Liberia with a population of 3.3million people is a country emerging and recovering from a 15yr civil war. In January 2006, presidential elections were held which brought an historic result, a female President, Mrs Ellen Johnson Sirleaf who is trying her best to turn the country around in the wake of unimaginable atrocities and massive debt. The UN has a significant and highly visible presence in the country. Like Chad 80% of the population live in poverty, on less than $1 per day. There is inconsistency in the provision of health services, with many hospitals decimated and staff either fleeing the country or being murdered trying to protect their patients. Currently, there are 2 Consultant Obstetricians in the whole country and only 27 qualified doctors with no further training of medical staff since 1990. This has meant that midwives have taken on roles for which they have no training, but have tried to do their best in the absence of appropriately qualified medical personnel. Like many parts of Africa Traditional Birth Attendants (TBAs) have attended births, often leaving high risk women until it is too late to intervene and save mother and baby.

Unlike Chad where there are a greater number of medical staff and midwives in and around the capital, Liberia is suffering from serious shortages of all resources, human and otherwise. Hospitals vary in their policy on charging for medicines. In the largest hospital JFK, medicines have to be paid for unless they have been donated. This is managed by a large board being placed on the wall in the main public area where the list of donated drugs can be seen by the public. The families then know that they will not be asked for money. Magnesium Sulphate to treat eclampsia and Cytotec to help prevent post partum haemorrhage have now been added to that list. Redemption Hospital does not charge for any treatment or medicines. ELWA is a private but not for profit hospital which charges with all monies being reinvested into the hospital. All three hospitals have been instructed that the drugs we donate are to be given free of charge with the understanding that we will review the future of donations if we find that women are being asked to pay for them. Excellent accounting and reporting arrangements are in place with the pharmacist at Redemption Hospital insisting on an empty Magnesium Sulphate vial being returned before he will issue another! The visits made in 2008 identified huge training needs and from an evaluation&nb sp;by the midwives of the May visit, they recognise the deficits in their knowledge and training.