Enova Mission Program
Many months ago, Dr. Michael Klein came into Enova’s office to purchase a pair of loupes. Coming from Chicago, there was some instant bonding over our Midwestern roots. When the office learned of Dr. Klein’s commitment to mission work around the world, it only further excited us. We sat him down and talked with him about his work abroad, filming it and holding on to it for future use.
Five or sixth months later, we got the update we were waiting for. Dr. Klein sent Enova an email with some pictures from his recently completed trip to Liberia with the caption “Great 2 months operating in Liberia on children. Here are just two photos.” Having spoken with him in person about his mission work in general (and his motivations behind doing it) we now had the chance to hear about a trip fresh in his memory. To truly understand and contextualize Dr. Klein’s trip to Liberia, it is important to first understand some of the history of the country.
Liberia lies along the coast of Western Africa, with close to 5 million inhabitants spread across more than a dozen ethnic groups (Full Map). The country’s population also speaks more than 30 indigenous languages, each spoken by only a small minority of the total population. While many of the ethnic groups are indigenous, the 19th century brought changes to the country’s population that led to intense conflict and war.
In the mid-1800s, many groups throughout the United States favored re-settling of freed slaves to the coast of west Africa. Different entities had very different reasons for favoring resettlement, some more humanitarian than others. Some advocates felt that a future in Africa was the only way freed slaves would ever be truly free and accepted, while others favored resettlement so as to not destabilize the American slave economy.
In some ways, culture in Liberia reflects positively on the American efforts of resettlement. The capital is named Monrovia in honor of U.S. President James Monroe, and Liberia remains one of three countries in the world not using the metric system of measurement (the other two being U.S.A. and Myanmar). However, in some important ways the efforts of resettlement have had a more tumultuous effect on the people of the country.
The people that descended from resettled freed slaves are referred to as Americo-Liberians. Despite making up a very small percentage of the population, the Americo-Liberians maintained control of government and greatly subjugated the indigenous people of the region. A history of tension came to a head in 1980 with a military coup, leading to more turmoil and two civil wars.
In the early 2000’s, the women of Liberia banded together to stop the fighting using the sex-withholding techniques of ancient Greek heroine Lysistrata. After these efforts, Ellen Johnson Sirleaf was elected president, making her the first woman elected to the position of head of state in Africa.
Through all of this (and a brief but devastating Ebola outbreak in 2014), Liberia’s healthcare system has taken a major hit and remains one of the least developed in the world. Malnutrition and female genital mutilation are widespread, and the number of doctors per capita is hugely insufficient (HDI statistics from the UN here). It is in this context that surgeons like Dr. Klein come into play. In his case, the place of work was Barnesville Jct. Children’s hospital in the outskirts of Monrovia.
When Dr. Klein describes the hospital in which he spent two months, some of the first words used are “huge” and “depressing”. The hospital was something else before it became a hospital, but Dr. Klein is not sure what. Surrounded by high barbed-wire walls and protected by large metal doors and a constant watchman, the hospital does not evoke pleasant or healing memories for an American listener. Yet, unemployment and theft are issues in Liberia, and hospitals in developing nations do not have a lot of money to spare for replacement equipment.
When it comes to the healing capabilities of a hospital, however, all that truly matters is the inside. Here, the image of Barnesville Jct. is quite different. The hospital has around 100 beds, complete with an entire malnutrition ward. There are hand-washing stations with Chlorine everywhere, and the Operating Theaters (OT) are “spic and span”. The OTs “could easily be in any US or European hospital.” Since it is a children’s hospital, caregivers are required to stay with every child. With mother, father, brother, or sister caregivers, the inside of the hospital presents a warm and safe environment for the patients.
Staffing the hospital is a different challenge; Liberia has a huge shortage of doctors and nurses as a result of the decades of conflict. Barnesville Jct. is able to staff the hospital with one pediatrician, an MD anesthesiologist, a nurse anesthesiologist, and other scrub nurses. For surgery, on the other hand, the hospital must turn to outside help. One surgeon is always staffed at the hospital, usually from Europe or America. Before Dr. Klein arrived a man from Duke University covered surgeries at Barnesville Jct., and after Dr. Klein came a woman from Italy.
The surgeons that work at the children’s hospital are always pediatric specialists. In general, the surgeons sign up for a 6-week commitment, which includes travel time and debriefing in New York. Once the surgeons arrive in Monrovia, they take full command of all surgical procedures that happen at Barnesville Jct. With a scrub-nurse as their assistant, the visiting surgeon tackles a variety of cases ranging from mild to severe.
In Dr. Klein’s time in Monrovia he performed 160 surgeries. Over 100 of his surgeries were hernias, with about a third of these cases being the most difficult Dr. Klein had ever seen. In addition to hernias, Dr. Klein operated on a patient with Perforated Appendicitis (stemming from Typhoid fever), two chest cases of empyema, and a 7-month old baby with intussusception. For very special surgeries such as neuro or esophageal, patients need to travel elsewhere, but this often requires hours of travel.
If a case can be performed by the visiting surgeon, it will be. For Dr. Klein this meant a very exciting case of retropharyngeal abscess. A 6-year old girl came in with the abscess in the back of her throat, restricting her breathing. When she was laid down for surgery, her body arrested, and an emergency tracheostomy had to be performed. The abscess was then drained using a laryngoscope. It was stabbed and, in the exaggeratory yet vivid words of Dr. Klein, “gallons of puss” came out. The tube was then left in for a week to help the patient breath and after a week the patient went home and the hole closed naturally on its own.
Through his six weeks in Monrovia Dr. Klein helped children in a region where help is not easy to come by. In fact, the Barnesville Jct. Hopsital is the only place in Monrovia where children can get free care. In a country with just under 50% unemployment, children remain at high risk of poverty, malnourishment, and lack of medical care. Doctors, organizations, and hospitals such as those in this story offer a chance at a normal life for at-risk populations.
Enova Illumination does not provide medical help, but we try to aid those that do. Dr. Klein is a frequent user of Enova’s headlights, and has even donated them to places he has visited. He left two Enova headlights in Kenya and says that the XLT-125A was essential in his more difficult cases in Liberia. While Enova doesn’t contribute medical expertise or time to mission doctors around the world, we do contribute resources. We are so happy our products helped in Dr. Klein’s missions, and we hope they will help in countless more missions to come.