Political seasons in Liberia are some of the most exciting times where candidates normalize false or make impressive promises.

With their speeches not rooted in evidence. But at the end, they always succeed in getting into power through deceptive talks, while citizens get discouraged at the end of the day, causing them to compliment the then leadership they were manipulated to change.

Campaigning has now become sweet talking the citizens to persuade them to vote for individuals, many of whom do not mean well for the country. Unfortunately, rhetoric has come to trump reality in the voting season where level of deception we witness in our society is mind numbing. We have seen broken promises over and over and again.

As I listened to talk shows, political rallies, jamboree, festivals and slogans as politicians may name them, I hear and see deceits. Most often, the opposition blocks are the one who try to bury incumbents’ gains without data to substantiate their claims.

Common phrases such as “the government or lawmakers failed us,” “elected officials did not do anything for the past 6 or 9 years,”  “most of the citizens are unemployed,” “no good roads in the country”.

“Many people are living in poverty.” Etc. their basis for making those claims are rooted in abstract or snapshot analysis, coupled with self-centeredness and hatred for neighbor regardless of the incumbents’ potential as well as what he has done and will do when elected again.

Even though it is true that there are citizens who truly love candidates despite clear signs that they are not capable of executing future assign responsibilities when elected, it is the beginning of betraying the country because of personal love for an individual not the country.

Across Africa, Libya is relatively regretting the death of Col. Gadhafi, Gambia who just out-casted President Yaya is beginning to accuse the most preferred individual, Adama Barrow of ruling the country alone. These plus many more are happening in around the African continent.

Deceptions used by would be leaders don’t only influence voters’ minds for accumulating personal wealth, but rather, it has made many regions or districts to be behind in terms of tangible developments-it has also changed the true meaning and independent capacity of voters to make sound decisions based on their own judgement or what they have observed over the years they were governed.

Because of political rhetoric that had infested people of voting age minds, this election season opinion poll has shown that 40% of voters are undecided (FrontPage Africa). Those are people who to my understanding, are in a state of dilemmas- they don’t know which way to go due to too many lies from people who want to occupy public offices.  

In addition, non-comparative issues like economy, health and social issues are routinely compared with other countries like Ghana and others to Liberia. Some said, Ghana budget is higher than Liberia.

Candidates who are making such claims have relatively done no research to understand Ghana’s strength of economy.

Questions to political leaders who are being unrealistic in addressing issues of importance in their quest for power are: How many internationally recognized universities does Liberia have? Is Liberia capable of awarding Ph.D. like Ghana?

How many flights land at Kotoka international airport as compared with the one and only Robert International Airport?

How many foreign companies CEOs are Liberians as compared with Ghana who has a policy that limits such advantage? How many foreign students do we have attending our universities that are paying higher fees than Liberians as seen in neighbouring countries?

We need our politicians to provide evidence-based solutions to problems that face their constituents. Let them tell us how they will address health care, education, transportation congestion, poor infrastructure, increasing unemployment and underdevelopment problems etc.

Perversely, we see righteous anger coming from people who had the power to make Liberia a better place against incumbents as if they were living on another planet.

This is dishonesty at the highest level. 

For the health sector, how many of our candidates  contesting for the higher seat in this country have ever been admitted at our referral hospitals or donated essential materials prior to their involvement in politics?

The only thing they did was to seek medical treatments outside of the country in areas that they have no idea how they got to where they are. 

When do they realize that “mobile clinic” is an effective way of reaching out to people who are in need of health services? I doubt if those they recruited to render services to our citizens are trained and certified health workers who are licensed appropriately.

Instead of stating exactly how they  are going to handle the preventable deaths that are occurring at our referral hospital because fees are not paid prior to patients’ admission, they are doing “mobile clinic” that is not sustainable/ is political strategy to gain votes-it will vanish as soon as election is over. 

Regrettably, why should the health sector of this country allow our citizens lives to be risked in such a manner? There is an existing chain of command at the central, county and district levels.

