Health Care for the Last Mile

Healthcare for the Last Mile

(Photos by Rachel Larson ’15)

When Rachel Larson ’15 touched down in Liberia, Africa, just two weeks after graduating from St. Thomas, Ebola was still an international concern. Liberia, one of the countries hardest hit by Ebola, had just experienced a small resurgence of the virus after having been previously declared Ebola free by the World Health Organization in May 2015.

Larson described the media coverage at the time as “very hysterical,” which led to some of her friends being concerned for her safety.

But Ebola, in one sense, was precisely why Larson had left her home of Apple Valley, Minnesota, and moved more than 5,000 miles to Liberia, a country of around 4 million people located on the West African coast. She works with Last Mile Health (LMH), an organization partnering with Liberia to repair its health infrastructure.

While LMH was started before the Ebola outbreak, the epidemic highlighted the intense need for such work.

Larson, who double majored in justice and peace studies (JPST) and global health while she was at St. Thomas, was so captivated by LMH and its mission that she decided to graduate early to accept her position.

Traveling as a Tommie

While making a move to Africa so soon after graduation might intimidate some people, Larson, who is known for her impeccable organization skills, put her St. Thomas time to good use so she could, in her own words, “immediately contribute” upon graduation.

While applying to colleges, she knew that studying abroad would be a priority for her, and even though she was concerned that it would be too expensive through St. Thomas, she did her due diligence anyway. She came across the Keri Kohut Memorial Scholarship, which is named after a 1993 St. Thomas graduate, that helps psychology, JPST or social work majors study abroad.

She contacted the JPST Department to inquire if she could study in Northern Uganda and have the credits apply, which led her to the new chair – Amy Finnegan.

“I don’t think I ever told Amy this, but I went home that night and looked up the articles she’d published and was really inspired and excited about her research interests and her work in [the area of] health equity,” Larson said. “Amy’s background … led me to assume that JPST would probably be a good fit for what I hoped to learn about.”

Larson ended up majoring in JPST, as well as doing an individualized major in global health. She spent fall 2013 in Northern Uganda and followed that trip – with the help of the aforementioned Keri Kohut Memorial Scholarship – with homestays in India, Argentina and South Africa through the International Honors Program on Health and Community: Globalization, Culture and Care.

She said those trips were beneficial because she was surrounded by people who reminded her to deeply examine what she was experiencing and to not forget the privilege that allowed her to be where she was.

“Gently, [faculty and mentors] challenged us to think critically about the impact we might be having on the people whose homes and communities we were visiting, and the ways in which we might be projecting our own assumptions and experiences on what and who we were learning about,” Larson said.

Rachel Larson

Rachel Larson ’15

Alongside her peers, Larson analyzed the complexities of engaging in work to address social, political and environmental challenges both at home and abroad, and how to thoughtfully bring about change. She’s carried that mindset with her, and said that her year abroad greatly informed her decision to move to Liberia.

Finnegan added that she saw Larson flourish while she was abroad. So, when Larson showed up in spring 2015 asking for advice on whether or not she should apply for a job with LMH – one that she would have to graduate early to accept if offered – Finnegan, who knows one of LMH’S founders, Raj Panjabi, was able to confidentially say she thought

Larson should be a good fit for LMH, and that LMH would be a fit for Larson.

“She had all these different paths she could take and was very organized in exploring each of them,” said Finnegan, crediting Larson’s planning skills for her ability to travel so much and still be able to graduate early. “It just made me so happy to think about her there, and what she can bring to Last Mile Health, but also for her, that one of her first jobs would be with an organization that’s so committed to social justice.”

Serving the Last Mile

LMH started in 2007 under the name “Tiyatien Health” – which means “justice in health” in a local dialect – and was organized by American health workers and Liberian survivors following the Second Liberian Civil War, which devastated the country’s health care infrastructure. Quickly, the burgeoning organization realized that the greatest needs were in Liberia’s so-called “last mile,” where some people couldn’t access a health care worker because of distance and poverty, and were often dying from treatable diseases, such as pneumonia, diarrhea, malaria and malnutrition.

“Many Liberians have to go to great lengths, including crossing log bridges and hiring canoes to cross rivers and streams, in order to reach the nearest health facility,” Larson said. “Those who can’t walk due to illness, injury, pregnancy or disability are carried in hammocks. In the most remote communities, there’s no electricity to charge a phone to call for support during an emergency – let alone cell service – and often no proper road for an ambulance to drive on, were it possible to call one.”

Travel is complicated, Larson emphasized, because so many of Liberia’s roads are unpaved. The rainy season then results in “unfathomable quantities of mud everywhere,” compounding travel challenges.

