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Visiting Liberia: Reflections of a School Nurse

By Kathy Rossman

As a school nurse, my first visit to Liberia was viewed through a public health lens. Human wellness is complex – involving physical, emotional, mental and spiritual aspects. Liberia’s history of civil war and the recent Ebola crisis combined with a legacy of government corruption deeply affects thinking. While visiting villagers, there was a clear lack of confidence in local healthcare. Reports of “padded payrolls” and hospitals devoid of medications are common with patients being required to fill prescriptions in the community pharmacy and return for administering.

Financial difficulties influence health decisions. I learned of sick family members visiting a clinic, receiving a diagnosis, then having no money to buy the prescribed medication. Instead, many use “country medicine” to treat themselves with allegedly medicinal leaves or roots. Illiteracy limits understanding of discharge instructions and which prescriptions are vitamins versus critical antibiotics. There’s an acceptance that illness is inevitable.

Diets dominated by rice, cassava, and greens get most calories from local palm oil with little protein from meat or beans — contributing to weak immune systems and

inadequate capacity for repairing injured tissue. It was clear that adults, particularly men, were fed before children. Though I saw many nursing women, it was unlikely they were consuming the additional calories needed for lactation. I wondered how this factored into Liberia’s high infant mortality rate. Additionally, nearly one -third of Liberian children under five are stunted due to poor nutrition.

Minor “discomforts” are minimized until the problem is inescapable – becoming more difficult and costlier to treat. Preventative health is limited. Many do not correlate traditional practices, like defecation in nearby bushes, with health consequences such as diarrhea and gastrointestinal pain. I saw a community latrine recently constructed by the YMCA sitting unused because no one agreed who should clean it or haul water for “flushing”.

Injury potentials abound. Babies crawl on littered ground near open cooking fires. Unaccompanied 4- and 8-year old children wash clothes in muddy water deep enough to drown in. An 8-year old wearing flip flops uses a machete to cut firewood. Black smoke from burning roadside trash filled with discarded plastic is inhaled. Thinking nuts from local cashew trees would be a good protein source, I learned from villagers that the fruit is palatable yet the nut shell is caustic, causing skin burns and scarring.

I thought it unusual not seeing Liberians wearing eyeglasses. GLTC adult literacy class students expressed a need for reading glasses. Departing through Monrovia, I met a Brussels Airlines representative who happened to be a Rotary Club member. After this brief encounter, connections were made and donations received that ultimately led to an eye clinic being held in Deanville. As a result, 140 community members were examined, 90 received free glasses, and 50 had medication administered for eye health.

Despite deficiencies in Liberia’s health sector, poor nutrition, and daily hazards associated with living in poverty, everyone smiled and welcomed me to a place they were proud to call home. We have much to learn! !

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