Are those drugs being tested for potency before administration to Liberians? It is so pathetic that issues of higher importance in this country are given “level playing fields” when it involves politics. Issues facing the health sector are like an ice bag-on top of it looks small but beneath is a very solid ice that can destroy whole ship.

Moreover, my worst discouragement was during the first Presidential debate held at the Paynesville city hall. Not one of those candidates could at a minimum level  address issues facing the health sector ranging from one of the higher big belly death (1,072) reported in this country through shortages of drugs and facilities around the country, disproportional ratio of doctor to patients (1:76,000), low salary structure for health workers who are cardinal to lives of the very would be President and their followers, counties hospitals have no functional ambulances to transport patients, to how will they retain health workers who turnover rates had increased drastically?

Even security threats pose by the “at risk youth” was not even addressed substantially. If you in-cooperate them in the government as claimed by some politicians or not, there is a fundamental way to mutually take them off the streets. This was missing by candidates who claimed that.

This fundamental way is rooted in research, nothing more but research. Without research that will provide data on each individual’s rehabilitation needs, you are not going to score any point. 

Until politicians whom many believe in can speak with facts, become diversified in dealing with numerous issues affecting every sector of government, what they think are their priorities will be of no preference to the citizens. And At the end, as a country, we will continue to acknowledge the past leadership that was once termed failed.

Certainly, this had started popping up by other opposition parties since President Ellen Johnson-Sirleaf, whose administration was once a failure is being appreciated for gains made because she is not contesting. To the electorates, your vote is the only power you have now. After elections, you have no more power to make the change you wanted.

I end with a quotation from Albert Einstein that states: “the problems we have created in the world today will not be solved by the level of thinking that created them.”

Eddie Miaway Farngalo, BSN, RN MPH,
0886484351/077590035, wonkehmie@gmail.com

Concession agreements are perceived by government and citizens as the source of employment and rapid economic growth. But in the minds of policy makers and affected communities, negative impacts such as land degradation, deforestation, water sources pollution, high prevalence of Sexually Transmission Diseases (STIs) including HIV/AIDS, high level of prostitution, deterioration of physical and psychological health, increased or more severe respiratory diseases etc. associated with mining activities are involuntarily least of their concerns or priorities at the point of awarding contract and even during the projects’ lifespan.   

In 2005, Arcelor Mittal Liberia signed Mineral Development Agreement (MDA) to begin iron ore mining in Buchanan and Yekepa concessions. The MDA was amended in 2006 after the first African female president-Ellen Johnson Sirleaf was elected into office.

Under the MDA, the company (AML) is expected to contribute $ 3 million to Nimba, Bong and Grand Bassa counties social development fund annually. The company is also required to establish and maintain medical and education facilities in all areas of operation, to serve employees, their families and the broader community, and to prioritize the employment and development of local Liberians.

With the mine’s lifespan at 25 years, 75 million is expected to drive community development projects which is aimed at uplifting and improving the lives of the affected people/communities. All these agreements signed under the MDA have fallen short over the years.

Sporadically, concessions especially in Nimba County had experienced series of demonstrations due to what citizens perceived as inconsistency in operationalizing the amended Mineral Development Agreement of 2006. Even-though ArcelorMittal has slowed down operations in country due to drop in iron ore price globally, for the past two budget years, social cooperate responsibilities assigned AML have not been forthcoming (a Nimba County Lawmaker lamented) with some student groups describing the failure on the part of the steel giant to fulfil its responsibilities as “deliberate” (President of the Yarwin Mehnssonoh Student Association (YARMUSA), Randolph Glee told The informer News, 2013).   

In the midst of many lapses in executing its (AML) Cooperate Social responsibilities under the MDA comes contamination of water sources with heavy metals (Lead, Arsenic, and Mercury) in communities within concession areas.

A cross-sectional study conducted between July and September 2014, during which water samples (1 bottle from each community) were collected from communities within the concession area and were analysed for heavy metals at the Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy Commission in Accra for heavy metals revealed that communities/towns highly affected are Gbapa with Arsenic level of 0.08mg/l and Mercury level of 0.04mg/l; Yekepa with Arsenic level of 0.016mg/l and Zolowee with Arsenic and Mercury levels at 0.0805mg/l and 0.04mg/l respectively in surface waters. For ground waters, Liabala reported Lead level of 0.064mg/l, Zolowee Arsenic level of 0.0065mg/l and Mercury level of 0.0285mg/l respectively.

