Dr. Paul Farmer relays health care challenges in impoverished nations

URI College of Nursing sponsors talk at R.I. NEC; students to visit clinic in Liberia

KINGSTON, R.I., December 15, 2017 — At the height of the ebola crisis in West Africa in 2014, a young girl no older than two arrived at an Ebola Treatment Unit in Liberia organized by Partners in Health. The child’s entire family had succumbed to the disease, leaving her frightened, alone and facing an uncertain future with no family to care for her.

“A clinician – probably a nurse – removed her earrings and had the awareness to put them in Clorox rather than just throw them away,” said Dr. Paul Farmer, founder of the global health initiative. “Those earrings were the only thing the baby had to remind her she even had parents.”

The story is both heartbreaking and uplifting. It serves as a reminder of the critical role health workers perform, not only in providing treatment, but also in providing care.

Similar scenarios play out every day in impoverished regions starved of even the most basic health systems. Overcoming such disparities in some of the world’s poorest, most remote locations — especially those wracked by virulent outbreaks — is Farmer’s mission, which he relayed during his presentation, “The Caregiver’s Disease: Ebola and the Challenge to Nursing in West Africa,” at the R.I. Nursing Education Center in Providence on Dec. 12. His talk was sponsored by the University of Rhode Island College of Nursing, which offers instruction to juniors, seniors and graduate students at the center, part of the new South Street Landing development.

“These places are clinical deserts compared to Haiti,” said Farmer, the renowned physician and medical anthropologist credited with revolutionizing health care in the Caribbean nation. “During the ebola crisis, 99 percent of the deaths were in three countries (Libera, Sierra Leone and Guinea). Why? Well, they just didn’t have health systems. I can’t imagine any work that is more satisfying than going to a place and giving medical services to those who don’t have them.”

Five URI nursing students will do exactly that in the Spring 2018 semester when they travel to Liberia to help treat patients at a Partners in Health clinic. Elaine Parker-Williams, a doctoral student in nursing at URI who is from Liberia, will lead the nurse practitioner students who will work with patients at J.J. Dossen Memorial Hospital in Maryland County, Liberia, especially those suffering from diabetes and hypertension, among the leading causes of death in West Africa.

“The students will be able to assess patients, diagnose and recommend treatment,” Parker-Williams said. “This is a global initiative for the University, so we can see what is happening in health care in developing nations. We’re exposing the students to these areas of need, which will hopefully gear them toward careers in global health.”

The URI students — Bethany MacLeod, Kristen Remeika, Caryn Amedee, Phoebe Hall and Christina Lewis — got the chance to learn about global health from the master, when Farmer met privately with them and URI faculty and administrators for more than an hour before his presentation. He relayed the challenges of providing care in such remote, foreign locations, and described what is needed from health care workers overseas.

“You’re not going to become culturally competent. I’m not culturally competent in Haiti and I’ve been going there for 35 years,” Farmer told the students. “What you really need to know is how to nurse. We need nurses who can nurse and doctors who can doctor. That’s what we didn’t have during the ebola crisis.”

What they did have were plenty of misconceptions regarding the genesis and uncontrolled virulence of the devastating disease, from some locals who blamed spiritual origins to many outside the region who assumed the victims’ own actions or eating habits worsened the outbreak.

“The drive toward exoticism is a big problem with infectious disease,” Farmer said. “These people didn’t die from eating bush meat or from anything they did, but because of a lack of medical care. The first thing we do in one of these outbreaks is stop caring for the sick (instead, simply isolating them in an attempt to slow the spread). That is particularly painful for clinicians, especially nurses.”

Those health care workers continue their mission despite the extreme dangers they face, especially in poor regions lacking proper sanitation and protections for those working with patients.

“Caregivers were the most at risk,” Farmer said, noting hundreds of nurses and doctors contracted the disease while treating patients. “It’s especially tragic for health care workers who knew what they were getting into and still tried to help save families.”