Bushrod Island – Dominic W. Rennie struggles for visibility as he ushers two visiting reporters into his dark office on a sunny Saturday afternoon at the Redemption Hospital located in the heart of one of Liberia’s largest townships – New Kru Town.
Report by Alpha Daffae Senkpeni, [email protected]
The lights have been off for several hours and Mr. Rennie, who is the Administrator of the hospital, has to wait for several more hours before reviewing a pile of files on his desk.
“As you can see here now, we used to have constant electricity but since Friday, we have not had constant electricity due to the limited budgetary support. This is not good for a referral hospital,” he said, shoving a chair from the edge of his desk.
“Suppose someone is sick and there’s an emergency – what do we do?”
The hospital will soon run out of supplies, and the administrator is also not ruling out a collapse of the facility if intervention is delayed.
“Right now we are facing challenges in the areas of electricity, transportation for the staff, fuel for the generators, and we also have problem with drugs supply,” Rennie says.
The main problem promulgating the constraints for the hospital is limited or delayed budgetary disbursement, the administrator said.
Redemption Hospital, the largest government free health center in the country, is allotted US$2 million in the fiscal budget but receives less than US$1.4 million due to frequent budget shortfalls.
It’s almost four months now since the hospital received the second quarter of the budgetary allotment. The third quarter allotment of US$500,000 from the Ministry of Finance is pending. Unfortunately, it was drastically cut to US$60,000 in the recast budget by the new government.
The delay in disbursing the money is compounding the challenges at the hospital, Rennie says, “And the US$60,000 is very little and would not cover the hospital’s operational cost”.
Already, Rennie and his team are sweating over a hefty debt incurred due to delays in the disbursement. Vendors are breathing down their neck, and with a major cut in support to the hospital by the government, the hospital is bound for more trouble.
An assessment conducted by the Ministry of Health through the US based Clinton Foundation shows that US$7 million per year would be an adequate fund to operate the hospital.
The hospital record shows that in 2017, it received the highest patient load in the country, which amounted to 148,655 patients.
The 150-bed hospital is absorbing massive challenges in a catchment community of 400,000 population while it continues to take in referrals from several counties including Gbarpolu, Grand Cape Mount and Bomi Counties.
Politics Eclipsing Health
These challenges of the Redemption Hospital are becoming public and scary amid critical reactions over President George Weah’s administration decision to allot US$250,000 for feasibility study for the construction of a military hospital early March this year.
President Weah broke ground for the military hospital in the proximity of the Edward Beyan Kessely Barracks along the Roberts field highway and named it in honor of his number 14 jersey worn during his days playing for the national team.
President Weah assured that the designed was approved and financing was already been arranged although the details of the project is unknown.
However, some experts say the government must give priority to existing medical facility before building new ones.
“Although I appreciate expanding health facilities in the country, I think the government must ensure that existing health centers are fully supported,” one medical doctor said anonymously.
“Everyone knows how vulnerable our health sector is even years after the outbreak of the Ebola, so once we continue making decisions that are politically driven and forget about tackling the real problem that means we might be at risk.”
Terror of the Past
When the Ebola virus disease began ravaging Liberia beginning 2014, Redemption Hospital bore a severe brunt. It was probably hit the hardest in the country. The virus killed 12 of its staffs and the hospital became an epicenter.
“This was where the first medical doctor died in Monrovia. Where the first nurse died and after that there were series of deaths,” Rennie recalls.
Dealing with the tension from the community, and managing a major holding center for suspected Ebola patients during the height of the outbreak, the hospital maneuvered and later bounced back to play a major role in rolling back the virus.
Barely three years after enduring a catastrophe, recovering from the turmoil of the world’s worst Ebola outbreak, the health center is again struggling to cater to patients on a daily basis.
Currently, it runs the only functioning Infectious Unit in the country – where patients can be treated when there’s an outbreak of infectious disease in the country. But medical experts say the vulnerability of the hospital created by limited resources is a massive health risk for the country.
Massive Challenges: Electricity, Water and Drugs Shortages
Following frequent failed requests to the Liberia Electricity Corporation (LEC) to connect the hospital to the national grid, the administration was constrained to initiate a system of power supply via its two generators. This ensures patients are care-for, surgery rooms are in-tight, and pharmacy and other major parts of the facility are electrified.
Staffs access to electricity is now scarce, and even crucial parts of the hospital are also spending long hours without electricity. The shortage of fuel for the generators is becoming an alarming constraint.
“If you do the mathematics, every month we operate on about US$160,000, so imagine if we’re receiving 60,000 for three quarters, which means for three months, we will not be able to break even with our expenses,” Rennie said, dissecting the complexities of the hospital’s tight budget.
Already, the delay in sourcing funds from the Ministry of Finance is pushing the administration to the limit, increasing their debt to vendors.
“We have a lot of debts out there – debts for drugs, debts for fuel, cleaning materials, food for patients, oxygen”, he said.
The National Drugs Service supplies drugs but have endured its own challenges which has disrupted regular supplies to the hospital.
“At Redemption the doors are open but the writings are on the wall, that if you can’t do anything that is needed to be done, obviously we will have serious problems.”
There’s also inadequate water supply to the hospital due to inconsistent supply from the Liberia Water and Sewer Corporation. So, the facility relies on a water source in the community where resident also fetch water.
Community Worries
A stone throw away from the front gate of the hospital, Julie Kumeh chats with her two daughters as they do laundry.
Julie witnesses the tension and rants of patients every day at the hospital.
“Many people are complaining about the medicine business (shortage of drugs) at the hospital and some people can be very vexed. I even saw it for myself, how the medicine shortage is a problem,” she said.
A week ago she gave birth to her eighth child at the same hospital. But she had to checkout early because of limited bed space.
Her daughters are too young to understand the ramification of the challenges of the hospital, but they dredge up scenes of chaos and sorrow during the Ebola outbreak. By then, the hospital was overwhelmed, they remembered.
“I hope they bring medicine for the hospital, because plenty people can say medicine cannot be there,” one of her daughters said with a giggle.
At the back of Julie’s zinc shack, Simpson Nifore is preparing for his day’s job.
He works for a private pharmacy just across street – from the main entrance of the hospital.
Nifore is pretty aware of the drug shortage and electricity outages at the hospital, but says the community can only worry about the situation and do little.
“What can the community do? It is the government that we are looking at because even when we complain about the problem at the hospital, nothing will be done,” he says.
Fearing Collapse
While residents and patients are increasingly growing wary of the situation of the hospital, the administrator fears that the relevance of the hospital to the community would decline once the existing challenges deteriorate.
“You see people are listening, people are watching and when we are not able to provide the necessary conducive environment for the patients, they will definitely be demoralized and then we start having complaints that staffs are rejecting patients,” Rennie says.
At the same time, expert foreign doctors or specialists are becoming impatient over salaries delays.
Rennie says the hospital is worried that doctors might lose confidence in the hospital and leave the job, thereby creating gap in the availability of medical service at the facility
‘No Define Donor Support’
Rennie refutes speculations that the hospital receives huge donor support, adding, “We do not received any well-defined donor support”.
“The support we received is through the performance based contract and it’s from the World Bank. And that support is not much, it’s only helps us measure performance at the end of the day and give you a small amount to assist you (the hospital).”
“But with these additional responsibilities we have not seen increase in budget. So it is important that we need to look critically at how the problem of Redemption hospital can be addressed,” the administrator said.
“With all that we are doing, if we can function properly it will definitely affect the health system.”