The Bush

Muddy roads!

August 12, 2012

Last weekend we went for an adventure.  There’s an old mine on a hill called Mount Nimba, and a group of the expats here decided to go sightseeing.  We got a little more than we bargained for in the day: ask me about it when I get home, it’s a good story.

So I got back from ‘the bush’ two days ago.  A group of clinical supervisors [among others] were travelling around to visit some clinics in Nimba County, so I tagged along for the ride.  I saw seven small health clinics and got a taste of rural healthcare in Liberia.  I sat in during the supervision which was very interesting.  I was with a doctor who was doing the supervision, and we sat in the room with a screener as they saw patients.  I learned a lot about HIV, TB, malaria management and Liberian healthcare protocols.  It turns out that the national protocol for diagnosis of pneumonia in children is pretty bad; the protocol is that if the individual has a high respiratory rate, that person can be diagnosed with pneumonia.  It doesn’t require additional assessment by listening to the lungs or anything.  Fast breathing = pneumonia.  This leads to the incorrect diagnosis of pneumonia in a lot of people, which definitely messes with the statistics.  It was very interesting to learn about so much, the doctor was very good at explaining things so I benefitted highly.  Overall I was really impressed with the clinics themselves and I am very glad to have gotten the chance to see them and get a bigger picture of healthcare in Liberia. 

Other than seeing the clinics, being in the field involved a lot of driving and waiting for meals.  There was never a shortage of food, just irregularity of meal times.  We drove maybe 4-6 hours a day going between the clinics, and that was actually very tiring.  The roads are very bad, so that I have bruises on my shoulders and hips from the bumps.  Also, I discovered that land cruisers can lean very far to the side without tipping over; I was very afraid more than once or twice before I started getting used to it!  There were a lot of people in the car, and usually something dead under the back seat.  Haha, we kept passing hunters who were selling bush meat, so that’s how the dead animals ended up under the seat.  Ansbeg [I think it might be an anteater or something similar, I also heard it called an ant bear] and ground hog were my new culinary experiences from the journey.  I also tasted palm wine: it was stored in an old oil container.  Very healthy I’m sure.  The Liberians are big fans of the stuff, so I’m glad I had the chance to try it.  I’m trying to get my hands on some ‘white bucket’ soup while I’m here, but I’m sad because it’s hard to find.  [Haha, google it to see what comes up for white bucket, otherwise I’ll explain when I get home!]

Well, the rainy season is in full blow.  It’s been raining every day for a while now, which necessitates creativity when trying to get dry laundry!  I got caught in the rain today as me and another person drove home from church.  We were on motorbike, so it was a muddy drive!  I’m really thankful for the raincoat I brought – definitely a necessity here. 

I have officially moved to Ganta for the remainder of my time until I go back to Monrovia for my flight home.  In one week I will be on a flight headed home.  I find that pretty crazy, the time went so fast.  Coming, I thought that two months was going to be a long time, but now leaving two months wasn’t nearly long enough!  I really like it here; I’ve gotten teased more than a few times about how much I love Liberia!

Liberian Healthcare

August 3, 2012

I feel as though I should talk more about healthcare and what I’ve been actually doing at work since I’ve been here at the health center.  I’ve spent the vast majority of my time in the emergency room.  I’ve found that it’s where I get the most opportunities to learn new things, so I have stayed there for the most part.  I have spent some time on the wards and in maternity as well though.  The ER here is hugely different from the ER in Canada, and the cases are [mostly] different from anything in Canadian emergency rooms.  Hands down, the most common thing I see is severe anemia secondary to malaria in children under five years old.  Before we even start the screening process, the first thing we do when a child enters the ER is to check their conjunctiva to see how pale it is.  Typically it’s very pale and we send the child to the lab to check their hemoglobin.  I saw one child whose hemoglobin was down to 3.0, which is very low and needs a blood transfusion right away.  Of course, that was the day when the lab had none of the supplies needed for blood typing, so that child waited for a long time to get transfused because the family couldn’t afford to purchase blood and the lab wasn’t able to blood type the child or the family to find a donor.  Not so good. 

