SALUTE TO A NURSE ABROAD

Greetings all-

Just a note from John to let you all know that once again I'm setting out on a mission with Doctors Without Borders. I am leaving New York today, with my final destination Zemio, a small village in South- eastern Central African Republic. I should be there for 6 months before I return home. The work will consist of outreach nursing which will be primarily assessing and treating vulnerable populations and refugees in the area. Malaria is the biggest problem there, I will also find my skills in burn and wound care very handy! We will also be teaching local and government staff with medical, social and logistic support. There is a small team already there in the project, I am excited to be joining them and to see what we can do together.I couldn't possibly be doing this without the support of my family and friends and most especially my partner Benjamin. Thanks to you all.Often when I am in the field there are moments when I wish people could see what I am seeing and doing. If you think of me while I'm gone, I'm probably thinking of you too.I'll be back in Europe and New York by Mid-August. Behave yourselves while I'm gone. Best wishes and thanks again!

John B. Fiddler was born in Dublin Ireland and has lived in New York City since 1984. Originally pursuing a career in fashion he was inspired to become a nurse after witnessing the devastation of AIDS in the city. After graduation in 1998 he worked as a Critical-Care Burn nurse, including working with survivors of the 9/11 attacks. After receiving his master's degree in Nursing in 2004, he joined Doctors Without Borders. He currently is working again with doctors without Borders in The Central African Republic.John penned the story, "Waterlife," which was included in the anthology NURSES BEYOND BORDERS. I hold him in AWE!

Return to Guatemala

Here I sit in my comfortable living room. My children are healthy and well-fed, intelligent and kind. They are well clothed, with shoes that fit and coats that keep them warm..... They have regular access to medical care, getting their dental, medical and eye check-ups yearly. My pets are not emaciated or flea ridden... My husband and I both have well paying jobs. for miles in ill fitting shoes. ....I have a car that runs well, on streets that are paved, well-maintained. I have heat to warm us in the winter, air-conditioning to cool us in the summer. We have hot water. We have washing machines and dryers. We have electricity, cable TV, reliable internet access. We have so much to be thankful for. We have each other, family and love. Those three things are universal. The “stuff” is just a perk.

This past week, as many of my friends and family know, was spent in Guatemala. This was my 4th trip to the clinic in San Raymundo. Please do not think of me as a self-sacrificing, amazing person who goes for completely altruistic reasons. It is not true. I go because every year, I receive so very much. Personally, it puts into perspective, my life, my goals, my desires. Do I really need a new phone, a new pair of shoes, another gadget? It helps me to rely not on diagnostic testing, as there is very little available to me when in clinic. But, rather, it helps me to develop my hands on skills and diagnostic abilities based on patient presentation, what I see, what I feel.

I bring back the blessings of hundreds of people, thankful for a moment with the gringos and the care we provide. I bring back the stories of love, hope and sorrow. I bring back knowledge from every single member of the team I travel with...they all teach me so much. The students I worked with this week made me a better teacher.

The translators, our voices and our ears, infuse the spirit of their people into English that we can understand. And, sometimes no words are needed, simply a tearful hug says so much more than any language can convey. I come home with more friends, the camaraderie of the providers, the long hours, the tears that we’ve shared, bond us in a way that I’ve never been bonded to others before. Do not think of me as a giving person. Think of me as a person who has been enriched beyond anything she has hoped to be enriched, loved more than ever, taught in a way that she’s not been taught before and thankful for things she’s never been thankful for.

As I sit here and attempt to put into words the week that I had, I find it difficult. I arrived in San Raymundo with a bus of about 45 other volunteers. The team is made up of many different people with unique skills. We had pharmacist, pharm tech, non-medical people, surgeons, students, nurses, nurse practitioners, laboratory techs, dental hygienist....so many skills, so many uniquely appropriate for this trip. We arrive on Saturday and unload our belongings, claim bunk-beds, set up rooms, ORs, labs, pharmacy. I was able to help do some physical exams on some patients who came in that night in hopes of having surgery in the morning. Clinic then runs from Sunday thru Thursday. We start at 7:30 and go until the last patient is seen. Meals are provided and prepared by a staff of local women. I miss that already. ………

We saw sicker patients this trip than I’ve seen in the past. More grossly abnormal clinical findings. More heartbreak than before. More joy than before. We had several patients that we simply had to say, there is nothing we can do for you, your condition will ultimately lead to your death, we are deeply sorry. It is such a difficult conversation to have in this country. But, to have it with a patient and their family that have the wild hope that the gringos can fix anything can cause my heart to stop for a moment. We hold hands with these patients, we offer comfort medications, we help the family to understand how to help these people have a peaceful death. We pray with them. We cry with them. …..

