shut up christine

i didn't write this. this is from the journal of a doctor friend, sriram.

The road from Monrovia to Zwedru is brutal. In Burundi the roads are so bad that sometimes you have to go so slow that a man on foot can walk up to your car and kill the driver; Rural India the roads somewhat seem to hold up. They are often given more care by the government than the government gives their people(not by much)

The road from Kenya to Uganda at midnight has so many potholes that it feels like bullets are rattling the bus windows. The road from Monrovia to Zwedru however is by far the worst. It takes nearly 20 hours to go 300km in the rainy season. The red mud would be perfect for pottery. It is wet and soft and abundant. You could probably make all the world’s pottery from a single small strip. There is no road. To call it a road would be far too generous. There is mounds of wet red slosh that threatens to engulf your vehicle and bring it to a standstill every few minutes. There are certain stretches along the road where it looks like a graveyard for trucks and aid vehicles sunken door deep into mud. Along the 20 hour ride there exists several areas where a long line of trucks and cars are backed up along a narrow strip of land. Only one car or truck can pass at a time, and each one takes their due turn getting stuck and subsequently pulled out. A couple days ago, we waited for four hours pulling trucks out and getting pulled out ourselves until we can finally pass. The locals tend to come to particularly hopeless mud pits of road to earn some money pulling out folks.

At first, it feels like just a ridiculous inconvenience. Then after further reflection a road this bad is something like a human rights violation, or a a loss of dignity for Liberians at the least. 25% of the population live in Monrovia. Families can’t move out of Monrovia, to see each other, the supply chain of any good slows to a halt, small businesses wither as essential goods are absent, and vaccines and medicines and equipment all get stuck on the roads, with unreliable procurement to run any decent hospital. A young woman died last month of anemia before she was able to pass through on the road to a hospital. Bosco, the Rwandan doctor I am working with was called emergently from a peripheral health center to come see a pregnant woman who had an obstructed labor. Due to the roads, he came just in time to declare the mother dead. Any attempt to meet Millenium Development Goals on maternal mortality must take into account these roads. Stuck at a checkpoint of nature, a car in the mud. An unnatural failure of leadership.

The first day here in Liberia we rounded at the rural hospital in Zwedru. An older man admitted to the hospital was hunched over gasping for breath, his elbows deeply indenting his lower thighs. He could not speak in full sentences. The lack of air was causing a state of near panic. A brief listen and percussion of his lungs and it was clear he had a whole lot of fluid accumulated on his left which severely impaired any attempt to oxygenate his blood. We told him that we needed to stick a needle in the fluid around his lungs and drain it. We said we thought it would make him feel better. His first question was not about the risk of the procedure, or if it would hurt or what the chances are that it would truly make him feel better. His first question was “How much will it cost?” A dying man’s first thought was about money. He was surprised to hear it was free.

Perhaps there is no clearer indictment of a failing health system when your most vulnerable and dying think first and foremost about cost. The first time I heard this question from a patient that needed an emergency procedure to save his life was in South Los Angeles. Apparently the poor in the United States and Liberia have some parallels, and similar fears. The fear of indebtedness is ubiquitous and transnational. May the solution, may those that work for free and just health be equally transnational; May we seep hope into the soul of broken health systems and fundamentally transform their rotting core.

Sri 10/16/2012