Experiences in Nursing, Nursing Education and Leadership in Liberia Before Ebola and Beyond

Nursing experiences in Liberia have been fraught with challenges because of the lack of infrastructure made worse by the civil war.  Edwin’s first years as a nurse at the John F. Kennedy Memorial Hospital, we were providing delicate nursing care, such as inserting naso-gastric tubes and administering blood transfusions without electricity, we just used candle and flashlight. We could work for months without pay; so nurses did not go to work on time and those on shift could not wait after their shift to turn over. There was a lack of drugs and medical supplies to provide nursing care to the patient. We knew what to do, but we lacked the resources to implement, so the patients just stayed in bed; some developing decubitus ulcers while others died slowly.  I also had the experience of providing nursing care to patients in mass casualty situations during the civil war. We were providing nursing care to people with multiple injuries, most of them non-survivable. It was very agonizing to see your fellow men in this kind of situation.  Walsh (2010) notes in her dissertation research, “the Liberian nurses’ describe the frustration with the lack of supplies, equipment and wages.”

Despite all of these challenges, being a nurse in Liberia was a dream come true for Harriette.  I wanted to be a compassionate person who could make others healthier.  Being a nurse was wonderful, then I thought I could do more and share my knowledge with others and be a teacher.  I found myself in the classroom helping to prepare nursing pupils and realized that I was not prepared or trained as an educator to take on my new role.  I was provided with the opportunity to attend a few workshops that actually helped with the classroom management and developing session plans. 

Harriette and Edwin were fortunate that they both met Dr. Edna Johnson, a retired nursing professor from the United States who was working as a missionary in Liberia.  Both Edwin and Harriette talked with her about their desire to attend a master’s in nursing program and she told them about the Master’s in Nursing Education program that would begin at Mother Patern College  of Health Sciences in Monrovia in 2010.  The program had received funding from USAID and World Learning that would provide scholarships to cover the cost of tuition and books.  The students had to apply and be accepted to attend, their school of nursing needed to allow them to take a leave of absence with a contract to return for a defined time period.  In addition, for a student like Harriette who lived in a rural area many miles from Monrovia, she had to leave her family for the 15 months duration of the program. 

Critical thinking and evidence-based nursing are the two key words that came to light for Edwin, Harriette and their classmates in the MSN program. Today, it’s clear to us that nurses should be critical thinkers when providing nursing care and when interacting with clients. Nurses should be involved in research so as to provide evidence-based nursing care. Attending the MSN program greatly changed our thinking and understanding of educating nursing pupils, focusing on clinical teaching and student centered approach, rather than the old medical or traditional model of training.  During the program it became clear that nursing is a distinct profession and competent nurse leaders are the best people to take charge of nursing education and leadership.  As graduates of the MSN program we now have the education to work with the Liberian Board of Nursing and Midwifery to improve nursing education in Liberia. 

During the Ebola outbreak all of Edwin and Harriette’s job related activities were forcibly shut down by the Government due to the closure of the schools.  Because of our roles as educators and as nurses we were sought out to provide health prevention education and training, as well as leadership during this crisis.  Harriette participated in training mid-level health workers on Infection Prevention Control in Lofa County. I delivered the best of MSN education and the organizers of the training did like every presentation and methods of teaching and wanted me to join their organization as a full employee, but I refused because I was committed to her calling.  Likewise, Edwin was given the position to supervise the National Catholic Ebola Infection Prevention and Control training workshops in the Monrovia archdiocese and Gbarnga diocese. As a training supervisor, I needed to know a lot about Ebola transmission and prevention of Ebola. My experience was that most of health care providers who got infected did so because of lack of previous knowledge about Ebola transmission. Up to 400 health care providers, according to report from the Infection Prevention Control Taskforce meetings got infected and half of that number died. At the initial most of the health care providers used standard precautions rather that the extended precautions. Additionally, some got infected with the Ebola virus while giving home-based treatment [without personal protective equipment] when their working areas were shut down because of Ebola. At the community level I realized that people got infected because of disbelief and mistrust in Ministry of Health and Social Welfare.  These experiences also led me to potential career opportunities and I am now working as the Coordinator for the MSN program at Mother Patern College of Health Sciences in addition to taking on many other important duties there.

The experiences of Harriette and Edwin are reflective of the transformation of the graduates of the MSN program.  They also highlight some of the findings of Curry, Taylor, Chen and Bradley (2012) who interviewed 17 health care leaders from four sub-Saharan African countries, including Liberia.  One of their key findings was having a value-based vision for improving the future of the country, which these experiences reflect.  Another finding was tending to relationships, which these experiences also highlight.  The value of higher education and leadership development in transforming nursing cannot be underestimated.