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WATER: Poor Sanitation Killing Liberia’s Young

Rebecca Murray

MONROVIA and BOPOLU, Liberia, Nov 23 2009 (IPS) - Nineteen-year-old Beauty Phillips clutches her emaciated baby tightly to her chest. At seven months, Inga suffers from malnutrition.

This is 7-month-old Inga Phillips's third visit to the Slipway health centre. The clinic's is unable to care for severely malnourished children with diarrhoea and dehydration. Credit:  Rebecca Murray/IPS

This is 7-month-old Inga Phillips's third visit to the Slipway health centre. The clinic's is unable to care for severely malnourished children with diarrhoea and dehydration. Credit: Rebecca Murray/IPS

On this chaotic Friday morning in the Slipway Clinic registration room, over one hundred mothers, their crying infants wrapped in traditional lappa cloth, wait on narrow wooden benches for hours to be seen.

“She is always sickly,” explains Phillips about Inga’s constant vomiting and diarrhoea. “I get my water from the community hand pump, and for my toilet I’m going to the waterside or common toilet. This is why I think my daughter is getting sick.”

One out of nine Liberian children die before their fifth birthday, or 110 out of every 1,000 live births, according to the Liberia Demographic Health Survey in 2007. Thirty-nine percent of children are stunted or short for their age.

Malaria, diarrhoea and respiratory illnesses like pneumonia are the leading causes of death here.

The crowded slum of Slipway lies along the polluted, marshy shoreline of the Mensurado River, near the heart of downtown Monrovia.

Although Liberia Water and Sewer are trying to reconnect pipes destroyed during the decades-long civil war, most residents cannot afford to buy or access the water.

Private septic tanks overflow regularly, and burning trash lies in heaps among the sewage surrounding the marshy pit latrines. 

Liberia’s population is estimated at 3.5 million. “Over three million Liberians have no access to safe sanitation facilities,” says Muyatwa Sitali, communications officer with Oxfam UK, which spearheads Liberia’s water, sanitation and hygiene consortium.

“Most people have no choice but to defecate in the open, where both their lives and dignity are at risk,” Sitali explains.

President Ellen Johnson Sirleaf has implemented a free nationwide public health care policy for children under five years old, a crucial step towards her promise to provide universal health care for all Liberians.

Still reeling from the decades-long civil war, Liberia’s 2008 Poverty Reduction Strategy estimates almost two-thirds of its citizens live below the poverty line.

This is Inga’s third visit to the tiny government health centre in Slipway, built to serve 15,000 community members. She will most likely be given an oral rehydration salt tablet (ORS) and spoon-fed protein out of a plastic sachet in the feeding room out back.

However, the clinic is unable to care for severely malnourished children with diarrhoea and dehydration. These cases are referred to government hospitals, and hooked up to feeding tubes and IV fluids to replenish electrolytes.

This year, the World Health Organisation (WHO) renewed calls for supplementary zinc treatments for diarrhoea for up to two weeks, which “decreases the duration and severity of the episode and the likelihood of subsequent infections in the 2–3 months following treatment.”

WHO adds, “Low osmolarity ORS and zinc are inexpensive, safe and easy to use and have the potential to dramatically lower diarrhoea morbidity and mortality.”   While low osmolarity – a formula with a lower concentration of salt – ORS supplies are available in Liberia, zinc treatments are yet to be formally introduced. Dr. Vivian Kpeh, who runs the Slipway clinic with the help of international health charity, Merlin, is working with the Ministry of Health to address this issue.

“If we included zinc in our guidelines, especially with children under five years of age, it could get good results instead of referring the children for other treatment,” says Kpeh. “Maybe severe dehydration will not happen, because we have stopped the diarrhoea.”

A five-hour drive inland from the capital, along muddy roads that are almost impassable during rainy season, the young patients at the Chief Jallah Lone government hospital in the rural town of Bopolu share the same deadly illnesses as their urban counterparts.

Esther Floumo, a 21-year-old mother and farmer whose husband was killed during the civil war, is here with her third child, one-year-old Caroline.

Attached to an IV drip, Caroline is suffering from severe malnutrition, diarrhoea, vomiting and dehydration after being fed a steady diet of mashed up burnt rice, mixed with untreated well water.

Caroline is slowly getting better; when she first arrived at the hospital one week before, she had to be force fed through a tube.

“There is very poor sanitation here,” says Bennie Clarke, the RN on night duty. “Most people do not have toilets in their homes; they use the river here or pit latrines. People are washing their clothes, taking water to cook from the river.”

“We treat the patients like Caroline with ORS, and if it’s severe, with IV fluid,” he says.

“We used to have zinc, but we are out of it,” he sighs. “Let’s say three or four months ago we had it here. Christian Aid was supplying it to us. They are just helping, sending supplies.”

“ORS treatment with zinc – as a policy it is accepted in Liberia,” explains Dr. Bernice Dahn, chief medical officer at the Ministry of Health.

“It’s just a matter of getting the zinc treatment.  It means that we at the MOH have not focussed on procuring this. Currently we have a large quantity of ORS in country, that’s what we are using for now.

“But we don’t have zinc right now. It’s a matter of being a part of our essential drug list. We are doing a revision of the essential drug list, and hopefully we will have it next year.”

“Access to healthcare in general is so low in Liberia, its about 40-41 percent,” says Dr. Musu Duworko, WHO’s Family Health and Population Advisor in Liberia.

“We have a whole problem with system distribution. (Supplies) could be at the depot here in Monrovia or at the county depot, and not available at the county facility.  The closer clinics are accessible, but there are some where even the motorcycles cannot go.”

With the lack of access, capacity and medicine, twinned with the country’s abysmal sanitation conditions, the Ministry of Health has its work cut out for it.     

“Much has to be done to help Liberia get close to meeting the Millennium Development Goals on sanitation,” says Oxfam UK’s Sitali. “Without concerted effort that will be a far-fetched dream and lives will continue to be at risk.”

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