On Oct. 25, 2014 I led a
team of 4 nurses and a pharmacist to Ecuador for a medical-outreach mission
trip. Our clinic was 4 days long we
spent 2 days in San Josue, Ecuador and 2 days in Liberador Bolivar. We worked
from 9am to 5-7pm. In those 4 days we saw over 700 villagers… absolutely
amazing. The needs varied from villagers simply wanting vitamins to needing
emergent care. Returning this year to Ecuador was a blessing especially to see
the knowledge the villagers retained from last year’s teachings and care we
provided.
I enjoyed watching my
team grow individually and as a unit throughout the trip. As a leader I was able to use my knowledge
from last year to be there for my team. I enjoyed being able to experience the
medical mission to the fullest by having the freedom to be a part of each
assessment area for example the triage, in-depth assessment area, pharmacy
area, teachings, and prayer area. Overall,
I think I enjoyed being able to pray more this year with the villagers than
last year the most, because it created a bond between myself and the villagers
that I will hold close to my heart forever.
The thing I enjoyed least
was some of my team members being ill, myself included. Some of my team members
were ill before we even left the states as was I, some became ill in Ecuador,
and after we returned home. I was very worried about them. This was the most
challenging aspect because as the leader I felt a little helpless not being
able to know why they were ill or being able to relieve their illnesses.
The cultural difference that
I observed was the male dominant society. One of the village nurses that helped
us was not able to do anything like going with a patient to the hospital
without getting permission from her husband first. She had mentioned having to
ask at the right time, but in the end he still said no. Our translator was a
newlywed who was in a more modern relationship; however she still needed to be
home to make her husband supper before he came home from work. Another example was one of our patient’s, Lida,
she was a young woman that suffers from a dura tear with excessive cerebral
spinal fluid nasal drainage for the past 6 months. She has been waking up in
the morning to a soaked pillow in the morning, having frequent severe headaches,
memory loss, and other complications. Her memory loss is so excessive she
forgets she is cooking something and it burns… in turn domestic abuse is the
result. I explained the complexity of her condition and informed her of the
need for surgical intervention as soon as possible. She needed to have her
husband come to talk with us to decide, for her, what she should do. When the
husband arrived and talked with myself, the Pastor Luis, and the Pastor’s wife Karen,
the result was unreal; as the Pastor talked with the husband there was no
emotion from the husband; then the husband said, “ It is not my problem… it is
her and her families problem.” Tears
poured down Lida’s face. As we talked
more with Lida is was clear that domestic abuse was the likely reason of the
dura tear. Although this is sad situation,
I remind myself of is that Pastor Luis and his wife Karen are teaching the
community how to appreciate your spouse and value equality within marriage as
they demonstrate this on a daily basis.
The most difficult
cultural difference is the ability to pay for healthcare versus the United
States. In the United States we have government funding, foundations, special
hospitals, or payment plans to assist with getting the treatment we need when
we need it. In Ecuador, they need to pay for clinic visits and specialists.
Some hospitals provide free care and procedures, but the patients need to buy
the medications, anesthesia, and much more before anything will be done. If the
procedure needs a specialist for the
surgery payment needs to be provided before the surgery. For example, Lida, a
young women with the dura tear, needs emergent surgery, but is not able to
afford to pay for the medications, transportation, or other aspects of care
that she needs to have prior to the surgery, so she goes without. Her condition
would be a neurological emergency in the United States. Another example is an 8 year old little girl that
has a narrowed airway passage and has seen a specialist that informed her
family she needed surgery or could possibly die. The family has no money to pay
for this $1000 surgical procedure. In the United States these things would be
taken care of right away. I think people take this for granted in the United
States. Yet, in Ecuador these people fear for their lives on a daily basis and
pray that God provides a miracle.
Another cultural difference
is the happiness and love the people of Ecuador radiate to each other as well
as visitors. As a sign of respect when
you meet someone new, are greeting someone you have known forever, or when you
say good-bye you give them a hug and a kiss on the cheek. This is actually one
of the things I miss most when I return to the states from Ecuador. Similar to the United States, the aspect that
is hard to wrap your mind around is the abuse that occurs behind closed doors
and the lack of love in some families; however there are organizations that are
available for people to utilize to escape these circumstances in the U.S. and
in Ecuador there is not.
The people of Ecuador are
very kind and understanding. I needed to use my Spanish speaking skills much
more this year which was a challenge. I am not a fluent Spanish speaker, but
the Ecuadorian people did not criticize, did not laugh at me, and did not judge
me as a stumbled with my words or required a little extra time to think of the
right word I needed to use. Instead,
they would help me by suggesting words, help teach me proper pronunciation and
vocabulary, and laughed with me when I made jokes or said something silly.
My most “memorable moments” are caring for Lida
the lady with the dura tear with excessive cerebral spinal fluid leaking from
her nose and Rosa Rodriguez an 103 year old lady with extreme pain:
Lindsay one of my team members was assessing Lida
and called me over. Lindsay explained that Lida was having memory loss,
headaches, dizziness, and burning with excessive nasal drainage that pours from
her nose when she simply looks down. I ran to get a glucometer and asked Lida
if she could give me a little sample of the drainage from her nose. She looked
down and I couldn’t believe at how fast and how much drainage poured in the
cup. I tested the nasal drainage for glucose which is an indicator of a
cerebral spinal fluid leak if glucose is present. The test came back positive
with a glucometer reading of 241.
Although, this was a very difficult diagnosis to explain to Lida, being
able to diagnosis her or at least have a idea of the seriousness of her
condition put into action a immediate interventions for Lida. All Lida needed
to do was let us know she wanted help and if money wasn’t an issue be open to
having surgery. After hours of praying with Lida, providing information of the
seriousness of her condition, and informing her of complications she could
experience if she did not have surgery, Lida informed us she wanted the
surgery, so she could better take care of her kids. Lida doesn’t have support
from her family or her spouse. She continues to have to live in an abusive
relationship. The bravery Lida showed at
that moment was truly unbelievable.
