History in the Making - Michelle (Mickey) Guerreo

 The stethoscope give-a-way was by far the biggest hit. We took it back to basics for the nurses, and we can tell that it was really useful information for them. During the Respiratory sounds lecture, we taught them how to wear the stethoscopes and use them to assess heart and lung sounds. Most of the nurses had never used a stethoscope before. It was amazing to see the change that came over the nurses when they realized they were going to receive the stethoscopes they were practicing with.

Vietnam is still very much a Communist country, control and permission comes from the top and trickles down. The nurses are on the bottom of that chain. They need permission to do anything. Right now, their job is to wait for orders to be given to them, and do not make any patient care decisions without contacting the doctor first, if that doctor is wrong, or prescribes the wrong drug or dosage, the nurse is still responsible to carry out his order and dare not question it. The nurses are not seen as intelligent enough to perform physical assessments or interpret test results, only doctors carry out those types of tasks.   In a code situation, you will see 4 or 5 doctors and no nurses.Also, the Vietnamese people take very long lunches during mid-day; the break is about 2 hours, and all work stops. The hospital halls are empty, and family members can be seen outside the patient rooms cooking and enjoying meals together.

There is a strong family presence in Vietnam, family is required to provide bed linen, patient clothing and meals. There is even a building on campus to house the family of patients that are in a visiting hour restricted unit like ICU.

I have never had to give a speech before, and I spoke twice at the opening and closing ceremonies. The heads of the VN government were there, as well as respected American physicians like the past and current President of ACEP and IFEM. Also, the weather in Hue during spring is usually sunny and warm; while we were there it was neither. Each day was wet and cold!

Touring Hue Central Hospital, the hospital version of a CNO gave us a very up close tour. I found it important to see the area and real life experience of the VN nurse. I met with many patients, doctors and family members, and heard the patients’ stories. We even got to see the Vietnams' first heart transplant recipient. I met a patient in the ICU who spoke perfect English, and he held our hands and thanked us with tears in his eyes for our presence and helping the hospital.

 One of my favorite experiences was during the nursing conference. We were given two English speaking VN physicians to make sure our content was being translated correctly. During one of the days, a conversation during the “Tubes and Lines” lecture broke out into a full blown conversation between these two doctors and the nurses. I was amazed. It was history in the making. The nurses voice was being acknowledged in a way that we hadn't expected. They were sharing information on an equal level. To me that was the most amazing break through.

~Mickey Guerreo

Michelle (Mickey) Guerreo, RN was our fourth scholarship recipient in 2011.  MIckey will graduate with her BSN in September. She has been an ER nurse at a 60 bed inner city Emergency Department for seven 7 years, and the night shift charge nurse for two of those years. Prior to being a nurse, Mickey worked as a unit coordinator in the ER and post-op units. Mickey is passionate about, and dedicated to Emergency Nursing. She is active in her hospital community, as well as her local and church community. Mickey travels to Vietnam for three weeks, once a year, to lecture on Emergency Nursing and procedures. In 2011 she was the Co-Chair of the Vietnam EM Symposium and organized the whole thing. It is her travels that have prompted her to advance her career. Her goal is a Masters in Public Health.

WORLD MALARIA DAY 2011

About half of the world's population, are at risk of contracting malaria, especially those living in developing countries. World Malaria Day 2011 is a time for examining the progress made towards malaria control and elimination. Progress is being made but there is still much work to be done. We at ONAAT salute everyone engaged in the admirable goal of erradicating malaria by 2015.

                 Read below an excerpt from "T-Girl" by Sue Averill, a real-life story of the price malaria extracts. 

"She came at the end of another hot humid day when even a sip of water instantly erupted onto our skin as sticky smelly sweat. We’d learned if you don’t drink, you don’t sweat, although the nurse in me wondered how our kidneys were faring. With an exhausted sigh and stretch of cramped muscles, I finished my line of 100 patients in the crumbling structure of Kakata Internally displaced Persons (IDP) Camp and glanced toward the entranceway. There was a thin, ragged child lying unconscious on a straw mat on the filthy concrete floor. Her breathing was rapid and shallow and not a sound came from her parted cracked lips.".....from "T-girl by Sue Averill

I WILL NEVER FORGET

                Ecuador was AMAZING!I had such a great time. It was so different from what I expected, but in the best way possible. Our team was remarkable; we all clicked right away from the first day of meeting each other.

