On the Forefront of Addressing Sexual Violence in Liberia

In Liberia, baby steps are being made toward comprehensively addressing the needs of rape and sexual abuse survivors. Clinicians and social workers form the frontline of this comprehensive approach. All week the EQUIP Liberia Protection and Health teams have been conducting a  training of 17 clinic staff from across NImba in the Clinical Management of Rape. The training was conducted with the support of USAID’s Rebuilding Basic Health Services (RBHS) and along with staff from International Rescue Committee (IRC) clinics, the Nimba County Health Team and RBHS’ Family Planning and Reproductive Health Advisor, Maima Zazay.

Philip from EQUIP Liberia’s Protection Team talking about legal and ethical issues of treating survivors.

The refugee influx along with Liberia’s own development makes the issue of sexual gender based violence (SGBV) a hot topic. It is the norm in Liberia for violence such as rape or other types of sexual abuse to go  unaddressed and untreated. EQUIP’s Gender Based Violence Program is actively making efforts to shine light on these issues and work with Liberia’s justice system to find perpetrators and get convictions. Truly something that is unheard of in many countries and particularly across Africa.

Trainees work in  groups on case studies.

Along with the justice component of SGBV there is the clinical management of gender based violence. Women (also, men and children) that have suffered these attacks should be seen in the clinic immediately. The training that EQUIP conducted gave clinicians the tools they need to counsel, examine, document, treat, refer and collect forensic evidence for rape and abuse survivors.

Liberian’s always make time to relax! Even during a training!

The communities that the trainees have come from (many from clinics along the Ivorian border) commonly witness the results of this type of violence. The rippling social, physical and psychological issues of such abuse are commonly seen in the communities EQUIP Liberia serves. These issues are not foreign to Liberians because unfortunately during the war many suffered these atrocities.  Cases are unfortunately drastically under-reported and most go untreated for physical and emotional problems that result from such abuse resulting in long term psychological  and reproductive health damage. The participants were eager to learn how to work with the survivors in their area to begin healing and hopefully assist survivors toward justice. The work and documentation of some EQUIP clinicians, in the past, has made it all the way to the Supreme Court.

EQUIP’s Liberian staff conducted the majority of the training. It is amazing to see the poise and the growth of the EQUIP staff as trainers. EQUIP is known for effective trainings and this was no exception!

Lawrina Donkeh, Reproductive Health Supervisor, EQUIP Liberia training on clinical issues

Photos taken by Jessica Hoover, EQUIP Liberia

Trainings that address SGBV open the door in Liberia to discuss sensitive issues and train health care providers to care for those in their communities who have suffered rape or sexual trauma. EQUIP Liberia  is at the forefront of addressing these issues head on through our supported clinics and our Gender Based Violence (GBV) Protection Team.

- EQUIP Liberia Team

Community Case Management of Malaria: Success Stories

Two year old Patience B, was burning with fever while tied to the back of her 6 year old sister Kou.

Kou was drawn by the crowd circling newly trained gCHV, Elina Kolleh, EQUIP’s National Director, Mr. Roland Suomie and National Malaria Control representative, Asatu M. Dono. Both had determined to take a full week to visit every gCHV trained by Equip Liberia in Nimba County under the Community Case Management (CCM) malaria pilot program. They had anticipated the arduous journey required by vehicle over rough, deeply pitted roads, to get to the various remote communities that the pilot program served, but to get to Zahn Glounla had the added challenge of a tippy dug out canoe ride across the Yah river.

Even that did not thwart their determination to ensure the CCMP was a success.

While showing the M & E team her newly acquired back pack, ledger, RDTs and other supplies, Elina noticed Kou watching her. She recognized her and knew her mother, who was working on their farm nearby. Elina sent for the mother to come and gently took the child, inquired about her medical history, checked for fever and methodically completed the RDT (rapid diagnostic test) for malaria). Patience was RDT positive.

By giving ACT malaria medicine within the first 24 hour onset of fever, Elina not only reduced the negative impact of malaria on the child, but also reduced its spread in the community.

Three weeks after the gCHVs successful community case management of malaria training in September, 19 gCHVs had treated 633 under 5 year old children with malaria in their community, 59% of those children were treated within 24 hours since the onset of fever.

