The foundations of Gambia’s healthcare system:


a medical student’s perspective

It was yet another Thursday and once again, my team was on-call duty. It’s funny how my entire body just refuses to cooperate on such days as though it has an unsettled business with anything that has to do with “on-calls”. I mean, I wouldn’t even blame it because making it to classes and ward rounds until 2PM isn’t in itself easy so adding “Ndemban” (where on-calls are held) to the list sounds a like an unfair punishment especially on hot sunny days. But how could I even complain? This is the challenging profession I have chosen to dedicate my life to so perseverance comes into play when the ride seizes to be smooth.

I arrived at “Ndemban” just in time and as usual, the triage which is a station right at the entrance of the Accident and Emergency unit (A/E) where patients are first seen in order to document why they have come to the hospital was being handled by a nurse. The place was actually flooding with patients and the typical me was making a mental picture of how the nurse actually serves as the first point of contact with each of those patients, such important personnel at the very beginning. In case you are arguing that an emergency situation would be totally different because a doctor is likely to come running in an effort to find out what’s going on, well, be rest assured that you’d fine a nurse rushing towards the concerned patient to quickly take note of what is referred to as “vital signs”. Vital signs include important information such as a patient’s blood pressure, temperature, pulse, respiratory rate, and oxygen saturation in the least and they go a long way in providing a clue about a patient’s overall wellbeing whilst signalling early signs of infection. In fact, in some cases, the nurse has to brief the doctor on how the patient has presented including information about the vital signs to fasten and ease the process of differential diagnoses. I quickly made my way inside to the surgical department and there lies different patients, different problems, different needs and of course, at the centre of it all, different nurses. The A/E is such a busy place and the healthcare workers in this department make me believe they have a degree in either nursing or medicine and another in public relations because it’s magical how they are attending to one patient and reassuring another who wouldn’t stop demanding to be attended to immediately as well. As though confused, I stood on my own trying to figure out the beauty of every hospital’s building block disguised as nurses. How exactly one of the nurses inserted both a urinary catheter and a Nasogastric tube for one patient and rushing to fix a cannula for the other within a very short span of time continues to baffle me. At some point, walking appears to be a waste of time to them I believe, as they begin to sprint from one patient to the other addressing their needs accordingly.


The following morning, I was posted at the Intensive Care Unit (ICU) and believe me when I say, the ICU mainly continues to thrive because there are nurses. This is a ward with patients so delicate that it takes beyond medication to revive their normal state of health. But what I can say? Nurses have got to be the human representations of empathy. You’d find ICU nurses attending to the needs of both conscious and unconscious patients, feeding a patient who cannot do so on her own, bathing the one who simply cannot make it out of his bed, ensuring regular documentation of vitals, dressing wounds that could instigate my tears just at the sight of them, consoling an escort who has lost a patient and the list simply goes on and on. I still recall the words of a particular doctor I worked with at the ICU during one of my rotations and he rightly said, “for any ward or even hospital to work efficiently, there must be nurses willing to work diligently. The importance of a bedside nurse cannot be overemphasized because the simple truth is, their services will always be needed. So, take my advice and learn from the nurses you find in every ward. Let not pride cloud your sense of judgement rather, allow humility to lead your journey as a student for an experienced nurse would always know something you’ve not been taught in books. There is a reason you have a rotation in your curriculum dedicated to learning nursing skills so learn from them accordingly with utmost respect. When you finally become a doctor, continue to enshroud yourself with respect and humility knowing fully well that doctors and nurses are simply a team. We all cannot be doctors neither can we all be nurses and that is exactly where the beauty lies. Teamwork always saves the day.” These words sounded like some sort of revelation to me as I nodded my head to allow the wisdom being spoken sink in. If that is the thought of a qualified doctor on how crucial nurses are in healthcare delivery, then you can imagine where I stand as a student. Just as the doctor rightly stated, as medical students, our first exposure to clinicals is actually the “Nursing Skills” rotation. Quite frankly, my practical knowledge of almost all the basic procedures such as cannulation, urinary catheterization, placement of a nasogastric tube, collection of blood samples and others have been taught to me by nurses. Regardless of whatever calibre of doctor I become, the fact remains that nurses have been an integral part of my journey.

Healthcare delivery continues to be an important part of our daily lives as humans continue to alternate between good health and sickness. The roles of nurses amidst the continuous process cannot be downplayed at all especially in The Gambia where nurses outnumber doctors by a very significant margin. Thus, in my capacity as a medical student, I join my colleagues, doctors, and the world at large in extending my heartfelt appreciations to the backbones of healthcare delivery in The Gambia. Your efforts are commendable and in your various capacities as hardworking General Nurses, Nurse specialists, and even aspiring nurses, we applaud your invaluable contributions to the country’s healthcare system. As we mark the National Nurses Week 2022, I implore you all to keep giving this noble profession your very best for the sake of every vulnerable patient. Our country’s healthcare system is already a fragile one surviving on the pillars of professionalism, work ethic, empathy, and a sense of team spirit amongst its practitioners. This must not be compromised at any point for your value as nurses is not even up for a debate; our hospitals shall be handicapped without your noble services. Long live Nurses and the Nursing profession!

“The world would understand if the white uniform of a nurse is stained by blood or body fluids, but not with neglect or lack of work ethic. Such a noble profession should only be practiced by those of noble character.”