Gayah Kezele, Medical Teams International's Liberia Country Director, Dan Ward and I traveled to the Liberian district of Grand Cape Mount, a primarily Muslim region in western Liberia. We wanted to visit with staff and see a few of the clinics in which we work. On a nice road, the drive from Monrovia to the town of Senji in Grand Cape Mount took about one and a half hours. During the war, this was a ‘no-go’ area nine years ago. It is now safe and Medical Teams International is working throughout the district to support the majority of its clinics and health centers. Through a grant funded by the U.S. government, Medical Teams International is supporting 22 health facilities (20 clinics and 2 health centers). A clinic is the first point of contact when needing health care services to people in the community. A health center is the next step up which serves as a referral center for cases that can’t be treated at the clinic.

We first visited a clinic in the village of Karnga, with a population of 1,105 people. Once off the paved road, we drove over a rough, dirt road. We were on this road for about 30 minutes, surrounded by trees and shrubs on both sides until we came to a clearing. This clearing is Karnga. Being in Karnga was a bit surreal because we were completely isolated from the outside world. And yet in this remote setting, Medical Teams International is ensuring that health care services are available free of charge to the people of Karnga. We were greeted by the clinic Officer in Charge who gave us a tour of the small clinic. MTI supports the clinic and staff by supplementing with medicines; addressing issues contributing to poor health including HIV/AIDS; and providing training to improve service delivery. The Officer in Charge at the clinic said that if Medical Teams International was not involved in this project, the clinic would not be open. People in Karnga would have to travel long distances to the next major town to receive care. This clinic is not only saving livings, but is also improving the quality of life for the people living in Karnga.

We then traveled to Sinje to tour the health center that Medical Teams International is supporting. Sinje is the major town in this part of Grand Cape Mount, and the Sinje health center serves as the main referral facility for the surrounding villages. The Officer in Charge of the Sinje health center said, “the partnership with Medical Teams International is very important because Medical Teams International

provides medicines that supplements what the Liberian Ministry of Health provides. Their support makes it possible for us to provide free service to the population, as well as incentives to keep important staff working in the health center. We would not be able to continue our work at this level if it weren’t for Medical Teams International.” In our tour of the facility, we saw children with anemia and malaria from neighboring villages whose clinics are supported by Medical Teams International. The children were sent to the Sinje health center for a higher level of care. The work of our Liberia staff is making a significant difference in these communities. I was very impressed with the staff’s skill, commitment and passion for service.

One of our staff members, Kota, told me, “We established community committees in the villages where Christians and Muslims from the community meet together to address issues facing the community. The Christians are asked to pray to start the meetings. Then the Muslims are asked to close the meeting in prayer. Both groups see the advantages of working together as a unified group in order to address the health care issues facing their communities. Through the leadership of our Liberia office, there is a transformation taking place in the way the two religious groups view each other and show a dedicated willingness to work together. In a country like Liberia where national unity is the number one priority following many years of civil war, it’s good to know that Medical Teams International is contributing by building bridges in Grand Cape Mount. I should also say that with the hire and placement of Dan Ward in Africa, our new Africa Regional Director, we are building a unified Africa team that will provide greater support to our country directors, which will lead to greater effectiveness and opportunity.

You may ask what impressed me most on this trip? Without question, I’d have to say it is Medical Teams International’s African staff. We have amazing people on staff in Africa. They are committed to the mission of the agency and work tirelessly to fulfill that mission. They are risk-takers and innovators in very challenging environments. They understand what it means to ‘serve the least of these’ by treating people with respect and love. I learned much from our staff in Africa and I am humbled and privileged to work alongside such a high caliber of people. As the Africans say, God is good, all the time; all the time, God is good.

Dan Ward and I left Nairobi, Kenya and flew to Monrovia, Liberia in West Africa. It was a 6 ½ flight to Monrovia from Nairobi. It was good to be back in Liberia; my last visit to the country was in 2006. I knew there was progress and stability in the country following the civil war that ended in 2003, but it was good to see how much progress had been made. Keep in mind, there is still a long way to go, but infrastructure is improving making life a bit easier, and there is peace that allows for development to take place. My goal on this segment of the trip was to introduce the Liberian staff to Dan Ward, MTI’s new African Regional Director; visit the health projects that Medical Teams International is implementing in the western part of the country; and spend some time with our Liberia staff as most of them I have never met.  