                On Sunday, we performed screenings all day of the children who came to be evaluated.  We screened over 48 kids and performed 28 surgeries over five days.  I learned so much and had plenty of opportunities to practice my Spanish.  It was definitely a learning experience which needed flexibility! 

                The first day of surgeries went kind of slow because we were learning where everything was, best ways to communicate (who needed to interpret) and developing our flow.  The nurses there in the OR were fabulous, so shy of us at first, but by the second day, they were joking with us in Spanish and asking favors and teaching us about their culture. 

                For me, since I spoke some Spanish, I connected more.  It is like my world paused for a week, and I was able to get a glimpse of life there in the town we were in, in the hospital we were in and with all the staff.  I felt like I was treated normal, like one of them.  They included us, it was like one big hug the entire week, like open arms.  Everyone in the small hospital was so curious to see us and talk with us; the OR was full most of the time.

                The women down there astonished me!  The OR would have other procedures going on at the same time as our operations, women would come in to have their babies every day, we would see them go into the birthing room, then a few minutes later, no noise or screaming, they would roll them into the recuperation room and a few minutes after that bring the baby to latch on. 

                The kids and their parents affected me most.  Each was so different and so special.  We operated on all ages from 2 months to 15 years.  Mostly cleft lips, palates and scar reconstructions (from burns).  So sad to hear some of their stories. On the fourth day, we had a 6 yr old boy come in for surgery; his dad was soooo nervous and scared, more than the patient! After the surgery I went to update his parents, but only the mom was there. I updated her and returned to the OR. Later I learned that the dad had gone to buy a Popsicle for Dr George (our main surgeon), as a thank you!  Oh my goodness that twisted my heart like no other! To think the only thing that you think of or can do is buy a Popsicle for the surgeon!  No one in the states would even think to do it, nor would a doctor much appreciate it.  It my touched my heart.

                One 13 year old’s father didn’t even want him to come; the boy only let his mom talk to us during screenings, and would keep his hand over his mouth after surgery was done. (palate) Before the surgery he was so nervous, I was trying to get him to talk to me, so I could calm any fears, I had my mp3 with me (English and Spanish songs), I asked him if he would like to listen to some and he nodded yes!  It really was the little things I tried to focus on.  God bless them, they fumbled through my Spanish with me!  ha-ha, but I would think it would be even scarier to not only go in for surgery with a condition you have been living with since birth, but by foreigners as well.

                By the end of the week, when everyone had exchanged directions and Facebook pages, the nurses started to cry, which made me cry. They all wanted to know when and if our team would be returning soon. It was heartbreaking to not have any answer. I hope so.

                 I spent some time after hours with them too, going salsa dancing, karaoke (my first time ever, and it was out of the country!) and eating fresh crabs, etc.  They taught me a lot about the language and culture, and I tried to learn as fast as I could.  I will never forget this trip.  I think it is my favorite so far, and I wish to return in the future.

~Laura Weisgerber

ONAAT's third scholarship recipient, Laura Maria Weisgerber, RN, BSN,went on her first medical mission to with Healing the Children to La Troncal, Ecuador from March  12 through March 19th, 2011

Over Coffee With Doctor Z

     

           During the summer of the year 2000, I was working on a women’s health project in Kosovo as part of the war recovery effort. One fine day, I had an appointment to meet Dr. Z., the director of a health house. A health house is a large facility that provides primary care to residents within a municipality. On the way, Sami, my driver, gave me lessons in speaking the Albanian language; I gave him lessons in American slang.

        On our arrival, Dr. Z. greeted us with a warm handshake and grandly showed us into his office. Sami, who served as our translator, told me that Dr. Z. was inviting us to have coffee.

