As a nurse-midwife in Liberia, Marion Subah has been taking care of mothers and their newborn babies for more than 40 years. “I want to make sure that they stay well, and when they are not well, what can I do to help them to be well,” she says.
The oldest sister in her family, she was born to be a caregiver, she says. “If you are the oldest sister, you start learning to care for people very early. I would help the younger ones eat, make sure they were clean, and was looking around for what needed to be done. You start with your siblings, then it’s your schoolmates and other people in your community. You are looking out for people, trying to make sure they are fine.”
Growing up in Liberia, Subah remembers everyone saying she’s just like her grandmother, who was a traditional midwife. “She was a very caring person, who did all the deliveries and led a group of women who took care of women who were pregnant.”
After graduating from high school, Subah decided to go into nursing. She wanted to take care of children, but early on in her career saw that it is mothers who take care of children. That led her to midwifery. “If I take care of mothers well and give them the guidance they need, they will be able to take good care of their children,” she explains.
These days, as the country director for Last Mile Health in Liberia, she leads a team of 180 people dedicated to making sure even the most remote communities have healthcare services, especially children under five.
“Over 40 years, I have now become more of a health system leader looking at the whole health system,” she says. She oversees Last Mile Health’s partnership with the Liberia Ministry of Health to scale and sustain the National Community Health Assistant Program, the country’s first national community health worker program.
Her role is two-fold, she says. On one level she interacts with parents, reminding them they have to speak up for their children to get the services they need. As a healthcare leader, Subah is making sure the people who are providing direct care, especially in remote communities, have the correct training and resources they need to provide quality care. “For example, when a child comes in sick with fever, we need to check them for malaria or pneumonia, which are common things that happen with children. I make sure health workers have the tests kits they need, and the medicines to provide treatment. And I make sure they have qualified supervisors to observe, mentor and coach them, ensuring health workers are providing the correct services.”
Nurse Leaders as Decision Makers
You need nurses who know what they are doing, but you also need leaders who are effective communicators who can make things happen, says Subah. “Leaders are people in healthcare who use data based upon evidence, both quantitative and qualitative, to make decisions. You cannot just come and guess that this is happening. You need that data to talk about effectively solving problems and for getting the resources that you need.”
Data in the form of past history is also very relevant to providing care, stresses Subah. “When caring for a woman in labor you can plan and make good decisions if you know whether it’s her first or second or third pregnancy, whether she had problems in the past, whether she has the resources and experience to care for the baby. When a child is sick, it helps if you have information about the child’s past history.”
Most importantly, leaders are life-long learners, Subah adds. “In health services you cannot learn something and go on with it forever. We learn new things and are able to adapt.”
The Role of Technology in Meeting the Health Worker Shortage
The number one challenge in healthcare today is that there are not enough qualified health workers to take care of people, says Subah. “We see lines of sick children, or children coming in for immunization and they’re waiting because we don’t have the right number of people to take care of them.”
But advances in technology give her hope. “To meet universal coverage of people, we have to use technology and self-care, as we don’t have enough nurses for everyone. I think that's the direction that healthcare is going. If we can work towards empowering people with the tools they need to take care of themselves, and people don’t go to nurses and doctors for all the things they are able to do, then we have a chance to get to universal coverage and meeting other healthcare challenges.”
For Subah, self-care is doing as much as you’re able to stay well—making sure you eat the right food, get exercise and enough sleep, and being calm. These are things she reminds herself to do as well. As she travels the long distances to get to the remote communities that need her help, she notes it’s easy to complain and get preoccupied with the bad roads, for example. “Instead, I just look at all the green on both sides,” she says. “I watch nature—the trees, the flowers, the sunset, the water. All of those things are helpful for me.”