As a result, in 2013, “Last Mile Health” emerged with a more focused mission: Close the health gap by bringing health care to these last-mile communities. At the local level, LMH recruits, trains, equips, manages and provides monthly pay to more than 300 Community Health Workers (CHWs) who function as health professionals in their remote communities by providing primary health care services to their neighbors. LMH also currently supports the Liberia Ministry of Health in preparing a program to ensure that, by 2021, the 1.2 million Liberians who live more than 3 miles away from the nearest health facility will have access to a CHW.

Panjabi was named one of Time magazine’s 100 most influential people in April 2016, and his work with LMH was profiled by Bill Clinton.

It was LMH’s mission that resonated with Larson.

“I really value that the organization is dedicated to values of health equity and recognizes that health care is something that all people need to live dignified lives,” Larson said.

The outbreak of the Ebola virus that began in March 2014 highlighted the need for such work, especially in Liberia. According to the Centers for Disease Control and Prevention, there were around 28,000 cases of Ebola across the world during the epidemic. Liberia and its neighboring countries of Sierra Leone and Guinea were the hardest hit. Liberia, with 10,000 cases, had the second-highest number of cases, and the highest death toll, with nearly 5,000 casualties.

A January 2015 report from the World Health Organization noted the lack of doctors in West Africa – at a ratio of one or two to every 100,000 people – as one of the potential reasons for the spread of Ebola. Many facilities also did not have isolation wings, protective equipment or staff trained in infection control.

When Larson arrived in summer 2015, the worst of the Ebola outbreak was over but health workers continued to contain individual occurrences and survey the situation. And while Ebola was a serious threat in Liberia, Larson noted that the “country continues on” and that what was happening on the ground was more nuanced than what was portrayed in the media.

Capturing Powerful Images

As a partnerships and development associate with LMH, Larson supports business development, fundraising and communications. She collaborates with various teams to keep up to date on programming, solicits new financial partnerships, maintains relationships with existing donors and communicates with external audiences – including writing grant proposals and reports.

She said that one of her favorite aspects of her job is the variety of it, and that it has grown in ways she hasn’t expected.

In particular, she’s put her photography skills to good use.

Patients wait at an outreach clinic provided by Last Mile Health and a county health team in the remote community of Boe-Geewon.

Patients wait at an outreach clinic provided by Last Mile Health and a county health team in the remote community of Boe-Geewon.

“She has a beautiful eye for photography,” said Amy Walburn, the director of national partnerships for LMH. “She has captured some really powerful images of the way our work impacts the communities and beneficiaries we serve.”

Larson said that one of her most memorable experiences was when she traveled to Rivercess County in December 2015 and photographed CHWs completing a training module on child health. As they departed, they received their medicine kits.

“They filed out of the classroom with big blue plastic bags carried on their heads, under their arms, and were walking out of the school and going out into the community,” Larson said. “Some were walking, some were on motorbikes, all going back to villages to provide health care services to the children in their communities.

“I was able to catch a few of them and ask basic questions about how they felt and why it was important to be trained in child health, and heard several stories about how, for a long time, children in their communities have been getting very ill, and, in many cases, dying of these easy-to-treat conditions the CHWs can now treat themselves. It was really exciting to see their excitement, and that this is the beginning of a change for these communities.”

‘Make the Impossible Possible’

Larson said she’s grateful for the ways her St. Thomas education – particularly her JPST major – allows her to look critically at large-scale problems, such as the quality of the health care infrastructure in Liberia.

“My education at St. Thomas … taught me the importance of looking at the diverse contributing factors that create and sustain patterns of inequality and marginalization,” Larson said. She cited the situations that have led to damaged health care infrastructures in Liberia as an example. While travel difficulties are an easy problem to point out, she said, to truly understand what is happening, it’s important to look at complex and historical dynamics, such as slavery, the colonization of Africa and politics from the Cold War.

“My pathway helped me to understand the tools and skills to dissect those things,” Larson said. “It’s one thing to know there’s a lot of factors that influence justice and peace, and it’s another to start to have the skills and to think critically.”

Her abilities haven’t gone unnoticed: Finnegan and Walburn both praised Larson in that regard.

“In resources-poor areas, things often don’t go as planned,” Walburn said. “She’s an amazing critical thinker, which gives her the ability to [make contingency plans]. ”

“We’re lucky to have Rachel as a critical member of our partnerships department in Monrovia, [Liberia,] and she’s already made an impact on our work in a short time,” Panjabi said.

For Larson, her ability to make an impact with LMH is why she chose to join them in the first place.

“It’s really rewarding to be working in Liberia at a time when the country’s leadership has made a bold commitment to strengthening health systems. This could really be a turning point for Liberia,” Larson said. “Making the impossible possible. That’s what these folks are doing. There’s so much work left to do, but transformation is already happening in small ways.”

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