I had the option of going to an expat church in Dadaab today but decided to travel with the medical team to another village called Kokar, a village of about 5,000 people. The trip to Kokar was only 1 ½ hours from Dadaab. As is our protocol, we traveled with a police escort. When we arrived in Kokar, Dan Ward and I helped set up and run the pharmacy. Things ran smoothly and we had tremendous support from the community. The community leadership loves having the Medical Teams International team visit because without us there would be absolutely no health care at all. It’s not an issue of accessing care that already exists; it’s an issue of making it available. After we finished the clinic for the day, the community insisted that we stay for a feast. The community leader said, “I’d rather starve and my family starve before letting us leave without feeding you.” After the team saw over 60 patients, with shoes off, we sat on a mat in the community room. The men brought us 2 big bowls of rice and a large plate of goat meat. We also had some tea with camel milk. Everything was very tasty… really. I was then given a cup of pure camel milk to drink. It seemed salty but other than that not too outrageous. We received many thanks from the community leadership and were told that we are welcome any time to Kokar. They will ensure that we remain safe. “You will have no problems here in Kokar.” Today, there were no problems, just the opportunity to make health care available. What a great way to worship the Lord on this Sunday morning – through word and deed, we showed His love. To God be the glory!

Today we visited Damajalee and Hamey, two villages on the Kenya side of the border with Somalia. Medical Teams International has been working in these villages for the past six months. Since the two villages are located less than 10 miles from the Somali border, it is necessary to travel with a police escort. The dirt roads were rough, and with the heat of the day, the dust flying in the air seemed more biting. We drove 2 1/2 hours at high speed over rough roads to get to Damajalee, a city of 17,000 people. I was told that we drove so quickly in order to reduce the risk of ambush. I appreciated the safety measures as we bounced around on our bench seat in the back of the Toyota Landcruiser.

In Damajalee we only stopped to visit the clinic and meet with the community health worker and the nurse. The clinic was open and we were given a tour of the small facility. We found the clinic dirty and felt that the staff could do more to keep it clean. Andrew Njenga, Medical Teams International Project Manager, has been speaking with the district health office about this problem, but it has been difficult to see any positive results. Andrew will continue to press the local authorities to ensure that the clinic remains clean. After our courtesy visit, we took off for the village of Hamey where our medical team will be working for the day – another 45 minutes of bouncing in the Landcruiser.

Upon arrival in Hamey, a town of 8,000 people, we stopped alongside a large tent. The team members began setting things up for clinic services while some of our staff went into town in order to let people know that we are open. People began showing up at the clinic. Initially, it seemed like any other clinic I’ve seen in Uganda or Liberia. But I knew this clinic day would be different when I saw an elderly man leading a donkey pulling a cart. On the cart was an elderly woman covered up in a blanket. Andrew examined the woman and determined that she had Stevens-Johnson Syndrome, a life-threatening reaction to medications. The reaction was causing bleeding around the eyes and mouth with severe pain. Andrew and our volunteer began running an IV right there on the cart. It wasn’t 10 minutes later, a woman came to the clinic carrying her 1-year-old baby boy. It was suspected that he had measles and pneumonia. One of our volunteers told me that the child won’t survive the next few hours unless we can get an IV into his arm with medications. Fortunately, another medical team member, Ashley, worked in an ER at home and became a specialist in inserting IVs into children. With Ashley’s special skill, the line went in and the child began to receive life-saving medication. We knew however that mother and child needed to be sent to the hospital in Dadaab, which was over three hours away, and that we would be the ones to take them.

Shortly after this, a second child was brought in with the same symptoms, and then a third child. All received the same quality care; all are improving. The critical baby and mom rode with us to the hospital in Dadaab. We helped with admitting the child and informed the nurse at the hospital of our diagnosis and treatment. We also left some food for the mom because most hospitals in Africa do not provide a meal service for patients or family. Andrew and the team visited mom and baby each day and brought food for the mom. The baby is improving and will survive. I was told that two of the children and the elderly woman in the cart would have died if we had not intervened.

Andrew also told me an amazing encounter he had while caring for the woman on the cart. He said that the woman’s sister came up to him and asked, “Who do you worship?” 
Andrew replied, “I worship God.” 
Woman: “Are you a Christian?”
Andrew: “Yes, I am a Christian.”
Woman: “You know, in the Muslim faith, we call each other ‘brother’ or ‘sister’ but they have not helped us like you Christians have helped my sister on this cart. This makes me wonder why am I a Muslim?”

Andrew and team are demonstrating the love of Christ to these Somali refugees and the refugees are taking notice. So today we saved three lives. It was hot and dusty. I bounced around in the back of the vehicle for over three hours; I’ve been wearing the same clothes for three days and feel very dirty. But we saved three lives today. Awesome!

After several good meetings with key staff members from our Uganda office, we are travelling today. We are flying from Kampala, Uganda to Nairobi, Kenya. From there we will drive out to some of the nearby regions affected by the drought to meet with staff and volunteers and check on the progress of our work there. 