I am seeing and learning many new things.  I have learned to suture wounds, have done many interesting dressings, and have heard so many stories.  There was a young boy who came in with meningitis.  A child was beat up by his siblings and came into the ER pretending to be unconscious to get his brothers in trouble.  I saw a woman whose husband hit her over the head with a machete, and the cut was so deep you could see her skull.  A woman came in with an ectopic pregnancy and had to be transferred immediately to have surgery.  A woman who had an unsafe abortion and came in with sepsis.  A man who had lived for four years with a necrotic ulcer covering his entire left leg.  A young man with a broken leg and multiple bleeding wounds acquired in a motorbike accident.  Malnourished children with severe edema in their arms, legs and face.  This is a taste of my work here.    

Sometimes, patients who come with complications are those who first went to traditional herbal healers.  I would be very interested to learn more about how traditional healers work here, and what they use.  You see their work often: people with leaves inside and wrapped around wounds are the most observable example, which also makes the wound very difficult to clean.  Interesting stuff.      

On the maternity nursing front I have exciting news: I have finally seen a baby being delivered!  I decided to try the maternity ward again last week and was rewarded with not one, but five deliveries in three days!  I watched the first ones and was able to assist with the two births, although there were complications so it was a bit scary and I never got to catch the baby.  I feel as though I’ve finally fulfilled some kind of mission; I’ve been trying to see a delivery for so long I was starting to wonder! 

During the deliveries I noticed some huge things that caught me off guard.  The midwives tend to be very harsh and unkind with the mothers [this could be a culture difference that I’m not used to yet], and the words “hurry up” and “you’re not pushing because you’re lazy” were heard more than once.  I also heard “If you don’t hurry up and push, you will kill your baby.”  Imagine being that mother!  I try to clamp my mouth shut to avoid getting myself into huge trouble, but I do ask questions.  After the baby is born, the umbilical cord gets cut and then the baby is taken away, cleaned, weighed and wrapped to stay warm.  It is then left on a table and [I’m not exaggerating] ignored by medical staff.  This is shocking enough with a healthy infant, but I also saw this for a child in respiratory distress.  The nurse suctioned with very little effect until the baby was at least breathing [gasping], then ignored the baby and helped the mother open and drink a soft drink. 

Also, ask me about the patient who was diagnosed with dysentery.  Unbelievable.  

I've had a lot of time thinking about whether or not I would actually be able to work here on a long term basis.  This summer has confirmed to me that I want to work long term in a place like Liberia, but to do so I need to significantly increase my experience and scope of practice.  Midwifery would be the most useful here, and the scope of practice of midwives is similar to that of a delivery room nurse in Canada.  One of the main reasons why I get frustrated with healthcare here is that I see practices that I know aren’t correct, but I don’t have the skill or knowledge to do much if any better.  I see so many cases where the diagnosis clearly is not correct and the prescription is not how it should be, but I don’t have the training to know how to correct what is being done poorly.  So I feel that before I can feel good about practicing here, I would need to get more experience and training.  So yes, the thought of doing this for real sounds realistic to me.    

You’re Canadian, you shouldn’t be cold!

July 26, 2012

Yep, you guessed it – I’m freezing right now.  I’d love to actually see what the temperature is;, it’s probably around 20 degrees would be my guess.  It’s been raining a lot in the past few weeks, almost every day for several hours.  I walk about twenty minutes through a swamp and market to and from my work at the health center, and it’s been interesting to see how fast the path deteriorates.  Same goes for the roads.  It’s funny, I got caught in heavy rain as I was walking home the other day and so I stopped underneath a shelter in the market until it lightened up a bit.  One vendor about my age was trying very hard to sell me fake nails, and he just didn’t understand why I didn’t want them! 

So this past week I’ve spent all of my time working in the ER.  The past few days have been very stressful and pretty frustrating actually.  There are two rotations here, and the first rotation has an amazing nurse who I love.  She is supportive and is very good at letting me do everything that I’m competent to do, and then teaching or showing me how to do new things.  She is very good and has helped me learn a huge amount.  However this week it’s been the other rotation, and I’ve had a rather hard go of it.  There’s a physician’s aid scheduled to be working in the ER, but because I’m there he stays in his office all day and reads, or even leaves the health center.  This leaves me running the ER by myself and with no reliable support person.  Honestly, the hardest part is keeping my emotions in check when this guy comes back, because he often is quite annoyed that I’m not able to run the place very smoothly.  Because I haven’t been trained to diagnose and prescribe medications, and I’m not comfortable doing so outside of my scope of practice with medications and conditions that I don’t understand well!  So it’s been a bit of a rough week.  Although that being said, there have been a lot of very interesting cases and wounds coming in this week, so it’s also been very good in that manner.  I have about one week left at this health center and then I’ll be moving back to Ganta to find other work. 

