Amanda Judd tells about her mission with Refuge International

We arrived excited to get the San Raymundo temporary hospital up and running. We had lost time with flight delays and reroutes due to Hurricane Patricia, which was pounding Dallas with an unexpected wallop and caused baggage to be delayed and people to be stranded. Fortunately, thanks to the well-oiled machine that is Refuge International, we were up and running by Sunday afternoon. 

The San Raymundo facility is run by a local group of citizens who open up the compound about every 2 months to Refuge International's medical staff and alternately with a group of Italian medical staff who helps in the San Ray facility. While unpaid volunteers provide all of the care, the local group charges a very nominal fee to the patients to cover the costs of the building, maintenance, and upkeep. Having vested interest in the medical care for the community, the locals seem to respect and appreciate the volunteers from Refuge International. The community organization provides Refuge with a locked storage room to keep supplies safe when Refuge is out of the country. This was a good thing, too, since many of our supplies were delayed for 5 days with all of the reroutes. 

This is a view from the roof of the temporary hospital, overlooking the cafeteria, the adjacent school (in green), and some of the sleeping quarters.

Early morning OR setup.

This is me, ready to go on day 1.

As an ICU nurse, I was assigned to the PACU, and I was able to observe some of the earliest procedures prior to having patients. I was lucky enough to be on a mission with Dr. Cockburn, a urologist, and his lovely wife Judy. Judy was such a warm, inviting person. She managed intake flawlessly while Dr. Cockburn did consults and surgeries. 

One of the first patients to get a procedure was done by Dr. Cockburn and had a softball-sized fatty tumor removed from his buttock. Dr. Cockburn and the patient allowed us to watch the procedure. The patient was numb but awake. He remained very stoic throughout the procedure and was hesitant to admit that he could feel the removal, at times. It's interesting how different pain is perceived culturally. As Americans, we would probably yell out and make them stop the procedure until we were completely numb, this patient tolerated it until we asked him and was grateful once the procedure was done.

Dr. Cockburn operating.

We did many procedures throughout the week. Of course, the kids always capture your heart. The little boy seen below was named Franco. He awoke quite confused from anesthesia but was quickly captivated by one of the games on Eleanor's phone. He was excited to tell us a story about his "pets". He has 2 chickens and 3 fish. One day he decided to take one of his chickens to school for show-and-tell, but was bemused to find that the chicken had laid an egg at the school. In some ways, I think that it's the sharing of experiences that may have a more lasting impact than the medical procedures themselves.

Franco with Eleanor, the NP who worked as an RN in the PACU, and Ashley, the translator. 

A beautiful little girl who had a tumor behind her ear removed. She and her mother were an absolute joy to care for. She awoke from surgery happy, smiling, and full of giggles. 

San Raymundo at sunset.

Of course, there are stories that are gut-wrenching, and make you wonder if our best intentions are not always in the best interest of the people.

With the exception of my luggage showing up, this day was fairly routine in the way that medical clinics become very routine after a few days when everyone knows their places and jobs. I had retired early to enjoy a shower with my own bath products and had crawled into bed to read my newly arrived book when Nancy (the trip leader) came in and asked Dr. Janet Sweetman, ER doc, to please come to the PACU where a baby that had just been delivered today was retracting with an SpO2 of 50%. For those that don't know this is bad, very bad. 

Evidently, the baby was not trying to latch a number of hours after she was delivered by c-section. Eleanor, the NP working in the PACU, is a lactation specialist at home. Her gut told her something was wrong, so the baby was hooked up to a pulse oximeter. That was when the dangerously low O2 levels were discovered. 

This is when teamwork and ingenuity become really important in a resource-poor environment. 

We managed to get a modified O2 hood on the baby, but had to figure out how to transport the baby to the nearest hospital for more intensive care. Someone was able to get an ambulance, which was more of a regular vehicle than what we think of as an ambulance, to transport the baby The final piece of the puzzle was how to keep the baby warm on the 20 minute transport to the hospital. We all looked at each other and collectively said, "Skin to skin, " but who was going to do this? The mother was unable to travel with the baby because she was still recovering from her c-section. One of the midwifery students immediately volunteered and we quickly moved to the other room where I held up a sheet for her to tuck the baby into her shirt and they were off in the night to the hospital.

