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Last Updated: Friday, 18 July, 2003, 12:59 GMT 13:59 UK
Diary of a Liberian aid worker III
Medecins Sans Frontieres is one of the few aid agencies still working in Liberia.

Tom Quinn, who works for MSF, is writing a diary for BBC News Online.

Tom Quinn
Tom Quinn who works for MSF in Liberia

0900 GMT, 18 July

Just as I'm getting myself ready to leave for some R & R, things have begun to go downhill again.

It all happened yesterday when rumours were swirling about that there was fighting at Klay Junction about 35 km north of the city. I was up at Rick's Camp - about halfway towards Klay - checking on the new clinic.

It all seemed calm, perhaps a few more people there. Then I heard artillery up the road we use to get in. Still perhaps 5 km away but hmmm, a bit worrying.

Everybody ran out of the clinic and it was clear if they blocked the road, we would be trapped. It's the only way out of the camp. We had to suspend the clinic, a couple of days after we started it up. So frustrating.

I moved on to another of the camps that's a bit less exposed and carried on with some malaria work. Found another four kids with kwashiorkor from protein deficiency.

It's getting so regular now; very worrying that it so common when it's such a serious condition. Anyway, brought them back to town.

Later on, our head of mission, Alain, tried to get back to those camps in the north of the city and couldn't get through.

The rebels had pushed much further down the road. They're now at the Po river, very close to the camps and the staff there can hear small arms fire and mortars.

He's going back out there today to see if things have stabilised.

The people in the city are pretty anxious about whether the fighting will reach the middle of town. The word in the street is that the rebels, so far, have said they don't intend to come in.

I'm really torn though. I have to go on this seven-day break to Sierra Leone. I'm exhausted and I don't think the boss would let me stay.

On the other hand, it feels like a bad time to go. The only consolation is that I have great faith in the clinic supervisors. They'll manage fine without me.

I hope I will be bringing back an extra nurse, Amie. She got cut off in the fighting last month and ended up in Sierra Leone. We need all the hands we can get.

Got to get my stuff together for the flight now.

1700 GMT, 16 July

Still opening clinics. Well, re-opening them in this case.

Today I've been at Ricks camp, which before the fighting used to be one of the busiest in the town. Now it's down to around 2,000-3,000.

But they still need a clinic to pick up the serious cases and for someone to be watching out for the people in the camp if there is harassment from militias.

That's not a big threat at the moment. Malnutrition is though.

I've just seen three cases of kwashiorkor. It's not so rare around here because there is such high protein deficiency and when that happens in children you get this swelling of the belly, a sort of apathy and tiredness, even loss of appetite.

In the camps it usually comes from kids only being fed this staple mush called "fufu", which is made out of cassava. You see them chewing on this grey lump of doughy stuff. It fills the belly but has no protein at all.

The three kids are off now for intensive feeding in the middle of town. And the new feeding centre that we're building is progressing well.

The walls and roof of the pharmacy and storeroom are up. The wells are being dug. All of the kit we need to finish the job is now off the planes and into town.

Mind you, none of that deals with the background problem, which is how to get some protein into the diet in the camps.

After Ricks clinic I was into a training session for the senior Liberian staff here. That malaria treatment I was talking about the other day depends on accurate testing.

So there we were, 30 of us, practising pricking each other's fingers with this kit called a Para Check that gives a very quick diagnosis of whether there are malaria parasites in the blood.

I'm surprised and proud to say that we all passed the test - we're fever-free health workers.

My spirits are rising for other reasons at the moment. On Friday I'm off for a week's break to neighbouring Sierra Leone. I need a breather.

1700 GMT, 14 July

This week it's malaria - as well as cholera and malnutrition.

Just been planning a training session with one of my clinic supervisors to expand our new drug treatment regime.

So many people here live with this terrible disease as if it's inescapable. Half of the kids that we see in the camp clinics have got it.

Under-fives with fevers, vomiting, headaches, they're just queuing up. And the standard treatment in this part of the world, chloroquinine, is just not working.

We've started treating with a combination of drugs that we hope to roll out into all the clinics. The difference they can make is dramatic.

When we were starting the trials a month and a half ago, people who had been taking chloroquinine for years had just one day of the new drugs and came back saying, "Very strong medicine. It's working already".

That's just because the parasite is so resistant to the old drugs.


Not that everyone is unhealthy. Over the weekend I made the mistake of signing on for a football match between the NGO workers and the "refugees", the displaced people we're trying to help.

It took place in the town's main stadium , the SKD, where so many of these people have taken refuge under the huge 20,000 seater stands.

Tough game. We finally lost 1-0. The NGO staff were not quite fit enough. I can't really blame the heat , it was only 28/30 degrees. Not too bad for Liberia. We just couldn't keep up with them.

