Seven students from Niagara University’s College of Nursing had the opportunity to learn about the culture and people of Liberia, as well as the disparities in healthcare settings and nursing education, during a cultural immersion trip to that country in December.
The trip was organized by faculty fellow Dr. Zeinab El-Housseini, who grew up in Liberia, and her family members, academicians themselves, who still live there. When Dr. El-Housseini shared her plans to go back home in December with Dr. Christine Verni, dean of the college, and how the trip always leads to a greater sense of gratitude, happiness, and kindness, Dr. Verni suggested they consider organizing a mission trip for students.

The students toured Mother Patern College of Health Sciences in Monrovia with Sister Barbara Brillant, dean of the school.
With the assistance of professionals in the country, Dr. El-Housseini developed an itinerary that included visits to private and public colleges of nursing and hospitals, a health clinic, and an autism clinic, all located in Monrovia, the capital of Liberia. The students were able to care for patients in the emergency room and observe the healthcare professionals in the operating rooms, ICU, and NICU, as they learned firsthand the differences between the facilities and the schools, as well as between healthcare and education in the United States and in Africa.
They also met with Dr. Jarso Maley Jallah, the Minister of Education for Liberia, to share their insights about what they encountered on their trip, and enjoyed numerous opportunities to experience the culture, food, and friendliness of the Liberian people.
“I really wanted the students to notice that these individuals don't have the same resources, and they do not make the same amount of money as we do here, but one thing that they carry with them is kindness and joy,” said Dr. El-Housseini. “Nursing students are going to have bad days, they're going to be tired, but they have to keep a kind attitude toward their patients and toward their fellow nurses, knowing that care quality shouldn't be affected by the external things happening around them.”

The students visited the NICU at JFK hospital.
The most obvious takeaway for the students was the disparities between the facilities they visited, and between the way healthcare is delivered at home and abroad.
“We visited three different hospitals (John F. Kennedy, Catholic, and Jahmale) along with various small private clinics. Each clinical setting was unique in its own way, providing insight into how the healthcare systems operate in countries that lack many valuable resources, and how the medical teams have adapted to those lack of resources. JFK was the first hospital we visited. The emergency room (about a 6 x 30 ft. hallway) seemed to have more people than there were square feet.
“Each patient was severely ill, but the vast majority didn’t have access to a bed and instead sat in plastic lawn chairs, shoulder to shoulder to one another. There was no air conditioning, so the heat was insufferable to some of the fellow students, and you could only imagine the effects this heat had on the already suffering patients.
“The other clinical setting that truly stood out was Jahmale hospital and for all the opposite reasons as JFK. Jahmale is a large, pristinely clean hospital with many of the resources that you’d see in the United States (if not even better). We saw an MRI machine, X-ray machines, a large lab, and much more. However, I don’t think we saw a single occupied patient room or patient in general.
—Nicholas Proenza

Rooms in a clinic the group visited.
“The emergency room I worked in for a few hours was no wider than 10 feet and was essentially a long hallway. This experience was deeply saddening and made me more aware of the disparities these communities face. JFK Hospital was a public hospital, and it was disheartening to see how many individuals weren’t able to receive care after waiting in line all day. I was told this wasn’t even a busy day, and it’s usually much busier, with lines extending outside the door.”
—Jonah Lubick
“In the triage area of the ER, there were no beds, individual rooms, or dividers. Many patients were confined in a narrow hallway, seated in lawn chairs awaiting treatment, all while experiencing high temperatures with minimal air circulation. I was so impressed by the efficiency of the staff as they moved from patient to patient with ease and composure. After spending four hours working, I was completely exhausted, drenched in sweat, and shocked that it was apparently a ‘slow day.’
“A huge limitation of the healthcare system is the resources they have available. The hospitals we visited lacked necessary imaging equipment, such as ultrasounds, CT, and MRI machines. In fact, there is only one MRI machine in the country.”
—Allison Busha
“I can’t describe entering our first clinical as anything other than absolute shock. Seeing so many very sick people in an ER sitting on folding chairs genuinely blew my mind, most of them seemingly suffering from illnesses that would have been easily treated in the States. I remember being really surprised when I saw them using gloves instead of tourniquets on people’s arms.”
—Barry Colby
“There is a disparity in the availability of equipment for both screening procedures and for everyday interventions such as finger sticks, blood draws, and cotton swabs for cleaning. These items are so readily available in the United States to the point that oftentimes we take them for granted and waste them.”
—Christina Stokes
“The lack of resources was staggering. They lacked everything: supplies, medications, staff, money, space, and proper facilities. I saw healthcare workers doing the best they could to help their patients with the limited resources they had available. To me, the emergency room felt chaotic, almost like a war zone. This environment was entirely new and unlike anything I had ever experienced before.”
—Elizabeth O’Hara
Other differences also stood out.
“I was surprised to learn that surgeons did not specialize as surgeons in the United States do; however, the surgeons explained that the diversity in their abilities allows more individuals to receive more of the surgical interventions they need.”
—Allison Busha
“Family are quite involved in the healthcare team. For example, at JFK hospital, the nurses would draw labs off of patients and their family members would then have to walk the vials to the laboratory to be tested. After paying for the blood to be examined, family members would then walk the results back to the hospital so that their loved one could continue to be cared for and treated.”
—Victoria Gallo
They were also surprised to discover that healthcare is dependent on a patient’s ability to pay.
“I was most shocked to learn about how all medical treatments, including lab tests and scans, have an additional cost on top of paying an initial treatment fee. This was very upsetting to hear, especially after learning that some Liberians only make $100 USD a month, making medical care low on their list of priorities.”
—Allison Busha
“There was no concept of insurance, and many people that were in the emergency department were formally discharged, but were prohibited from leaving due to unpaid bills, meaning they had to wait for family or friends to come up with the money in order to go home.”
—Christina Stokes
“Having money can truly make a difference in healthcare. Money can afford you a hospital bed, a private room, and even more adequate care. It can also provide access to surgery. When we visited more expensive clinics and hospitals, the infrastructure and patient care were noticeably better. However, even in these facilities, there were still areas where resources were lacking.”
—Jonah Lubick

The group was greeted with singing, dancing, and signs to welcome them to Liberia.
While the disparities may have been disheartening for the Niagara group, the warmth of the Liberian people made the journey worthwhile.
“When we arrived in Liberia, we were greeted by Dr. Z’s family and friends. They were singing and dancing to welcome us, holding banners that made us feel truly appreciated. I immediately felt a warm and happy sense of welcome.
“Everyone seemed to cherish the presence of others. I saw several groups of people hanging out together, laughing, and talking. It was clear that, even though they didn’t have much materialistically, they valued being with one another above all else.
“The culture was full of warm welcomes and acceptance. I don’t think I met a single person who didn’t welcome me to the country. Everyone was polite, upbeat, and kind. It truly felt like a tight-knit community.”
—Jonah Lubick
According to Dr. Verni, experiences like these help students better understand Niagara University’s Vincentian mission and what it means to care for those who are underserved, poor, under-resourced, and vulnerable. She also noted that, especially in Western New York, it is important to know how to care for a diverse population that may be used to a different way of delivering healthcare. But, perhaps most importantly, the students, themselves, are interested in developing a cultural competence as they prepare for their future in healthcare.
“The students are very much interested in moving beyond their backyard to see what nursing and healthcare looks like across the globe and how it differs from what they've grown up with and what they've been exposed to,” Dr. Verni said.