Liberia’s Maternal Health Crisis
Molly Raskin writes to Every Mother Counts about her recent trip to Liberia, and highlights not only the state of maternal health, but also an individual who is making a difference for his community.
Written by Molly Raskin
Having survived Liberia’s 14-year civil war, Dr. Mosoka Fallah carries with him countless stories beyond most of our worst nightmares. But there’s one story he’ll never forget, and it began when a young pregnant woman staggered into the clinic where he was volunteering as a surgical assistant for Doctors Without Borders during the worst of the war.
“She had been walking for three days,” Fallah says. “She was pregnant with twins, but she lost one of the babies along the way. We had to perform a Cesarean section to save the other baby…but it was too late.”
Dr. Fallah, who was born and raised in West Point, Liberia’s worst slum, still fights back tears recalling the moment he realized the woman was too infected for a successful surgery.
“Three whole days,” Fallah repeats. “This woman had to walk this long, and this far, to get care. It was horrible, but it’s not an isolated case. It was, and still is, typical.”
Liberia’s war ended in 2003, but the country’s health infrastructure remains in shambles. Despite an effort by the government, led by Africa’s first female President Ellen Johnson Sirleaf, to reduce maternal morality rates to meet the Millenial Health goals the United Nations set for the country, the majority of Liberian women still lack access to medical care. The country’s maternal mortality rate (MMR) is among the highest in the world — estimated at 990 per 100,000 live births — approximately four women die each day from pregnancy-related complications. It’s a staggering statistic, and one Dr. Fallah says he won’t stand for.
“Pregnant women here don’t have any options,” says Fallah. “They face too many challenges — the lack of midwives, the long distances to care, then the cost of care if they can access it.”
Photo: Molly Knight Raskin
To help tackle maternal mortality head-on in his home country, Fallah decided to leave a lucrative research position at Massachusetts General Hospital (Fallah earned his Master’s in Public Health at Harvard University) and return to Liberia to create a non-profit maternal and infant health clinic — called Refuge Place International — in a poor, populous community called Gardnersville on the outskirts of Monrovia, Liberia’s capital.
The town lies at the end of a seemingly interminable dirt road marked with deep potholes, mounds of clay and large rocks. By car, it’s 40 minutes from main road. By foot, it’s no less than an hour, and from there it’s an additional hour by taxi — assuming one is available — to the closest hospital.
On a recent visit to the clinic, which sits on a serene, grassy swathe of land surrounded by thatched houses, Fallah proudly takes our four-person production team on a tour of the impressive, well-equipped facility, which he plans to open in late March. Fallah raised the money to create the clinic from friends and colleagues during his five years of medical school in America. He also used his own funds, often putting half his stipend as a graduate student in the bank and struggling to live off what remained.
To date, Fallah’s team has finished construction on the clinic’s spacious, clean waiting room, a labor/delivery ward, a small pediatric clinic, a pharmacy and a post-partum ward boasting a brand-new bathroom that Fallah hopes will have running water.
For a community where most women give birth at home and many of them die in the process, the clinic is cause for celebration. “We don’t even have basic first aid here,” says Aya Cassi, one of the 100 women who have already signed on to volunteer for the clinic. “When we heard about this place, we felt like our dreams were coming true.”
“If you know what it means to bear a child, then you know that at the end of nine months, if you loose that child, the pain is unbearable,” adds Cassi. “We don’t want to loose any more.” Cassi says many pregnant women have died in labor while being transported by wheelbarrow to a clinic, which is common in Liberia when women are in too much pain to walk.
Fallah has recruited trained midwives to staff the clinic all week, and two physicians to work weekends to treat the most serious cases. His long-term plan for the clinic extends well beyond the healthcare he and his team will offer at no charge. With the knowledge that poverty and lack of opportunity worsen Liberia’s maternal health crisis, Fallah is hiring as many women as possible as volunteer community health workers, training them to educate girls about reproductive health and the importance of education. He also hopes to construct an area where women can make and sell arts and crafts. “When a woman is economically empowered she’s much more able to make decisions about childbearing and get to a hospital,” Fallah explains.
Photo: Molly Knight Raskin
Fallah knows the number of women and children he can treat is limited; he can only make a dent in the urgent maternal health crisis in Liberia. Just this week, for example, government health workers across the country went on strike, demanding increased wages and better working conditions. The strike has crippled what little maternal health care the country has in place, and endangered countless expectant women.
But Fallah says no matter how overwhelming the issue, he’s not one to dwell on challenges. “If you grow up like me, you know what it means to survive,” he says. “People ask all the time why I’m back in Liberia, where things are so hard. And I just tell them that I want to wake up every day and make an impact. These women need help, and we’re here for them.”