Andrew and I had a patient that came to us. She had a history of stomach cancer about a year ago. She presented to us with a mass in her abdomen, weight loss, decreased appetite. It was obvious to us that her cancer had returned. After consulting with other providers, we were sure that there was no medical treatment left other than comfort care.

Nancy came in to translate for us. I was the medical voice, the one that gave Nancy the words to speak. The woman’s family came in, her niece, daughter, sister, brothers. Such an amazing family ready to take her home and love her, to give her comfort and care in her last days on earth. The patient clung to me, I held her, kissing her dirt streaked cheek, answering questions from the family. The love enveloping her was palpable. The family embodied strength for me. I cannot help but think about my own personal story here. My dear uncle is terminally ill with metastasized prostate cancer. My family embodies the same strength, the same palpable love, the same joy and appreciation for my uncle and one another. I couldn’t help but cry then. I am crying now as I type this. Family love is universal.

In the midst of the tears, the sometimes hopeless feeling that we are unable to help, to do anything....we were blessed with the joy of a birth in clinic. Our midwifery student, Deb, took the lead. The room was full of counting...I’m certain I can count to 10 in Spanish now after doing it several times. Mom was stoic, dad was quiet. This was their 8th child. I was not in the room for the birth, but to hear that newborn cry across the clinic. To see our students deliver, comfort, assess and beam with pride was amazing. There is so much hope in a new child. So much joy. So much awe.

Guatemala is a lush, green country. The volcanoes, flowers and amazing weather make it a fantastic place to visit and enjoy. As we drove from clinic to our 2 day stint in Antigua (where we were able to unwind and be tourists), I plugged myself into my ipod and stared out the window. It is also a country of poverty. of garbage strewn across the countryside. Of children running down the dirt roads with no shoes. Of dogs running wild and emaciated. Of people lying beside the streets, on makeshift sidewalks. My hope is that they were simply asleep there, that they were still breathing, but I cannot be sure. …..

What made this trip the best ever for me? It’s hard to sum it up in a sentence or two. The entire
medical team was amazing. We worked together with a seamlessness and efficiency I have yet to encounter. No one said “I don’t want to do that” or “I cannot do that”. Everyone was ready, willing and able to go outside of their comfort zones, they were able to move away from things they knew and were able to do well, to find new and creative ways of treating and caring for their patients, to help other members of the team....no question was too dumb, no provider knew everything. Patients were receptive and thankful. Difficult situations posed all of us opportunities to grow, to empathize and to learn.

I have come home more content with my life. My family, my loves. I am happier with my career and where I am. I am a better student. I am a better teacher. I would not be half the practitioner I am if I did not take these trips. I am able to use skills that I don’t always use in the states, but am reassured that I still have them ready and waiting should I need them. I am more thankful for my health, my friends and the health of those around me. I am more thankful for mi familia, my friends and my colleagues. I am more than when I left. I thank you all for being with me in spirit, in kind and in body. I am just thankful and blessed. I am ready to go again. Until next year....
Jennifer Tucker, FNP

Jennifer Tucker is a Family Nurse Practitioner. She resided in Medina, Ohio with her husband of nearly 17 years, Jeffery, and their two children, Jillian, 13, and Joseph, 10. She works full-time at the CVS Minute Clinic. Recently, Jennifer was awarded the Lifesaver Award at the annual Convenient Care Clinician Congress in Orlando Florida. She received this award for successfully managing a full cardiac arrest and anaphylactic incident in her stores this past year. Jennifer was a ONAAT schlarship recipient in Feb 2010 and she just made her 4th trip to Guatemala this October, 2010. Jennifer precepts students from her alma mater, Case Western Reserve University, on a regular basis.

