When you hear the phrase medical mission

Transcription

1 HUMAN DEVELOPMENT Pakistan Medical Missions: An Extension of Our Skills as Emergency Room Nurses Authors: Alicia Bowman, RN, BSN, CEN, and Brenda Gately, RN,BSN,MSEd,Smithville,Mo Section Editor: Pat Clutter, RN, MEd, CEN, FAEN Alicia Bowman, Kansas City Chapter ENA, is ED Staff Nurse, Nurse Sonographer, Liberty Hospital, Smithville, Mo. Brenda Gately, Kansas City Chapter ENA, is ED Staff Nurse, Nurse Educator/Clinical Instructor, Liberty Hospital, Smithville, Mo. For correspondence, write: Alicia Bowman, RN, BSN, CEN, Kelly Drive, Smithville, MO 64089; J Emerg Nurs 2007;33: /$32.00 Copyright n 2007 by the Emergency Nurses Association. doi: /j.jen When you hear the phrase medical mission trip what comes to mind? Is it flying to remote parts of the world and feeding starving children? Maybe it s being part of a surgical team that sets up in a third world hospital to assist with much needed surgeries. The term could conjure up visions of trekking into remote jungles to bring medical attention to uncivilized tribes. Possibly, you do not have any preconceived ideas about what is involved in medical missions. You may be asking yourself what is a medical missions trip, who goes, and how do you decide where to go and with whom. How long you are gone and how dangerous is it? Do you get paid to go or is it an expense that comes out of your pocket? Well, these were the very questions that we began to ponder and discuss in March 2006, never dreaming that it would lead us to a medical trip to Pakistan in the fall. The experiences that others have had on medical mission trips are unique to each individual and trip, and are as varied as the imagination allows. This is our story. Who Are We? We are 3 nurses from the Kansas City, Missouri, area with a variety of backgrounds and experiences, all with one heart to take our nursing skills to a third world country and put them to good use (Figure 1). One nurse, with over 20 years of experience, mostly in the area of public health nursing was the seasoned member of our group. Two of the nurses who were relatively new had spent the last 5 years in the emergency department. In regard to medical mission experience, 1 of the 3 had already completed October :5 JOURNAL OF EMERGENCY NURSING 463

2 FIGURE 1 Left to right: Doris Egli, Alicia Bowman, and Brenda Gately at the entrance to Christian Hospital in Sahiwal, Pakistan. 2 prior medical mission trips to Cambodia and Kenya. For the rest, the trip to Pakistan was the maiden voyage. Why Pakistan? As with any medical trip the decision regarding where to go and what organization to go with is always a major factor in the planning process. Many times the process begins with a desire to travel to a particular part of the world and then researching mission trips scheduled to that particular area. As our planning began, more than one trip we were interested in fell through for various reasons, including lack of physicians available, medical team at capacity, and trips scheduled for times of the year that were not compatible with our schedules. Then, through a series of interesting circumstances and in-depth research, we came across the Pakistan trip. What Were Our Expectations? To be honest, we really didn t know what to expect on our trip. What we knew for sure was that the area we were going to in Sahiwal, Pakistan (on the eastern border near India) had a hospital and nursing school already established, and that the organization sponsoring the trip was going to be celebrating their 100th year of having a mission in that area. Beyond that, we were unsure of what our duties would be, but all of us had the hope we would be FIGURE 2 Typical surroundings in Pakistan. able to travel out into the communities and take care the medical needs of those less fortunate (Figure 2). Many times the process begins with a desire to travel to a particular part of the world and then researching mission trips scheduled to that particular area. What We Discovered and What We Did Many medical missions are organized by specific religious groups. The organization we joined for this trip was called Associated Reformed Presbyterians (ARP), a church organization based out of the Carolinas primarily. As stated earlier, the ARP was having their Centennial Celebration during the same time we were going to be there. The mission was situated in a beautiful walled compound that included a hospital, nursing school and dormitory, an area of housing for the hospital personnel and physicians, an area of housing for the missionaries, and a large hostel that housed hundreds of orphaned, poor girls ranging from 6 to 18 years of age (Figure 3). The girls lived there during the school year. Just a couple of weeks before our arrival, the mission was beginning to venture out into the communities to conduct some public health education clinics. Unfortunately, during the time we were there, all of those clinics were 464 JOURNAL OF EMERGENCY NURSING 33:5 October 2007

