Interview: An update from Dr. Raj Panjabi on the Ivorian conflict

Beth Cohen ( Bio  /   Posts )  |  Tuesday, May 24, 2011 UTC

A month ago we spoke with Dr. Raj Panjabi, Harvard physician, PopTech Social Innovation Fellow and co-founder of Tiyatien Health, an innovative organization founded by survivors of Liberia’s civil war to pioneer community-based health care in eastern Liberia’s rain forests. Panjabi has been traveling back and forth to Zwedru, a Liberian town only ten miles from the border of the Ivory Coast, where he and his colleagues have been caring for refugees of the Ivorian civil war.  While the violence has decreased throughout large parts of the country, areas remain unsafe, and consequently hundreds of refugees continue to pour over the border into Liberia. We spoke with Panjabi late last week to learn more about what’s going on on the ground.

PopTech: You’ve just returned from Zwedru, Liberia where the refugee crisis continues.  What kinds of problems are you seeing among the patients you’ve been caring for?
Raj Panjabi: We’re still seeing both acute problems brought on by violence, and chronic problems that are brought on by poverty.  The violence continues to be evidenced in gunshot wounds.  It is also causing new cases of malnutrition because as the villages’ populations increase – in some cases five-fold – there’s simply not enough food to go around.  There are also mental health needs that are arising as a result of the violence.

This is on top of chronic food shortages, malaria, HIV, TB and the risk of maternal mortality in what has been called by the UN one of the poorest places on the planet.  The health care system, which was already weak due to years of conflict in Liberia, is quite strained with an influx of people.

What are your patients telling you they and other refugees have experienced that led them to flee? And what happens once they do escape?
The violence has been extreme. For years I’ve worried, having grown up in Liberia and having worked now for several years with other survivors of the war, about how dehumanized West Africa has been. What we’re hearing from our patients is that the mothers and fathers have seen their children killed in front of their eyes, the children have seen their parents’ homes burned to the ground.  They’ve seen their parents shot. 

If refugees are able to escape, they face a lot of challenges. One of the realities we know from Human Rights Watch is that women face the possibility of having to resort to survival sex – trading sex for food – because they don’t have money to buy food and because of the food shortages.  There’s also a lot of exploitation as well – we know that there are reports of rape of young girls and women.

Can you tell us how you and your colleagues at Tiyatien Health are addressing the area’s health needs?
For several years we’ve been training community health care workers to provide health care to their neighbors by going door to door and providing care where doctors can’t reach. We have a team of 40 community health care workers who we’ve been training to do HIV, TB and mental health care.   Right now mental health care is very important for people who’ve experienced the kind of violence and disruption these refugees have experienced.

As it turns out, many of the people coming over from Ivory Coast are relatives of our health care workers.  They know their language.  We rely on them to identify sick refugees and provide them with care and an understanding that they’re not alone.

One of the great things about being focused on community-based care, and not just hospital-based care is that when I, as a doctor, finish caring for a refugee patient who has suffered from bullet wounds, I can rely on our community health care workers to make sure that the patient will be visited at home, that she’ll have social assistance, and that her children will be watched for malnutrition.  Even though she is away from home, the patient is linked to a community that she can become part of. 

What can you point to that says definitively yes, your work is having impact?
While only a fraction of the UN’s $300 million appeal has been funded, the amount of funding we have had has been used to save many lives. And we know that when Americans have an outpouring of generosity like they did after the earthquake in Haiti that we can save many lives.

As for impact, after seeing an infant die in our hands due to malnutrition, we advocated for our partners to start a malnutrition unit that’s serving about 20 children per week who are coming in with starvation. We’ve seen kids coming in looking like skeletons on the brink of death, and in a matter of a couple of weeks literally coming back to life, and then returning to their communities with their mothers.  That’s the beautiful thing about how simple these interventions can be and how much impact they can have. 

Another area where Tiyatien Health is having impact is with our ambulance service.  We have been asked by the UNHCR, the UN Refugee Agency, to help with arranging ambulance services for very hard to reach communities.  We’re working in some of the most remote rainforests in the world where there are only 11 people per square kilometer.  It can take people in these villages up to 17 hours to walk to the closest clinic.

In the last three weeks we’ve managed to put to use two ambulances to provide mobile health services.  Every day there are 6-12 patients that are using this service, everyone from mothers in the middle of a complicated childbirth who would die if they weren’t able to access to a c-section to children with malaria who need blood transfusions. 

Finally, we’re continuing the work that we’ve been trying to do all along with local health care workers and the Liberian Ministry of Health and Social Welfare.  It may, in fact, be the best answer to this crisis.  By investing in their training now to respond to this acute crisis, we’ll not only be responding to the conflict, but once the conflict we all hope resolves, we’ll actually have invested in an army of community health workers that could provide hope and healing over the long-term to these communities.   

This interview has been edited and condensed.

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