Safer Maternal Health in Liberia

"You want to make sure that the surgery you are performing is safe for your patient so that no complications arise." OB-GYN Dr. Kezelebah Goyah discusses providing safe maternal healthcare in Liberia.

Dr. Kezelebah Goyah is an obstetrician and gynecologist (OB-GYN) based at C.B. Dunbar Maternity Hospital in Liberia where he also serves as Chief of Medical Staff. Dr. Goyah is a Lifebox Fellow, leading the implementation of the Lifebox Clean Cut Program at C.B. Dunbar Maternity Hospital. He also works training junior doctors, obstetric clinicians, and other medical workers in Liberia.

“There is so much need in Liberia for qualified OB-GYN doctors, and that was an important factor in deciding to pursue this as my profession. As an OB-GYN provider my work is linked to sexual and reproductive medicine, including cesarean sections. Serving people in these areas brings professional joy and fulfilment.

It is very difficult to become a doctor in Liberia, but it is so worth it because there is a dire need for qualified doctors in our country. In 2016, the doctor-patient ratio in Liberia was one to 15,000. The World Health Organization recommends standards that include the ratio of one doctor for every thousand patients.

Our resources are very limited, and there is only one medical school. That medical school has capacity of only 50 students per year. There needs to be serious resources invested in the education and training of medical professionals to meet the national health needs of Liberia and serve our people.

As one of the poorest countries in the world, we have a very high maternal mortality rate. We see maternal mortality as one of the major challenges of the health system, so many women – 661 out of every 100,000 births – die. Reducing maternal mortality is one of the reasons why providers like me chose this specialty.

It’s rewarding when a patient comes in very sick or in distress, and you are able to intervene. In no time, you see the patient is relieved of the distress or complications, you see the joy on the face of a patient holding a baby and smiling. That’s what we achieve: giving hope to families.

However, in Liberia there is a great shortage of manpower at every level of the health system and this is a huge challenge. A lot of our patients are very poor and often cannot afford to pay for health services. We rely on external funding and the level of funding does not meet the demands.

Additionally, we are limited at our facilities due to shortages in medical supplies. Sometimes, when you want to intervene and help a patient you may not be able to do so in a timely manner due to a delay in supply delivery. There is lack of effective ambulance service, as the hospital has only one functional ambulance and the majority of our patients are in rural communities that are hard to reach.

Patient safety is very important. You’re not dealing with just one patient, you’re working with a mother and a child. You must make sure that they leave with a healthy body and a healthy baby. The very first thing on your mind should be to prevent surgical site infection. You want to make sure that the surgery you are performing is safe for your patient so that no complications arise.

Clean Cut implementation team at C.B. Dunbar Maternity Hospital, Liberia. Dr. Goyah, center, top.

COVID-19 has had a negative impact on our health systems. Firstly, there was initially a strong fear that when people arrived at a health facility they would contract the disease there. A lot of people would stay at home and only show up when serious complications occurred. In terms of maternal health, many women attempted delivery at home.

In addition to that, health facilities in Liberia were already experiencing supply shortages but with COVID-19 we had to use personal protective equipment (PPE) and other supplies more regularly. Many of these supplies are were available, and this remains a huge challenge for us.

During this time, our national government and many NGO partners, including Lifebox, stepped up to provide face masks, gloves, and other severely needed supplies. But just as equally important were the trainings from Lifebox on standard hygiene, the use of PPE, and infection prevention.

In Liberia, I hope to see some serious positive changes in the future. The first thing I want to see is a reduction in maternal mortality: to reduce surgical site infections (SSI) and prevent complications from surgery. The second thing is I want to help build a healthy population through my work. And the third thing is I want to help conduct and improve research.

Watch Dr. Goyah discuss his work providing maternal care with Lifebox CEO Kris Torgeson and Lifebox Program Coordinator, Dr. Clarence Yaskey.

Lifebox played a key role in pushing me to do research and think in terms of quality improvement. Now, instead of just focusing on seeing my patients, I think about areas of improvement: what things I can do to make my service and care for my patients better. Additionally, I am focused and keen on preventing SSIs, so I usually follow every necessary step to the detail.

My work with Lifebox has changed my mindset and elevated the quality of care. There is a tendency for people to get used to doing things a certain way, so any change can be a challenge. This work allows me to talk to and help convince others on why we should be doing better.

My message to my colleagues: take every part of your job seriously, get to know your patients, remember that patient safety is very important, and take all possible steps to reduce SSIs.”

Read more about Lifebox’s work in Liberia here.