NURSES BEYOND BORDERS -- A Limited Editon of Print Copies Now Available

A Limited Edition of print copies of the anthology Nurses Beyond Borders: True Stories of Heroism and Healing around the World, is now available!

Just in time for Christmas shopping, the book is a perfect gift for all,especially for those with an interest in humanitarian pursuits. Book Clubs will love the way the stories challenge our thinking and our view of the world! A list of discussion questions is included in the appendix.

The cost is $15 per copy plus shipping. Order your copies today by emailing nancy@onenurseatatime.com Please indicate if you want your copies sent via 'book rate' ($2.38), First Class USPS ( $2.75)or Priority mail ($5.35). Make all checks or money orders to : "ONAAT," as all profits from the books sales will go to "One Nurse at a Time," an organization that supports nurses in their humanitarian pursuits both at home and abroad. Read about ONAAT at www.onenurseatatime.org

NURSES BEYOND BORDERS is a great read! I say this honestly without prejudice. None of the stories are my own, but I did have the pleasure of and the privilege of being The Story Gatherer (some call it Editor) for this wonderful collection of stories of nurses practicing their art and science in other countries.

Please read below for more posts and comments from other nurses and authors including Greg Mortenson of The Three Cups of Tea fame. This IS a book that will change your life!

Get your copy today!

Nancy Leigh Harless,Editor, Kaplan Publishing,
Nurses Beyond Borders

NURSES BEYOND BORDERS -- Review by Joe Niemczura

For a week or two after Port-au-Prince was flattened by the Haiti earthquake, we were glued to the TV while the human drama of recovery from a disaster was played out live, unscripted, made possible by the sophisticated technology of TV and global communication. We saw the recovery crews pulling out the people or their remains, watched the reporters interview nurses overwhelmed by the sheer numbers of patients, watched as mobs of desperate people swarmed the trucks delivering food and water, which was at first dumped out the back of the truck as it moved along, barely in control. The images highlighted the heroic nature of relief work. This epic disaster now moves to a quieter phase as it takes its place alongside the stories of 9- 11, Katrina, the Tsunami, wars and other manmade or natural events of history.

What was has been striking about all of these is the growing recognition of the role that nurses play in these events. At one hospital the CNN crew was referring to the workers as doctors, until the people delivering care came over to correct them. This has always been true about disaster publicity - the care is delivered by whomever happens to be there and more often than not it is a nurse.

And so this is the background from which I discovered the writings of Nancy Harless. I was fortunate to receive an advance copy of her latest book, Nurses Beyond Borders, around the time of the earthquake. Like Ms. Harless, I have worked overseas and written about the experience. And like her, I have spent time trying to make sense of the experience, trying to explain it to others who I am not certain are really interested. Ms. Harless has worked in Mexico and also the Balkans during the recent war. Her previous books explore previous travels.

Nurses Beyond Borders is an anthology. Two dozen nurses told their story about working in different parts of the globe. In some cases it was wartime - our own Viet Nam War or one of the civil wars of Africa. In other cases, the nurses may have been on a short-term mission trip or travelling. The stories are loosely organized into four categories - transition, shadows, humor, and looking back. There is no overarching "plot" nor is there any moralizing about the choices made by the nurse or the patients. As in the tradition of the best nursing "war stories" the clinical exemplars are just told, not a lot of frills or embellishments. and the reader is allowed to draw their own conclusions or ask their own questions. Ms. Harless wrote the introduction and a sort of study guide which is appended to the back.

The introduction is probably the clearest statement about the phenomenon of becoming a Global Nurse, of any that has been written. I found myself wanting to cut-and-paste the whole thing into this review. I knew I was in for a treat when she wrote "....Sit back. Get comfortable...." and then a few sentences later followed it up with "..... And then get uncomfortable -very uncomfortable - so uneasy that you too, feel the call for action...." My reaction was, here is a person who gets it and knows from whence she speaks. There is a danger in describing overseas experiences, which is to romanticize the events, or the people who do this sort of thing, or their thinking. During a war, there will be periods of time that are boring, or where senselessly awful things happen for which there is no whitewash. Or we are led to think that the person telling the story has led a spotless personal life; or that the person never experienced fear and doubt during the experience, which is a particular failing of stories told by Christian Missionaries. It was something to which I was determined not fall victim in my own writing. Telling the real truth is something nurses pledge to each other at work and in their professional lives, and Ms. Harless deserves praise for that same commitment to truth she has continued in this work. These storytellers shared the aspects of global nursing that make it intense and very rewarding as well as a journey of personal discovery and service to humanity. Bravo.

