Ebola Treatment Center, Day One

After a few days of training with MSF in Geneva and a grueling journey to Sierra Leone, I entered the Ebola Treatment Center in Freetown where I will be working for the first time on Monday. Here are my observations and impressions from day one, before all of these little details become part of the norm and don’t seem so important:

At the entrance to the Ebola Treatment Center (ETC) compound, we get out of the car, wash our hands with 0.05% chlorine water, spray the bottoms of our shoes, and have our temperature taken. All visitors, staff – EVERYONE – goes through these steps before entering the center from the outside.

Once allowed inside, we proceeded to the entrance to the low risk zone – again, washing our hands and spraying our shoe bottoms. Then on to the dressing rooms, one side for men and one for women (we have been warned to only wear discreet underwear into the ETC, as you often sweat so much inside the suits that when you remove them, your sticky scrubs come right off along with them – so no thongs for us!). In the dressing room you find a pair of scrubs, which are being washed constantly all day long and hung out to dry, and hopefully a pair of heavy plastic gumboots that fit. These are also washed and dried throughout the day, but after lunch there were no more boots to be had…

From there we headed over to the medical “office” tent – one area for administrative work, one where there are white boards detailing patients and needs, etc. A second space is set up for work – mixing IVs, nursing roster, etc. The third space is for the pharmacy folks who pack the med bags. The ground inside the ETC is covered with heavy, broken sharp grey rock. As you’re walking in your gumboots, it’s a bit uncomfortable and sloppy, but I’m sure I’ll get used to that quickly.

Since we were on orientation, we spent the day doing various things. I spent the morning in triage, which I really liked. However, it’s not triage OUR way; we don’t respond quickly to the sickest patients. Here, we respond first to the NOT sick, and get them out of the center with a certificate that says they do not have Ebola. Hospitals and clinics won’t allow them in for care without this. Plus, people are worried about little things and want to be sure they don’t have Ebola.

This is how it works: People come in (after washing their hands, spraying their feet, and having their temperature checked at the entrance) and sit in a holding area consisting of plastic chairs 2 meters apart, the safe distance. We healthcare workers stand under a shade, behind an orange double fence blocking off 2 meters’ distance from them. No confidentiality at all. We get their demographics, register symptoms, and begin to make a determination about whether or not to admit. Today many had vague symptoms, but were relatives of confirmed Ebola patients – a husband, sister, and baby. I guess that’s not unusual. We also know the “hot spots” where many cases are coming from, to raise the suspicion level in certain cases.

Today we admitted about half a dozen people. As we’re doing their paperwork, we give them a bag of water and a sachet of Plumpy Nut (a peanut-based paste for treatment of malnutrition) and ask them to eat and drink. A psychologist comes and asks the patient about who they can call to advise, what they need done, finding a caretaker for their children, etc. There is also a Health Promoter who talks to them about what’s happening.

Oddly, enough, the new patients are stoic. No comments, no questions. They just sit there across a far divide from us. I would be screaming and crying and begging if it were me being told I was to be admitted to an ETC!  The patients are then moved to another holding area and a nurse in full Personal Protective Equipment (PPE) comes to get them, take them to a bed, and get them settled.

The ambulances also come in the triage area, and we have a whole procedure there are well. First, they back halfway into the orange double fence area, then wait for the hygiene team to come spray the vehicle, remove the patient/stretcher, spray again, spray inside, then bring the patient to triage, where we do our work from across a 2-meter table-like barrier. The only time we get any closer is with goggles or a face shield, when leaning close enough to take a temperature with the little electronic gun from 6 inches away.

Things are separated here into areas for suspected and confirmed Ebola patients. In the ward for suspected patients, they are given a bed in a private “room” consisting of a concrete floor, walls of vinyl tarps, roof, sun shade, buckets for Oral Rehydration Solution (ORS), vomit, washing, and stool. The suspected area is separated from the confirmed, and they try to put the “not highly suspected” as far away from the sick ones as possible. You don’t want someone who just has malaria to be exposed to Ebola in the ETC.

The confirmed section has bucket showers for patients, and male and female latrines. This confirmed area also has a separate section for those with the highest nursing/medical needs. It is known as “ICU” even though it really only means IVs versus simply oral medications. Today I got to don full PPE and go into “ICU”. I think I’ll be doing that a bit more often because I can start IVs.

There is also a third area for recovering patients. These people are feeling better – they can walk, feed, and care for themselves - and are awaiting tests. Patients must test negative twice in 72 hours in order to be discharged home “cured”. Caregivers for children are recruited from the survivors because they have immunity for an unknown period of time.
 
We caregivers have one donning room with very helpful people getting us dressed, and two different doffing stations where they tell us step by step what to do as we remove our PPE. We can be inside for only one hour at a time. Today I was only in for 30 minutes, just being shown around, without doing any care on day one. I felt OK, not terribly hot or bothered, but the nurse orienting me was soaked when we came out. One of the docs was in for 90 minutes, and literally poured sweat out of his boot! One style of PPE is lighter than the other, so everyone wants the one with the blue stripe.

There are bags of water at various points, and squat latrines for staff. The spaces everywhere are really vast – lots of room so as not to touch anyone. Things move slowly. Since there is no such thing as an emergency, no resuscitation, etc, we take our time to work out the best plan of action for everything.
 
