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What We Can Do: Nurses as Advocates for Community Education

  • August 13, 2016
  • Education, Medical Outreach Exchange, Liberia

Micaela Theisen, DNP, FNP-BC, RN

Micaela is a nurse practitioner in the Seattle area who has worked and volunteered in a number of developing countries, most recently in Liberia during and after the Ebola outbreak.

Nurses are the backbone of the healthcare system in Liberia, as they are in many developing countries. Outside the city, they often are the healthcare system. With very few physicians in Liberia, nurses are often faced with very complex patients which they must evaluate and diagnose on their own and with very limited resources. While talking with the nursing team during downtime in a Liberian Ebola Treatment Unit (ETU), I heard numerous stories of neighbors knocking on their doors in the middle of the night, seeking out the only skilled healthcare provider for perhaps several hours drive or walk. There is often no ambulance or hospital to call for, so the local community members went first to the nearest nurse. I heard stories of babies delivered under dire circumstances and mothers dying when perhaps with just a few more services—a better road, a closer clinic, a critical medication—could have led her to safety. I listened to nurses talk of identifying measles keratomalacia (which often results in blindness) and cerebral malaria and a ruptured placenta and doing what they could until their patients could be transported to a tertiary facility, where, even then, care might not be available. These extraordinary nurses have been forced to make decisions that even the most seasoned of developed-country clinicians might cringe at.

In their training programs, they learn most by seeing and doing, day in and day out. Knowledge is generally passed down verbally, but there is little opportunity to review things not understood well or dive into an area of interest or seek the answers to questions that had no resolution in class. In their local School of Nursing there is a small library with dated textbooks, some with covers torn and pages turned up, that are shared among all the students, and they have occasional access to the internet, but it all pales in comparison to the myriad resources available to most nurse trainees in more developed countries. My local nurse colleagues eagerly shared a single, tattered, and long outdated surgical nursing textbook during their downtime from the ETU. With a small donation, we were able to start a medical library in the ETU with books on pathophysiology and disease process, tropical disease, physical assessment, and midwifery among others. The textbooks complemented our daily lectures on various topics presented by the foreign medical team (nurses, doctors, and social workers) and our national nurses, who in addition to being enthusiastic learners were also ardent educators. The books and presentations were “very, very helpful to me,” said Frederick Tukpah, one of the national nurses. “We don’t have the opportunity for continuing education here. This is our chance to learn and read about the things we didn’t learn or cannot always remember from our training,” said Frederick, who has wanted to work in the healthcare field since he was a young boy. He was on a path to medical school when the civil war broke out and his father lost his job, leaving his family unable to afford the costs. His family never recovered from the effects of the war, and so he struggled through various jobs until he was able to put himself through nursing school.

Joseph Gbellemah is a former elementary school teacher who went to nursing school after the war because he saw a dire need for medical care in his community, particularly among his young students. “The thing I love most about nursing is simply caring for people in need. I loved teaching children and now I love caring for them,” said Joseph. Joseph plans to resume teaching at the elementary school in the near future, in addition to working in the hospital. “I want to teach health sciences to the children. We need more opportunity for everyone to learn IPC (infection prevention and control) and we need more students interested in health care professions.” Joseph said the textbooks and lectures at the ETU were “extremely important to me, so I can share this knowledge with others. These are important resources for us, because we do not always have access to so much information.”

As a nurse volunteer in Liberia, or any number of other developing countries, progress can be frustratingly slow. We cannot build roads right away to more easily bring the sickest patients quickly to care, though we’d like to. We cannot eradicate malaria, though we dream about this nightly. We cannot immediately build and staff the hospitals and clinics necessary to provide even the most basic of healthcare, but what we can do, immediately and with very few resources, is share experiences, knowledge, and education materials with our national colleagues, and support a long-term global effort to improve the health profession training. Building a stronger nursing force and developing local nurse leaders is quite possibly the most important thing we can contribute and something that will last for years to come.