FEATURE

Nurses First

How three women in New York are improving health care in Liberia with one simple but effective strategy.

by Paul Hond Published Winter 2017
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Aaron Debah (left) speaks with a patient. In Liberia, families are often involved in their relatives’ care. / Photograph by Molly Knight Raskin

One of the first Liberian nurses that NFA recruited was Aaron Debah. There are a few things that make Debah unusual; not least is his specialty. Most nurses treat physical ailments — malaria, HIV/AIDS, high blood pressure. But Debah is focused on mental-health conditions, which are less understood, and bound up in superstition, doubt, and stigma.

In 2011, Debah was among the first graduates of a course started by the Atlanta-based Carter Center to help establish Liberia’s first mental-health program. There was, then as now, one psychiatrist in the whole country. 

When he started, Debah was the only mental-health clinician not just in Ganta but in the surrounding county. The region’s sole hospital, where Debah works, serves half a million people, many of whom lack running water and electricity. Debah has a mental-health radio show and invites listeners to call his cell phone. Often he will walk long distances to visit individual patients.

Ridge met Debah during her first trip to Liberia. Now thirty-six, Debah, who survived the war by hiding with his family in the bush, has the unrelenting, do-what’s-needed manner of nurses everywhere, but which in him seems distilled to its purest form. “When I think of my own stories, about my own life, going through the course of the war, I feel challenged to help these people,” Debah told journalist Molly Knight Raskin ’02JRN, who has been making a film about him since 2011.

“This was an area completely ravaged by war, and people carried that event with them. Acknowledging their trauma was a starting point.”

NFA support can hardly account for Debah’s fortitude, or the scope of his work, but in combination they have yielded significant results. Raskin observes that simply by being allowed to admit their problems and talk about them with Debah, people are getting better: they start working again, care for their children more attentively, or talk to others about their depression. “This was an area completely ravaged by war, and people carried that event with them,” Raskin says. “Acknowledging their trauma was a starting point. Aaron is breaking open that shell of trauma, giving people an outlet to talk about it and reducing the stigma.”

As Ridge points out, families tend to be very involved in relatives’ care in Liberia, and so Debah never really addresses just one person. “It’s very rare to decontextualize the illness from the family structure,” Ridge says. “In the US, I’ve had dozens of patients whose significant others I’ve never seen. In Liberia there is a larger family context that must be dealt with, and Aaron is fully committed to dealing with that and other social structures that influence a lot of mentally ill people.”

On March 24, 2014, PBS NewsHour aired a segment about Debah’s work, produced and narrated by Raskin. The week after the broadcast, the Liberian government reported that two people in Ganta had tested positive for the Ebola virus. These were the first known cases in the country. Over the next year, Ebola would kill five thousand Liberians, many of them frontline health-care workers.

 

Walsh, who now works as a nurse practitioner in a women’s health practice in New Jersey, was an NFA donor when Ebola struck. She says she was “floored” by how adaptable the organization proved to be during the crisis, changing its programs in the face of this new horror. Liberian nurse Christina Andrews made sure that her HIV patients had access to their medications after the Ebola outbreak forced their Monrovia hospital to close. Others focused on Ebola education and prevention, such as encouraging handwashing. “Having nurses in Liberia identifying needs and implementing relatively simple solutions that could help a large group of people was incredible to see,” says Walsh. She was so impressed that in 2015, when Ridge asked her if she would join the board, Walsh embraced the offer.

According to Richard Garfield, NFA’s results make sense: smaller organizations, funded by individuals, have the flexibility to deliver more targeted care, whereas large international organizations — ones heavily funded by governments or the UN — must adhere to their benefactors’ conditions, however flawed or inexpedient.

“If you’re a small organization with a long-term commitment in one place, rather than trying to staff offices in a dozen countries, it’s easier to do the right thing in paying close attention to what the caregivers themselves are saying,” Garfield says. 

 

During the Ebola epidemic, Aaron Debah risked his life every day tending to the sick. He had a wife and three kids, including a newborn. At one point, he developed symptoms and had to quarantine himself from his family. It turned out to be malaria.

The Ebola outbreak wiped out hundreds in Debah’s community. Debah persevered. With great tenacity and optimism, he took on more work than ever, helping survivors recover psychologically.

The city of Ganta has begun to come back from the war and the epidemic, but there’s still a long way to go. Ridge, after a four hour drive from Monrovia, arrives in Ganta on Tuesday night. She checks in to Jackie’s Guest House, a small, well-lit, lively hotel with a restaurant and free Wi-Fi.

The next day, Ridge meets up with Adolphus Andrews, a nurse with some training in dentistry who runs an NFA initiative for oral health, and Clinton Zeantoe, the dean of United Methodist University’s Ganta campus, who installed clean-water systems in local schools to protect children from waterborne illnesses. 

When asked why he became a nurse, Zeantoe says, matter-of-factly, “I wanted to serve humanity. It’s not about money. You contribute to helping someone who is ill, and you see them get well. They are in need of care, and you are there, and at the end, they say, ‘Thank you. I’m well today.’ That brings satisfaction to me.” 

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