One of USAID President Malaria Initiative’s (PMI) global targets is: 85% of children under five with suspected malaria will have received treatment with ACT malaria medicine within 24 hours of onset of their symptoms- a monumental goal in rural Liberia, where access to health facilities can range up to a 25 hour walk! The EQUIP PMI supported Community Case Management of Malaria Program puts that target within reach.

Article contributed by Audry Waines, Equip Liberia

Pictures taken by Roland Suomie, Equip Liberia

Community Case Management of Malaria: Placing health interventions where it counts

 

Zahn Gounla is one of 17 communities benefitting from the first Community Case Management of Malaria program approved by the Ministry of Health in rural Nimba County since the 1990 war. Chosen because of it challenging distance from the nearest clinic, community members have to cross the Yah river in a canoe and walk another 4 hours distance, to seek curative health services.

Equip Liberia, in partnership with USAID and the Ministry of Heatlh, launched the pilot training of 21 general Community Health Volunteers (gCHV) in September 2010. (CHA’s) Community selected gCHVs have an average 7^th grade education, requiring trainings to be simple, where necessary translated into dialect and with much time given to demonstration, practice and role plays.

Malaria is very common in Liberia.

It constitutes about 35% of outpatient consultations.

It is estimated that there are 4-5 malaria episodes annually in children aged 0-5 years. (LIMIS 2008).

Since the gCHVs serve deeply rural areas, their competency is carefully evaluated before being given the tools to confirm malaria through RDTs (Rapid Diagnostic Tests) and given the medicine to treat the under 5 population in their community.

Community sensitization on the issues of prevention is also an important function of the gCHV. Counseling of mothers and caregivers on early health care seeking behavior, regular use of Insecticide Treated Nets, proper compliance to medicine regime and follow-up are key responsibilities of gCHV.

Story contributed by Audry Waines, Equip Liberia

Tomorrow: How Equip Liberia’s gchv’s life-saving malaria treatment skills saved one child’s life

The Work Continues in 2011

Forgive us for failing to post. Things have been a little crazy around here. Between holidays, clinic accreditation and thousands of refugees from the Ivory Coast the blog has taken a backseat, but a New Year is here and opportunity to redeem our failed blogging past! We will “try small”, ok?

In case you haven’t been watching or listening to international news lately let us fill you in. In November 2010 the Ivory Coast (Liberia’s eastern border country) had an election in which the incumbent, Laurent Gbagbo, was beat by his opponent, Alassane Outarra. In the weeks following the election there was much debate over the true winner. Gbagbo claimed that he was the winner and guess what? So did Outarra. Gbagbo has since refused to relinquish power although many world leaders and the U.N. have agreed that Outarra is the rightful winner. There was violence in Cote D’Ivoire’s capital Abidjan and more violence along tribal and religious lines across the country. Thousands (25, 000 + are registered with UNHCR) of Ivorians have sought refuge by crossing the border into Liberia and Guinea, primarily Liberia.

An Ivorian man crosses the river that separates Liberia from Cote D’Ivoire to bring his aging mother across to safety.

Thousands of people have crossed into Liberia since November in these 3 dugout communities.

EQUIP Liberia work spans nearly every corner of Nimba County.

Nimba County shares it’s western border with Guinea and it’s eastern border with…you guessed it…Cote D’Ivoire.

Nimba County highlighted in red shares an eastern border with the Ivory Coast.

The majority of Ivorian’s that have crossed into Liberia are in Nimba County. They are spread across communities that dot the border of Liberia. EQUIP operates several clinics that have experienced a dramatic refugee influx since the November elections. EQUIP is responsible for maintaining our clinics along the border as well as responding to the burgeoning health needs of the refugees in our clinic catchments. EQUIP has also taken on the water and sanitation needs of these communities. Our pump and well technicians have raced up and down the border repairing pumps and rehabilitating broken water points so that these communities can have adequate, clean water sources for the increased population.

