The Long Journey Home
December 2, 2009 |  by Geoff Brown

Rajesh Panjabi, SPH ’06

Rajesh Panjabi has told the story of his 1990 escape from Liberia countless times, but it hasn’t made it any less powerful. Raj was only 12; he and his family (his parents were immigrants from India) had lined up to board a plane, part of a hastily organized evacuation of the capital, Monrovia, as rebel troops commanded by warlord Charles Taylor descended on the city. The international airport was closed; the Panjabis were waiting to board a privately chartered cargo plane at a small local airport. But the plane was not for everyone. “The only way to get on that plane was to have the right color passport, skin, or money,” Panjabi says. There were two lines: the one the Panjabis and others of means stood in, and another line farther from the plane. Panjabi will never forget the people in that other line. “There were children and women in torn lappa [traditional] cloth, being systematically restrained by soldiers,” he says. “When the plane took off, the back hatch was still open. You could see those whom you had left behind.

“That was the moment Liberia gave birth to my conscience,” says Panjabi.

Panjabi’s devotion to his homeland never faded in the years following his departure. If anything, it strengthened as he and his family started from scratch in a strange new country. Panjabi’s father—who had stayed behind—eventually fled on what would be the final evacuation flight and rejoined the family, which settled in North Carolina. Panjabi, who received his MD from the University of North Carolina, says that he wanted to go back to Liberia in 2003, but the country once again “was in hell—going up in flames,” he says. Taylor was attempting to hold on as two other rebel groups tried to remove him from power. In the meantime, Panjabi traveled to Afghanistan to learn about health care in post-conflict societies. Finally, in 2005, he was able to fly back to Monrovia; at that point Liberia was a nation of more than 3 million people and only 51 doctors.

“I had mixed feelings,” Panjabi admits. “I was so thrilled to reconnect with that part of my life, recollecting old memories I had lost—but there was a deep feeling of sadness. I remembered Monrovia as a thriving city, a place where other West Africans came to vacation. When we entered Monrovia, there was no electricity, no water, and one traffic light. My old school had been used as a hideout by militias. The walls were broken down.” It was almost as if the country itself was trying to make it difficult for Panjabi to return. But his sense of possibility is unflappable. “We could start to see the potential for pragmatic change.”

A new president—Ellen Johnson Sirleaf, the first woman president in Africa—had won the 2005 democratic election. Some services were being restored. Some health clinics reopened. In 2006, along with Liberian native Weafus Quitoe and others, Panjabi started Tiyatien Health (the word means “truth and justice” in a Liberian dialect). The group currently operates out of the 75-bed Martha Tubman Hospital in Zwedru, a 10-hour drive southwest of Monrovia. Tubman Hospital is effectively the only hospital for a region of about 300,000 people. (Baltimore City, with a population of 650,000, has 11 major hospitals.) Tiyatien Health works with AIDS-affected women, community health workers, and other medical and public health personnel to design and enable the delivery of comprehensive HIV and primary health care.

Panjabi has a particularly magnetic personality—a very handy gift for one involved in something as relentless as providing health care in a country without basic infrastructure—and he’s put it to good use by recruiting other Johns Hopkins alumni to work for Tiyatien Health. These include Tiyatien’s medical director, Kerry Dierberg, SPH ’05, Med ’06, whom Panjabi met at Massachusetts General Hospital when both were doing their residencies. Panjabi’s story and Tiyatien’s goal of providing comprehensive health care to southeastern Liberia also brought Mark Siedner, SPH ’06, Med ’07, and John Kraemer, SPH ’08, to the group as research directors.

Twelve hours after getting a call from Panjabi in the spring of 2007, Kraemer traveled to Liberia for a two-week research mission. The long road trip—and the isolation of Zwedru—were new experiences for Kraemer, who had never traveled outside the United States. (“I grew up in Kansas, and it’s a long way from Kansas,” he says.) But Panjabi says that his friend jumped in with both feet. “It’s an area where a few resources can do so much good,” says Kraemer. “[This is] a pretty optimistic group. It’s a group that has [Panjabi’s] personality. The team was united by passion.”

Tiyatien has already had a few successes in Liberia, particularly in getting antiretroviral HIV drugs to rural hospitals like Tubman through a model program called the HIV Equity Initiative. For Panjabi and Tiyatien, it’s a broad-based effort to improve health across a swath of areas, including a few areas in desperate need of improvement.

“We’re trying to bring about the freedom of opportunity,” Panjabi says. “We’re trying to build a movement. That’s what it’s going to take.”