Refuge Place International (RPI) was established to make health care accessible to the poor in Liberia, especially the most vulnerable: women and children. Liberia, located on the west coast of Africa, with a population of 5 million, is one of the poorest countries in the world.
The Liberian health system was devastated by the long-running civil wars (1989-1997 and 1999-2003). Steps toward recovery in the sector was undone by the crisis wrought by the West African Ebola outbreak (2014-2016). The high rate of maternal and child deaths in the country already faced was exacerbated by the impacts of the outbreak. Throughout the country access to health care is limited, with inadequate numbers of health facilities and health care workers for the population. Access to care is lowest in rural areas, with 90% of health facilities located in the capital, Monrovia.
RPI founder, Mosoka Fallah, having grown up himself in vulnerable communities in Liberia, was committed to improving health outcomes for his fellow Liberians. He wanted to make quality health care accessible to the poor, especially for the most vulnerable. As a graduate student in the US, Dr. Fallah established the NGO Refuge Place International, that would have a focus on maternal and child health. He put all his earnings in to purchasing land and construction materials for a clinic in the slum community, Chicken Soup Factory, that was home to his family.
This first RPI clinic was opened on June 9th 2014. It was forced to shut after only one month to protect the health of staff when Ebola reached the Liberian capital. Mothers, children and the entire population were at increased risk of suffering and death from non-Ebola conditions due to the closure of health facilities and infection of health care workers with Ebola. Ebola caused the deaths of a high number of health care workers in the country.
When Dr. Fallah came across a woman who had given birth to twins in the street because she could not access care however, he arranged for the World Health Organization to train RPI staff on Infection Prevention and Control and build an isolation unit for suspected Ebola cases. RPI was able to reopen and provide desperately needed health services.
RPI was able to provide clinical care to 5000 pregnant women and children and had 210 safe deliveries during the outbreak. The organization was able to prevent traditional midwives from practicing unprotected deliveries as they were recruited to refer all deliveries to the clinic for safe births, where the trained staff used Personal Protective Equipment. Thirty-five Community Health Workers were mobilized to provide Ebola messages and distribute hand washing buckets and chlorine in the community. As a result of this multi-faceted clinical and community health approach, the RPI catchment area did not see a single case of Ebola and no RPI health care workers were infected with Ebola.
RPI demonstrated a capacity to provide poor women with safe, high quality maternal health care during the Ebola crisis. Since that time RPI has continued to provide care in this vulnerable community, and as patient numbers grew, the clinic was expanded to a health center.
RPI has also expanded into underserved rural areas. Dr. Fallah was asked to bring health care to two rural communities where he worked during the Ebola outbreak, Low Cost Village and Nyemah. In these communities pregnant women would have to be carried on a hammock for hours to reach the nearest health facility, leading to unnecessary deaths of women and babies. Employing a co-investment approach whereby the local community provided labor and local resources, and RPI provided professional labor and more expensive materials, RPI was able to partner with these communities to construct a clinic at a low cost. The clinic in Low Cost Village opened in September 2019, and the Nyemah clinic will open in 2021.
This co-investment approach is being replicated in three other rural communities throughout Liberia currently. In each of these partnerships the local community has committed to participating in and taking ownership of the project. Women leaders have been at the vanguard of these initiatives in each of these communities and have mobilized the local populations.
RPI’s vision is to grow this model throughout Liberia and make quality health care accessible to all in partnership with local communities.