Words don’t seem adequate to describe the tireless way that so many of EQUIP Liberia’s Liberian staff have worked to help their Ivorian brothers and sisters. While many of the ex-pats working with EQUIP have had to sit in meetings with UNHCR and other large NGOs our Liberian counter parts have driven out to the border areas nearly everyday since the end of November. Many of them working through the holidays to meet the needs of those communities. For many of them the memories are not so distant of a time when they fled over the Ivorian border in search of safer ground. They are the real heroes of this situation. They have distributed supplies, reported important details of the situation, repaired wells, and educated the refugee populations on safety issues. The work has been great, but EQUIP’s staff has risen to the challenge with incredible willingness.

Unfortunately there is no end in sight to the situation in the Ivory Coast. Gbagbo has not relented and the U.N. has not yet ousted him. It seems to be a waiting game for everyone, both for the international community and the refugees waiting along Liberia’s border to return home. Over the next weeks and months UNCHR has plans to move the refugees from the Liberian host communities and into a camp. EQUIP will still be in these communities long after the refugees have gone. We will be working to maintain quality health services and water and sanitation for Liberians and Ivorians alike.

Community members observe one of our WATSAN technicians assessing a broken water point.

The refugee response has taken over much of our time and work, but there is still much to do on our regularly scheduled projects…already in progress! We received some exciting news last week! EQUIP Liberia has been approved by charity: water for another round of funding for water and sanitation. charity:water visited Nimba a few months ago and recently reported about their time in Liberia on their blog!

Read what charity:water had to say about their experience with EQUIP Liberia and the water and sanitation impact in Liberia.

charity:water is a great organization and an even better partner in WATSAN work. This funding will provide clean water sources for many communities as well as build the capacity of our EQUIP technicians to care for the water and sanitation needs of their people. We are excited and grateful for the opportunity to continue our WATSAN work and our relationship with such a great partner!

Thanks for reading this blog. Thanks for believing in the work that is being done here in EQUIP Liberia’s little corner of the world. Please continue to check back here for updates on refugee crisis and EQUIP Liberia’s impact on communities across Liberia.

Peace,

The EQUIP Liberia Team

We're Back!

Welcome back to the blog! It's been quite a while since we've posted. O.k., that's a bit of an understatement! Nevertheless, the Equip Liberia blog is back up and running and has had a facelift! We hope that you will follow all that is going on in Liberia through Equip's work. This is the place to come for real life stories about the transformation that is taking place in many Liberian communities as a result of Equip Liberia's work. Follow us via google or get updates sent directly to your reader!

World Malaria Day

Today is World Malaria Day! Malaria is still the number one killer in Liberia. To commemorate World Malaria Day and to get the message out to the communities about how to prevent malaria, EQUIP Liberia has teamed up with some local artists to record a song highlighting some basic ways to fight this disease. The song was sponsored by USAID President Malaria Initiative (PMI) : from the American People." Check it out below!

Update on Dave's Father

Here is an update on Dave's father from Jan, Dave's sister:

Hello All,

Today brings good news! Dad's surgery was very long (61/2 hours) but went well. He was able to come off the breathing tube and be moved back up to the 5th floor on Neurology ICU at 4am. I spoke with his nurse this morning who says he wakes up easily, is able to speak in a raspy voice, knows who and where he is and the reason he is there. Knowing why he is there is a big change from the day before surgery and reason to say Hallelluliah! They are also starting to remove one or two of the many tubes so he will be a bit more comfortable. We have been told that he is at risk for a number of complications, especially over the next week so will continue to pray for a full recovery.

Dave, Matthew and Rebecca arrived safely last night and Dave has already been able to see Dad.

He continues to need lots of rest and low stimulation. I suggest we keep visits very brief over the next few days.

Please forward this or call anyone not on the list who does not use email. We love our support network and know that prayer is powerful!

Love,

Jan

Prayer for Dave's Father

Dear friends,
On April 13th Dave's father was taken to Vancouver General Hospital for a brain aneurysm. Fortunately it was a slow bleed, therefore immediately on arrival he had surgery to relieve the pressure on his brain. Early this morning he went for a second surgery to clip the aneurysm. The surgery took six hours and was more complicated then expected, but amazingly he is among the one third that have survived to this point. The next eight days are crucial and we call upon your prayers for our great father and grandfather Garth.

