A young woman lies in intensive care at Liberia’s Phebe Hospital.
Her mother comes running in with the drugs she needs, but the doctor shakes his head. It is too late.
“When patients come, we are obliged to send (family members) out to get drugs. Sometimes by the time they get back (the) patients are dead,” laments Dr Jefferson Sibley, the hospital’s medical director.
“People are dying in front of our eyes, and we cannot do anything.”
Battered by years of civil war and then in 2014-16 by the worst Ebola epidemic in history, Liberia’s health sector is on its knees.
The crumbling infrastructure lacks almost everything — medicine, beds, equipment, ambulances, even a reliable electricity supply.
Phebe, in central Bong county, is the second largest hospital in Liberia, with 200 beds and seven doctors on its staff.
Despite chronic shortages, it still manages to treat at least 2,500 patients every month.
“We are supposed to get supplies from the ministry of health and the National Drug Services (NDS) but we haven’t received supplies for almost a year,” Sibley told AFP.
“We can’t do anything about it.”
Malaria was the cause of death of the woman in the intensive care unit.
She was 25.
‘Only the mercy of God’
According to the World Health Organization, total health expenditure per person per year is about $100 (87 euros) in Liberia, among the lowest in the world.
There is fewer than one regional or district hospital per 100,000 people in the country of about 4.7 million.
In 2010, accordiong to the latest available data, there were eight hospital beds per 10,000 people.
In Jenepeleta, a village 30 kilometres (19 miles) from the hospital in Phebe, Regina Kollie, 45, is trying to lower the fever of the youngest of her five children, a four-year-old girl.
Like many in the region, Regina sought help in traditional medicine and gathered leaves with which to wash her daughter, following the advice of a healer.
The treatment is not working and the child’s fever has raged for days. But going to the hospital is not an option.
“I don’t have the money to take my daughter to Phebe. The ambulance used to help us in these cases, but we don’t see it any more,” Regina says, weeping.
“The two ambulances we had are broken down,” Sibley confirmed, noting the vehicles had been “instrumental when it comes to saving lives”.
The ambulances “used to go for pregnant women, children and other people who are seriously ill in the villages… and bring them to us,” he said.
But now if there is an emergency case, “only the mercy of God can help.”
Surgery by storm lantern
“We have so many problems, but the key problem is that no funding is coming to the hospital,” said Sibley.
“We find ourselves indebted to vendors. People we take fuel from, people we take drugs from, all of them refuse to supply us because we owe them lots of money. The hospital owes $300,000 (265,000 euros) to vendors.”
The hospital’s electricity is frequently cut off, plunging it into darkness at night and forcing the lone surgeon to carry out operations by the light of storm lanterns.
A shortage of medicines is also crippling Liberia’s largest national health facility, the John F. Kennedy Hospital in Monrovia, says its medical director Jerry Brown.
“There are some drugs you can’t find in local pharmacies and government regulations prohibit us from procuring drugs currently from pharmaceutical companies outside the country,” the chief doctor told AFP.
“Our next source of drugs is the National Drug Services,” but it provides only enough to treat the most vulnerable, including children.
The hospital was negotiating with the ministries of health and finance for authorisation to buy directly from manufacturers, Brown said.
Health Minister Wilhelmina Jallah said the problem stemmed from the previous government, under which hospitals ran up big debts by obtaining drugs and fuel on credit.
“We have inherited all these debts, and the vendors no longer want to give us credits,” she said. “We have to pay some of these debts so that we can open the credit lines.”
In a sign of progress, eight container-loads of drugs had arrived, and these will help to ease shortages, she said.