Teams go in every hour or so: IV/ICU team, oral med team, admission and discharge team. Nurses (most not very skilled) and our expat doctors go in together. Outside is a group of nurse assistants. Hygiene goes in with the medicals. After the medicals leave, the nurse assistants have their rotation to feed, give ORS, bathe, etc.

One cool thing is that the ICU has a corridor down the middle, with two 1/2 –meter tall plexiglas walls and the patient beds all around, so we can literally walk down the middle, not in PPE, and see and talk with our patients. This minimizes the time we spend in PPE. It’s the same in the other wards, though not plexiglas. Instead they have a double fence 2 meters wide so we can talk to the patients across it without having to be in PPE. There are also slanted “one way” tables so we can pass them meds, food, whatever. We slide it down to them across the 2 meters, or push it with a stick if necessary. It’s the same at the entrance to the ICU: two slide tables so that from the outside you can slide in another IV bag, tape, or whatever they might need that they didn’t take in. Pretty smart system!

In addition to all this, there are more tents for logistics, resting area for staff, and an additional one that just opened today because the number of patients was higher before discharges.

Blood is drawn by the lab team three times a day and there’s an actual lab (not run by MSF, but some other entity). They process the samples in about four hours, so we can clear those who are not sick quickly and send them out with their certificate and a big “congratulations”. They also routinely screen for malaria. Most are positive and so get treated. Admission orders include systematic malaria meds, antibiotics, Plumpy Nut, and Tylenol if fever. IVs are mixed by the nursing staff. It made me a little anxious because I’m not sure they are very diligent about what they are doing. D50 is added to LR, plus potassium if the patient has a lot of diarrhea. IV paracetamol is given if they can’t take pills.
I sat awhile with the Sierra Leonean nursing assistant staff outside of ICU. If find that if you do this in the beginning, they get to know you and word spreads quickly that you’re a good person. One of them said, “Americans are so simple.” I asked her what she meant, and she explained, “You are always nice, always soft in your way, not hard like the Swiss and Europeans.” They had lots of questions and are supposed to be teaching me Krio, the local language. Here are some basics we’ll use a lot:
 
You belly de run?  or You de gombelly? = do you have diarrhea
 
You hed de acts?  = You have a headache?
 
You de feel pen (tapping shoulders)?  You have joint pain?
 
You de feel weak?
 
You de eat?  = Do you have an appetite?
 
You de cough?
 
I need to practice for tomorrow because I’m sure they will ask and give me more homework.

Oh, and I actually got to be an ER nurse! Two young men brought a boy who had pulled down a container of lye onto his head and face. No one knew what to do. He was not sick, just injured. So I tossed them some bags of water (all of our water for washing has chlorine), and had them rinse him down about 10 liters. Then I got him a blanket so he wouldn’t be wet and naked to take to another facility (we are ONLY an Ebola treatment center and can’t do anything more). I felt pretty good about it, but think he will have some serious eye damage…
 
Overall, I’m feeling pretty positive about this mission. I think this is going to be good!

No hugs to all.  No touching.  But much love,
Sue

Volunteer opportunity in El Salvador - Operating Room Nurses

Healing the Children SW Chapter needs 3-4 operating room nurses for a surgical trip to Santiago Texacuangos, El Salvador. The trip's focus will be ENT and Plastics ages children through 17 years of age. The team will stay in San Salvador, El Salvador. The trip is from February 28-March 7th 2015. Voluneers pay, air, lodging and meals (dinners and breakfast). This organization will be returning to the hospital "Hospital La Divina Provdencia" for the 6th year and welcomes nurses willing to take on the challenge of operating in a less-than-familiar settings. :)

If interested, please email healingthechildren@comcast.net

Anita is back from Ecuador!

Thanks to One Nurse At a Time and their scholarship program I was able to fulfill my dream of international volunteering.

 

 In February of 2014 I was given the gift and opportunity to travel to Esmeraldes, Ecuador with the Ecuadent Foundation.  The team of surgeons, anesthesiologist, operating room nurses, PACU nurses, equipment technicians and Spanish interpreters performed and provided care for approximately seventy patients. My most memorable moment would be witnessing the joy of the parents face when they saw their child after their cleft lip repair. Due to limited time, we were not able to provide services for all that came seeking, so it was difficult to see the faces of families that had to be turned away. Esmeraldes is a poor city of Ecuador. The people have very little money and possessions, but they have something money can not buy. They have a strong spirit, love for their family, country and culture. 

The people of Esmeraldes gave me more than I could ever give them. I provide pre and post anesthesia care for newborn to18 years of age in the United States. I have seen an increase in Spanish families that speak very little to no English. Being in Ecuador and not having the ability to fully communicate due to my limited Spanish, at times I felt alone and isolated. I now have the experience of understanding how my Spanish families may surely feel here in the United States. I love the country and people of Ecuador. They will always have a special place in my heart. It is my plan and dream to continue volunteering my nursing skills to those in need. THANK YOU AGAIN FOR THE GIFT OF GIVING!!

Anita Sawczenko

Wendy Libowitz tells about her trip to Tanzania

I have always loved to travel and visit other parts of the world.  For years I had dreamed of having the opportunity to do some type of work abroad and fantasized about joining the Peace Corps, but life took me in another direction.  So, when the chance to participate in my first international mission arose in 2008 I took it, albeit with some trepidation.  Having loved that first trip, I sought out other opportunities, which lead me to Missions For Humanity.  Missions for Humanity is a non-profit organization which sends teams to both Honduras and Tanzania annually in the summer to serve some of the world’s poorest communities.  Teams provide medical, dental, and humanitarian aid as well as work with local school children and teachers.  Groups have been traveling to Honduras since 2004 and Tanzania since 2007. In Tanzania, Missions For Humanity operates in conjunction with Caritas Dar Es Salaam, another organization, which essentially serves as Mission For Humanity’s in country hosting organization.

