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.  

ONAAT MEETING

We had another successful ONAAT Meeting this morning...discussed our objectives and goals for the year, our fundraising plans and ideas for building and growing One Nurse At A Time. We met in Fremont at Hale's Brewery and had a fantastic lunch, great conversation and meeting! 

Some of the highlights we would like to share with you:

1. Fundraising -

This continues to be a constant concern. We want to help nurses everywhere, but we need to have the funds to help! We would love to have any ideas, thoughts or a person who may be passionate about fundraising talk with Sue about helping us meet our goals for One Nurse At  A Time. Some ideas we tossed about were text to donate, volunteering at local marathons (getting name out there), talking with larger corporations about donation and support, as well as thinking about Christmas! What! Yes, Christmas...hopefully we can connect with a great organization or club out there that may be looking for a charity to donate to during the holidays. 

2. Edna hospital Nurses -

We talked a lot about these four passionate nurses who are very interested in humanitarian work in Somaliland. A formal financial request was sent in by these nurses seeking financial assistance with their project to One Nurse At A Time. Here is a great link to learn more about Edna Adan University Hospital. Our goals are in line with getting resources and financial help out to these women who will be doing amazing and hard work in Somaliland. If you know someone who may be interested in helping, please email Sue!  Sue@onenurseatatime.org

3. Past ONAAT Scholarship Nurses -

This probably means you! =) We would really like to build up our community and our network of nurses and nurse volunteers. This means we need to hear from you. Sue will be working hard these next few weeks to months by reaching out to all of you for networking, giving you an update of where we are, and any financial assistance you can muster. =)

4. April Conferences - 

Sue is totally excited to go to this next month's conference! The conference is through the University of Phoenix Omicron Delta Chapter in Savannah Georgia, April 27th. If you are interested please click here Omicron Delta Educational Conference. The conference is based on International Nursing: Making a Difference One Nurse At A Time! Sue will be speaking at the conference and is so excited to talk about International Nursing!  Please register to attend!

5. Nursing Retention Research -

As a nurse, I can see the young newbies coming straight out of nursing school excited and thrilled to be out on their own caring for patients and making a difference in people's lives. As a nurse, I can also see nurses struggling with expectations, feeling like they are not making a positive change, overwhelming feelings, poor self-care and then sadly leaving the profession all together because none of these things are met. So, we hope to reach out to one of our recent scholarship recipients (you know who you are =) ) and work towards getting this information tied in closely to the satisfaction, sense of well-being, love for nursing, gratitude, and overall joy that humanitarian nursing brings to nurses all over the world!!

Whew!  It might not seem like it was a long meeting, but we all laughed, shared, pulled out great ideas from each other, and rejuvenated our own goals for One Nurse At A Time! Thanks so much for all of the hard work that you all put into our organization gals!!  

This means you -  Sue Averill, Karis Cady, Helen Jose, Christine Van Horn, and Kristi Whiton

All smiles!

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

Pediatric Surgery in Ecuador

by: Deborah Skovron

Within the clearly apparent physical outcomes of a pediatric reconstructive surgical mission lies an outcome that may not present itself quite as immediately to the volunteer nurse.  While this less physical outcome does not reveal itself in as dramatic a way that surgical intervention does, it is as significant, as permanent, and as enduring as any physical reconstructive outcome.  I was fortunate to realize this outcome while on a surgical mission to Ecuador last week.  I hope that by sharing this story, other volunteer nurses will realize the impact their contribution has in the lives of their patients well after they part ways.   
This mission was not my first surgical mission to this tiny South American country; I've been fortunate to return often as a volunteer PACU nurse in various Ecuadorian hospitals.
In 2012 I volunteered in a small public hospital's PACU in Salinas, Ecuador.  I returned this February to the same city but to a different hospital.  
On "triage" day I was responsible for patient intake information, weights, heights, etc. for prospective patients.
The day was moving along at a quick pace; families with kids were filling the hallways and spilling over to the outside.  
I had triaged around 90 kids, had had lunch, and was digging in for more patients when the exam-room door opened, a family entered and in an instant there was a young boy wrapping his arms around my waist with all of his might. A huge, happy surprise for each of us!!!!!  I was elated to see this young boy, this smiling face; to see him well, to see he had remembered me. The hug endured. Happy greetings were all around; young boy, parents, and nurse!
(I had recovered this young boy last year following the repair of a congenital anomaly. He had a great deal of discomfort, had difficulty ambulating, his parents were distraught, he had numerous surgical drains, incisions, and dressings. I spent hours with him, managing his pain, helping him to cough and deep breath, encouraging him to ambulate, reassuring his parents that all would be well. And indeed, all did go well; he was soon discharged.)  He had returned now, unexpectedly, for the second of four surgical interventions.

With that show of affection I realized, in an instant, that I had played a very significant role in this young boy's life last year; more than I had imagined. I had been placed in his mind as a GOOD memory, a thing with which he had a connection.  Along with a positive surgical outcome there had been an incredible consequential outcome; the creation of vital human bond between a young boy and an older woman, an Ecuadorian and an American, a patient and a nurse, a disadvantaged citizen and a citizen of means (relative term.). This was such a stark, impressive realization; quite significant for me. Now, at home, I feel even more a part of this global community; what a gain!! And not a "pat on the back" kind of a gain but a quiet, internal, satisfied gain.  

He did have his second reconstructive surgery last week; I was able to care for him again post operatively. He recovered quickly, he's speaking some English, he's a whiz at jig-saw puzzles, and he's a fan of chocolate Ensure.

I was once again able to practice the art of nursing; human to human caring.  I was not restricted, nor was my care defined by the rush, scripted, often routine approach to patient care in a large institutional care center that I often find associated with my job in the states.

While nursing theory, medical science, and evidence-based practice has advanced the profession of nursing, to be one with another in a time of need is the hallmark of nursing......and there in lies the charm and the appeal of humanitarian nursing.