It had all been set up so professionally with uniforms for the teams and a formal trophy presentation at the end. But not for my shelf, I'm afraid.

Another good news story from the MSF team. We had been really worried about one of our locally recruited nurses, Amie, who had got caught up in the fighting on the edge of town when the rebels came past our clinic.

We just got a message that she has turned up safe and sound in Sierra Leone next door. Well actually a long , long way from where she started. But it just shows you what's been happening to the people of this country; swept in all directions by the fighting and the fear.

They're still worried now. Worried that there's a lot of talk about peacekeepers but nothing official from President Bush. Uncertainty is very bad for the nerves.

17.00 GMT, 11 July

A bit slow in getting fingers to the keyboard today. I've spent the day initiating a new volunteer into the tricks of cholera treatment in Monrovia.

We're getting some extra help with fresh nursing hands arriving - just as well because the pressure is certainly increasing.

There were 350 new cases last week. That was up from 200 the week before. Certainly the worst epidemic here for many years.

Hardly surprising though. There are so many people squashed into places where they don't normally live - in fact where nobody should be expected to live - that disease is bound to spread.

There are 53,000 extra people scrambling for space in central Monrovia at the moment. Just down the road here there are 1,000 of them in one derelict government building with no running water or loos.

You can image the mess and the risks to health.

So even with the improvements in water trucking that are beginning to happen, the only way to help prevent infection is to track back to the patients' homes and get to work with chlorine and hygiene education.

At least we're catching most of the cases. People here know that you have to get to the clinics very quickly and they know where we are now. If you can stabilise a case in the first four hours with re-hydration, they're pretty well safe.

That's not so easy if you've got more complicated cases.

I had another sad one today. A girl of perhaps 14 - very difficult to tell because she was so painfully thin.

She had been getting thinner for some time apparently and now she had shingles and was pretty poorly. I'm afraid it looked like TB or even Aids.

The official figure here is around eight to nine percent of the population with HIV. Trouble is that if you're a teenage girl you're very much more likely to be a victim.

Depressing reminder again of all the things that you really can't make much difference to.

13.00 GMT, 9 July

A very upsetting thing just happened to me.

A mother had brought her little five-year-old daughter into our clinic in one of the camps here in the city.

The poor girl took one look at me and freaked out, scrambled into the corner of the room and started shrieking and sobbing.

She was uncontrollable and clearly very frightened of me.

That was bad enough, but what made it much worse was the reason.

We are pretty sure she had been raped.

She was bleeding and could only be approached by female staff.

We sedated her to do a proper examination.

The physical damage was not as bad as it might have been and we have dosed her with prophylactics against diseases.

But the psychological damage will almost certainly be much worse.

We will get that rape project back on track.

We have already got a couple of senior ladies, who will generate respect and calm, trained and ready to spread the counselling skills.

But the terrible thing is how women here are so used to abuse.

On a happier note, we got our cargo plane from Europe into the airport this morning with some of the material we need to set up the therapeutic feeding centre and a lot more for the cholera clinics.

What a joy though to start making an impression on the food problem.

I was talking to the camp committee yesterday - people from the camp who run the camp.

They were reeling off a huge list of all things that they needed: sheeting, bedding, water... the lot, basically.

And then they started telling me how the kids' bellies were swelling because they were starving.

"Ah, well," I said. "As it happens, we can start solving that right now."

"There is a feeding centre coming right here this week."

It was great to see their faces.

They loved it.

1400 GMT, 7th July

Everyone in the city is holding their breath about whether or when American troops might arrive to be part of a peacekeeping force.

In fact the security situation has got a bit calmer over the last few days.

I've heard no shooting from the outskirts for some time now and none of our patients have any stories about fighting. So the ceasefire seems to be holding.

Today I've been whizzing round between the clinics. Managed to start up two new ones, largely because of the energy of our new logistics guy, Pierre, who is the driving force behind this work.

There's an extra cholera treatment clinic with another 60 bed capacity and we've re-opened the outpatients clinic at Redemption Hospital that had to be shut down at the height of the chaos here.

Some problems because there had been looting and damage but at least it's functioning again. It used to have over 5,000 consultations a month and the demand is much higher now.

That's something that became very clear from the stats that I was doing in the quiet bits of the weekend; the numbers of patients that we've been handling has doubled in some of these clinics since the latest upsurge in violence.

On the cholera front, the extra beds are sorely needed and we've got yet another clinic planned to open by the end of this week. It all comes down to clean water in the city.

The system has broken down and unless you can afford to buy bottled stuff, you're at risk. Which is where health education comes in too.

MSF has just started some radio drama spots to try and get the message across about how to minimise the threat for families.

The threat that so many of them worry about though is the way people behave with guns here.

There's a real concern that there could be even more anarchy if Charles Taylor steps down and then out of the country. As I said, everyone's holding their breath.

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