Darling Girl, nine, is sitting on her bed in the new paediatric ward at Redemption Hospital in Monrovia. She has recovered quickly after having her appendix removed and is keen to be discharged so that she can go back home. Proudly she displays the big bandage on her tummy to anyone who wants to see it.

"This is a good hospital," says Darling Girl's mother, who has been staying with her daughter at the Redemption hospital. "And it's very good that it's free."

Darling Girl, from Bushrod Island, is one of the 1,200 patients who are admitted to the hospital each month. The facility, which is owned by the Liberian Ministry of Health and Social Welfare, is playing an important role in providing health care to people on Bushrod Island, one of the poorest and most densely populated areas of the Liberian capital, and to the wider community in Monrovia.

With the refurbishment and construction of the Redemption Hospital in Monrovia, Liberia, now completed, MSF is phasing out its support of the hospital and the Liberian Ministry of Health will assume full responsibility for the activities and management of the hospital.

Since 1999, Médecins Sans Frontières (MSF) has continually supported the hospital, located on Bushrod Island, by providing expatriate staff who work alongside Ministry of Health personnel, incentives to local staff, drugs, medical equipment, and logistical support.

The hand-over, planned for over a year and originally scheduled for the beginning of September 2005, was moved back three months to allow for the Liberian elections to take place.

At the end of November 2005, MSF expatriate staff - a doctor, midwife, nurse, surgeon, as well as coordination personnel - will finish their work the hospital. MSF will continue to pay incentives to Ministry of Health (MoH) staff, supply drugs and materials and provide logistical support until the end of February 2006.

"MSF has supported Redemption Hospital for seven years and we are now ready to step aside and proud to hand over a completely refurbished and fully equipped hospital with trained staff to the Ministry," said Pascal Duchemin.

"Redemption Hospital has gone through a great transformation over the past years - it is now a well-equipped facility with 150 beds and this is benefiting the whole community," said Pascal Duchemin, Head of Mission in Liberia. "By providing access to free quality health care, it is having a big positive impact on the health of the population of Bushrod Island and of Monrovia."

New focus

With the transition from war to post-conflict rebuilding, the context in Liberia is changing. MSF, committed to addressing the humanitarian needs in Monrovia, is adapting its programmes to the new situation and will focus its efforts on reaching particularly vulnerable groups, like mothers and children.

In the immediate future, MSF is concentrating on Island Hospital, also on Bushrod Island, where it will begin to offer obstetric referral services and expand its current paediatric services.

In addition, MSF will continue to support primary healthcare services in Monrovia, through clinics in New Kru Town and Clara Town.

To mark the completion of the refurbishment and construction project as well as the hand-over to the MoH, MSF has organised a photo exhibition at the hospital that shows the transformation of the hospital with 'before and after' pictures.

The exhibition is located immediately outside the hospital walls to allow not only patients and visitors but also members of the wider community to visit the exhibition.

Refurbishment history

In late 2003, MSF began an extensive refurbishment of the Redemption Hospital to expand and improve health services offered to the community.

Once built as a marketplace but converted into an outpatient clinic in 1982, the facility was later turned into a hospital with 50 beds. With the health situation deteriorating in Monrovia, MSF stepped in to support the hospital during shorter periods in the 1990s and then began its longterm support in the last year of the decade.

Before the renovations began the conditions at the hospital were cramped and dark. The hospital's medical director, Dr Kanda Golafale, has been at Redemption since 1997. He remembers what it was like to work at the hospital prior to the renovations.

"It was so dark in the rooms, even in the middle of the day, that we had to do consultations by candle light", said Dr Golafale. "Now it is a hospital to be proud of, with everything we need. It's the difference between night and day, literally."

The renovations, costing just short of ââ?š¬777,000, have involved virtually all parts of the hospital. MSF has constructed new paediatric, isolation and obstetrics wards, administration offices, and entrance area, and the medical, emergency and surgical wards and the operation theatre have been refurbished. In the backyard area, there is now a new morgue, waste station, two water towers, and kitchen and laundry facilities to support the running of the hospital.

A swamp behind the hospital was drained to make space for a new outpatient facility. The health centre, named New Kru Town Clinic, now sees more than 9,000 patients each month and is operated separately from the hospital.

Work in periods of extreme violence

More than 200 people work at Redemption Hospital today. One of them is Elizabeth Weah, who has been a midwife for almost 30 years.

"I like my work here" she said. "Sometimes it is very busy with many complicated deliveries. But the relationship with the patients and the staff makes the work easy."

As fighting in Monrovia intensified in the summer of 2003, the hospital, located in the path of advancing rebels, had to close. But people in the city were in desperate need of medical services and in order to continue offerring health care, the hospital moved to the compound of MSF in Mamba Point. Many of the Ministry of Health staff from Redemption came to work at the temporary hospital and many also stayed in the compound during the weeks of the heaviest fighting.

When the violence subsided in late August, the hospital could move back to its premises on Bushrod Island and in December 2003 the planned refurbishment project, which had had to be postponed, could begin.

During the years that MSF has supported Redemption hospital, the organisation has worked in close partnership with the Ministry of Health and the management and staff of the hospital. In September 2004, this relationship was strained by a strike over the level of staff incentives. After a period of discussions and conciliatory gatherings, a solution was found and work could continue as normal at the hospital.