____

It is a very helpless feeling to do all that you can do and still know that it might not be enough. To know that the randomness of birth would likely give this baby every chance in the world at home but here life hangs by a thread. That Guatemala has the worst newborn mortality rate in the Western Hemisphere and how none of that matters when the mother is looking at all of us wondering if her baby will die and all there is to do is pray. And you pray regardless of what you believe because that's all that you can do. 

When a nurse volunteers to take the baby to the nearest hospital on her bare chest because that's the best chance to keep the newborn warm and alive until it arrives. And it is all that we can do to not break down and cry because of the life that hangs in the balance. 

We were all restless in bed while holding our breaths waiting for news of the baby. 

I always think of things that I have read when I have experiences like this.

"so much depends
upon
a red wheel
barrow

glazed with rain
water

beside the white
chickens."

-William Carlos Williams

____

In the morning, after transferring the baby to a local hospital, along with some of our L&D and neonatal nurses who stayed for a few hours, the baby did well and was nursing. 

____

This baby was the 7th daughter of a couple who had so desperately hoped for a son. The only son that they had was stillborn. You couldn't help but notice the tears and ambivalence of the father when he found out that it was a girl. The mother had opted to have a procedure so that she would no longer get pregnant, so this baby was their last chance for a boy.

A few days later, the father came back to the hospital desperate because the nearest hospital was a private hospital. The hospital was pressuring him for money that he didn't have before they would release the baby. The baby wouldn't have survived to make it to the government hospital over an hour away. We couldn't help out the father with money because that would set a bad precedent and be unethical. 

 

This brought up many ethical questions. Should we have even tried to help the baby, if the parents couldn't afford the care and we couldn't give them money to help? Had the baby taken an anoxic hit that would cause complications for life? The issues of ethics comes up in one way or another while doing medical work in underserved areas. It is a tough thing and lends itself to criticism and the concept have having an overall code of conduct on these trips.

Guatemala is such a beautiful country but it's tough here. Really tough. We have people coming from Altaverapaz- a few hundred miles away. The national cancer center is not functioning. Treatable cancers are now a death sentence in Guatemala. People in government hospitals are expected to pay for and bring their own suppose including sutures, etc. If you cant afford private care, you are up a creek without a paddle.

____

And then there is happiness:

One of the days midweek was a 14 hour day today with one amazing highlight. A woman walked in with imminent labor and delivered her baby within about 20 minutes. She rested in recovery for about 3 hours and she walked home with her husband, mother, and healthy baby. This was a picture of the beaming abuela with her new grandson.

Joy is contagious. She hugged and kissed all of us even though we had nothing to do with the delivery. This work is the antidote to compassion fatigue. 

I thought of a book that I read, "Maybe that was how to heal. I told myself stories and learned that I could be made of the ones I chose to tell, not simply the ones that life had laid haphazardly around me."-Francisco Goldman, The Long Night of White Chickens

Abuela with her newborn grandchild.

San Raymundo, Guatemala

San Raymundo, Guatemala

San Raymundo, Guatemala

San Raymundo, Guatemala

San Raymundo

San Raymundo

The improvisations:

One of the nurse anesthetists had to give a patient a nerve block. He rigged a machine that was like a train of four to a long needle to locate the nerve. He injected the patient and it worked beautifully.

We needed some y-tubing in the PACU because we had only one air compressor and 2 patients that needed O2. Some tubing, a syringe, and a few minutes later, we were in business.

The last day during the last surgical recovery, the power went out. Cell phones lit the OR. Iphones were finally used for a greater good.

We wrapped up after 4.5 days of clinical. Hopefully some lives were changed and maybe made better with this Refuge Mission. The team was a huge part of the success of the visit. It was a great experience and I hope to do it again.

Final tally:

And a great team:

Thanks to One Nurse at a Time for giving me the scholarship and the opportunity to participate in this great mission with a wonderful organization. I will definitely work with Refuge again and I would highly recommend them for future scholarships.

Happy Thanksgiving,

Amanda Judd

Dora the Explorer Returns to Honduras!

Hi All, 
 
I'm in the midst of a 2 month mission with MSF/Doctors Without Borders to explore the health situation all over Honduras.  With my partner Edgardo (who I met in Uganda in 2006!) and a driver, we're visiting all of the hospitals in the country, some smaller health centers, community leaders, other "actors" in health ... And looking at what might be good interventions for MSF future projects.  
 
