A Travel Nurse Volunteer in Liberia: The Acclimation

Acclimation Phase: The Language

The first week here in Liberia, has somewhat reminded me of the first week of a new hospital contract. Getting to know the staff at work and remembering names is always a challenge for me.  Simply figuring out the general processes and workflow at any hospital is always a challenge.

Here, it’s just slightly more difficult.  Even though the local language is English, the English spoken here is much different than US English.  I would equate it to a somewhat ‘Caribbean’ feel.  The words are jumbled together and the pronunciation is slightly different.  Sentence structure is totally ignored; sounds are left off of the ends of words and for me their speech seems very fast.  An example would be ‘How are you doing?’  In the local dialect, they would say something similar to ‘How ooo gittinon?

Please realize, I don’t bring this up to make fun, degrade or anything of the sort.  The language here has been a major challenge for me.  I’ve traveled quite a lot to foreign countries where English is not a primary language and several of them where English is seldom spoken.  I anticipated some difficulties in acclimating to the local community but I never expected the language to be as big of a barrier as it has been for me.

I’ve been very frustrated with myself and my lack of comprehension of the language.  It’s interesting, when I travel (for example) in a Spanish speaking country, I don’t have much difficulty understanding and getting my needs met.  Rarely do I get frustrated with conversation or my lack of understanding.  Here, I have been completely frustrated with my inability to understand the locals.  I find that I have to request that they repeat nearly everything that is said.  Following a conversation between several locals is nearly impossible and speaking to someone via phone is a lost cause.

Acclimation Phase: The Nurses Role

C3 is a young organization.  They have been serving St Timothy’s Hospital in Robertsport for (I believe) only two years. Most of the previous volunteers have been physicians or advanced practice RN’s. Due to this, the role of the RN is not clearly defined.  During my first few days at the hospital, I found that I felt I was pushed extremely beyond my comfort level.  Working in the emergency department, the nurses basically appear to run with little to no physician or P.A. (Physician Assistant) assistance.  The nurses are ordering treatments, medications and making decisions on admissions.  In the O.P.C. (Outpatient Clinic), where I worked on Tuesday, I was operating basically as a general practitioner/physician; doing assessments, ordering lab work and writing prescriptions to be filled as well as determining the time-frame for the patient to follow-up.

This was extremely stressful for me.  I do not operate this way in the states and something felt wrong about being able to make decisions of my own accord.  I will say that I asked MANY questions, and also had the P.A. on duty check over my assessments and orders.

Acclimation Phase: Why am I here?

As I mentioned previously, C3 is a young organization and newly operating in Robertsport.  The role of the Nurse volunteer has not yet been fully defined and I’m feeling the lack of definition as I begin my volunteer time here.

Having worked at St Timothy’s for the past several days, I have asked myself this question time and time again.  Why am I here? The ER appears to run well, the OPD meets the community needs and the inpatient unit (which is mostly pediatrics) nearly has more nurses at a given time than they have patients.

I’ve spent a lot of time considering what the Nurse’s role ‘should’ involve here in Robertsport.  Working alongside the current staff has enabled me to be able to identify several areas in which there could be some improvements. From sanitation to general processes.  I do not feel that the community needs me as a staff member; they really do have adequate staff as far as the nursing staff is concerned.

What the community and the hospital do need are better processes, organized procedures, and suggestions on how to improve.  How does this get achieved?  This is the bigger question. I’m totally unsure at this point how receptive the current staff is on ‘change’.  Having worked as a Travel Nurse for the past 10 years, it’s been ingrained in me to ‘leave it alone’ when it comes to attempting any changes.  As a traveler, the hospitals are generally not very receptive to changes and certainly not from someone (like myself) that is only at the facility for a short period of time.

Will the staff here react the same?

It’s also interesting to note that I feel my acclimation is phasing out exactly like a typical travel contract.  See my recent article Life: 13 weeks at a time – as a Travel Nurse.

Personally Speaking:

I think it’s important for the reader to note that I am on a solo volunteer trip.  There is no C3 support staff here in Robertsport.  I am currently the only volunteer (although there is another volunteer arriving at the end of the week).   I am in communication via email and phone with Dr. Montana (founder of C3) who is available to me 24/7 as needed.

I consider myself a pretty independent person when it comes to traveling solo.  I’ve traveled solo in multiple developing countries including: Vietnam, Guatemala, Mexico and Panama.  I have to say that so far, this experience has been quite a challenge for me on a personal level and has pushed me near my limits.  I’m hopeful that these feelings are all a part of my ‘acclimation’ phase and will soon pass as I adapt to the local environment.  It’s also interesting to note that the things (lack of supplies/patients dying/local living conditions/etc.) that I thought would be my biggest challenges in adaptation, have not been.  So, perhaps once I am through the acclimation phase and figure out what my role here is, I’ll feel less pushed to the limit.