Car Talk
Pothole warning system
Augustine and I are on our way to JDJ Hospital in Niesa District, an indistinguishable tract of make shift huts, homes, store fronts and cell-phone stalls thirty minutes drive from the Capital resting in a blur of ailing mini-vans, dust clouds and swift-moving limbs. The road to Niesa seems especially bad this morning. I am noticing the details of its degradation like one notices a liver spot or facial crease in the mirror one day with the sudden realization that years have gone by. The asphalt, which was set over three decades ago, has suffered twenty years of civil war, pounding seasonal rains, and lack of alternative routes. Where there is asphalt there are also innumerable breaks in the surface not unlike a devil’s minefield. What seems like insignificant holes the width of Dobermans’ haunches is in reality steep drop-offs at least six inches deep. Put two wheels of a sedan in them and the bottom of the vehicle takes on a sickening thud then dull scrape. Of course Augustine and I ride in a sedan and I am driving. In Liberia, if you can afford it best have a Jeep.
“When are they going to fix the road,” I ask Augustine, “if I were the President, that would be the first thing I would do-- Build a road as smooth as a baby’s bottom from here to Nimba and Lofa.”
“There are plans to rebuild the road,” Augustine replies, “this was one of Sirleaf’s campaign promises.”
“Her first term or her second?”
Augustine chuckles.
“Who is going to build it?” I ask.
“The Chinese,” Augustine replies.
“Of course the Chinese,” I say, “what haven’t the Chinese done in Liberia besides not build a good grocery store in Monrovia.”
“Oh, they just built one,” Augustine informs me, “It’s called ‘Liberia’s Most Excellent Grocery Store’.”
“Bastards,” I say, “the Chinese are ubiquitous. They are colonizers who use checkbooks instead of swords. Maybe I should become Chinese.” Augustine looks at me funny.
I am joking but not, albeit a little frustrated so not thinking straight. The health program I run funds 80% of IRC-Liberia, but whereas my counter-parts drive Toyota Land Cruisers, I somehow get a Toyota Corolla that has a working man’s B.O., a dent in the front passenger door and a bumper sticker that reads, “Real men don’t rape.” Right.
I am also tired of being mistaken for being Chinese. I have lived in Liberia for almost two years, but the same dialogue gets played over and over again, particularly up country.
A typical situation up-country
“Hey White man!” someone will say.
“I am not White,” I will say, “I am Taiwanese.”
“You are Chinese.”
“I am Taiwanese. Taiwanese American to be exact.”
“You look Chinese.”
“You look Nigerian.”
“I am not Nigerian.”
“I am not Chinese.”
“Nigerians are bad people who rob.”
“Well, then you know.”
“Know what?”
“How it might feel to be mistaken for Chinese.”
“But I am Liberian and cannot know.”
“No, how it feels for ME to be mistaken for Chinese.”
“But you look Chinese.”
“Oh, God.”
Augustine and I have become close friends. I hired him as health assistant my first month in country after noticing that the only person listening to my tirades during weekly doctor jaunts at JDJ was a skinny nurse aid taking notes. Augustine has distorted my notion of what is common. He is excellent on the computer and knows rudimentary programming. He stays on a project until it is done. He responds to feedback. When I ask him what he wants to do, he says things like building children’s playrooms in the hospitals we support or reorganizing the neonatal care units so that babies get fed and administered medicine within a normal work-flow. Come to think of it, I love Augustine.
Augustine accompanies me every Sunday to do rounds at JDJ. Though I am actually discouraged by my boss to do clinical work because it “takes me off my game”, I believe that personalization of work is exactly what is needed to understand how to build and maintain strong and sustainable health care systems. That is my job. I call it having skin in the game, or in our case, blood and vomit on the shirt. If you don’t feel it, smell it, or see it, you will likely ignore it and really, f*&k anyone who wants to tell me how to spend my free time. Our trips to JDJ start at 9:30 and end around 4:00. They have become Augustine and my ritual, our weekly marathon, a seriously unromantic steady date. The work is usually hard, frustrating, and dramatic with rare periods of satisfaction but we always learn, which to me is a main point.
Augustine Koryon
“So tell me our systems are making a difference at JDJ,” I say to Augustine.
“Our systems are making a difference at JDJ,” Augustine says.
“Really?”
“Well some systems are working better than others,” Augustine laughs, “in the ICU, the nurses are trying to use the drug consumption ledgers.”