Comparing/matching these results gathered from the mining concession with W.H.O permissible levels of 0.001mg/l for Arsenic and Mercury and 0.01mg/l for lead showed that those water sources are highly polluted with three (3) heavy metals (Lead, Mercury and Arsenic).

Notably, the above WHO permissible level of chemicals detected during rainy season when the water table was high, shows how toxic/concentrated it will be for human use/consumption during dry season when the water table will be very low.

Numbers displayed above have lesser meaning to people/readers if consequences of it long time human exposure/usage is not exposed. Therefore, below are adverse effects associated with the three heavy metals that were detected at higher level during the research.

Impacts of Lead, Mercury and Arsenic on human/public health

Lead in water

Long time exposure to lead can cause cancer, damage nervous system in children, brain disorders, autoimmunity (the immune system attacking itself), kidneys problems, miscarriages, reduced fertility in men and the circulatory system (Momodu and Anyakora 2010 and Ofosu-Asiedu et al., 2013).

Mercury in water

Mental disturbance, speech impairment, hearing loss and difficulties in movements are health problems that may arise from mercury toxicity (Momodu and Anyakora,2010). In addition, tremor, irritability, learning disabilities, reduced cognitive functions, immune suppression, nervousness, memory loss, excessive shyness, lack of sleep, muscle weakness, headaches, and hallucinations (false visions) are other health effects associated with mecury ingestion  (WHO,2003, ATSDR,2014; Park and Zheng,2012; Ray et al.,2014; Homes et al., 2009).

Arsenic in water

Arsenic is the main source for so many public health problems in some parts of the world. Its consumption in water is related to the development of cancer at several areas of the body (skin, bladder, and lungs), developmental effects, cardiovascular disease, neurotoxicity and diabetes (WHO, 2011, FAO/WHO, 2011a; FAO/WHO, 2011b). Furthermore, arsenic had been considered one of the most common heavy metals that pose health threat to human lives.

Now that human exposure to heavy metals identified in Yekepa mining concession have been known as major sources for chronic illnesses as well as social conditions/problems that individuals suffered/ are suffering from, health of the public is compromised or at higher risk.

Especially for permanent residents who depend on surface and ground water sources for living (bathing, cooking, washing, fishing etc.).

During the research period, as I walked on the streets of Yekepa, I saw young and elderly people bathing, washing clothes and fetching water for homes from the re-developed stream that originated from the old mines.

The colour of the water is brown and at some point red-showing snapshot/face pollution in the sights of passer-by without chemical analysis.

Moreover, I saw AML staff bathing, washing and cooking with mineral water bottles (Aqua life) and even I did use it as well for those purposes.

Sadly, ordinary residents (not employees) have no different safe water sources they were drinking from at the point the research was conducted besides those very water sources that were sampled for testing and even till date. 

Possible issues of public health concern raised from polluted water detected are:

1) is AML aware of the poor quality of water within the concession areas that is why staffs are given mineral water?

If yes, what have been their social cooperate responsibilities in making sure that ordinary citizens or residents are prevented from such grievous public health risk?

2). what have been the roles of the public health department of AML, if there is any in protecting the general public from such disaster?

3). How stringent are the Environmental Protection Agency and Land and Mines public protection laws as they relate to Yekepa concession?

 4). Has the annual research to be conducted in the concession areas as inscribed in the MDA been relaxed by the Ministry of Land and Mines?

5). Have the county authorities cared to find out why employees of this company were given mineral water to sustain them daily?

6). Is it that the company is incapacitated to build or hire similar water producing company that will benefit the larger community while boosting public’s health?

7). Or the very poor research culture in Liberia was taken as an advantage?

There are lot more unanswered questions about why things happened that way. But the public health dangers of our citizens continue to be our greatest concerns as public health specialist.

