“Her face can change!” Words exclaimed frequently yet with surprise that something encouraging has come from such desperation. She came almost entirely skin and bones carried into the hospital from a distant county, guided by hope on a far horizon. When Julia first came she was hollow, an outline of a girl. Some sketched ideas abandoned by her parents and left at the mercy of other relatives.
On arriving into the ER, she was right at the front of the line. Our physician assistant team are well-drilled to care for the sickest children in an organised and compassionate way, and soon recognised the swollen moon face setting into the night above her legs drowning in fluid. The cute baby face her parents brought into the world marred by a viral double helix eating its way through blood cells and hopes alike.
In the 80s HIV was a whispered disease, death carried and isolated into small communities. Fear spread through many who did not understand why they were suddenly losing weight, coughing and vomiting. Soon it was everywhere, tearing through communities. Now treatments are available, and HIV is in the public eye, treatable and managed like high blood pressure or diabetes. Yet still many children are brought to our hospital very late.
Available and free treatments are how we want it in Liberia. Here every child who comes malnourished is tested, and treatment started as soon as possible along with the feeding. Julia’s smile once again re-emerged, first a weak sunrise over a previously hopeless ocean, then stronger, fuller, and a true realisation of who she could be. Every day her face fills out with new possibilities. Her grandmother, who had not believed that Julia could be saved, had come to ELWA children’s ward more to satisfy the flock of relatives wanting to make sure that she had tried everything. Now seeing Julia play with the crowd of other children in the hospital, eagerly taking in the collection of toys and shows on the ward, has brought more joy than she could have imagined. Julia tells the nurses she wants to be like them, helping to look after other sick children. Her two year old eyes have seen too many sisters and brothers die in distant villages.
So how to change the face of child health in Liberia? How to not only nourish the system with resources but also to help the staff to deal with the attacks which threaten to drain those? COVID-19, Ebola, malaria, malnutrition. All of those have done real harm to the healthcare system’s ability to care for Liberia’s most vulnerable under 5s. The resource envelope is constrained. Even with more medication, more plumpynut, more beds …. at ELWA I’m the only doctor with paediatric postgraduate training. Without our dedicated team of nurses and physician assistants there is no way the children who come to the hospital can be helped.
Lasting change must come from within as the nation moves forward. Yes the collection of organisations and individuals who support ELWA Children are desperately needed to help that effort. But we will come and go. Liberia remains, and we pray her children are healthy and well-nourished long after we leave. Many more Julias will come and need help, and I cannot treat them all alone. My face will change, grow old and fade. May more faces from both Liberia and further away come and serve until children are no longer malnourished but full of healthy eyes for their future!