Andrew Schechtman of charity Medecins Sans Frontieres has been witnessing the tragedy unfold in the Liberian capital, Monrovia. He has sent parts of his diary to BBC News Online.
Helping Liberians is 'worth the risk'
When a door slams, I jump thinking it to be a mortar
shell exploding in the distance.
The sporadic bursts of gunfire
during the day are not so worrisome.
Most of the bullet injuries
we've seen have been from falling bullets. We never hear the gunfire
before the bullets fall.
I assume that they must be fired from too
far away to hear.
This also leads me to believe that bullets that I
hear being fired will most likely land somewhere far off. Following
the logic, I feel safer when I hear the gunshots.
know if this logic holds true or if it is a desperate attempt to find
a pattern, to find predictability, to find an illusion of safety
amidst the chaos.
The newborn baby boy faced an uphill battle from the beginning.
mother had been in the earliest stages of labour when two
minimally-trained birth attendants tried to assist with his birth.
Despite the fact that her cervix had only dilated to two centimetres
instead of the required 10, they climbed on her and pushed on her
Doctors are discharging people who have nowhere to go
They put instruments inside her and ruptured her bag of
waters, trying to hasten her labour.
She arrived at our hospital after
two days of their earnest but misguided interventions, burning with
fever and bleeding from her vagina.
When we examined her, her cervix
was still only two centimetres dilated but was now also swollen.
Listening with the fetoscope pressed against her uterus, we couldn't
hear the baby's heartbeat.
Our fear was that the baby was dead in the
womb. The limitations of the fetoscope, a very basic stethoscope-like
device which was essentially just a hair better than putting ones ear
directly to the woman's belly, left some hope for the baby.
have been alive and we just didn't hear his heartbeat. We started our
patients on strong intravenous antibiotics to combat the infection and
gave her drugs to induce labour.
Improvised oxygen mask
Six hours later, her fever was down
and the baby was delivered. He was a beautiful little baby boy but
hadn't tolerated the intrauterine ordeal well.
He came out floppy and
blue. We resuscitated him as best we could and he improved.
a little less blue and his breathing slowed to a normal rate. I started
him on the same strong antibiotics I had his mom on and initiated a
sugar water infusion since he was too weak to start breast feeding.
had recently received an oxygen extractor for our hospital and he would
be the first patient to benefit from it. The oxygen extractor creates
oxygen from the air using electricity and is quite practical in
settings where oxygen tanks are hard to come by.
We improvised a
baby-sized oxygen mask by cutting up a plastic one litre bottle and
hooked him up to the machine.
He seemed to be getting better. The
blueness receded almost to the point where one could say he was
starting to look a little pink. Along with our oxygen extractor, we
had also just gotten a pulse oximetre, a device that can read the
oxygen level in the blood when clipped on a finger.
We tested our baby
boy and his response to the oxygen. His oxygen level was 78%. This
was not good. A normal oxygen level is over 94%.
This baby needed an intensive care
This baby needed to be put on a ventilator. He needed the
oxygen pumped into his lungs until the antibiotics could kick in, until
his little body could mount its own immune response against the
infection he'd contracted in his mother's womb.
But there is no
neonatal intensive care in Monrovia. There is no ventilator. He died
an hour later. We had done all we could.
Fatu (not her real name), a 20-year-old woman, was brought to our
clinic from the nearby community of West Point.
She had been raped
the night before by an armed man.
In a private examination room with the
presence of a female escort, she calmly shared with me the details of
her attack as the tears quietly ran down her face.
Liberians have nowhere safe to flee to
Four armed men
wearing masks grabbed her and threatened to shoot her. One fired his
gun into the air overhead.
She fell to her knees and begged him not
to kill her. He dragged her to a place that people
had been using as a toilet and threw her to the
He held his bayonet over her, threatened
to kill her, and raped her.
I examined her and completed a legal
report I gave to her in case she had the opportunity to prosecute her
assailants in the future.
This was not likely. She didn't know who
had attacked her and there is no functioning system of law in
The streets now are filled with armed men, boys recruited
to fight, given weapons, and provided little if any training.
are not professional soldiers. These are ill-disciplined boys with
To compound the problem, these recruits are not paid for their
work. Instead, they are encouraged by default to "pay themselves."
This means grabbing whatever goods of value they can get
their hands on, looting from the civilian population, businesses, aid
organizations, and sometimes from each other.
The general lawlessness
that this promotes has led to a lot of rape.
I gave her single dose preventive treatments for all the treatable
venereal diseases - gonorrhoea, chlamydia, trichomonas, and syphilis.
gave her a course of post-coital (commonly called "morning-after")
contraception to prevent pregnancy. Perhaps most importantly, I
educated her about and started her on an antiretroviral drug
combination for preventing of HIV infection.
She had survived a
I was glad I was able to offer her state-of-the-art medical care in the aftermath to minimise the chances that her
tragedy would be compounded by a sexually transmitted disease, an
unwanted pregnancy, or Aids.
I gave her care that I think was as good
as that which she could have received in most emergency rooms back home
in the United States. I think she deserved at least as much.