Especially, when research results and recommendations were shared with company and authorities responsible for public health protection but landed on deaf ears (3 years now).

Based on the results from the study, inhabitants are prone to suffer from health conditions that are associated with heavy metals identified during the research unconsciously due to ignorance, weak regulation on the part of public protection agencies, withholding of research results that might have been conducted before AML begun operations from the general public.

The saddest part is that communities who depend on these water sources for living are unwillingly contracting diseases that are less likely reversible with suffering and death being the final destinations for affected people.

Youths who get exposed to those heavy metals overtime lives’ expectancies are most likely going to be shortened or will suffer irreversible disabilities that may undermine their social lives as well.

Let me clearly state here that due to the nature of the study and history of previous mining in the Yekepa concession, it cannot be certain that AML is wholly responsible for water pollution detected within concession areas operated by them till date. On the other hand, AML and other protection agencies cannot be fully extracted from whatsoever current/future public health ailments suffered by citizens within the concession areas.

To prevent further public health damages, I recommend that: the county authorities especially, representative of the district make the provision of safe drinking water a priority by using some of the social development fund while lobbying with AML for more funds that will adequately provide pipe-borne water throughout the concession areas; ArcelorMittal must conduct a detail study on the impacts of their operation in all the communities within the concession on both surface and underground water sources quality including tubers, vegetable, soil, fish etc. since those chemicals are preferably hosted by those food stuffs.

In addition, the Company should also prepare an action plan to track the possibility of ingesting heavy metals by affected communities, monitor and evaluate the results over a period. On the part of the County Health Team (CHT) representing the Ministry of Health, its main focus must be driven towards preventions rather than curative since diseases or conditions caused by those metals accumulate over time.

Finally, Government through the Environmental Protection Agencies and Lands and Mines must decentralize their activities targeting concession areas rather than deploying few and often inexperienced and/or people who are less knowledgeable of the health implications associated with chemicals normally used in minerals extraction around country.

On top of all, those individuals must be people who cannot be manipulated by cash or kinds against the public’s health and what it means for it to be compromised.    

Eddie Miaway Farngalo BSN, RN, MPH,
0886484351/0777590035/wonkehmie@gmail.com

In Low In- come (ICM) countries like Liberia, Human resource for health catastrophe is one of the fears for health system performance. Countries health and development goals (safe pregnancy and delivery services to mothers) are weakened by this crisis (WHO). Lack of motivation, incentives misdistribution, and migration of health workers within and outside the country top the causes of health workers shortage.

Even-though the causes are known, they   receive little attention and are poorly addressed in health related policies (Dubois, 2003; Muhimbili University of health and Allied Sciences Analysis; Wyss, 2004).

Often, shortages of health work force are addressed merely by recruitment and deployment of similar cadre in remote areas. Retention and performance including personnel motivation, work environment, personnel management system and work organization process are overlooked (Dubois and Dussault, 2003; Muhimbili University of health and Allied Sciences Analysis; Prytherch et al., 2012; Manongi et al., 2006; Dieleman and Hammeijer, 2006; Willis et al., 2008).

Understanding the influence of working conditions (combination of compensation, nonfinancial incentives and workplace safety) on health workers’ performance is cardinal in addressing human resource for health as well as achieving both international and national health goals (WHO, 2006).

Lehnman et al. (2008) and Leshabari et al. (2008) discovered positive working environment, open communication, career advancement opportunities as well as recognition and rewarding of hard working health workers as major underlying factors for staff  management/retention while minimizing migration as well (Lehnman et al., 2008; Leshabari et al., 2008).

For this to work, Dieleman and Hammeijer (2006), Willis et al. (2008) concluded that strengthening human resource management system coupled with  serious consideration is needed in the role of governance in addressing human resource management (Dieleman & Hammeijer, 2006; Willis et al.,2008).

In Liberia, factors mentioned above are numerous-with many important players who have higher percentage (5346 (68%) out of 8553) (Liberia Human Resource for health data, 2009)  in the health care delivery system being marginalized on one hand, and minority but well attended to on the other. Such unequitable distribution of resources continues to create tension and dissatisfactions within the country’s relatively low number of health workforce. This has a propensity to further fragment the health care system of Liberia.

