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New PA Graduate working in Liberia

A Report from Liberia by Emory PA class of 2014 graduate, Diana Culbertson, PA-C  

Things are going really well and I am loving the work I am doing.  I am stationed in the southeastern part of the country on the border with Ivory Coast.  We are living in army style tents and all the staff that I am working/living with are African (mostly Liberian) so we get to eat lots of interesting food!

There has not been a case of Ebola in this region since January so we are not currently treating any patients but we have had to have the PPE training in the event that cases appear.  Liberia was hoping to be declared Ebola free in the next week or two but then another case appeared in Monrovia, the capital, so we have had to stay vigilant about looking for new cases and doing lots of public health work and social mobilization projects to spread awareness and help prevent new cases.

Liberia1I have spent the past couple of weeks going out “into the bush” as they call it.  We take motorbikes for several hours into the jungle (it is a beautiful although a somewhat frightening ride) to visit communities that are not otherwise assessable and have thus far only received information about Ebola by radio. It has been quite an experience to be the only “white lady” in a community that hasn’t seen a white person in years, if ever.  Fortunately I am working with Liberians who speak the local languages, although many here speak some English. The communities have been very welcoming and eager for information about Ebola.  There is widespread fear and many misconceptions about the cause of the disease and the way it is spread.  It has been rewarding to sit and talk with families about the signs and symptoms and how they can help protect themselves. Liberia4

We have also been working with schools in these communities to be sure they have government specified safety plans in place as kids return to school.  Honestly, this means a lot of hand-washing and keeping up basic hygiene and not coming to school or social gatherings if you are febrile.  If there is a silver lining here, I think it is that some basic public health measures, like  good hygiene are being heavily encourage and being adapted as habit, which can only help to improve health overall.Liberia2

The recent case, which appeared in Monrovia, was possibly transmitted by sexual contact and this has been the feared elephant in the room.
We know that Ebola lives in semen for at least 80-90 days, so in theory, men can spread it well after they have recovered.  However, there has been a lot of psychosocial work done here to stop the stigma that is placed on patients who have recovered from Ebola and this message has been boiled down to “once a person is cured of Ebola you don’t have to fear them, they can’t get you sick.”   So most people here are completely unaware about the sexual transmission piece.  So our next project is going to be encouraging condom use, again, if there is a silver-lining, let it be improved health practices that protect from the many easily preventable diseases with simple measures.

Liberia 3In the next week or two I should officially have my Liberian PA License so I will be able to start working in some of the small clinics near where we are based.  There is such a need, which after working in Africa before, it doesn’t surprise me but it always astonishes me and galvanizes my drive for why I became a PA in the first place.  There were only 50 doctors in Liberia (a country of almost 4 million) and only 1 health-worker for every 3,400 people before Ebola and 180 of them lost their lives during this outbreak.  I wasn’t aware before coming here, but Liberia trains and uses Physician Assistants and I have met quite a few of them.  It has been fun to talk with them about what it means to be a PA in Liberia.  Many of them don’t work with doctors at all because they are the only healthcare provider in the whole district.  They all have incredible tales of treating Ebola patients and they all have lost several colleagues to the disease.  At one time or another they all have thought they also had Ebola but their tests came back negative and they are still here, working to stop the spread, they are all my heroes!

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