).

SURGERY
The total number of surgical patients was 859. Most of these patients were adult female. Below is a chart showing the data. Also, an average of 72 surgical cases were performed each month. The total surgeries were 863. Most of the surgical interventions were emergencies due to the escalation of the Civil Crisis and the fact that we were in the field hospital. The most frequent reasons for surgery at Phebe during the period were as below:

PATIENTS	# of patients	Percentage
Adult	809	94%
Children	50	6%
Male	256	30%
Female	604	70%
TOTAL	859	100%

Procedure	2003	Percentage
C-Section	290	33.6%
BTL	26	3.0%
Salpingectomy/Ectopic Preg	70	8.1%
Herniorraphy	102	11.8%
Exploratory Lap.	77	8.9%
Evacuation of Uterus	104	12.1%
Others	197	22.5%
TOTAL	864	100%

Special Study/Programs
Dr. Jefferson K. Sibley was able to take part in the Roll-Back Malaria workshop in Addis Ababa, Ethiopia. Dr. Sandoe took part in the Prevention of Blindness Conference in Accra, sponsored by West African College of Surgeon.

Visiting Staff
Dr. Challoner visited Liberia during the heat of the war to assist Phebe and other organizations. Due to insecurity at that time, she had to cut her visit short and return but not without making some donations of drugs and medical supplies to Phebe, ELWA and JFK hospitals.

Constraints
The major constraint during this reporting period was the instability that led to our evacuation from the Phebe Compound. Changing our environment had a great negative impact on the staff and patients we serve. The next is the unavailability of drugs and medical supply, which is a direct result of the war.

Thanksgiving
Thanks to all Phebe supporters in the year 2003. We welcome your support and prayers. Finally, to God be all glory for the great things he has done.