With inconstancy in maternal mortality rates (994; 700 etc) over the years, and with the current MMR at 1,072; (meaning 1,072 out of 100,000 women died during child birth) (LDHS, 2013). Sadly, subset of the health workforce (Nurse Anaesthetists) who is specialized in reducing or minimizing such disaster and providing critical cares, lack recognition and career ladder.

Nurse anaesthetists are registered nurses with minimal qualification of Associate Degree who are mostly sent to the Phebe Para-Medical School by County Health Teams base on need. They are trained for two years to administer anaesthesia (sleeping medicine for operations) with the objective of reducing maternal death as well as providing critical cares for patients with extreme disease complication (s).

“I believe the goals and objectives of training nurse anaesthetists in this country are to produce qualify and competent anaesthesia providers who will help to reduce motility especially maternal and neonatal by providing safe anaesthesia with careful monitoring and management of any complications.”

Contrary to Memorandum of Understanding (MoU) signed between the students and the County Health Teams (CHTs), most of them get deleted from government’s payroll. As a result, they are left with no option but to go through this major and intensive lifesaving training at their own expense.

Even, after completion of the study, there is usual fallout between the graduates and the CHTs. This is because CHTs “failed” to recognize them as important cadre in emergencies and as people who are specialized. Unlike general nurses, Medical doctors, Physician assistants etc. who often serve as managers for this group. 

“I applied for study leave for anaesthesia since there was a need for anaesthetists in Kolahun, Foya N Vahun districts including certain parts of Vonjama district that might have Obstetrics emergency cases that fall in the catchment of Kolahun Hospital. Memorandum of Understanding was signed for support and I must spend two years with the Hospital before seeking for another job elsewhere. Everything came fruitless with my name deleted on payroll and incentives which is performance based.”

Work done by nurse anaesthetists cannot be ethically executed by mere doctors (doctors with no specializations) who are in higher demand and mainly situated doubtfully in hospitals. Those anaesthetists are on 24 hour calls like resident doctors. They are routinely called to assist on inpatient wards, in the Emergency rooms (ER) whenever nurses are face with hospital related difficulties as well as critical care.  

“Just imagine wat will happen if anaesthetists in this country decide to leave the various hospitals for just 30mins. There will be a complete massacre for our mothers in this country. Not even counting other conditions. What kinda of country is this?”

“Why will you want an Anaesthetist to work for 24hrs and be paid an Eight hours salary and doing most of the Dr work? Incentive not coming at all. Even if it comes, it late (several months). The fact is we are the most ignore group in the health delivery system of this country.”

“We are the most ignored group in the health sector. Most of our doctors in the ministry were once in the operating rooms doing surgery…These people know that they never had any good and successful surgery without good and efficient nurse anaesthetists. But they have all ignored us because they are now on top and don’t care who an anaesthetist is.”

Lack of recognition for this profession had led to sub-standard theatres being operated (no anaesthetic drugs, outdated anaesthetic machines) mostly in rural parts of the country. Yet still, unrecognized and un-incentivized nurse anaesthetics are “playing magic” to save patients’ lives especially, maternal (big belly) cases.

“For me I work in the rural area as the only anaesthetist for over four years. The lack of anaesthesia machine, oxygen, anaesthesia drugs and gas, not receiving my incentive and salary as per my qualification after I have presented all necessary documents, and being alone in the county …are some of the problems I have been faced with over the years.”

Perpetually, many health worker (across midlevel) who have advanced themselves receive incentives for previous positions or degree obtained (Nurse, Nurse Aid, etc.). Consequently, performance at job site is highly diminished.

“I was nurse aid and then I went to nursing school and got BSC. Since I came back 5 years now, I am still taking the old incentives. For this reason, I don’t care to go to work every day because I need to survive.”

“When I graduated as a nurse, I was sent by the hospital to the anaesthetists’ school in Phebe. Since I came back, I have submitted all my documents to the HR office but nothing better. I am still making my old nurse incentive.”