I recently returned from a trip to Tanzania, Africa from July 5 – July 19, 2013.  This was my second mission with Missions For Humanity having previously served in 2011.  This year I was a part of a group of 22 people from the United States – two physicians, one dentist, one dental assistant, two nurse practitioners, two nurses, seven teachers, one college student, and six high school students.  Volunteers from the USA were joined by a large number of Tanzanian staff from Caritas who served as our drivers, guides, interpreters, and coordinators.

This year our work in Tanzania occurred in rural communities typically within a two to three hour driving radius of Dar Es Salaam, a city on the Indian ocean in the more southern part of Tanzania. The care provided in the medical clinic I would describe as that of an acute illness/primary care nature with conditions treated including both acute and chronic illnesses.  Patients ranged in age from newborns to the elderly.  Approximately 1350 people were served in Tanzania in 2013.  All care at the clinics was provided for free.  All of the supplies and medications used at the clinic were brought to Africa from the United States, which amounted to over 50 pieces of luggage transported by our group.  My primary work role in the clinics was that of the “pharmacist,” preparing and dispensing prescriptions and providing the necessary patient teaching regarding such things as medication purpose, dosing/administration, storage, and side effects.

Some of the highlights…

The hugs, smiles, handshakes, and words of thanks I received from many local people.  Although in my mind my actions in many ways were small or what I could give patients limited, the deep appreciation people showed me was heart warming.  The knowledge that in some small way I contributed to making people feel cared for and not forgotten in an underserved part of the world was a powerful experience.

The team was a highlight of the trip.  Participants from the USA ranged in age from about 14 to 73.  I really enjoyed the multi-generational makeup of the participants.  Working in collaboration with local staff enhanced the experience as well.   It’s interesting to me how you can take essentially a group of strangers and some acquaintances and after a few weeks a great camaraderie and friendship develops.

One evening our entire group was invited to the home of the Caritas director for dinner along with all his staff.  This was an amazing, once in a lifetime cultural experience.  There was an enormous feast with many foods I had never seen before. There was lots of time to socialize.  I sat with a young man who clearly was extremely knowledgeable about his country, providing so much information and answering questions.  Overall the evening was delightful with perfect weather, wonderful food, and great company.  I will never forget this night in my life and how welcomed I felt in Tanzania.

On a long drive one evening I overheard three adolescent American students and one Tanzanian young man sharing their passion for music.  Despite the thousands of miles between their two countries they shared many of the same favorite artists. Listening to them sing and connect over their common interest was a shining example of human similarities and common interests in a world which often seems to focus on differences.

An unusual experience on the trip was having the opportunity to teach bottle feeding in a rural village.   At one village, twin infants (about eight weeks old), whose mother had died following childbirth, were brought to the clinic.  The provider who saw them was concerned as one of the infants, in particular, seemed developmentally delayed and poorly nourished.  Both were reportedly being fed cow’s milk.  The following day our group delivered baby formula and bottle feeding supplies to the community.  I had the opportunity to explain bottle feeding via an interpreter.  While it seemed unusual to promote bottle feeding in a society where that is not the norm, it seemed like the best option for helping these babies receive better nutrition.  After leaving the supplies in the village my fingers were crossed that the new experience would be successful.  Feedback from local staff a few days later was that the babies were taking the formula well.

A final highlight for me was that my 17 year-old daughter accompanied me on this trip as a student volunteer.  She loved the trip!  The experience for her was maturing and educational.   She valued being part of a team, enjoyed the work, and loved playing with local children.   Both during and subsequent to the trip her participation sparked great conversations between us as she shared thoughts on topics such as poverty, happiness, health care access, and ethical dilemmas.  She learned many things, which neither I nor a textbook could ever have taught her.

Visiting a country as a nurse on a mission has given me perspectives I would never have obtained through travel alone.  I have seen parts of countries which would never be on the “tourist” route.”  I have had the privilege of getting a glimpse into the lives of local communities and understanding in more detail some of the health challenges facing the developing world.   I do however, recommend trying to find the time to see some of the “touristy” things a country has to offer as, in my opinion, that’s part of the fun of the experience.

I’ve found working in a developing country to be a humbling experience.  In my daily life I often feel stressed, like I’m on a treadmill trying to keep pace with my responsibilities – family, work, home, etc.  I never take time to look at how fortunate I am in my life.  I take for or granted that I have access to clean water, ample food, health care, and free education for my daughters.  On my mission I observed in wonder that people would walk miles to receive healthcare.  I was moved by the hug of a patient who thanked me because she would otherwise not have been able to afford to see a medical provider or pay for medication.  I felt so appreciated by someone who just wanted to shake my hand and offer their words of gratitude in some cases because I gave them something as simple as a bar of soap or a tube of toothpaste.  When reflecting back on my mission the expression, “Don’t sweat the small stuff” comes to mind.  I am reminded to put my stressors and experiences into a new perspective, appreciating all that I have and knowing that some of what I believe in my mind to be important, taxing, or stressful in the scheme of things and the greater world really is not.