I was just thinking, it’s a shame I wrote about food when I did.  The day after I posted about Liberian food, I had a true culinary experience to write home about.  The ambulance hit and killed a ground squirrel, so they brought it home and the guards cooked it up and we ate it for supper!  Honestly, it tasted really good too, the meat was very sweet.  I was at the market yesterday, and we saw monkey and dog meat [they call it white bucket].  I’d love to get a chance to try both, we’ll see if that pops up.

My motor biking has plateaued for the moment, and I haven’t had a lesson since Sunday.  I actually had a bit of an accident on Sunday, the bike fell over on top of me and I scraped up my arm and hand a bit and got some killer bruises.  It’s kind of embarrassing because everybody asks how I got hurt when they see the scrapes on my arm, they always laugh when I say “well, I was learning how to drive motorbike when…”!  It’s good for me though, it’s put a solid healthy dose of fear into me for the next time I drive.  That motorbike is heavy!

Yep, so I’ve been keeping [fairly] safe and healthy and I’m still very much enjoying Liberia.  The picture was taken in the market I walk through every day to get to and from work.  The market day is every Tuesday, so it wasn't open when I took this!

A Day in the ER

July 18, 2012

So today I was in the ER again today, and had a very busy day.  We had our normal influx of malaria patients – send them to the lab for a definite diagnosis and give them a prescription and off they go, unless it’s really serious.  I’ve been learning so much, especially in the ER because they have me doing screening, histories, admissions, diagnoses, and prescriptions.  All on unfamiliar illnesses with people who have major trouble understanding my accent!  Talk about a fast learning curve!  One of the physician’s aides has been particularly helpful to my learning by explaining everything to me.  Today however, was a particularly exciting day in the ER.  There was a motorbike accident today, and we received four wounded men who promptly bled all over our floor.  One had a broken foot and a large head wound, while the others got away with shock, vomit, sutures and minor wounds.  I think one walked out of the ER with an undiagnosed broken foot [his foot looked like yours Mom], but who knows.  I’ve noticed this before, but it was particularly apparent today that they don’t really use analgesia here.  People are very vocal about even minor pain, but when it comes down to it these patients are going through a lot of painful procedures without anything for pain control.  Tylenol and ASA are the only things being prescribed, and Lidocaine is used sometimes with suturing.  Other than that, grit your teeth and deal with the pain.  I found it very interesting and good experience, but it was also quite sobering.  I will be very careful on motorbikes from now on.

Speaking of which, I have some very exciting news.  I have learned how to drive motorbike!  I had my first lesson yesterday, and practiced again today shifting into higher gears.  I’ve been deemed competent, although I haven’t ventured to the roads yet so that’ll be my test.  It’s very safe too – the guy who’s been teaching me is a doctor, so I’m set for life!  :)  [joking!]  That’s true, but I am also being very careful, no worries!  

So yeah, in summary I'm really loving Liberia.  

Food on the Brain

July 16, 2012

So I have two important things on the brain right now: palm oil and fish bones.  Firstly, palm oil is delicious and Liberians certainly love to cook with it.  It’s making me break out actually, but it’s so totally worth it.  Tonight I had Liberian sweet potato and arrow (? It’s a root) with a fish and palm oil soup [every sauce here is called a soup.  From what I can tell, if it’s eaten with rice and is cooked/served in separate bowls, you’re eating soup!!].  I almost died of pleasure at the potato and arrow root with the palm oil, but the fish bones are really starting to get on my nerves!  Today I successfully swallowed three fish bones in two meals, and not for lack of taking my time picking them out and chewing properly!  I swear, they appear out of nowhere – bam!  By the end of my portion I’ve caught myself starting to wonder if it’s actually worth the work!