“After going through an intensive 6 months training as a mental health clinicians, I am still paid as an ordinary nurse. I have no office for me to meet my patients. I am working on the ward.”(Mental Health clinician)

 This type of human resource for health error has made those groups or individuals’ significant role in reducing life threatening consequences or deaths especially, big belly as irrelevant.

Realistically speaking, such constant error had become a norm while stalling career development and ladder but making the health workforce obsolete in the 21st century.

Suffering from similar elementary error by HRH are the mental health clinicians who are trained by Carter Center –Liberia chapter. After six months of intensive preparation, those clinicians and their expertise in managing daily psychological challenges coupled with Post Traumatic Stress Disorders (PTSD) due to the 14 years of civil crisis during which over 250,000 lives were lost and the just ended Ebola outbreak. As such, knowledge gained is lost due to lack of recognition and incentives by local health authorities.

Worst, the national human resource for health census conducted in 2009 did not capture Nurse Anaesthetics, Environmental Health Technicians, and Mental Health clinicians as a profession. Evident that lack of recognition affecting those groups are of national consensus (involving the government).

“Anaesthesia in Lib. is like tea without sugar if I may say. Our leaders (anaesthetist leaders) have not done us any justice…more anaesthetists in Liberia are seeking greener pastures for better life…

We decided to go into this area because we want to help reduce this foetus/maternal mortality in our country, but our efforts are not recognized at all my brother…if u read the national health plan of Liberia, there is no portion that talk about anaesthesia. There have been numerous meetings in and out of Liberia concerning fetal/ maternal mortality, but I can’t remember any involving anaesthetists.”

Can the continue poor and weak health system be confounded by some of these HRH errors? Or the sharp increase in maternal mortality rate that is disproportionate to funding received? Or it the reasons why many youths are called “trouble youth” because they lack psychosocial counselling?

Passing an act and implementation are two different things. Even though acts attaching relevance to post basic programs have being passed by Legislators, they (acts) sit on the shelves to collect dust without being operationalized.

Because of this, overall performances and working conditions of health workers in immediate rural areas are impaired by those challenges.  The government and its regionalized structures should be responsible for creating a conducive working and living environments, address health workers’ dissatisfactions timely, fairly and equitably, encourage career advancement especially in areas of specialization, create a “bottom to top” communication channels where frustrated health workers can voice and  share with top management.

To accomplish this, efforts must be focused on refining the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.

Provide just benefits, housing near the health facilities for emergency health workers (Lab tech, Nurse Anaesthetist, Midwives) because they are on 24 hours call instead of administrators who works are basically limited to 8am-4 pm; improve incentive since those individuals are specialized.

Finally, research exclusively focusing on health workers motivation must be conducted as soon as possible. This will inform policy directed towards health system strengthening to be rooted in evidence. 

The Author:

Eddie Miaway Farngalo a trained and registered nurse who practiced at the Jackson F. Doe Memorial Regional Referral Hospital, he returned to graduate school and completed a Master of Public Health degree in Health Services Planning and Management (Ghana); served as a Health Training Specialist and Surveillance Assistant, Grand Gedeh County (IOM); triage nurse at the Sinje ETU; Community Support Officer for Ebola Community Care Center, Karnplay Nimba County (Project Concern International). He is currently a researcher.

Lives of citizens seem to be at deeper risk with most county hospitals covered with darkness due to fuel shortages. Residents, who have no means of travelling oversea for treatment like the privileged are in yawning trouble if they fall at sick-since the already insufficient hospitals serving catchment communities lack fuel to run generators, ambulances, as well as suffering from severe drugs shortages.

Hence, diagnostic equipment is useless. Consequently, actual lab tests for sound clinical judgement are compromised (effective treatment plans). 

Clients who have been attending some health facilities that lack those basic and essential logistics, have turned out to avoid seeking health at health centers or hospitals that are in WHO’s standard 5 km distances that are doubtfully followed. As a result, traditional healers are most likely expected to regain their relevance.