Mission work has been a career highlight for me.  It gets to the heart of why I chose to become a nurse in the first place, the desire to help others.  I enjoy the challenge of functioning in a resource limited setting and getting creative, at times, in order to help patients.  On this mission, as with the others, I came home feeling as though I took away more from the experience than I gave.  I hope to have another opportunity to work abroad in the future.  In fact, I hope to someday be in a situation that allows me to do it for a longer timeframe.

I encourage other nurses or people interested in participating in some type of volunteer experience to try to find a way to make it happen.  People sometimes say to me that they think it’s great I’ve gone on missions and they too would like to.  However, that comment is usually followed by a list of perceived reasons preventing them.  Some of those issues are real limitations, but many people, I think, just need a cheering squad to help them pursue their dream.  If it’s your dream, try to make it happen.  It’s not easy in many ways…time away from work and family, sometimes long journeys to get places, lack of creature comforts, but likely you will feel fulfilled by the experience and then, I suspect, be looking for your next opportunity.

Thank you One Nurse At A Time and Barco's Nightingales. The financial assistance you provided was tremendously helpful.  But also, thank you for giving international/volunteer nursing a presence and encouraging nurses to get involved.  It’s wonderful to have an organization that values the contributions nurses can make outside of their regular work environment.

Tanzania with Missions for Humanity, Wendy Libowitz, RN, MS, CPNP-PC

Wendy Libowitz has been a registered nurse since 1995 and a pediatric nurse practitioner since 1998.  Nursing is a second career for Wendy.  She worked with adolescents in a community program management capacity before becoming a nurse.  Wendy’s work experience has included acute care, home health, and school nursing.  She currently works in a nursing consultation capacity for a private company.  She has volunteered as a nurse in Honduras and Tanzania.  She also volunteers for several organizations within her community.
Wendy holds a BA in Judaic Studies, BS in Nursing, and MS in Nursing all from the University of Massachusetts, Amherst.  She is interested in pursuing a Master of Public Health degree next and aspires to move more into a public health nursing role in the future.
Wendy’s other passions include her family and pets, outdoor activities, and travel.
Today, thanks to generous donations from Barco's Nightingales, Wendy left for a 2 week medical mission trip to Tanzania with Missions for Humanity.  We can't wait to hear all about it when she returns.

Mosby's 3rd Annual Superheroes Nursing Contest

Our very own, Sue Averill,RN, BSN, MBA and Co-founder and President of One Nurse At  A Time has been nominated for Mosby's Third annual SUPERHEROES of NURSING contest. Winners will be announced in October.

Sue Averill, RN, MBA, considers herself a “humanitarian snowbird.” While she works half the year in the emergency department of a large metropolitan hospital, she spends the other 6 months volunteering abroad. Her travels read like an atlas.

When she returned from each trip, friends, acquaintances, and even perfect strangers would ask, “How can I do what you're doing?" Sue always found time to chat and guide them along their path. Then, she decided to answer these questions not only for friends and colleagues, but for all nurses! She co-founded a non-profit organization, ONE NURSE AT A TIME, (One Nurse) in 2007 and continues us to serve as President for the organization. Her goal is to make it easier for nurses to use their skills around the world

 Over years of trying to expand her own volunteer experiences, Sue had become acutely aware that there was no central database/website to inform nurses about volunteer opportunities. The information available on the Internet was available only in bits and pieces. It became a priority to create a central database as part of the One Nurse website; this database is updated annually to assure it remains current and correct.

Although the majority of Americans have some understanding of what nurses do in the United States—working in clinics, hospitals, nursing homes, and the community—most of them have no idea what nurses do when they volunteer abroad. International volunteering involves a wide breadth of work: teaching, diagnosing and treating, and functioning as hospital administrators and logisticians. They, like medical MacGyver’s, must wear many hats and stretch far beyond their scope of practice at home. Sue wants the public to recognize the great value that even one single nurse brings to a mission, to a people in need, so networking is a huge part of the One Nurse organization. Representatives speak at public forums, maintain an active presence on Internet social networks, write articles, and publish articles and stories. 

Doing volunteer work, by definition, doesn't pay. Many, if not most, international organizations ask nurses to pay their own costs. Because Sue wanted to overcome that barrier so that more nurses could share their skills and expertise in the world, they created a One Nurse scholarship program that offers $1000 to qualified applicants.  

  When discussing why she has put so much effort into building a nonprofit organization for nurses Sue says,”The key for me came during a surgical trip to Pakistan – by comparison to girls and women there, I have lived a charmed life. I was born in a time and place that fosters independence, education and freedom for women. I believe it to be my responsibility to give of myself for the many gifts that I have received through no merit of my own. My goal is to make it easier for nurses to use their skills to help people around the world, to lower the entry barriers, to increase public awareness of the role and contribution nurses make in the humanitarian world. I truly believe we CAN change the world. “

Now if Sue Averill isn't a Nursing Superhero, I don’t know who is!

Jo in Ecuador

 I  am Josephine Sullivan, an Operating Room nurse from Louisville,KY. This was my third surgical mission
with Healing the Children to Ecuador. The mission was made possible because of a scholarship from One Nurse At a Time and Barcos Nightingales.  You need to know that Ecuador is important to me because ,when I was seven,we had an exchange student,Pauline,from Quito live with us.I remember telling her that ”Someday I’ll go to your country. “It was good to be back in Ecuador and I have started  planning  my return. I now have friends there that are glad to see me, what fun.

