Stuart (left) with workshop participants.
Stuart (left) with workshop participants.

Gail Stuart, PhD, RN, FAAN

January 2011
APNA Member Profile

 
T

he country of Liberia has experienced its share of tumult and trauma. Founded and settled by freed American slaves in the early 1820s, Liberia lies on the West coast of Africa. In the 1980s a military-led coup ushered in a period of instability that has included two civil wars and a devastated economy, not to mention atrocities such as rampant sexual assaults, the drugging of child soldiers, and forced amputations. Homes, offices, shops, schools and health centers were destroyed. Today, as Liberia seeks to emerge from an unstable past and embark upon the path to recovery, its ability to diagnose and treat the traumas and mental health problems of its people is paramount.  This is where APNA member Gail Stuart comes in.


Workshop participants - Stuart is in the back row on the left.

Gail Stuart, PhD, RN, FAAN is a Dean and Distinguished University Professor at the Medical University of South Carolina in Charleston. Her clinical expertise lies in depression, anxiety, and cognitive behavioral therapy. In 1999 she received the APNA Psychiatric Nurse of the Year Award and she served as APNA President from 1995 to 1996.

Last summer Stuart got a call from the Georgia-based Carter Center, a non-profit founded in 1982 by former President Jimmy Carter and his wife Rosalynn Carter. The Center's Mental Health Program had just begun a five-year initiative aimed at aiding the creation of a new and enduring mental health system in Liberia. The head of the initiative, Dr. Tom Bornemann, personally knew Stuart from her active involvement in a number of interprofessional groups. Stuart, who wrote the noteable textbook Principles and Practice of Psychiatric Nursing, was tapped to develop a curriculum for training psychiatric nurses in Liberia.


Living conditions in Monrovia, the capital of Liberia.

The Carter Center planned to train 150 nurses in Liberia to provide psychiatric care. "The idea is to train / educate the first group and then they would become the trainers for other cohorts - 2 each year," she explains.  "This is a 'train the trainer' model which empowers the home country and gives them the skills, rather than folks from the states coming in, doing their thing, and then leaving."

She made the 16 hour flight to Liberia in October and there witnessed firsthand the untreated psychological wounds ravaging the country's people. Stuart also stresses the resilience she witnessed in Liberia's people. "They want to recover, rebuild and restore their country. They care for and about each other and have a passion and a spirit that light up their eyes," she wrote recently.

During her week-long trip Stuart "met with 40 individuals, nurses, faculty and members of their Ministry of Health. We spent three full days in a workshop reviewing every aspect of the curriculum I had drafted - tailoring and refining it for their cultural and unique sets of issues and needs." She also met with nursing schools and members of the Liberian Ministry of Health. "I was so impressed by their commitment to the task and the energy they brought to the process," she says.


Working in small groups during the workshops.

Of the challenges faced while in Liberia, "there were many," she says. "The most prominent was that they are so far behind in the resources they had. Nursing students were being taught from psych nursing textbooks that were 10 years old! The internet only worked intermittently and they had very, very few resources to draw upon. Nonetheless, their thirst for new knowledge was high and they leaped on any resources presented."

Once back from her trip, she "worked hard to revise the curriculum to incorporate all that I had heard...and listening to them and their stories was a major learning lesson for me." For example, she integrated into the curriculum the folklore of "open moles" which some Liberians believe are soft spots on the skull through which bad spirits enter the head. The resultant effects are similar to the symptoms of anxiety and depression.

The curriculum, once approved by Liberia's Ministry of Health and Social Welfare, will train 150 nurses over the coming five years. It is "designed to be five courses taught over a four to six month period of time," she says.  Liberia's six nursing schools will also use the curriculum. In a country where licensed mental health professionals are rare, the implementation of Gail's curriculum will exponentially increase the availability of mental health care to its 3.4 million inhabitants.

On a more personal note, Stuart has found her experience with this project rich and life-changing.  "The work we did together while I was there was some of the most rewarding in my career.  Equally important, I believe that in some very fundamental way my trip to Liberia touched my soul and I returned a changed individual."

January 2011 Members' Corner