Written by: Deborah Wilson, RN, MSN, MPH, CRNI
Sometimes, you make a choice that sets you on a completely different life path than you ever imagined. In 2014 when Medecins Sans Frontieres (MSF) asked if I would go on mission to work as a nurse during the Ebola outbreak in Liberia, saying yes, set off chain reaction that changed my life forever. That mission and the timing of my return (two days before the first nurse came down with Ebola in Texas) catapulted me from a quiet comfortable life to one where I found myself speaking out publicly on the harm of political policies and actions of communities when fueled by the fear of Ebola rather than common public health sense and evidence based science. This led me to seek and complete a MSN/MPH at Johns Hopkins.
Coming off night shift at the ETU in Liberia (October 2014)
Usually, after a mission, a hot shower a good meal and some wine lets you go back to your life – almost like nothing happened. But this time so many things continued to haunt me. The intensity of working in a 120 bed Ebola Treatment Unit highlighted issues about working in the global humanitarian field that left me with more questions than answers.
One was the perception that on missions national nurses did most of the work, but they were not always treated as colleagues. Expatriate nurses were always the supervisor and meetings that decided plans of action or care in the clinic/hospital or field usually excluded national staff. Of course, it is complicated, many factors are at play in the international humanitarian world, but I could not help but wonder if there was a way that we could change this.
The 78 Liberian nurses that I supervised when in Liberia, worked for the whole duration of the Ebola outbreak not just for a few weeks like us international ex-patriate nurses. They did not have the option of being flown to a country where they could receive state-of-the-art treatment if they contracted Ebola and they had to fight their Ministry of Health to get paid. In fact they were not paid for more than six months and never received the hazard bonus that they had been promised.
In the face of such information my desire to see improved collaboration between national and expatriate nurses seems minor but it continued to haunt me. I looked for articles about working in humanitarian emergencies and discovered that of 30 that I read only 2 had interviewed or surveyed national staff experience. The rest focused on expatriate experience and opinion.
So I decided to do my own independent study as a student. I obtained IRB approval both from Hopkins and the Liberian Review Board and flew to Monrovia to interview nurses that worked for various international NGOs.
A Liberian nurse that I had worked with during the Ebola outbreak completed the John Hopkins ethical and human subjects modules so that he could be an official co-researcher. The quality improvement study we conducted asked the question “Can an increase in collaboration between expatriate and national nurses improve the clinical outcomes of patients?”.
Darlington, my co-researcher, and I taking a break from interviews (November 2017)
We interviewed 20 registered nurses representing ten different international NGOs. The interview questions included asking what was positive about working with expats, what was negative and what ethical conflicts arose. The nurses provided numerous examples of how clinical outcomes of patients were adversely affected by expatriate nurses not listening to their suggestions, advice or on-the ground experience. The nurses also had an opportunity to discuss the effect of the Ebola outbreak on their nursing profession and well-being.
Currently my co-researcher and I are working on data analysis with plans to publish our findings. Some of the findings that I hope will enrich global nursing experience and capacity are:
- The Liberian nurses were empowered by having the opportunity to articulate their experience, and having their ideas and suggestions listened to. What if more opportunity was given for these nurses to find their voice, express their views and learn how to lobby for themselves?
- They spoke of how working with expat nurses ignited a passion for their profession. The care, friendship and follow through that they witnessed expat nurses embodying inspired them to emulate this in their own practice.
- Suggestions the national nurses had revolved around: inclusion in decision making and respecting that they are qualified nurses as well and know their people better than we do.
The nurses strong desire for access to higher education was consistently expressed and because this was their voice, their desire I find myself exploring and meeting with people and organizations that are interested in making that happen.
The future is unknown but from that one decision to go on mission during the Ebola outbreak a whole new life and purpose has been awoken in me for which I am very grateful.
Three years after the Ebola outbreak, an opportunity to meet up with some of the nurses I worked with. Here we are just watching the sunset on a beach in Monrovia.