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.