One of the things I was really excited about coming here for was the chance to try new foods.  This might be embarrassing, but I figured I’d give the food an honourable mention and fill you in on what I’ve been filling my stomach with for the past almost four weeks!  To put it simply: rice, palm oil, beans, potato greens, hot peppers and fish or chicken.  From what I’ve experienced so far, you can make a lot of Liberian food using those ingredients.  So palm oil is nothing like what I was expecting.  First off, it’s red and doesn’t just taste like oil.  It actually has a unique flavour which is amazing.  It also stains everything it touches; clothes, skin, whatever.  White girl that I am, that does present somewhat of an awkward problem at work where there is no silverware and eating with your hands is expected!  I’m sure I’ve provided the staff at the health center with a generous share of amusement as they watched the white girl “eat like an African”!  One of the staff was teasing me today, and told me to use a spoon – he then spelled spoon on his hand and said, “This is a Liberian spoon!” 

So I’ve only found one food item that I really don’t care for: fufu.  It’s one of three cassava variations available here [fufu, jhibi (?), and dumboy], and comes as a sticky paste.  You roll it into bite-sized balls in your hands and then dunk it in a fish soup [sauce] that’s made to be very slimy to help the fufu go down easy.  The taste isn’t terrible, but combined with the texture it’s definitely not my favourite.  I do like jhibi though when I’ve had it.  The one time I’ve had dumboy, I’m pretty sure I didn’t eat it the proper way, so I don’t feel like I can speak for it. 

In terms of fresh fruits and vegetables, the options are fairly limited.  That being said, bananas are ubiquitous and super cheap.  Pineapples are harder to find, but cost 50LD for the large ones so the price makes up for it when you can find them [there are roughly 75LD in 1USD]!  I’ve been particularly enjoying the avocados, which are known here as butter pears.  They can also be hard to find, but for a large avocado you pay 15LD.

The street food has also been interesting when I’ve gotten the chance to try it.  I tried a ‘meat pie’ in Ganta the other day, and noticed that it had no meat but contained plenty of hot peppers and oddly enough, spaghetti noodles.  It certainly tasted fine though.  The rice bread is also quite good, almost like banana bread but not as sweet and much denser.  Corn is all over the place but I haven’t bought any yet.  I’ve enjoyed the coconut a lot; I prefer the older ones with more meat, but the coconut water in the young coconuts isn’t bad either.  I’m very sad that mango season is over, but I got a good share of mangoes while I was still in Monrovia during my first week here.  I think my favourite street food is the boiled peanuts.  They’re amazing.  You pay 5LD for a huge handful of peanuts, and then you get to shell them and it’s absolutely fantastic.  I picked up a fried plantain at the market earlier this week, which was really tasty.  I also bought some bread that the woman said was shortbread – it’s not any kind of short bread I’ve ever experienced.  I don’t know yet whether or not I like it, but either way it’s interesting!

So there’s my thoughts on food, you might have noticed that I’m a big fan!  Haha.

I need to be FAT.

June 30, 2012

Ok, so I’ve always thought that I’m a reasonably flexible person in most situations.  That’s so being tested here, wow.  This is a whole new level of necessary flexibility that’s somewhat intimidating.  While I was still in Monrovia I was chatting with one of the organization founders and she said something that I really liked and has impacted me.  She said that to be a missionary, you must be fat: Flexible, Adaptable, and Trusting in God.  I liked that for several reasons: one, it sounds amazing, and two, it’s really true.  That’s just been really stuck in my mind for the past couple of days, especially with what’s been going on and the uncertainty regarding what I’ll be doing while I’m here.

So a few days before I arrived in Liberia, the funding for the main health project of Equip Liberia was given to a different organization.  Translation: the work that was planned for me no longer exists with Equip Liberia.  The handovers start in about a week or two from now, and before August is over they will all have been handed over to the other organization.  It’s kind of a weird time to be here doing healthcare then, since it’s all being terminated.  Equip had originally planned for me to work at the main health care center in a small town called Saclepie, but it will be handed over within two weeks.  So I ended up travelling to Ganta to try and figure something out from there, and help out as possible.  I was told to make myself comfortable in Ganta for at least a few days.  Yesterday I was at a meeting with staff and I was speaking with one of the midwives, and we made a decision that I would move to Saclepie to work until the handover as soon as we could get a ride on an ambulance that was passing through.  Literally within thirty minutes I was on an ambulance headed towards Saclepie!  The absolute definition of a split decision, my friends!  Tonight is my second night here in Saclepie, and so far I really like it.  It’s much smaller than Ganta, and doesn’t even have a gas station.  Needless to say, there’s no grocery store either.  The house is very nice though: everything is bright blue – walls, floors and curtains all!  There is no running water, but the house does have electricity for five hours every day.  Honestly, I’m surprised at how little the water/electricity thing bothers me.  It’s really just a little inconvenience that can easily be gotten used to. 

