Okay, maybe time for a bit more background on this group I’m visiting. Last Mile Health, known locally by its indigenous name “Tiyatien” has its roots in a belief in social justice and the belief that health care health care is a crucial part of social justice. As the crow flies, we’re not all that far from Monrovia, but the past two days have been a vivid reminder that in Africa, a map doesn’t tell you the distance between two places. Most people out here just can’t get to even basic health care, and statistics like infant mortality are appalling (~18-23% Think about that number: 18-23% infant mortality). As Raj explained, “The real reason these people don’t have health care is because some economist looked at a spreadsheet and decided it was too expensive – too few people spread out over too large an area.”
There’s a perverse sort of winner-take-all economics that comes into play with rural health care. People gravitate to the biggest facility they can reach, which becomes overcrowded, and gets more money on next year’s governmental budget. Folks who can’t reach a facility (e.g. it’s a 24 hour walk from Billibo to the nearest clinic) don’t go. They get sick and possibly die unrecorded in the healthcare demand records, so no money is allocated to the needs of their community.
Raj says that Last Mile Health focuses on communities that are more than 5 km or a two hours walk from any sort of services, which encompasses most of the population outside of the capital. He found himself caring for these people by a roundabout path, following his family’s itinerant tendencies. His grandparents were displaced from what is now Pakistan during the partition of India, and his father moved from Bombay to Liberia during the seventies to pursue business opportunities. Raj was born and raised here, but fled to North Carolina with his family during the Liberian civil war. He is a native Liberian in all ways but one – although born and raised here, the country’s constitution reserves citizenship for those “of African descent”. But his heart and mind are here – honestly, it keeps throwing me to hear him say “we” and mean he and his fellow Liberians.
Anyhow. During college at Raj spent a summer fellowship in Alaska seeing how rural medicine was practiced and became convinced that Liberia’s remote communities required a model of health care different from what was being provided. As soon as he finished his residency he came back. While the country tried to build itself back from the ashes of the conflict that killed over 10% of its population, Raj began forming this organization to serve the unserved rural poor. He has a “day job” as professor at Harvard Medical School and physician at Brigham and Women’s Hospital in Boston, where he lives with his wife and two year old son. But he makes it up to Zwedru and Konobo something like five or six times a year to dive back in and continue building the organization.
Anyhow, that’s Raj, just one story of one person in the project. Everyone here has stories – Breeanna, Alex, Patrick, Alphonso, Alice Unice – I only got to hear a few of those stories last night, and they were all amazing. Me: humbled.