Dave left Liberia within six hours of hearing the news. Amazingly he found a ticket that was half the usual price; therefore he took Matthew and Rebecca with him to be with their grandfather. For those who are in Vancouver, Dave can be contacted at (604)-876-4694. Thanks again for your prayers and support,

Dave & Audry

Urchin Adventures

The three youngest members of the Waines family are back from boarding school in Senegal for the month and Liberia is a brighter, more adventure filled place once again.

The other day Rebecca and Matthew along with volunteers Sarah and Christoph decided to swim out and explore a rarely exposed reef just off the beach. After some time of checking out the interesting coral, sea life, and even an eel, the tide started to rise. They were almost back into the water when Matthew slipped and fell, his hands and feet landing right into a cluster of spiky sea urchins!

Poor Matthew had to be carried all the way back home because it hurt to much to walk. Fortunately Sarah is an emergency room nurse. Unfortunately this meant that she had to spend the next two hours using tweezers to carefully pull out over 90 urchin spikes from Matthew's feet and hands, while Audry kept the patient happy with a steady stream of snack food.

Matthew soaking his urchin infested hands

Four CHA Graduation Ceremonies

This last week EQUIP celebrated the graduation of over ninety Community Health Ambassadors in four different ceremonies.

The Community Health Ambassadors (or CHA's) have always been at the core of the work here. They are volunteers that go through a fifteen month long training program, attending workshops and trainings. They learn about good hygiene practices and simple ways to prevent disease. Most importantly, they learn how to impart this knowledge back to their communities through health talks and powerful dramas in their local dialects. We have now trained over 6000 CHA's and that number keeps growing.

Three of the graduations were in Nimba County, in the towns of Garplay, Karnplay, and Bonlay. The fourth occured in Garmu, in Bong County. All four events were filled with festivities. The graduates performed dramas and songs highlighting simple ways to prevent diseases and speaking out against harmful cultural beliefs. Many local officials and chiefs were there to accept the CHA graduates in their new role as role models and ambassadors of preventive health care.

CHA graduates in Bonlay march and sing on their way to the ceremony.

Two CHA graduates perform a drama while an audience of school children look on.

The new CHA graduates of Garplay District in Nimba.

A Visit With the President

A few weeks ago, key members of the EQUIP Liberia staff were invited to an audience with the president of Liberia. Her Excellency Ellen Johnson Sirleaf thanked us on our ten years of service to the country of Liberia. We were able to show her our video and had the joy of sharing with her about all our various projects.
From left to right: Audry, Rachael, Roland, David, President Johnson Sirleaf, Ruth, Alice, Joseph, and Amy.

God Provides A Miracle On The Road

Sarah, a volunteer nurse from Alaska has been acting as our medical coordinator in Nimba for the past 4 months. Her heart for God is astounding. She is so compassionate and dedicated to her work in building the capacity of the clinic staff, encouraging them to pray and follow God passionately; she has small youth support groups etc. She was traveling from one of our remote clinics, the new one (we just built with BPRM funds) in Gblarlay, carrying a sick child with an enlarged spleen and blood in her urine, to Ganta hospital with her mother, about a three hour trip.

Visibility is often limited as cars and trucks pass on the dusty roads. She had just passed Grai (an hour from Gblarlay) and was approaching a small bridge when through the dust they noticed an overturned van with people crawling out of the windows. Her adrenalin peaked and she felt ill equipped wondering what she would find and how she could help. She took a deep breath of the Holy Spirit and prayed. Altogether 11 people came out of the van, including one baby. She wanted to do triage (a first-aid procedure for emergencies) but the group was too big. Some were staggering in shock. She gathered them all together in a circle and announced, “I want us all first to pray and thank God that He has spared our lives.” So everyone bowed and prayed before their Maker. She then had them each do a self-assessment, just like she was leading a fitness club. "I want everyone to raise their hands, wiggle your fingers, move your feet, how is your head, push on your stomach, (considering internal bleeding), any pain? "etc...