I’ve met so many people in the past week and a bit.  The Liberian people are so friendly and welcoming.  The culture is so interesting, I feel like there is so much to learn!  I went with two friends to a graduation celebration today, and it so was such a neat thing.  There was dancing, and the traditional body paint on the women.  As people entered, the women did a traditional dance type-thing with you, to welcome you to the party.  They danced around you, hugged and kissed you on both cheeks as they sang in their tribal language.  It was beautiful.  I’m really glad I got that opportunity.  

Dancing goats, speed ruts and lightening

June 29, 2012

Ok, so since I don’t have access to internet here I’ve been writing as things have been happening.  My plan is to backdate everything and post up to date when I get a chance.  Sorry for the explosion!

So after false tries on Monday, Tuesday and Wednesday, we finally made the drive up to Nimba county yesterday (last Thursday).  We got a late start out of Monrovia; we had hoped to leave the office around noon but didn’t get out of the city until after 4pm.  The drive was beautiful though, and I experienced many new sights and smells.  The one that most sticks out in my mind is rubber.  Important rubber fact number one: burning rubber smells terrible.  I’m not talking about the burning tire kind of rubber smell either, it’s much more pungent.  It’s a smell that I will never forget, you smell it so often here especially while driving.  Rubber trees are all over the place here, and it’s very cool how they harvest the rubber.  It seems to be very similar to maple syrup collection, just tap the tree and collect the sap.  They add some chemical which reacts with the sap to make it into a solid.  There are Firestone rubber stations where Firestone buys the rubber from people.  I haven’t been able to get a price, but everyone says that rubber is very profitable. 

So the drive from Monrovia was a great experience.  The first three hours of the drive are on “good roads”, which back home would be considered pretty terrible with potholes left right and center and chickens all over the place.  But the last two hours are really what is worth writing home about, that is what you call an intense road.  I wish I could show the size of some of these potholes, combined with how many there are: it’s ridiculous.  I don’t know how normal cars can travel on that road, it was bad in a land cruiser - I got a fair share of air time on that ride (and enjoyed it all)!   It was really surreal though, because we reached the bad part of the road right when it was getting dark.  As we drove along, I started to notice flashes of lightening; it was really a neat experience.  Travelling to a new place on bad roads in a crowded vehicle during a lightning storm certainly meets my criteria for an exciting adventure.  The Liberians say that when you drive on bad roads, you are dancing.  So I can officially say that I have danced in the rain during a lightning storm!  I love it!

Welcome to Liberia

Well, here I am in Monrovia, Liberia.  I made it safe and sound with no problems after getting to the airport.  We had some major flight issues the night before I left so that I ended up buying full fare tickets, but in the end everything worked out and I got here!  So far I'm loving it here!  My first day yesterday included spicy crawfish (delish), ping pong, homemade pita pizza, and my first ever bucket bath.  It was also my second 'malaria friday', making the day quite epic.  :D

So I arrived here yesterday in the late afternoon.  For the moment I'm staying in a compound with some other westerners until I can get a ride up to Nimba where I'll be doing health care stuff.  From the sounds of things, I think that should be around Monday or Tuesday.  I'm still not exactly sure what I'll be doing, but I'll find out when I get there!  It's going to be about a five and a half hour drive to get there, depending on the roads and traffic. 

It's nowhere near as warm as what I had expected.  It is pretty humid, but otherwise it's been very comfortable t-shirt weather.  Although actually it's cold enough right now that I'm wishing I had brought my sweater with me when I left the compound today!  Haha for my first day in Africa, I'll take it!  The compound is very close to the ocean, and from the roof there is a beautiful view of the sea and the many dugout canoes that line the beach.  My friend brought me to see the beach, and it's so funny because you can see hundreds of really big crabs running along the water line.  Funny little creatures.  Also today I saw the biggest gecko I've ever seen - it was as long as my forearm and bright yellow and red. 