So far, it's been fascinating!
 
The country is lovely:  rolling hillsides of banana trees, sugar cane, corn, "African Palms," seaside communities.  Highrises and places where horses still do much of the work.  Claro phone satellite dishes on top of tin roofs and communal wood fires and cooking ovens.  Eating fresh fish and shrimp/conch every day along with fresh hot rolls sweetened with coconut oil.  Edgardo tucked into a bowl of stewed iguana (yes, I had a taste - not bad) and iguana eggs.  Birds of prey that look like small vultures scour the fields for dinner.  There are pine forests and cactus and pine forests.  Herds of cattle graze on the sides of roads and amble down the middle of traffic.
 
People have been very friendly everywhere and certainly stare at our Toyota Land Cruiser covered with the doll figures in the picture (MSF has long worked here with the street population, HIV, violence, etc).  
 
So far we've been mostly in the north/Caribbean coast and the past few days have been meeting with Garifuna leaders.  Garifuna are ethnically different than native Indian/Spanish mixed folks - they were originally black African slaves taken to the island of St Vincent, escaped and settled all along the Carib coast of Central America.  They retain their own language, customs, music (Punta) and traditions. Our interest is to see if they have unique health needs - as a people, they are reputed to be more sexually active, have higher STI and HIV rates and have more young pregnancies (as young as 12 and 13).  From their perspective, they are simply more open about speaking of sexuality.  However, government statistics show double the rates of STI/HIV as the regular population and a UNICEF study showed average age for boys and girls becoming sexually active is NINE.
 
It's also been interesting to see the conditions of and in the hospitals.  The two main tertiary care hospitals are huge, sprawling, disorganized, smelly, and would be a nightmare to try to become involved in.  Both hospitals' ERs are chaotic, patients lying on gurneys lining the hallways unattended with blood hanging, open wounds, smell of infection, no cardiac monitors or IV pumps, crowded, no triage, armed men everywhere ... A real mess.  
 
Yet, here in Tela, their 10 yr old hospital is clean, neat, good equipment in working order, new mattresses, paint ... The only thing I can attribute the difference to is leadership.  Management that cares, is engaged and involved, with vision and pride in quality of services and facilities.  
 
So far the ideas we have are three:
 
1.  Provide HPV vaccine to children age 10/11.  There was one pilot program of about 30,000 doses done a couple years ago, but the government doesn't have the funding to continue.  We feel this would have a HUGE impact on the health of the next generation and an organization like MSF could pull it off ...
 
2.  A smaller community hospital Puerto Cortes has new leadership and desire to fix up their neglected facility.  With a staff who is eager for improvement, and without a lot of bureaucratic hang ups, we could rehab their ER, provide equipment and training plus get involved in their newly created Adolescent program so we could touch on all aspects of Sexual and Reproductive Health.
 
3.  Provide an interim physical space for a large hospital Pediatric ER - they are in the process of rebuilding but have no plans for what to do with the patients while the construction is being done (they say 6 months, but realistically 2 years!).  We could provide modular spaces or inflatables, take over the care and improve systems, training, etc.  and have a hand in the construction of the remodel.  Then once they are ready to move back into the renovated space, they would have had a couple years "doing it right" and would keep those new ideas and systems as MSF withdraws.
 
These are just ideas we're throwing out as we move along our journey.  It will be up to the coordination team and Geneva to make decisions about next steps.
 
Now it's Holy Week and the country is on vacation.  We're taking advantage of being on the coast to enjoy a few days of rest.  We'll do the same in our next weeks - work 5 or 6 days and have a day off in a lovely spot:  Copan, where there are Mayan ruins on the border with Guatemala and the islands to the south off the Pacific Coast bordering El Salvador.  What a wonderful adventure this is!
 
I'll be home soon,  ready to have a lovely summer in Seattle.  Hope all's well in your world.  

Much love,
Sue

Save the Date: Saturday May 30!

Posted on March 26, 2015 by Emily Scott

Transitioning to home life has been a bit strange. In my heart, I wasn’t ready to leave Sierra Leone. I wish I could still be there doing good work, falling exhausted into bed each night and looking forward to helping my patients again the next day. It’s an abrupt change: I went from feeling like there weren’t enough hours in the day to help everyone I wanted to help, to suddenly being back at home on my couch, not allowed to touch a patient for 21 days. The best thing for me right now would be to dive into another mission, but nobody wants me traveling to the developing world while I’m self-monitoring for Ebola. Fortunately, I have One Nurse At A Time to keep me busy!