There were two people that obviously needed help. One had had all the luggage land on his face when they flipped and he had a large cut across his face and was not well oriented. She suspected a concussion. Another had his hand hanging limply and arm badly scraped His wrist appeared broken. She found a piece of cardboard in the car and gently laid his hand that was swelling up before her eyes into the "splint" and found her trousers in her bag and used it to wrap his arm. She told him, "That arm appears to be broken, we need to pray that God will heal it." In her mind she saw all the poorly managed broken bones of a few of our staff in recent times...Liberia is not the place to break a bone!. She prayed with him, "Lord, we ask you to heal this arm, let the bone heal in your mercy, amen." It happened that this man goes to our church in Monrovia. When they got back in the car, she repeated her concern for his arm and they prayed once again, believing for his healing. After an hour trip to Saclepea Health Center, they carefully unwrapped his arm and there were no scrapes, no swelling and full function...a miracle! God is so good!

Equip Opens New Clinic in Gblarlay

On the 22nd of January EquipLiberia celebrated the opening of a new clinic in Gblarlay, a remote but lively town in Nimba County. The clinic provides health care for an area with a population of over 25,000 people and sees 700 patients a month. Since Gblarlay is located within miles of the border with Ivory Coast, the clinic also sees a large amount of Ivorians desperate for good medical care.

The celebrations started the evening before the event as the air of festivity in the town erupted into dancing and drumming, which went on all night. In the morning the fattened cow was killed and everyone gathered around the cooking pots preparing okra, palm butter, and of course, rice for the ceremony.

The ceremony was held just outside the clinic under a vast canopy of palm branches. Representatives from Equip, the local community, the Ivorians, the government, and the County Health Team all spoke. Together they told a story of a town in need and group of people who were willing to sacrifice so much to make this new clinic possible. The speeches were spaced out by different performances from local cultural groups.

After the program was completed and the ribbon across the door was cut, the food was served. All in all it was a festive celebration of a new clinic that will bring good quality, primary health care to a large area, saving thousands of lives.

Here are some photos from the event:

The children of Gblarlay

The cooks preparing the food

Two of the cultural dancers

Winter Newsletter

The newsletter for Christmas 2008 is now available to read at the Equip website. Just click here!

New Solar Lights Help Save Baby Daygon’s Life

I’ve delivered a lot of babies, but I’ve never seen a baby so blue and lifeless as long as this one was:

Last night, November 11, a handful of Equip volunteers, staff, and I were driving on our way to Ganta. We had been traveling all day, it was late, almost nine, and we were road weary. Suddenly I found myself taking a sharp, unexpected turn to the right, onto the rutted dirt track to our Equip Flumpa clinic. I wasn’t planning to visit the clinic at all, but having followed the unexpected urge to turn down the track, I thought I’d drive over there just to check the state of some rusting roofing sheets that I had heard needed to be changed. Surprised to see light streaming out through the windows and piercing the darkness outside, we went in to investigate. The clinic’s only patient was Oretha Daygon, a 23 year old lady from the village of Wheintin, who was just going into labor with her fourth child. Sarah, Equip’s American nurse supervisor, jumped in to help Nurse Aid Saye Klesa and OIC Patience Julu with the delivery. At 9:05pm, Oretha gave birth to a baby boy. He was born lifeless, and remained blue for a dangerously long time, despite persistent emergency suction and artificial respiration being given. Had Oretha's baby been born in the dark traditional midwife hut at her village of Wheintin, like her other 3 children, he never would have survived. After many tense minutes, the baby’s crying started to fill the clinic, signaling that he had finally started breathing and was not going to remain lifeless. The family and community members who were waiting outside burst into the clinic with song, dance, and shouting, filled with the infectious joy of new life.
The rescue of this handsome baby boy was only made possible by the recently installed solar power lighting, thanks to funding from USAID. These lights have brought about a great increase in night time emergency care and deliveries being given at the clinics, which has resulted in many lives being saved. Thankfully we have just been able to install these lights in all of our clinics. Praise God for the miracle of new life!

About This Blog

Dear Friend,
This little blog serves as a place for you to get updated on all things happening with Equip Liberia. We’ll try and keep a steady stream of news, photos, stories, videos, and prayer requests to let you know about all the exciting work that God is doing here. Please stay tuned and check back often,

- Christoph Sanz, Blog Editor