And so, I recommend this book to any nurse that is thinking of getting outside their personal bubble of comfort zone and out in to the big wide world. Get comfortable. Read… the get Uncomfortable… very uncomfortable……Joe Niemczura RN, MSN: Nursing Instructor a the University of Hawaii and author of “Hospital at the End of the World”

Sue Averill in Nigeria ~ Notes from the Field

Imagine a 2 year old boy weighing 12 pounds. He’s not quite 30 inches tall and his upper arm is one inch in diameter. He’s limp. His skin is dry and thickened with the appearance of crumpled parchment or elephant hide. He makes no noise in a concrete room filled with 70 crying children. His head is covered with patches of orange brittle tufts. His eyes are sunken, half opened and his teeth seem too big for his mouth.

In many parts of the world, malnutrition is the result of conflict, of displacement and of politics. In northern Nigeria, it’s a disease of poverty and ignorance affecting one child in an otherwise healthy family. Well paved roadways are flanked by boys shepherding goats and cows and sheep past fields of maize and millet. Markets sell rice and fish and peanuts. Vaccination coverage is virtually nil in a country dripping with oil. The same country that forty years ago brought starvation to the world’s attention with the tragic short life of Biafra.

The numbers continue to rise. More than one thousand new malnourished kids entered our small program in the past month. 22 admissions per week a month ago is now 46, and the average number of inpatients has jumped from 50 to 90. Physical space has grown from half of one ward to a new building plus 4 tents. The need for drugs and equipment outstrips the supply. Staff are tired.

Today I ask myself if the grass is greener on the prevention side … doing development work instead of this desert of treatment.

Keep sending us your positive energy.

~Sue

Sue has two stories included in the anthology Nurses Beyond Borders --"Susy" and "T-Girl"

Michele Upvall goes to Ghana

I read all the trite phrases about Ghana being the friendliest country in Africa and a great introduction for Westerners to such an unfamiliar continent. My first reaction was, “Sure..let’s really see what the truth is…too much hype from Obama’s visit, I bet”. Suspicion was warranted after my first journey to West Africa in 1986 when Nigeria experienced a military coup. It would not be the first coup I witnessed in my travels, but I had little desire to return to that part of the world.

It’s strange when an event is set in motion and you have no idea of what will happen next, part of what I enjoy about traveling. That’s the story of how I went from Cambodia to Ghana, two very different places with similar needs. A little over a year ago, a group of us nurses who had volunteered with the Angkor Hospital for Children in Siam Reap, Cambodia raised enough money to bring a Nurse Educator, Manila Prak from the hospital in Cambodia to the US for a month. Part of Manila’s tour was sharing about her work at the hospital to nursing students in the Pittsburgh area. I had hopes that Manila’s presentation would spark an interest in our nursing students to experience life abroad and I was not disappointed. After 6 months of meeting with a small group of students to plan such an experience, we decided to approach the service learning organization of Amizade (Portuguese for “Friendship). My original intention was to take the students to Cambodia, but the democratic process takes mysterious twists and turns and Ghana was selected as our destination.

The focus of Amizade’s work in Ghana had been building a library in the village of Jukwa, a few kilometers north of Cape Coast. Construction is not quite within our skill set and so a different program was developed to assist in the local clinics and give health talks to students at a local primary and high school. Two nursing students from Carlow University raised enough money (my family bought a lot of Easter candy and hoagies!) to go although none of were really sure it would happen until the day of our deadline with Amizade.

Neither Amber nor Cara had traveled overseas and in fact, this would be Cara’s first time on an airplane. Their first element of culture shock was the expense of it all, from passports to immunizations and even buying electrical adapters – they were still in the mindset of bringing a hair dryer. My goal was to explore the healthcare system of Ghana as much as possible within a short 2 weeks as well as volunteer at the clinic. At the same time, I was to be a support and sounding board to the students without having an official faculty role. The students were realistic in their expectations, wanting to see what life is about in a developing country and providing any assistance they could with the skills they already acquired from nursing school.