After our meetings with the Office of the Prime Minister and the UNHCR, we then visited the water pump funded by a husband-wife team of donors. Their son-in-law also provided great assistance, since he is an experienced water engineer in Africa.

The bore hole was drilled by the UN and the grant from our donors provided the pump. The pump is working very well. The UN hired a pump manager who turns on the pump on alternating days. There is also a hand pump near the pumping station for people in the village nearby to get access to clean water. The pump sends water to three large holding tanks about three kilometers (1.8 miles) away. Each tank can hold up to 10,000 liters (2642 gallons) of water. By gravity, one of the holding tanks sends water to a holding tank at our clinic. The other two holding tanks send water to two villages on either side of the clinic. Each village, with a population of about 1000 people, has four spigots from which to draw fresh, clean water. The local UN representatives stated this is the best water pump they have ever seen. It is functioning very well. There is a water committee in the villages that oversee the pumps. The water committee cleans, protects and regulates the water levels to instruct the pump manager to turn on the pump. The UN provides the funding for any repairs.

After visiting the refugee camp and meeting with UN and government officials, we drove back to Kampala, a 3 hour drive.

I learned that the percentage of births taking place in our clinic is up 87%. Clinic-based births benefit from the assistance of a birthing attendant and improve the chances of a healthy baby. This is unlike births that occur at home, where the mother would have little or no assistance. 

We are being asked how we are doing this! After meeting the staff at our clinic, I am not surprised by this success. They demonstrate the love of Christ so consistently. Not only do they have the technical skills needed to provide good health care services, they also have the patient care skills needed to help the patient feel important and loved.

Medical Teams international's Uganda staff is definitely fulfilling the vision and mission of the agency extremely well. Bible studies are carried out by the staff with UN staff and refugees participating. Additionally, our staff has devotions every morning with singing, Bible readings and prayer.

When we arrived in Mbarara, we had dinner with one of our volunteer teams. We learned that the UNHCR appreciates the Medical Teams International volunteer teams. UNHCR provides additional capacity to the team and encouragement. They also serve as a draw to the population in our clinic because the refugees like being seen by an American health care provider. Along with our Uganda staff, our volunteers make a significant contribution to the success of the clinic.

Last September, the UNHCR asked Medical Teams International to take over the health care for the entire camp. This means that we will be responsible for five clinics throughout the camp, serving a population of up to 70,000 people. The day following our arrival in Mbarara, we traveled over very rough roads for about 2 hours to get to the camp. At the camp, we paid a courtesy visit to the Office of the Prime Minister. We learned that the Ugandan government is very happy and supports our volunteer teams in the camp. A Ugandan government representative told us, “When we were planning to shift health care services to one organization instead of three, we felt that Medical Teams International was the best. But not only had the Office of the Prime Minister felt this way, the refugees also requested our volunteer teams. We asked the refugees which agency they preferred and one by one, they all wanted Medical Teams International.”

Apparently the clinic we are currently operating is the best in the camp and the best that the UNHCR has ever seen. There is real teamwork at the clinic that isn’t seen by the other agencies. As a result, the other agencies were asked to leave and the UN made the offer to Medical Teams International to take over the health care in the entire camp. We are now waiting on the UNHCR to finalize the budget we submitted to make this transition. We also recognize that we must maintain our culture as a Christian organization and will require our new staff to provide the same quality of patient care as we currently offer.

Sunday, 15 January, we drove to Mbarara in SW Uganda to visit Medical Teams International's work in the Nakivale Refugee Camp. The camp is managed by the United Nations High Commissioner for Refugees (UNHCR). Medical Teams International has been working there since 2009 providing health care services for up to 25,000 people as one of the UN’s implementing partners in health. The camp is over 85 square kilometers in size; a huge area filled with refugees from Somalia, Rwanda, Tanzania, Democratic Republic of Congo, Djibouti, Kenya and even one refugee from France. 

The majority of the refugees come from the Democratic Republic of Congo (DRC) because of the rebel fighting that has existed for over 20 years. Recent elections in the DRC are causing more Congolese to cross the border into Uganda and end up in the Nakivale Refugee Camp. 

Medical Teams International has done a great job in providing health care services to our assigned refugee population.

We left Portland, Oregon on January 13, 2012 for Africa. I'm traveling with one of my staff. The trip has taken us through Amsterdam, Entebbe and Kampala. The 20-hour flight was exhausting. Our plan is to go to Uganda, Kenya, Somalia and Liberia. My objective is to visit some of our medical clinics and work camps to see the progress that is being made in helping the hurting and hungry in these regions.