One Nurse At A Time is an awesome nonprofit that helps nurses volunteer their skills at home and abroad. I am lucky enough to be Vice President of One Nurse, and it is constantly inspiring to work with others who share my passion. I have loved watching first-mission nurses light up the way I did the first time I set foot in Kenya almost a decade ago. Because I feel so strongly about the importance of One Nurse At A Time’s work, I have helped organize our first fundraising event for this May. For those of you who have been enjoying my blog and want to support this kind of work for nurses everywhere, this is a way to do it! Myself and at least two other Ebola responders will be there to share our experiences in West Africa. There will be appetizers and drinks, a performance by a Guinean dance and drum group, a silent auction with some awesome items and experiences, and a chance to try on our Ebola suits if you want to!

All of your kind words meant so much to me while I was on this mission, and I would love the chance to see all your faces and thank you in person. You can buy tickets here and please feel free to invite your friends! Here’s the official invitation:

You are invited to One Nurse At A Time’s celebration

Come hear about Sue Averill and Emily Scott’s recent experiences working at Ebola clinics in West Africa

When: Saturday, May 30th at 7 p.m.
Where: Nalanda West, 3902 Woodland Park Ave. N, Seattle, WA 98103

• Appetizers and drinks will be served
• The Message from Guinea drum group will perform
• There will be a silent auction of art, experiences and get-aways

An amazing party supporting a great cause!

Tickets are $30 each.
Sign up here.
Map of event location

News from Sue in Sierra Leone.

Pic is of sunrise at 7 am over the ICU tent.  So hazy in the morning from overnight fires, smog from vehicles and perhaps a bit of marine mist.  Our ETC backs up onto the ocean.
 
We went 6 days without a new confirmed case.  Today we confirmed one - the 10 yr old brother of the man I sent you the smiling picture who was so grateful for himself and his siblings.  We discharged his 15 year old brother today cured, but admitted his 25 year old brother into Suspect.  I'm not sure why this family continues to be plagued - I'm assuming the house has been decontaminated and they are well off and educated, so not sure why we continue to get siblings infected ...
 
I was in Triage today and admitted 9 new patients.  I think 2 or possibly 3 will be positive.  No one looked especially sick, so hopefully they will all do well.  If their symptoms have been for 3 days, one negative test sends them home.  If it's been less than 3 days and the test is negative, they have to stay for another few days and retest before being sent out negative.
 
So now we have 4 confirmed cases total.  That's down from a high of about 50 when I arrived.  So many national and expat staff per patient, we're all tripping over each other.  Monday afternoon, they will announce national staff decreases and perhaps in a week or so, we'll also decrease expats.  ASSUMING the decrease in new cases continues as is.  Overall, all 3 affected countries have very few new cases and it seems the outbreak emergency may be over.  There might still be the odd case here and there, and still a need for vigilance and surveillance and a place to appropriately treat.  But MSF might be starting to fold up the tent and move on to the next crisis.  
 
There is always another crisis.
 
One thing I noticed that will make you smile.  Remember I told you about the humidity here - well over 90%.  Yesterday, I was making copies, slightly bleary eyed at 7 am ... The laser printer started to "smoke" - I first thought "FIRE!" from the poor quality electrical components here  .... but then I realized the paper was so damp, when it went through the heat of the printer, it was steaming!  Paper went in soggy and limp and came out crisp and dry!
 
Thank you all for always sending your positive thoughts in this direction.  These people need them so much.  Life may return to "normal" minus many family members, minus nearly a year of school, minus nearly a year of salary for many where businesses, schools and medical facilities have been shut down ... I hope some of the "development" charities come to help rebuild what's been devastated by this disease.  I hope the reflection and review process finds Lessons Learned that can be applied to the next disaster.  I hope the statistics and studies and research can lead to cures and early detection and better treatment modalities.  I hope we can avoid another horrific loss of life as we've seen with this epidemic.  I hope the world stops thinking "If it's not my country/continent/people, I don't have to deal with it.". I hope drug manufacturers and vaccine producers and the FDA all work together for PEOPLE and not PROFIT.  And I hope all of you will remain engaged and curious and interested in events beyond our borders, whether or not they directly impact you.  If you can't go yourself, please donate to good charities who can. Support people who can.  Stay informed.
 