   Our team consisted of four surgeons, four Anesthesiologists, two pediatricians, one nurse anesthestist, two nurse practitioner, two ENT Residents,two OR nurses, one nurse administrator, one OR tech. one first assistant and three other young people,who performed a variety of duties.Most of the team was from Louisville,a very agreeable and competent  group.
   We worked at two hospitals in four operating rooms. Manta had plastics and  ENT. Portoviejo had pediatric general surgery and orthopedics. My work was done in Portoviejo that included 6 orthopedic cases and 40 general surgeries that included mostly  hernia repairs and undecended testicles. The most rewarding was to return to a facility that I had worked in the previous trip to find I was remembered and welcomed by the staff and translators.  The young pediatric surgeon told me I looked like an angel and invited me to visit his office and meet his partners.He also took his young son and me to the park where iguanas live in trees.The hardest thing to endure was the mode of sterilization used in the facility.

The first unexpected event happened on the day of patient evaluations. They actually listened to me when I shared what had finally worked for us before. We seemed  organized and professional.It was heart warming.
The next unexpected event occurred after the second day of surgery.My Brigade leader,who I had never worked with before said “You really know your job.”I responded “I told you that.” To which she responded “But you’re really good.”I was speachless.She is not always generous with compliments. Having done the same job for 30 years,I am confident,but it sure is nice to hear.
   The Ecuadorian people are a very gracious and giving people. The major religion in the area is Catholic and being raised Catholic this was familiar and comfortable. Parental relationships are similar as the main focus of parents is on the well being of their children.Children are the same all over the world, curious and trusting or leery,depending on the day.I am fortunate,children don’t usually see me as a threat.
   What I have learned about myself is that ,I am no longer fast,but I am steady  for as long  as you 
need me to be steady.

   I was fortunate enough to have a week in Ecuador after our work was done.I stayed with a friend and was graciously welcomed by her family.We visited her cousin in San Lorenzo.a small village on the coast.We sat on the porch and greeted everyone that passed,we walked in the forest and we walked on the beach.I love beaches.When her nephew learned I was a nurse,he thought I should visit a child in the next village with a rare skin condition.Did I mention my friend is related to everybody.
   The condition is Ictiosis,genetic and uncurable. Medicines and creams for him are expensive.His father is a fisherman and he has a brother and a sister.His eyes are also in need of surgical attention.The next day I visited the Eye Institute in Portoviejo where they agreed to do his surgery and provide eye drops at no cost.He is six. Hopefully by the time he starts school he will be able to see out of both eyes at the same time.
   The creams and ointments for treatment are much less expensive in Kentucky,even  to ship. My family has agreed to help provide those for him.So if we can make a difference ONAAT, then we  start one child at a time.
   We also visited another hospital for a potential future surgical mission.It was a very new two OR department and a very gracious medical dirrector.I am very hopeful about the possibilities.

One Nurse At A Time And Barco’s Nightingales Foundation Collaborate To Reduce Maternal and Infant Mortality Rates In Somaliland

One Nurse At A Time and Barco’s Nightingales Foundation announced a collaborative effort to send a team of nurses to the Edna Adan Maternity Hospital in Hargeisa, Somaliland, to work with local medical staff and teach current nursing practice, techniques and standards of care.  This joint effort by One Nurse At A Time and Barco’s Nightingales Foundation is forged in the common values of integrity, commitment to the well-being of others, an innovative spirit, and a passion for inspiring to the hearts of others.

“This collaboration with Barco’s Nightingales Foundation transforms the positive impact of individual nurses multifold.  Together we are able to serve as the launch pad to attend to healthcare needs of one of the most medically under-served populations in the world:  the women of Somaliland,” said Sue Averill RN, cofounder of One Nurse At A Time.  “I’m hopeful that the success of Nurses for Edna will inspire other nurses to join with us, sharing their passion, skills and knowledge to benefit those most in need at home and around the globe.  I do believe we can change the world, One Nurse At A Time.”

Located in the Horn of Africa, Somaliland is an unrecognized, self-declared state. Women of the country struggle to receive equal rights and healthcare services due to gender inequalities, weakened infrastructure, lack of education, poor literacy rates, and limited access. These factors have impacted health services and as a result, maternal and infant mortality rates are among the highest in the world.

The Nurses for Edna hope to build a lasting relationship with the hospital, empower the nurses of the Edna Adan Maternity Hospital, and create a pathway for future nurses to volunteer with the support of One Nurse At A Time. Nurses participating in the trip include Wanda Chestnut, RN, DHSc, HIV/AID Specialist from Glen Dale, MD; Sarah David, RN, BSN, Emergency Nurse from New York City, NY; Beth Langlais RN, BSN, MN, Maternal Child Health from Seattle Washington; and Kimberly Law, BSN, RN(C) Perinatal Nurse Specialist from Penticton, British Columbia.

During the trip, the Nurses for Edna team will hold educational seminars for the midwifery students at the hospital, as well as equip staff and students with critical resources including DVDs, books, writing utensils, stethoscopes, and other general nursing supplies. Collaborating with hospital founder Edna Adan, the nurses participating on the trip will identify the needs of the hospital and the women it serves, and establish goals and a plan to achieve them.