3 FIGURE 3 The hospital compound in Sahiwal. halted due to the large numbers of foreigners in the area, and the stress on the police force to keep us safe during the celebration. That meant our focus was to be on the nursing students and hospital work. FIGURE 4 Brenda Gately holding a Pakistani baby with diagnosis of failure to thrive. Many medical missions are organized by specific religious groups. Initially, with little prompting, we ventured into the hospital setting to familiarize ourselves with the layout and operations of the hospital (Figure 4). At first glance, the hospital seemed to be similar to its Western counterpart; however on closer examination, the stark differences emerged. For example, the intensive care unit was nothing more than a large room with many beds, none of which had the necessary equipment needed to monitor the condition of the critically ill patients. This was especially concerning as all post-op patients went immediately to the unit to be recovered. The more time we spent rounding and interacting with patients and nurses on that first day, the more apparent it became of the extreme differences between our 2 cultures. That meant our focus was to be on the nursing students and hospital work. The medical equipment at the facility was an issue in and of itself (Figures 5-7). The equipment at their disposal was phenomenal thanks to the grants obtained through FIGURE 5 Teaching the students how to use the EKG machine. The electrodes were actually suction cups. the United States Agency for International Development (USAID). However, the nurses were still using instruments such as glass mercury thermometers on a daily basis whereas the state of the art equipment, such as an $80,000 f luoroscope, remained unused and hidden away in a closet due to lack of trained personnel. Even basic infection control was archaic, with an occasional bar of soap at the sink and no paper towels available for hand drying. Patient care was another area in which major differences could be seen. The Pakistani nurses had little interaction with their patients other than the dispensing of October :5 JOURNAL OF EMERGENCY NURSING 465

4 FIGURE 6 The sharps boxes at a neighboring government hospital. FIGURE 8 Students and their instructor on the left in the nursing class. FIGURE 7 The Pyxis or the drug dispenser located in a locked cabinet in the OR suite. medications and obtaining routine vital signs. On observation we soon discovered that the Pakistani nurses were reluctant to even touch their patients because of cultural influences. This is one area where we sought to make a difference. We looked for every opportunity to show these nurses the benefits and necessity of laying your hands on your patients; not only to do an accurate assessment of the patient s condition but also to express compassion and caring for their well-being. Much to our satisfaction, by the end of our trip we watched as these nurses began to become actively involved in the care and healing process of their patients. Not only were we involved in the hospital setting, but we were also enlisted to teach several classes in the nursing school. Language differences were not much of a barrier, as these Pakistani students had been immersed in English studies from a very early age. In fact all the charting done at the hospital was written in English. Our classes involved the instruction of and administration of injections, the etiology and treatment of hypertension, and the basic skills used for patient assessment. This experience also gave us an opportunity to answer their questions regarding nursing and nursing education in the United States. After seeing us in the classroom setting, our suggestions for improvements were accepted more readily in the hospital setting and relationships were being developed (Figure 8). Patient care was another area in which major differences could be seen. Memorable Patients We Encountered Of all the patients we saw, there were 3 in particular that tugged at our hearts. The first was a little 1-year-old boy who was no larger than a typical 4 month old. His mother approached us as we rounded in the hospital and begged us to come and help her son. As we moved toward his crib we saw his grave condition his labored breathing with retractions, and the vacant stare in his eyes. He also had a 466 JOURNAL OF EMERGENCY NURSING 33:5 October 2007

5 FIGURE 9 The only surviving child of a mother who had lost 5 others. fever. Our hearts went out to this desperate mother looking to these American nurses to bring some sort of miracle to her only surviving child of 6. As we reviewed his chart it became apparent that this young one had experienced a hypoxic brain injury at birth and hope for recovery was beyond reach. All we could do was gather around this child and pray, embracing the mother, and weeping with her in her despair (Figure 9). Daily we would stop to check on his condition and offer support to his mother. Eventually, the child was transferred to a larger pediatric hospital in a neighboring town. The other 2 patients were sisters, 15 and 16 years old, who had been admitted to the hospital 2 weeks before our arrival with the diagnosis of anxiety nervosa. These 2 girls each laid in their respective hospital beds in the fetal position refusing to interact with family or staff at any level. Their demeanor could best be described as catatonic with no explanation from the family for what may have caused this condition in them. We took it on ourselves to engage these young girls on any level. We would go in to see them several times a day, sit beside them on their beds, pray with them, and attempt to draw them out of their isolated state. By the third day of our visits these girls were sitting up, interacting with family, and actually taking short walks in the halls. Their family members were ecstatic with the progress these girls made in the short period of time we were with them, even to the extent that they threw us a party on our last day buying us breakfast and all celebrating the recovery of the sisters. Their transformation and FIGURE 10 Alicia with one of the sisters who had been catatonic previously. our experience with the young child left an indelible mark on our lives (Figure 10). Our Impact and What We Continue to Do Our experience in Pakistan was beneficial not only to the Pakistani people that we encountered, but to an even greater degree to the 3 of us. We left behind the knowledge to use and operate basic equipment they had at their disposal, but did not know how to use. We showed the students and staff the tangible and positive effects of developing a relationship and laying hands on their patients to expedite the healing process. Before leaving Pakistan, we had an opportunity to brainstorm with the hospital administrator, an American physician who makes frequent visits to the hospital for surgeries, and the public health worker on specific immediate improvements that could be implemented. On returning to the states, we gathered protocols from our hospital settings that could be incorporated and used as a basic framework for developing more efficient patient care. We all came home with a greater appreciation for the benefits and privileges of living and working as a nurse in the United States, as well as a first-hand knowledge of how our background, skills, and experience can improve the health care of people in other parts of the world and in other cultures. This truly was a life-changing experience, one that we would highly recommend to everyone. If you have ever wondered what it would be like to go on a medical mission trip, our advice to you is to take a leap of faith and just do it! Your life will be forever changed. October :5 JOURNAL OF EMERGENCY NURSING 467