Much love to all,
Sue

Reflections on a first medical mission

-Approximately how many patients were served by your team?

-580 patients were seen in the clinic over the course of 5 days.

-What I enjoyed the most:

         -How a team of professionals could come together to serve so many people in such a short amount of time – very fulfilling.

        

-How humbling the experience was, giving me a new level of appreciation for the simple and important things in my life

        

-Learning of the vast cultural differences, but also seeing how we aren’t so different in many ways.

         -Brushing up on my Spanish!

        

-The feeling of fulfillment I had knowing we helped so many people, while also learning and growing so much myself.

-What I enjoyed the least:

         -It was hard to see the extent to which some patients’ conditions had progressed without getting adequate treatment.  It was also difficult to try to manage patients the best we could within cost- and resource-constraints, while thinking of all the labs, tests, meds, follow-up, and therapies that we might treat the same patient with in the U.S.

-What cultural differences I observed:

         -The medical culture is generally quite paternalistic.  Patients are told very little about their diagnoses and treatments are often inappropriate or poorly explained to the patients and families.

        

-Women’s roles within society and family are more rigid, and this can impact their health: for example, they have quite a different culture surrounding birth, including who should be present/assisting and how they assist.  They also most commonly work in the home.

        

-Some of the folk remedies were interesting, for example, one patient mentioned that one relieving factor for his musculoskeletal pain was putting lemon juice on his head.

-One to three examples of “memorable moments”:

1.  My most memorable group of patients were 4 generations of women/girls of the same family.  One day I saw a young mother and her 3-year-old daughter.  The mother had been having occasional seizures for several years, and had never been told what was going on!  The next day I saw the “next two generations up.” I noticed a familial pattern of migraines and neuro issues.  The family sticks in my memory because they were so endearing, and also because even though I couldn’t do as much as I wanted for their more complex issues, they were incredibly grateful (as were all the patients I saw!) for the migraine meds and other therapies that I provided.

2. Watching the sunrise from the roof of the clinic before having breakfast and starting our day, hearing

the roosters crowing (and a turkey joining in, too!), and taking that moment to reflect.  It was a quiet, peaceful moment I had just to myself, before the busy-ness of the day set in.  From up there, you can also see all the patients lined up waiting to be seen that day and it really gives you quite a sense of purpose.

-What impact the medical mission will have on your nursing career:

         -This was my first medical mission, and I have a feeling it won’t be my last!  Here at home, I’ve already benefitted from a renewed perspective and passion for nursing.  Next to that “warm fuzzy feeling” you get from helping those with limited access to care, the biggest takeaway, as an NP student, was the confidence I gained in seeing large volumes of patients with limited resources.  In the Guatemala clinic, I couldn’t always make referrals I might have here, or rely on X-rays and other diagnostic tests to help me make certain decisions; instead, it was back to the basics with my history taking and physical assessment skills.  Furthermore, we had a limited formulary to work with, so it meant working with what we had and being flexible.  It’s amazing how much more confidence I have as a practitioner after working with such clinical challenges.

--Nora Maynard

It's not about the numbers

Once again, it was a very rewarding trip to the tiny town of San Raymundo, Guatemala.  Having been there last year, I pretty much new what to expect; long days, tired feet, less then ideal working conditions, and the opportunity to make a difference in the lives of some Guatemalans.  Our group of 43 nurses, NP’s, Dr’s, and helpers was less then what we had last year but we all expected to work just as hard.  As you can see in the first picture, “it wasn’t about the numbers” but they showed just how much we accomplished in such a short time. 43 surgeries were performed (orthopedic, GU, GI, and GYN), 580 patients were seen in the clinic, 1,444 medications were given out, 227 labs were performed, and 11 minor surgeries (mostly debreeding wounds) were performed. 

I worked in both the pre-op and the post-op areas on this trip.  Pre-op consisted of getting a brief medical history from the patient, getting an IV started, and answering any questions I could about the procedure.  I was also able to help intubate a couple of patients prior to their procedure.  Post-op consisted of making sure surgical sites were

clean and dry, the patient was kept comfortable and free of pain, and that they understood how to take care of themselves when they went home.  This of course was an excellent opportunity to teach good nutrition and the importance of cleanliness.  The biggest obstacle to overcome was the language barrier.  Although I speak a little spanish and some of the citizens understood a little english, the translators that accompanied us on the trip were invaluable.  Because of them, I knew my patients would be able to take care of their wounds and understood our discussions.  