Jo’s Nurses: Dream one. Do one. Lead one. One Nurse At A Time

Thanks to you, our donors, we successfully lead the inaugural Jo’s Nurses mission Feb. 23 – Mar 2 with Seattle-based Guatemala Village Health.  The four first-mission nurses selected were JP Denham, Kathryn McCarty, Wendy Clarke and Stephanie Saldivar.  I was privileged to supervise and mentor both weeks.
The first week we brought health care to the eastern Rio Dulce area and second week to Monterico, south of Guatemala City.  GVH “adopted” a dozen villages around these two cities and brings teams of medical and dental personnel three times a year.  Additionally, local representatives provide ongoing monthly support with medications for chronic illnesses such as diabetes and hypertension as well as ante-natal checks and vitamin supplements.

In five clinics the first week and four clinics the second, Jo’s Nurses triaged 60 - 80 patients per day, taught group visits for Gastritis/Headache/Body Pains, worked in lab and pharmacy, assisted in the children’s program with weights and measure, fluoride dental treatments, tooth brushing and Vitamin A/Albendazole/Multivitamin administration.
Clinics were conducted in health posts, schools and once in a pastor’s home.  Living conditions were generally comfortable, but remote and occasionally rugged.  Transportation was unique – vans, walking, small boats and in the open back of transport trucks to arrive at the villages.  All supplies were brought from Seattle by the volunteers.
I invite you to enjoy these excerpts from trip reports by Jo’s Nurses:

“Amazing, adventuresome, amazing, exciting, amazing, stressful, amazing, wondrous, amazing, overwhelming, amazing, exhausting, amazing….
“The second village we went to was up in the hills and quite remote. After spending the night on the clinic floor with a pillow and a blanket the adventure began with us driving up a dirt road with 15 people standing in the back of a pickup truck. It was stunningly beautiful. The sky was crystal blue and the sun was shining, homes made of bamboo and leaves…
“After setting up our make-shift clinic, I was introduced to a stern looking Mayan woman.  I wondered what her status was in the community. She was well groomed; she wore a simple beaded necklace and gold earrings. I decided to show her pictures of my husband and two daughters. It was a game of charades (she only spoke Ketchi) but I think she understood. I then took her picture.
“When I showed her the picture she shrieked with laughter. She ran around the room with my camera showing it to all available bystanders. I thought then maybe she had never seen a picture or herself in a mirror. Could that be so? Her reaction was priceless. Unfortunately, I did not get a picture of it because she ran away with my camera!  I got my camera back but never got a picture of her smile. I have it stored in my memory.
“When I came home people asked if I felt like we helped or made a difference. The answer is yes, but what they gave to me was much more than I could have ever imagined. They are happy people, living a different way of life, some of it clearly better, some of it clearly worse. I want to go back again, and again, and again.”   ---Kathryn McCarty RN
“Going to Guatemala was such a surreal experience, I'm not sure I could ever fully describe it in writing. I have dreamed of being involved in medical missions for quite some time - this is why I became a nurse. Being supported by One Nurse, I was finally able to take that first step. Having an experienced mentor (Sue) with us was absolutely invaluable.
“There is no way to fully prepare for a ride on the back of a flatbed truck or a riverboat into the jungle to be met by an entire village waiting. I was deeply impacted by the beauty and gratitude of the people we were there to serve.
“Somehow I attracted a variety of wildlife (an enormous spider, scorpion, tarantula, sting ray, a giant moth, and even a barracuda!) As physically demanding as this trip was, I felt energized and had no trouble with 12-16 hour work days, hauling gear from camp to camp. The crew was amazing - both the American and Guatemalan members.
“Being on this mission has served to fully confirm this trajectory for me. My wife and I have our sights set for being involved with long-term and hopefully permanent mission work as soon as we are able to.” ---JP Denham RN

“Traveling with One Nurse made me feel supported and taken care of.  I could concentrate on the experience and culture without worry.  It is an experience that has changed me. I owe Jo an amazing gratitude for helping me get started on medical work abroad.
“My greatest emotional feeling - how simple life can be. The families we saw had many issues which in the US would be taken care of easily. A good example is a patient with a blood sugar over 600 goes home in the village. A person in the US might get admitted with an Insulin drip, diet teaching and a follow up doctor visits.
“When children came from the school was my biggest surprise. They were piled loosely in a pickup truck. They got out and sat in the heat waiting to see us. It was lunch time. There were no lunch pails. I saw a girl eating a pig’s ear for lunch. It reminded me of my girls complaining about the cafeteria food. We are so blessed, it’s unbelievable!” ---Wendy Wescott RN
“I met Sue at a time that I needed a little inspiration and a little direction. Being able to go on this trip worked out effortlessly, and I feel like it is where I was meant to be. What I appreciated most was meeting other like-minded individuals, connecting with those around me, being in a new environment and being able to provide care to the people we served.” -–Stephanie Saldivar RN

Our plan is to continue to lead Jo’s Nurses missions, to support volunteer nurses, to mentor others and help change the world, One Nurse At A Time.    These missions cost about $2000 per nurse.  Tax deductible donations can be made via PayPal at www.OneNurseAtATime.org or mailed to One Nurse At A Time, 7747 38th Ave NE, Seattle, WA 98115.  