        Nothing happens in Kosovo before coffee—or, putting it more aptly, everything in Kosovo happens over coffee. Whether you are in a home, a school, or a hospital, you are always offered Turkish coffee. To decline is unthinkable.

        I soon found myself balancing a miniature cup on a child-sized saucer and stirring the contents with a very small spoon. As I sipped the thick, black sludge, flashbacks of drinking mud tea at childhood tea parties danced through my head.

        Dr. Z. was eager to learn more about my team’s work with the women from the villages. When I told him about the prenatal care we were providing, he expressed his deep gratitude with the comment, “This we have needed for so long, for our women to have healthy babies.”

        We began to talk about gynecological care. I told him how difficult it was to diagnose and treat infections in the stark ambulantas (health care clinics located in rural areas) without a laboratory or even a microscope to guide us. Dr. Z. nodded his head with understanding. The dreary laboratory in his health house could handle only a few basic tests, and the microscope in the corner was gathering
cobwebs, waiting for someone to be trained in its use.

        The conversation turned to the subject of family planning. I explained some of the options available to the women, such as condoms, oral contraceptives, and intrauterine devices. But when I mentioned medroxyprogesterone acetate injections, his eyebrows shot up in alarm. Then he and Sami began to engage in animated conversation. I wondered what I had said to cause such a commotion.

        Finally, Sami turned to me with a serious expression on his young face and said, “That drug will cause our women to be sterile. It will also cause tumors to grow in their bodies. Dr. Z. asks why are you giving it to our women?”

        I tried to assure both Sami and Dr. Z. that medroxyprogesterone injections were safe. I told them that although a woman may encounter a delay in the return to fertility for as long as 18 months after discontinuing use of the drug, she will not experience permanent sterility. I told them that we inform the women of the possible delay and encourage them to use a different method of contraception if they want to conceive in less than a year. I also stressed that this drug absolutely does not cause cancer.

        Dr. Z. put his coffee down with a clatter, abruptly left the room, and promptly returned with an open book, which he handed me with a questioning look. It stated that the US Food and Drug Administration (FDA) had not approved the use of medroxyprogesterone in the United States due to its possible carcinogenic effects and association with infertility. I was momentarily dumfounded because I knew with absolute certainty that this was simply not true!

        “Your FDA will not even allow it in your country,” he stated firmly, gulping his coffee. “This is a book from my training, my own medical school. It tells me one thing and you are telling me another. How can it be both?”

        Finally, the light of understanding dawned on me. I took a deep drink of the strong coffee, even though I knew it would cause a spasm in the back of my throat. I paused to consider how to best handle this delicate situation without embarrassing my host.

        After a moment, I turned to the front page of the book, pointed to the 1981 copyright date, and explained that he was absolutely right. When he had attended medical school in the United States, the FDA had not yet approved medroxyprogesterone because not enough was known about it. But after much study, the FDA did approve its use in the United States in 1992. I rifled through my backpack and retrieved an informational pamphlet about prophylactics, including the injectable types, and handed it to him.

        “The FDA has approved?” he asked suspiciously as he glanced through the pamphlet. I nodded my head, taking another sip of sludge. “And you, do you recommend it?” he asked with a small sip and a twinkle in his eyes. Steadily meeting his gaze, I replied, “I have recommended it to hundreds of women, even to one of my daughters.”

        “Ah, my books are like me; they are old,” he sighed.

I had a book that I wanted to give to him and I promised to bring it with me on my next visit. He thanked me. “I would be so proud to have a new medical book. My English is not so good when I speak, but when I read, especially if it is medical, I very much understand.” Dr. Z. smiled broadly and sat back in his chair.

        The only thing left in our cups was the fine ground sediment in the bottom. The meeting was over.