“So trying is good?” I ask, “In the U.S. trying is not good. Trying is a gerund. We try to avoid gerunds. Gerunds are bad.”
“I don’t know what is a gerund,” Augustine says, “But trying is good in Liberia. Better than not trying.”
“True that.”
“True what?”
“It is better to try than not to try.”
“That is true.”
“You tell the nurses that I will personally make sure that anyone who doesn’t account for medicines dispensed will be fired. It is their job. It is non-negotiable. If we can’t account for what medicines are dispensed to patients, we can’t tell what is released from the pharmacy or warehouse is not stolen.”
“You cannot fire the nurses. We don’t have enough nurses. Some of the medicines are likely stolen. It would be good if the administration could lead this effort.”
“It would be good, but they haven’t and won’t. We are talking about the same people, right? Jallaba, Shirley and Kai Kai? You think they will lead?”
“If Jallaba, Shirley and Kai Kai can’t adequately fulfill the requirements of their positions, then they should be replaced.”
“So you are saying to have them fired when they don’t have replacements. By the way, wasn’t it you who told me that they all run private clinics and are likely using the medicines that the nurses aren’t recording in the consumptions ledgers?”
Augustine frowns, “that may be true.”
“We just need a few more people, a few more eyes, and we will figure this out. We have to.”
public works
We have come to the point in the road where two excited gentleman fill potholes. Usually they are dressed in bright fluorescent vests and hard hats but not today. I remarked months ago how I was impressed by the enthusiasm of the city road workers but unimpressed by the pace of their work.
“They are not city road workers,” Augustine said, “they are ordinary men who are out to make money by working on the road.”
“What do you mean they are not city workers?” I said, “they have fluorescent vests?”
“Just because you wear a vest that resembles that of a city worker doesn’t make you a city worker,” Augustine said.
“Incredible,” I said, “who would ever know?”
“Most people know.”
On this day, the road worker conversation continues. I have noticed some gaps in Augustine’s analysis and like a sneaky cat, I am eager to entrap.
“So you really think that they make a lot of money?” I ask Augustine.
“Yes, they make money. A lot of people stop to appreciate their efforts.”
“But they don’t do anything. They put tree stems in the potholes to signal the existence of the known. They have been working on this road everyday for three years and it is worse. Sometimes they work without shovels. How much money do you think they make every day?”
Liberian highway
“Ten dollars, U.S.”
“Ten dollars, U.S.!! You mean Liberian dollars! You didn’t get much sleep last night, did you? How do they make money when no one gives them money?”
“People stop to give them money.”
“I am the only one who ever stops to give them money.”
“Other people stop to give them money.”
“I have never seen anyone stop to give them money.”
“Just because you don’t see people stop to give them money doesn’t mean people don’t stop to give them money.”
“Ok, well have you ever stopped to give them money?”
“I don’t drive.”
“But you do go to work in a car and as a passenger you are familiar with the concepts of volition, mouth, and voice.”
Augustine looks both sheepish and uncomfortable. “I will admit that I have not yet stopped to give them money.”
“You will admit that you have not yet stopped to give them money. You have worked at JDJ for seven years. During that time you have used this road almost every single day. You are one of the most generous persons that I know and you will admit that you haven’t stopped to give them money, but you think others do.”
Augustine is silent.
“Ha!” I say.
I slow the car down. One of the two road workers has recognized the sedan’s IRC logo and is approaching us with big smile. As I stop and unroll the window, the man who has a mildly bent shovel, rests it against his torso then bends down over it as if to prop himself up. The man has a grisly beard. His skin is thickened and deeply tanned. He tips his orange construction hat as I hand him a dollar bill and concludes the transaction with a gentleman’s bow.
“Thank you my boss man. Thank you for always noticing our work,” he says.
“Thank you for your work, but I am not your boss man,” I say.
“You are our boss man!” he exclaims.
“Ok boss,” I say, “later.” I gently roll back up the window and start accelerating ahead. From askance, the man looks momentarily confused but in the rear view mirror, I see him soon dancing and wildly gesticulating at cars coming from all directions in an effort to get them to stop. He and his partner will be working in the hot sun or capricious rain for at least another six hours. I know this because we will repeat the interaction that just happened on our way back. For now, Augustine and I continue in our current direction, winding, bumping, startling and chugging. There is still another twenty-minutes to get to the hospital, yet
Public transport system in Monrovia