Preventing Cervical Cancer in Kenya

I had the privilege of working in Kenya in January of 2013 with the non-profit organization Prevention International No Cervical Cancer (PINCC). It was my first time to Africa and my second trip with PINCC. We were a small group this time, 6 of us Americans –and our Kenyan colleagues numbered about 30 in total. I was with the PINCC group for two weeks – the first week was in the Kibera area of Nairobi, and the second week was in Kiambu area on the edge of Nairobi. The weeks were very different from each other in many aspects, and yet shared similar aspects too, like the wonderful Kenyan health care practitioners we worked with, and the gracious patients we helped to provide care for.

The health care practitioners we worked with had varied backgrounds and training –they included nurses; clinical officers; midwives; and obstetrician/gynecologists.  They were all, without exception, gracious and professional and a joy to work with. Their experience varied and in very short order we were able to see who needed particular focus on specific areas of instruction. That was the mission of this PINCC trip, to teach the local health care providers how to screen for cervical cancer and treat in the same step whenever possible. This model of teaching how to provide medical care, rather than providing it, is an example of sustainable health care work that has a big impact.
Kibera is an area within Nairobi that is infamous for its poverty and challenging living conditions. I have never experienced anything like it, and although difficult at times, walking through it and working within it will remain one of the most profound experiences of my life. The health care workers who staff the clinic in which we worked most often lived outside of the Kibera slum, and they took public transportation to the edge of the slum, and then walked in to the clinic on foot. This is because the “streets” (dirt paths) of Kibera are not wide enough for cars. There is no car traffic within Kibera.  
The clinic is part of an organization called Shining Hope for Communities or SHOFCO as we called it. It is a wonderful organization that offers healthcare, education and a sustaining community presence within Kibera. It provides a stable base from which to provide services and this is what we helped do! Some of our Kenyan colleagues had exposure to the concept of “see-and-treat” cervical cancer screening, or, visual inspection with acetic acid and cryotherapy, and some did not. Some had experience using speculums and some did not. Every day was different, which of course was wonderful, and so we began wherever the student needed us to begin. The work, therefore, included things like teaching the participants how to use a speculum and find the cervix; inspect the cervix for changes after the application of acetic acid; perform equipment checks on cryotherapy guns and performs the cryotherapy; do biopsies and do LEEPs (loop electrosurgical excision procedure).
Cervical cancer continues to be a leading cause of mortality in developing countries, as compared to more developed countries, where it is not among the leading reasons for female mortality.  The process-intensive screening that is done with pap tests, in more developed countries, is not suitable in developing/low resource areas. In contrast to the U.S., for example, where cervical cancer screening occurs nearly annually, many women in developing countries receive one screening in a lifetime. This is for many reasons, but geography; access to health care; lack of adequate local health system infrastructure – all of this plays a part in contributing to the increased morbidity and mortality of cervical cancer in developing countries. For these reasons, PINCC and other organizations, teach a method that screens and treats (if necessary) in one step. There is no specimen (Pap test) therefore there is no need for a laboratory or the personnel to interpret the specimen. The clinician doing the pelvic exam visualizes the cervix, and, using 5% acetic acid (vinegar) applied to the cervix, is able to determine if the cells of the cervix appear healthy, or, if there are pre-cancerous lesions. This method has been researched well and has been found to be as effective in finding pre-cancerous lesions as pap testing! And the best part is, it is inexpensive to perform, relatively easy to learn, and equipment and supplies needed are minimal.
Our Kenyan colleagues embraced this method of cervical cancer screening, and at the end of the week they were getting the exam themselves – often the first pelvic and cervical exam they had ever had. The most gratifying moments of these weeks included these exams that the students did on each other – they had clearly learned how to do a good pelvic and cervical exam and they trusted each other to do it well. Serving as their educator was an honor and a privilege.  I learned so much on this trip – particularly about how to teach. I have been a clinician for so long, it’s easy to reflexively perform a task, but it is much more difficult to sit back and teach – and allow the student to learn by doing. I also learned a little bit about the ways in which our cultures differ. It seems that our Kenyan colleagues are typically more soft spoken than we are, and a little bit less assertive in terms of learning needs. There was an emphasis on politeness in the Kenyan culture that I have not often experienced within the U.S. culture and I felt compelled to scrutinize myself to make sure I maintained polite manners!
The conditions in which we worked were difficult, e.g. there were a lot of patients, and they often had complex medical and social histories. Many women had been raped, and many were positive for HIV. Many were single and had had multiple pregnancies and miscarriages. All of this made for overwhelming encounters at times – but our students managed this with grace and ease. They work in such difficult conditions, the poverty is mind-numbing and they work within it all day without fancy equipment, running water or electricity. It is inspirational and I hope to remember these hard working clinicians when I catch myself complaining at my work at home.
One of the most memorable moments of this trip came at the end of the Kibera week. We had finished teaching and working in this very challenging environment and PINCC had certified and graduated a number of clinicians in this method. Being witness to their pleasure and satisfaction was awesome. We said our goodbyes and as we left, we went to a classroom of girls (the clinic is next to the Kibera School for Girls) and these young girls sang to us. They were all beautiful songs, but the last one was about self-realization and fulfillment.  When they were done there was not a dry eye amongst us! The fact that this kind of beauty, hope and joy can exist simultaneously alongside extreme poverty and desperate circumstances, gives me hope and sustenance to continue working to help my fellow human beings.
One Nurse At a Time made this trip possible for me and it was a gift I will always have. I hope to participate in a trip such as this on an annual basis – it will keep me fresh, flexible, and young at heart! It seems to me that this is a cycle of giving – ONAAT gives me the opportunity to do these trips, I give of my time and expertise, and the people I encounter give their grace and good will – and in this way, all of us contribute to an accomplishment that could not be achieved alone.    Anne Daly March 2013

The Art of Nursing and the Science of Medicine - Sue Averill

From Sue-

Last month I traveled with other nurses and doctors to Port Au Prince, Haiti with Project Medishare, working at Bernard Mevs, the only neuro-surgical and trauma facility in the region.  Project Medishare’s goal is to train Haitian doctors and nurses and to establish sustainable programs so the facility can function independently beyond the departure of expats.