Traveling 10 hours coach from Dulles to Accra was another part of the culture shock miasma for the students. Way too much excitement and too little sleep added up to a difficult first few days, coupled with the usual food concerns. I have never been known for my adventuresome palate- simple is always best for me. By the end of our 2 weeks, our mantra became, “no more rice”! The concept of time was another challenge as our biorhythms adjusted and “African time” took effect. For me, the experience of “African time” provides an opportunity to observe my surroundings and just put life into perspective once again. There are no “real” deadlines and somehow, everything all works out just the way it’s supposed to, including lost luggage that you realize you didn’t need so quickly in the first place.

One of my favorite observations was the influence of Obama at every turn. From Obama biscuits (cookies), wine, water bags, school notebooks and yes, even his picture on underwear, Obama had clearly taken over Ghana. Quite a difference from the previous Presidency and yes, it felt good to be able to travel and admit to being an American without receiving a treatise on foreign policy.

The Ghanaian facilitator, Kwame worked hard to make sure we were experiencing typical village life in Jukwa and at the same time introduced us to the healthcare system. From my experience in Swaziland I knew that it isn’t easy getting permission to tour hospitals and meet with nurse, but Kwame came through and we were able to tour the Cape Coast Regional Hospital, the Ankoful Psychiatric Hospital as well as meet with a nursing faculty member from the Nurses Training College. Wherever we went, we were greeted with “Akwaaba”, meaning welcome. And we truly felt welcome wherever we went. The children in the village shouted out “Obruni, obruni”(white person, white person) in a friendly way as we walked to the clinic or just explored the surrounding area.

Malaria, we quickly learned at the clinic, was rampant as well. Together the students and I learned about the testing, treatment and prevention of malaria from the patient’s perspective in the clinic. Cara had seen the video on malaria in our global health class last Spring semester, but when you meet people of all ages so profoundly affected by it, you gain new insights and feel a stronger commitment to its eradication.

Life at the clinic was similar to what I experienced in Swaziland so many years ago. Training for Traditional Birth Attendants took place on a monthly basis while every Friday was devoted to child health: registration of newborns, weighing and immunizing the little ones with moms and babies all dressed in their finest for their clinic visit.

It wasn’t all work for us and our timing was just right to receive an invitation to a local wedding at the African Methodist Church. Attending local events gave students further insight into the culture and going to church will not have the same meaning for them anymore after experiencing all the dancing and singing with the church wedding in Jukwa. The entire church, including us danced down the aisle to the collection buckets, not once but twice. The first collection was for the church and the second was for the bride and groom. Whatever people had to give was truly done in a spirit of cheerfulness and joy.

A visit to the orphanage was another special event for us and the kids loved the coloring books and other items we brought, but the sunglasses were an even bigger hit.

Our journey confirmed the travel guides that yes, Ghana is a safe and friendly country, one that all of us can easily return to in the future. Their needs are great, but their capacity for joy in life is even greater. ~ by Michele Upvall, "Born on a Rainy Day," Nurses Beyond Borders.

BOOK RELEASE SEPTEMBER 7th

Award winning author and nurse practitioner, Nancy Leigh Harless shares a fascinating collection of true stories from dedicated nurses who care for patients all over the world. In this inspiring anthology, they share their experiences working in countries such as Honduras,Canada, Laos, Chad, Liberia, Rwanda, Kenya, Saudi Arabia, Pakistan, Mexico, Mongolia, Viet Nam, Swaziland, Kenya, Cambodia and beyond, where the languages, procedures, equipment, and even the doctors may be incredibly different -- but where the ultimate goal of providing excellent care and utmost compassion remains the same.

The release date of September 7, 2010 is in digital form only. A limited number of print copies will be available for sale soon with all proceeds going to the non-profit organization One Nurse AT A Time (www.onenurseatatime.org) for scholarships to nurses who volunteer abroad. Email sue@onenurseatatime.org to place your order now!