

Lorenzo Dorr works at the grass-roots level to help deliver health services in far-flung areas of Liberia. In July, he was on his way to meet with community health providers in Konobo, one of Liberia's most remote rural districts.



The 50-year-old father of four has spent more than two decades working in Liberian community health. He was trained as a physician assistant and got his start providing essential care to residents of Grand Gedeh County. Over the years, Dorr has supervised medical clinics, mentored and trained community health workers and coordinated larger projects. In 2012, he earned a certificate in epidemiology and global health delivery from Harvard.

Dorr is now working with Last Mile Health, known in Liberia as Tiyatien Health, a nonprofit started by a Liberian-born physician that trains and deploys community health workers in remote areas.

While much of the attention given to Liberia's Ebola outbreak has focused on large cities, the country's far-flung, rural regions are beset by serious challenges as well. After a 14-year civil war that killed 250,000 people, the health care system was devastated and most hospitals and clinics were destroyed. Since the war's end a decade ago, community health workers have become a vital source of primary care for villagers who otherwise might have to walk for days to seek treatment.

Dorr coordinates anti-Ebola measures and helps train and equip village health workers in the southeast of the country, an area known for logging and gold mining. He'll soon start work in a county called Rivercess, one of Liberia's poorest, which thus far has seen one confirmed Ebola case. Dorr wants to limit the spread. He spoke with NPR from Grand Gedeh County, where he's based.

Tell me a bit about your background and the work you're doing.

I started out working in the southeast region in 1986. My first assignment was in a town in Grand Gedeh, but there was not really any health infrastructure, the clinic was not ready when I arrived. I operated from home until the three-room building was completed. It was the only medical facility with a professional health worker in the area, serving more than 10 towns and villages, and I was the only staff assigned. I was providing every service, from clinical assessment to treatment and dispensing of drugs. I had to deal with all medical situations. It was a challenge, but I was able to get through it. People would come and get me overnight, I'd have to travel four hours, two hours, tend to labor cases, do deliveries in communities away from the facility. There were a lot of challenges — we had no ambulance. That prepared me to go the extra mile. I was the only person they had.

There's been a scarcity of health workers to reach each area, each town and each community in Liberia. The rural health strategy is to establish the community health program to serve as primary health care providers for patients. The community health workers mobilize on vaccination and immunization campaigns and health-related programs, providing first aid to community members when they are sick, encouraging pregnant women to seek health care and mothers to seek postnatal care. Each community health worker caters to 250 persons. Where there are health facilities within 5 kilometers, they don't need community health workers.

I'm in a managerial position now. I'm supporting the county's anti-Ebola task force. We're training on prevention and awareness. The main reason we do this is so people know what the disease is, how it presents and what to do, so we will limit the spread of the virus. This is the key message.

My role is to coordinate all the Ebola activities in the areas. As of today, there has been no case reported [in Grand Gedeh County].

What's the mood among people now — are they afraid?

I'd say people are afraid, but they are afraid in good spirits. It's a fear that drives you to be more careful or cautious. You go about your activities so you don't endanger yourself and others.

Liberia has closed its schools to prevent the spread of Ebola. What are children doing?

Most children are doing nothing. Schools initially were closed because it was felt there should not be direct contact between people. Children are idle. It's not good for the children. If schools are open, it's another way to disseminate information about Ebola. School authorities could allocate time each day to share Ebola-prevention and -control messages. The students in turn could educate their families and soon the entire community, the nation, is well-educated and prepared to prevent and control the spread of the disease.

What role can religious leaders play in educating Liberians about Ebola?

The church [Christian and Muslim religious institutions] is very, very important. It's one of the key civil society organizations helping stop spread of disease in our country. Membership is very huge. Very few people are not affiliated with religious organizations. If religious institutions are involved in the fight against the disease, we feel it can go a long way.

What are some of the main challenges for health workers?

We should be prepared before a case is identified, not chasing after it after hell breaks loose. We should be ready to shoot at it as soldiers. If we don't fortify our positions, the enemy will infiltrate our camps and it will be difficult to regroup. But if we fortify our positions, we don't allow our enemy in.

Supplies have been a challenge for the county health teams/systems. There hasn't been much consignment of supplies coming down. Some facilities closed because they're not well-trained, they have no supplies. Little attention is being given to counties not experiencing Ebola so far.

We're doing all we can in terms of prevention even though there's little or no equipment at all in the health facilities. Educating the community is the most important thing. Know what it is, how the disease is contracted, how to keep people safe. Personal protective equipment is a challenge for almost all facilities in the country — gloves, gowns, aprons, masks, goggles, boots, caps. It is a real big challenge to health workers. They have to go slow, because they fear they will contract the disease without being protected. Health workers don't feel they're trained adequately; they fear they're not prepared enough to manage cases.

[Last week] there was a new development. The county health team reported about some consignment that's been shipped to the southeast. I've been told it includes personal protection equipment, complete sets. Exactly how much will come to the county we are yet to know. But it's good news. Let's see what happens in the next few days. We will be working in the coming days to identify how we could get the consignment for Grand Gedeh into the county as soon as possible.

Ebola is not the only health challenge, right?

Right now everybody is focused on Ebola. But before Ebola there were other diseases in the community — respiratory infections, sexually transmitted infections, malaria, diarrhea, etc. A lack of commodities and drugs, coupled with the Ebola issue, has taken its toll. People are dying from other diseases because there are no drugs. Not much is being done to re-establish activities regarding other existing diseases. Where I am, people lack essential drugs. Plenty of people are not able to buy [drugs] and not able to be treated. This has eluded the national government because everybody's focus is on Ebola. It's not healthy for the process of prevention. People would rather stay home, try traditional medicines and go to prayer houses and centers. They believe by prayer they will get well.

With everybody's attention focused on Ebola, we're neglecting other diseases. One has the right to worry about what will happen next.

You're planning to go to Rivercess soon — how many Ebola cases are confirmed there?

One case has been officially reported. But it's not clear. The only way it will be clear is when we travel to the area and see.

Note: We'll be checking in regularly with Lorenzo Dorr to hear how his efforts are progressing.
