Nicole Geller: Reflections on a Year of Service

Daisy WinnerBlog, Liberia, Midwifery

I have served as a Nurse Educator in Liberia for nearly a year, and have learned more in these months of service than I have in a long time. Every day, I am inspired by another challenge. And while I am not sure I could have done this work earlier in my career – I think I needed to grow into my role and gain some diverse experiences to feel confident – I do often feel like a new nurse, challenged and inspired, all over again.

Most of all, I learned this year that no matter where I go or how long I work as a nurse, when I walk into a new clinical setting, I will be tested. My background is very different than my Liberian colleagues and it took time to adjust to my surroundings. But my fellow midwives quickly adapted to my presence. They had me figured out before I could figure out where the cafeteria was or how to pronounce everyone’s names, and I know they are always evaluating my skills and my responses to challenges

I have had my share of “first days” over the course of my career and I have grown accustomed to earning my place in the “ward family”. My fellow midwives knew I was there to be of service and welcomed me after a few short days. Soon, I was allowed to sit in one of the chairs with a back rather than the rolling stool – a seat typically reserved for members of the ward family, rather than visitors. They see me as a friend and colleague, not just my endless supply of candy, and now together we watch OB videos on my computer and discuss managing clinical scenarios and cases. They appreciate my stories about things I have seen or done with patients or answers that I can find for us on the computer.

I am so proud of this work, because I know it pushes my students to think critically. For instance, I require my students to use the older, non-battery operated stethoscopes to evaluate the fetal heart rate, rather than a Doppler fetal monitor – much to the students’ initial dismay. But this technique is challenging to learn, and takes more time, as it requires counting the heart rate by listening over a full minute.

I try to teach my students to use their hands and ears rather than rely on tools they might not always have. I routinely ask them, “What would you do if you are working in a village, the battery on the Doppler has died, and the store is not open to buy a battery? How will you assess fetal wellbeing?”

They might have seen this as a challenge at first, but one day they saw first-hand how important this skill was.

As we were completing rounds, we approached a resident who was reporting on a pregnant woman recently admitted to the hospital. “We are not sure if the baby is alive…” And unfortunately, the Doppler did not work and we did not have a sonogram machine.

So, I examined the patient’s abdomen to find where the baby’s heart was located and rolled a pile of paper into a tube. I put down the roll, announced there was a heartbeat and a live baby, and proceeded to count aloud the beats over 60 seconds.

My physician colleagues asked me, the midwife, in front of my students: “Are there twins in there? How big is the baby? Do you hear accelerations?” My students saw that a midwife could work collaboratively with the physicians and answer their  questions about the patient’s condition, and not use a piece of equipment, but rather the very skills and techniques that we were working on together in the classroom. They understood that now, they, too, could do the same.