Nurses—Making a Difference in Global Health
Nurse Stories: Improving Maternal Health
Jhpiego's Marion Subah Strengthens Nursing Education In Liberia To Save Mothers, Children
By Ann LoLordo
Marion Subah nursed the children of Liberia during her country's darkest hours. As a brutal civil war engulfed her fellow Liberians, Subah was working
at a hospital about 180 kilometers north of Monrovia. At Phebe Hospital, her job was to help the director keep the hospital running and caring for the
thousands of patients who found their way to the campus. This mother of four was drawn to the children, many of whom were malnourished, anemic, wounded
and traumatized by war.
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Marion Subah, head of Jhpiego's Liberia programs, in front of theJhpiego booth at June 7-9 Women Deliver Conference in Washington, D.C.
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"Things were very, very difficult. We didn't have the kind of supplies (that were needed)," says Subah, who was working for the Christian Hospital
Association of Liberia (CHAL) to help secure medical supplies, drugs, even food. "We were trying to help people to find their relatives, to find them
housing as well as providing patient care and (treating) gunshot wounds."
It was a time of uncertainly and quiet valor for Subah and others. Hospitals were not spared the punishment of war. Providers and patients could be
targets of either side; soldier and civilian lay side by side. Children were particularly vulnerable. Subah can still remember the day she had to ferry
an SUV full of orphans to safety. During the journey, not a child made a sound - an unnerving sign of how emotionally scarred they were.
"That was the first thing that taught me about children and war," she says.
Subah remained in Liberia through the war and its aftermath, enduring several separations from her children and her husband. In 2002, Subah relocated
to the United States, where her two oldest children lived, and later moved to Baltimore to be a nurse at Johns Hopkins Hospital, one of the finest
medical institutions in the world. However, she knew she would one day return to Liberia.
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Marion Subah conducting a training session in Liberia
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That day came in 2008, when she was hired by Jhpiego, an international health non-profit and Hopkins affiliate, to lead its programs in Liberia.
Today, Subah lives in Monrovia, and the war she is fighting is one of neglect and deprivation: the years of civil strife undermined the health care
system for her fellow Liberians and depleted the country's nursing corps and educators. Subah is among a group of professionals from non-profits who
are leading a determined effort to increase access to quality health care and improve maternal and child health in Liberia by rebuilding the ranks of
the country's nurses with capable, qualified and skilled professionals. Nurses are main-line providers in Liberia, staffing clinics, health centers and
hospitals.
As part of the Rebuilding Basic Health Services project, Subah is working with the Ministry of Health and Social Welfare, the Liberian Board of Nursing
and Midwifery and professional associations to improve nursing education, the teaching skills of instructors and clinical preceptors, and the
educational environment as well as to strengthen health facilities serving as clinical sites for the Tubman National Institute of Medical Arts and the
Esther Bacon School of Nursing and Midwifery.
Liberia's nursing education had been unchanged for two decades because of the war: medical texts date to the 1970s and 1980s, and nursing practices are
outdated, as are the prescribed medications of choice. During the 15-year war, nursing schools suffered heavy damage; their hospitals were burned and
several schools closed. As a result, today's schools have lopsided teacher-student ratios, impairing the quality of teaching and students' ability to
practice clinical skills. Computers aren't readily available, and schools lack anatomical models and technology to facilitate teaching.
Subah, 53, is dealing with all of this as well as helping establish an accreditation system to ensure that the country's eight nursing schools produce
professionals who can provide 21st century health care to the West African nation of 3.5 million to help reduce the fourth highest maternal
mortality rate in the world.
"We introduced the humanistic approach (to nursing) into Liberia," says Subah. "In the simulation center, students practice and get it very well before
they go into the field so they don't practice on a patient."
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Nurse capping ceremony May 2009 at the Esther Bacon School of Nursing, Curran Lutheran Hosptial in Zorcor. Attended by President Ellen Johnson
Surlief and Jhpiego's Marion Subah. First capping ceremony in 20 years because the school and its affiliated hospital were badly damaged during the
16-year civil war.
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"The rebuilding efforts in Liberia remind me of the essential practices of a public health nurse," says colleague Udaya Thomas, a nurse who works with
Subah on Jhpiego programs in Liberia. "As Florence Nightingale taught, the nurse has to look at the whole picture: environment, sanitation, nutrition,
and not just the individual. Marion is the essential public health nurse and is working to help rebuild Liberia as a center for nursing training and
education."
In some ways, Subah has come full circle - Dr. Walter Gwenigale, Liberia's health minister, was the
director of Phebe Hospital and County Health Officer when Subah worked there during the war. In describing her time there, Subah recalls the verse in
the Bible where Paul commends a woman named Phebe "as a helper of many." As a wartime nurse in Liberia and today in her work rebuilding the country's
nursing profession, Marion Subah is indeed a helper of many, a dedicated, inspiring figure in global nursing.
Contact information:
Marion Subah: Msubah@Jhpiego.net
Ann Lolordo: Alolordo@Jhpiego.net