That is, herbalists (country medicine men) have become more accessible to them as compared with health facilities or centers that have become just an empty structure-no drugs to treat patients while turning out as areas where patients are given prescriptions that are usually disregarded after she/he (client) leaves the facility due to self-buying inability.

“This clinic here is empty today because no drugs. If drugs were here, this place was going to be pack. Normally, when we get drugs, I can treat about forty patients every day. We can only give them prescriptions that they can misplace every time because they don’t have money to buy it” (OIC who requested not to be named).

“me pa, I can go to country medicine man this time because any time you  go to the hospital, they will say no medicine, only paper they will give you to go buy and me I na get money”(Patient).

“Even the big hospital ser, le doctor them can be selling medicine to us because they say medicine finish so that their own medicine le bring to sell so they can get food money to eat. Le say that the government can’t pay them plenty months na” (Patient).

Government facilities in Liberia are believed to be “free of charge” but patients are buying fuel for ambulances and drugs for treatment. Thanks to the international communities for donating ambulances with the latest being three ambulances donated to Grand Cape Mount, Bomi, and Gbarpolu counties. Those ambulances are parked at the County Health Teams waiting for patients to buy fuel before they can move. With this, the intended purpose for which those ambulances were donated is less likely to be accomplished.  

“Since three months, the ambulances we have here have no fuel. Patients or people who call for their sick relatives are told to buy fuel before we go for them. Most often, they (patients’ relatives) will say no money to buy fuel for the ambulance” (Ambulance driver).

“No fuel for the hospital so the whole CHT is off. All our offices are not working besides the EOC that can help us to work because they have 24 hours current”.

“me pa I thought the government say we mon na pay money when we go for treatment but every time someone sick for you to call  the ambulance, they will say no fuel so we must buy it before they come for the sick person and we na have money ser for ourselves”(Stakeholder).

With high level of poverty in the country versus the relatively poor health seeking behaviour coupled with lack of basic lives saving materials (drugs etc.), there is a contradiction that “health  is a fundamental human right.” 

Most issues or challenges (lack of incentives for over 3 months etc.) raised or faced by the local health authorities and the health care workforce have been handled with no due diligence by policy makers.

Why the headquarters are relaxed in the midst of issues threatening the Public’s health?

Most serious health issues died natural death few days after they have been uncovered. Is it that health system is most peaceful than other entities? Or the health work force continues to be under threat/ has been intimidated by an oath given upon graduation? Is the Ministry so favoured by the central government for which no wrong is noticed? Or the Ministry is not fully supported despite the presence of several Non-Governmental Organizations?

There are lot of unanswered questions imminent in people’s minds about the way issues of importance like the health of citizens is overlooked in many ways by those who are charged with the responsibilities to “make things happen”.

Well, as we head for the national presidential and representatives elections, it is most likely that people in charge of allotments to local offices or hospitals have been adamant in terms of equitable allocation of materials essential for the smooth operation of the County Health Teams and its axillaries (clinics etc.). Moreover, it is not a secret that those who are privileged are uncertain about what the next regime will bring for them.

Therefore, they might highly be egocentric when it comes to efficient and effective usage and distribution of lives saving logistics and supplies at both central and local levels.

It must be clear that in terms of system, changing the head/management has no influence over traditional management (taking portion of materials for personal use or sale) of resources that are already limited gravely.

Until the functions of those in charge can be executed independently, replacing those in charge will yield no fruitful result but to rather picture good leaders as ineffective while the very behaviors or practices become more prevalent even when the individual has been replaced.

Lastly, much easier way for the system to compete with international standard is that the entire system must be overhauled from the least (cleaners) to the most top with people who will own it, while putting the public’s health as priority.

But when changes continue to be made at the top, management’s/ leaders minds are highly vulnerable to be poised by people at the operational level who have become accustomed to traditional practices that if not bow to, will definitely lead to character damage that will also lead to dismissal base on no cooperation from resident/old staff. 

