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.