At the end of our last
clinic day we were closing the clinic when an elderly woman was pushing another
elderly woman in a wheel chair down a dirt road. The lady in the wheel chair
was crying and in excessive pain. The woman pushing the wheel chair reported
that the lady in the wheel chair was her mother and is 103 years old. Her name
is Rosa Rodriguez. The daughter explained that Rosa had broke her left hip a
year ago and has had pain ever since.
Recently, she was having increased pain in both hips and her right lower
leg. As a geriatric nurse this broke my heart. We immediately gave Rosa some
Tylenol and I massaged her lower legs and hips with muscle rub. She continued
to cry and as a nurse I have never felt so helpless and useless as I did not
have the resources to relieve this woman’s suffering…at that moment I
understood completely what these people experience every day. I tried to comfort Rosa and I held her close
as she wept. I could not hold back my tears.
Many people surrounded Rosa and we prayed a long time for her. After we prayed, it was as if God reached
down and placed is hand on Rosa…she finally had stopped crying and appeared
settled. Although, she stopped crying Pastor Luis and I kept holding her hands
and everyone that surrounded her was silent, but you could feel the empathy for
Rosa in the air. We asked her daughter where she lived. She explained to one of
the volunteers and we lifted Rosa into the truck and drove them home. Her
daughter who was in her early 80’s had pushed her mother in a wheel chair about
2 miles to get her to our clinic. Pastor Luis and I wheeled Rosa into her house
and her great grand-daughters helped her into bed. I taught her great
grand-daughters how to administer the medications, properly lift her, properly
lay her into bed, and provide adequate nutrition as well as fluids. I overheard
Pastor Luis say to Rosa, “Do not worry. You are in your bed in your own home.”
Rosa looked at peace. I knew we had to get back, but it took everything in me to
leave her there… I wished I could stay with her and keep her comfortable. I
kissed her on her forehead and hugged her family. I asked Pastor Luis why he told her she was
home. He told me because she thought her family was leaving her with us, which
was another reason she was so scared. As we drove away I prayed that God would
hold her close to Him and her suffering would be lifted. Rosa Rodriquez changed
my life in ways I can’t even express… she has a special place in my heart that
I will hold dear for the rest of my life.
The impact this medical outreach mission
had on my nursing career is hard to put in to words. I will never be the same
nurse or person as I was before this mission. The people I met and cared for
changed me and reminded me why I became a nurse in the first place. In the
United States, people sometimes take nurses for granted and the passion of
nursing sometimes becomes dimmed by this. Sometimes nurses do forget why they
became a nurse in the first place because after days, weeks, months, and years
of staying late at work, not getting to use the bathroom for 8-12 hours,
missing lunches, and being ordered to do things without a please or a thank you
in return becomes tiring. However, after my mission last year and this year I
have come back to the United States with such appreciation for the things other
nurses have taught me, other things I learned on my own, and all the
patients/resident’s I have cared for throughout my nursing career. God provided
these rare opportunities to me and all I did was say, “yes” and he took care of
the rest. Helping over 700 people in 4 days is definitely works of God because
he gave all of my team, the volunteers, and me the strength, knowledge, and
skills to help each and every one of His people.
I honestly wish every nurse could
experience a medical outreach mission trip because I believe our society and
health care systems including clinics, hospitals, skilled nursing facilities,
hospice, home health care, school nurses, and every other nursing profession
would be changed for the better as every nurse would have a renewed outlook and
humbling experience to relate to when they are working with others.
I cannot thank One Nurse At A Time and
their supporters for the scholarship I received this year. Without them I would not have been able to
experience and learn the things I did.
Nursing is an extraordinary career and
takes very unique individuals…Being a nurse we affect many people on a daily
basis within our own communities… Being a nurse missionary we promote change in
ourselves, our communities, and the world.
Thank you,
Megan Duda R.N.
In collaboration with the Asociacion Medica Quirurgica de San Raimundo, Refuge International
makes three medical mission trips to San Raymundo each year as well as to other
sites in Guatemala. The organization also participates in a nation-wide program
called “Adios Lombrices,” which aims
to rid school-age children of worms, and a clean water project, which involves
constructing wells to provide clean water in rural areas. I
was impressed by a group of strangers who can come together in such a short
period of time and make the best of limited resources to provide much needed
health care services. The clinic where we worked is only open when volunteer
groups come to staff it, and it may be a month or longer before another group
visits the area to provide another round of services.
Every
medical trip has its challenges and frustrations, but they also have special
joys and memories. As a healthcare professional I wonder how I am going make a
connection with people from a different culture? On this trip, I was chatting
with a woman in her 50’s as she was getting prepped for surgery, and I jokingly
told her that after the surgery she would feel much better, and then we could
have a party and go dancing. She smiled
and nodded her head and then the anesthesia kicked in. Later in the recovery
area, she was sitting in a chair and I asked her if she was ready to
dance. Remembering our conversation, she
smiled and said, “I’m sorry, but I only dance with my husband.” We laughed together and I wished her well in
her recovery before heading back into the OR for my next case. Even though I did not perform the surgery, I
know that smiles and laughter can alleviate fear, raise spirits and provide
comfort. Smiles and laughter transcend cultural boundaries and serve as a
reminder that nursing is more than IV pumps, documentation and call bells. When
circumstances force you to get “back to the basics” you are quickly reminded
that the patient is the focus of your work and that you can make a connection
using the most available tool around--yourself.