Among my role as ER and Triage nurse, I was anointed “The Hysteric Whisperer." Many teenage girls and young women came to the hospital via ambulance or private vehicle presenting in catatonic states, hyperventilating or as “post-ictal seizure” patients.  We soon learned, these were anxiety/panic attacks. One teenage girl was brought, ambulance lights blazing and sirens blaring for "seizures" – but made eye contact and was purposefully moving around in the gurney - not in a post-ictal state. The doctor approached the patient and shouted, "Prepare to intubate!"

Three minutes later, I held the girl’s hands and helped her off the gurney and onto a chair.  Intubation was certainly not necessary. With an astounded look on his face, the doctor asked “How did you do that?  That was magic!”  I replied, “Want to know the magic? I put my face down close to hers, spoke very slowly, softly and quietly into her ear, and told her  'It's OK' over and over and over.  I pet her cheek, made eye contact and suddenly big crocodile tears began to slide out."

The Haitian population has several factors working against them:  the traumatic events of the 2010 earthquake - the country is still piecing itself together.  The fact that Haiti is an impoverished developing country with limited resources.  Add to that frequent sexual violence against women, family issues, loss of not only loved ones but schools and homes and churches, plus the surging hormones of teenagers, it's no wonder these young female patients frequently present with anxiety and hysteria.

A nurse’s approach is humanistic. It's thoughtful.  It involves comfort, care, touch, words and warmth. It's holistic. Nursing approaches patient care - whether in a hospital, a clinic, or a tent in Africa – from another direction than medical doctors.  Our professions are intertwined yet quite different.

It's the art of nursing versus the science of medicine.

- Sue Averill, RN

Navigate the World of One Nurse At A Time

David Fox and Sue Averill just finished working on this little gem for One Nurse At A Time. It is an excellent video and it takes about 4 minutes of your time to watch. The video briefly describes what we do, how to use the website, what is on the website and some great educational tools at your disposal.





I hope you enjoy this little gem of a video! I did! Please pass on to others if you wish!


Navigate the World of One Nurse At A Time - Video




Cheers -

ONAAT

Are you happy?

Over the holidays, my mother and I were scrolling through Netflix one afternoon when the kids were fast asleep and we came upon a friendly picture.  We paused for a brief minute and then looked at each other and said "Yes, let's watch it!"  

The movie Happy is a 2011 feature documentary film directed, written and co-produced by Roko Belic. Roko is an American film director, producer, cinematographer and actor. He had a directorial debut with the movie Genghis Blues (1999). That movie was nominated for an Academy Award for best documentary feature.  The title Happy pretty much sums up what the movie is about. The movie literally takes you into the lives and countries of about 14 different people. 

Why you ask am I blogging about this? Because it touches exactly what we do with our organization. It was amazing to see it, hear it, and watch how humanitarian volunteering can create happiness. Happiness is not just about volunteering, it's about several different aspects of life, and this documentary has tied up in a neat little bow for your viewing pleasure. The director Roko Belic was originally inspired to create this film after producer/director Tom Shadyac showed him an article in the New York Times entitled "A New Measure of Well Being From a Happy Little Kingdom".  According to this article, the United States is ranked the 23rd happiest country in the world. 

So, what makes a person happy? It was amazing to see and learn that a rickshaw driver in Kolkatta was happy running in the blistering heat, monsoon weather and living in a plastic shack. His happiest moments were coming home and seeing his son waiting for him and his son yelling out "Papa Papa!" Not only was he happy about his job, but he truly enjoyed his house, and his neighbors, they were a large family, caring for each other.  

The movie did break it down into research and statistical data of what and where happiness comes from - basically the happiness is about 50% genetic, our circumstances, such as our job, income, status, money and how healthy we are only makes up about 10%. Here's the interesting part--- 40% of happiness is based on intentional behavior...so the things we do to increase our level of happiness- this is where we have the most control over our OWN happiness!

To drill down further here some of the things you can do to improve your happiness :-)

1. Increase your physical activity - any kind of physical activity, change it up too, just don't go to the gym every day! 

2. Connections - family, friends, community - fascinating fact, a person who makes $150,000 a year isn't necessarily happier than someone who makes $40,000 a year. Interestingly, people who focus on making money or status are often more depressed and anxious. 

3. Appreciate all that you have - a great suggestion was to "Write down 5 things you are grateful for and do this every Sunday". Your happiness levels are bound to improve.

4. Compassion and Service to others - I love this!  People who focus and meditate on compassion have a higher level of happiness. The Dali Lama said "the true aim of cultivation of compassion is to develop the courage to think of others and do something for them". 

I loved this documentary, it touched something in me that I hope to keep my focus on this year. I loved it so much, I watched it twice! I hope you take the opportunity to watch it too. 

Compassion and happiness, 

-ONAAT CREW

http://www.thehappymovie.com/