So I'm trying to get used to the culture and language here.  They do speak English here, but the accent is heavy and there are many phrases and sayings that I don't remotely understand.  It's almost like trying to learn a new language at times, which is quite humbling and good for me.  I'll have to work on my comprehension skills, that's for sure!  I think I've been put on cooking duty for tonight, so I'm very glad I got the chance to cook a bit while I was in Newfoundland!  Hopefully I'll be able to avoid all major disasters! 

Ok, so that's it until next time.  :D

Preparations

June 9, 2012

My departure for Liberia is rapidly approaching.  I’m scurrying around trying to finish up my clinical here in Newfoundland while simultaneously preparing to leave for Liberia (on a side note, I have now successfully drawn blood cultures and initiated IV's!!!!).  I have my Liberian visa already, I got my last vaccination last night and I have a volunteer ID card with the organization I’m going through.  The flight loads look good at the moment, and it looks like I’ll be leaving close to June 21^st!  Things are really coming together and I’m getting so excited, but I’ve also hit the point where I’m now terrified.  There’s so much that I don’t know, and it’s quite intimidating.  I may have to check a bag for my flights, which is terrifying all alone - I don’t have the slightest clue how to do that!!! 

I’m really looking forward to learning more about Liberian culture, and ironically that’s also what I’m nervous about.  Where I don’t know anything, I really don’t want to unknowingly offend people because of my total ignorance.  But at the same time I can’t wait to learn about everything.  I don’t want to be a poor reflection of Christ because of myself and my western cultural tendencies; I think that’s what I’m most concerned about.  Prayer please! 

Maybe I should be sheepish about this, but I’m looking forward to checking out what the food is like!  Cassava in particular is something I’ve heard about so much, and I can’t wait to see what it looks like, what it is, where it comes from, how it tastes, learn how to cook it…!  And of course rice, can’t go wrong there.  :)  New experience, bring it on.

Beginnings

Talk about a crazy exciting time in my life.  I am in the middle of a six week stint living in Newfoundland doing my third year nursing preceptorship.  During this clinical rotation I get to practice all my advanced nursing skills such as IV initiation, drawing blood, NG tubes, catheters, tracheas, chest tubes and so much other fun stuff!  So far it’s been great, and I’ve been enjoying life here and love learning more about nursing and how to become better at my future profession.   

On a slight side note, you might know that I’ve always wanted to be a doctor.  At the end of the day, I decided to take a nursing degree because I want to do international missions work soon after I graduate.  My greatest fear with my life is that I will settle down comfortably and forget my passion for helping people in less fortunate circumstances.  I decided that nursing would better serve my long term goals and would still be useful anywhere in the world.  To help keep my focus on missions involvement, I have always planned on taking a summer to get the feel for nursing in an international setting before I graduate.  With graduation is in less than a year, this is the time. 

A few months ago during midterms, I sent an email to a missions organization asking them about their nursing internships and if I could be used anywhere as a third year nursing student.  I was simultaneously shocked, excited and terrified when I received an email telling me that certainly, I could be used.  And by the way, would you like to go to Liberia?

Needless to say, midterm studying wasn’t particularly effective!  After a lot of prayer, thought, and research, I decided to pursue the opportunity. 

So here I am.    

I am busy getting ready to head off to Liberia in about a month from now.  I plan on being there for approximately two months, and I am getting super excited.  I’ve started to research, think and work though getting the vaccines and medications I’ll need, getting everything on my packing list, keeping an eye on the flights, etc.  I’ll get my last dose of the rabies vaccine tomorrow – exciting stuff, let me tell you.  Although I have to say it’s probably a very good thing for me to know what it feels like when I’m poking needles into people all the time! 

I will likely be working in a health clinic where I will see and help treat people suffering from malaria, cholera, hepatitis, and that type of thing.  I also expect to see plenty of pregnant women – Liberia has one of the highest maternal mortality rates in the world.  I will have limited access to medical technology and electricity, which I have never experienced before. 

This will be hard, but I know it will be good for me on many levels.  In addition to learning more about nursing, I’m excited to see how I grow spiritually from this experience.  I know that as a result of this missions trip I will change in ways that I cannot even imagine.