The Author:

Eddie Miaway Farngalo is the Head of Research at the Center for Liberia’s Future, which is currently conducting a national study on community perceptions about Ebola and the reintegration of Ebola survivors, orphans and caregivers. 0886484351/0777590035/wonkehmie@gmail.com 

The Liberian media institutions (national and local) are highly interested in reporting political happenings (total coverage) as compared to public health related issues or/ prevention messages.

As a result, health which determines individuals’ social, political, spiritual, and metal outcome had been overridden by politics, which overweigh its outcomes negatively.

Health is the state of complete mental, spiritual, social wellbeing and not merely in the absence of disease (WHO, 1948). 

With the above definition of health by WHO, it means that no one is 100% healthy as maybe looked at by many who feel that they are sick only when they are unable to eat, walk, sleep etc. Worst, living on the part of continent where majority lack routine medical check-ups.  

As for the media (local and international) they play vital role as the link between health workers and the larger public by building trust, public awareness and preparedness in case of any disease invasion or exposure. This role of the media had been doubtfully executed even though its sole aim is to make business.

Both health and media authorities may argue that health information essential for public consumption is not  forthcoming while health authorities may think that media authorities find less interest in covering health related activities attentively. 

On either side, it is glaring that with the help of media (social, local, national) in Liberia, the minds of the general population especially, the youth had been occupied with politics over health matters (issues that can threaten their existence).

It can be recalled that during the deadly Ebola outbreak dated back in 2014 through 2016, media approaches in controlling the disease was not intensive- fewer music or promo were placed or captured on media frequently as compared to political season that is many months away but had been fully covered by media institutions.

For the latter, citizens, especially younger ones who are struggling to understand what personal hygiene is, are fully aware of political parties in terms of who is topping and who is the least favorite for the Presidency comes October, 2017.

All these happened not in the absence of media’s efforts. In addition, political activities like the mushrooms endorsements of various political parties across the country are almost if not fully covered by media (newspapers, talk shows etc.).

On the contrary, when over 50 midwives abandoned their facilities in Grand Cape Mount, the media reported it in a less serious manner without due diligence on life that will be lost due to the lack of those health practitioners.

Regrettably, locally and nationally assigned media reporters are more of politicians rather than public health educators. Most listened to talk shows are highly centered on politics rather than health which is an integral part of human day to day life as well as life expectancy determinant.

Yet again, how will the health systems in Liberia are prioritized by policy makers when the health sector has been presumed to be corruption free?

This is because media heavily focus on other sector’s financial mismanagement/malpractices rather than looking at how corruptions can be prevented. For example, the corruption scandal that gave birth to the word ”recuse” that led to the removal of Hon. Alex Tyler plus the most recent one involving Dr Kollie’s.

To say the least, lack of an emergency service at the most talked about capitol building that was unearthed by the collapsed of Hon. Varney G. Sherman during the endorsement of Amb. Joseph Boakai (FrontPage Africa, 2017).

Significant health related story like the last one was over shadowed by the wrongfulness of endorsing VP Boakai at the capitol building. It was given credence by many media institutions more frequently disregarding the public health implications that undermine the health system and preparedness level both locally and internationally in case of disease outbreak.

Disregarding media’s goal of maximizing profit, breeding youths in politics will balloon the already insecure and decrease levels of confidence policy makers, government officials and prominent Liberians have in the health delivery system that significantly underpins their decisions to seek medical treatment of any kind overseas.

Worth noting, if younger generation will be able to know the importance of health to their well-being, media reportage (talk shows, newspapers) need to be more health related focused along with politics because “men by nature are politicians.”

Let reporter in local communities or at national headquarters have little knowledge on mode of disease prevention and occurrences.

Finally, if media do not revised the level of relaxation on health related matters reportage (TBS, Bomber and, Costa shows etc.), our younger generation will produce more politicians rather than Medical doctors, Nurses, Physician Assistance, midwives etc. who will save the very politicians from dying prematurely of preventable diseases.

The Author

Eddie Miaway Farngalo is the Head of Research at the Center for Liberia’s Future which is currently conducting a national study on community perceptions about Ebola and the reintegration of Ebola survivors, orphans and caregivers. 0886484351/0777590035/address:wonkehmie@gmail.com