I left the health house hoping that Dr. Z. would offer more contraceptive choices to his patients in the future and become a leader in educating his fellow Kosovan doctors. It could happen, perhaps, after he has read his new medical book—and after more conversations with clinicians from other parts of the world over miniature cups of thick, dark coffee.

by Nancy Leigh Harless, BSN, WCHNP, Director Communications ONAAT

Reprinted with permission from Clinician Reviews. 2001;11(7):99-100.  Now on-line at http://www.nursetogether.com/Volunteer/VolunteerArticle/tabid/360/itemId/2462/A-Nurses-Experience-in-Kosovo.aspx

      
    “The extraordinary nurses’ stories in Nurses Beyond Borders have the power to ignite a movement of international volunteerism. As a nurse, this book reinforces what I already know: wealthier and more technologically advanced countries have a responsibility to help the undeveloped ones, not only through a sense of charity, but in order to promote permanent peace and security. With its insightful glimpses into universal health and safety concerns, this collection incites reflection, examination, and hope. ~ Greg Mortenson, author of Three Cups of Tea

CHANGING THE WORLD, ONE NURSE AT A TIME

Working abroad - especially with fewer resources than we are accustomed to - has a way of stretching us.  We must adapt our practices to different cultures, languages, lifestyles and approach to health and medical needs.  Our “Best Practices” nursing framework has to be set aside and replaced with a “MacGyver Mentality” to do the best we can with what we have at hand.

Humanitarian nursing requires an entirely new skill set.  Emergency nurses- with our flexibility, adaptability and broad knowledge base - are uniquely positioned to thrive in this unique environment.  Emergency nurses reach out eagerly (although not necessarily without fear) for new, rich experiences "up close and personal" in places we've only read about in National Geographic.

Emergency nurses think on our feet.  A 19 gauge injection needle can substitute for an IO in an overwhelming cholera outbreak.  A plastic water bottle with the end cut off serves as an inhaler spacer.  Duct tape will close a laceration.  Acetaminophen works wonders.  Smiles, gestures and pantomime substitute for language.

But hands on nursing skills are not all that are required in the complex humanitarian field.  Nurses become hospital administrators, teachers and trainers, water and sanitation engineers, midwives, logisticians, project managers.  We frequently diagnose, treat and prescribe in the absence of a physician.  Few non-governmental organizations have practice standards or guidelines, so nurses must arm ourselves with information prior to travel and herein lies the rub.

The lack of humanitarian nursing resources thwart even the most dedicated internet search.  One Nurse At A Time (http://www.onenurseatatime.org/) was created to fill this information void.  The goals of the organization are threefold: 
* to assist nurses volunteer their skills and knowledge at home and abroad
* to lower the entry barriers for nurses to volunteer
* to educate the public about the roles and contributions of nurses in the humanitarian world

Assistance.  The One Nurse At A Time website offers a free, up-to-date directory of national and international organizations using nurses in their programs.  It's also a place to ask questions:  How do I get started?  Where should I go?  How do I plan?  How can I balance work and family and volunteering?

Future plans are to create a body of freely accessible information covering topics related to humanitarian nursing to help nurses better prepare for unique practice settings.

Scholarships.  Volunteer work, by definition, doesn't pay.  Many, if not most, international organizations ask nurses to pay their own transportation, room and board, and sometimes a team fee.  In order to volunteer, the nurse must also use vacation time or unpaid leave from work.  Volunteers often can do one mission, but most can't afford to go frequently.  To overcome this hurdle, One Nurse At A Time has a scholarship program offering $1000 to qualified applicants - at least one per quarter.  Donations are most welcome and can be made online or by check (information on the website).  More donations translate into more scholarships.

Public recognition.  Telling our stories in public forums - social networks, articles, public speaking, anthologies like Nurses Beyond Borders (http://www.nursesbeyondborders.com/), reaching out to the public - all help to spread the word about the vital role we nurses play.  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. We are eager to share our experiences and challenge conventional wisdom about nursing practices in remote settings.

One Nurse At A Time has an ambitious agenda of partnering with hospitals to assist nurses volunteer, organizing a body of humanitarian nursing knowledge to prepare a unique skill set and continuing to provide scholarships and advice so that together - One Nurse At A Time - we can change the world.

By Sue Averill, RN, MBA President One Nurse At A Time.

Republished with permission:  Vital Lines’ and it is Volume 28, Issue 1 Winter 2011. Pages 3 & 8.