Most memorable moments for me were helping a 77 year old hip surgery patient walk,  intubating a patient before surgery, and meeting some wonderful people from all over the country who, like me, believe in helping out their fellow man.

This mission has made me appreciate the benefits we have living in the USA.  From our hospitals to the latest technology and equipment, we have the best at out fingertips.  Working in a third-world country and seeing what they have is an eye opener.  That being said, I hope to continue to be a part of the Refuge International Team and travel with them each year to help the people of Guatemala. 

Susan Callen

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

Tanya tells about surgical mission to Guatemala

In the five days that we actually treated patients our clinic team saw 1038 patients. Our team completed 206 surgeries in that same five days, including OB/GYN, ophthalmology, plastic and general laparoscopic surgeries. A lot of gallbladder removals, hernia repairs, hysterectomies, mass removals and some cleft lip/palate repairs were done. The eye team repaired a lot of cataracts, pterygiums and patients that were cross-eyed. Our outreach group saw 327 patients and our stove team installed stoves in over 100 homes. Each home received an indoor stove, an outdoor stove and a water filtration system.

There were so many things that I enjoyed on the trip, it is hard to put into words. I loved the people I met, the friendships I made and the patients I was fortunate enough to take care of. I especially enjoyed taking care of the children. Living in an area where medical care is far and few between, it seemed the children were even more apprehensive than typical, which made it all the more rewarding when they would warm up to you.

Having to say goodbye to all my new friends was the hardest part of the trip. Sure, the bathrooms weren’t five-star and the spiders came in extra-large sizes, but I knew about all that before going into the trip. What I didn’t foresee was the relationships I would build in such a short amount of time. The people I got to work with on the mission were one-of-a-kind. All there to help others, all there on their own accord; I feel so lucky to have gotten the chance to work with them for a week.

The people of Guatemala were extremely gracious. Every single patient (and their family), that left after a surgery, whether I took care of them directly or not, would give me a hug, a kiss, tell me thank you and God bless you. The amount of gratitude they had was overwhelming and it has made me crave going back.

They all appeared to have very close-knit families. Every patient seemed to have at least one or two support people with them-even the ones who had traveled four or five hours for the care. No one complained that there weren’t enough beds for the family members to stay in-they stayed in chairs, on the floor and shared beds with each other.

There were so many wild dogs. I was told that most of the people of Guatemala view dogs as a burden and it’s rare to have one as a pet. I guess because I was naïve to this, it came as a shock to see so many roaming dogs, semi-friendly but not tame necessarily.

Jello after surgery.

One morning, I was able to observe a bilateral cleft lip repair surgery on a two year old. It was interesting to actually see the process of this common procedure (instead of just the end result as a recovery nurse). I had seen the two year old boy the day before preoperatively, and obviously during surgery, but the best part was seeing him very shortly after his surgery. I was working in the recovery room and got to see him shoveling down jello, pushing his mom away in a, “I can do this on my own” way. Crying and whining for more jello. It was a moment I will never forget—the way the mom was tearing up watching him eat—without a cleft lip, and him without a care in the world that he had just had surgery.

Singing Happy Birthday to a patient.

Every evening a few of our co-workers who brought down their guitars would lead us in hymns that we would sing in the recovery wing of the hospital. Patients and their family members would occasionally join, and a lot of the songs we would sing first in English and then in Spanish. The first night they did this it gave me chills, and on the last night (when we only had four patients left spending the night), it made me laugh and cry. We transitioned from hymns to campfire songs and I felt as giddy as a school child at summer camp. We sung for hours into the late night, different people stopping by to join in or request a song. Here, I was once again amazed at how quickly I had become so close to the people I was working with.

One evening when I was on shift and the group had gathered around to sing to the recovery patients I was given the sweetest gesture by a seven year old patient. After I had finished rounding on patients I came to the group to sing along. This polite, small, seven year old boy, who I had gotten to know well over the last two days as he was recovering from his surgery, got up without hesitation and offered up his stool to me. Without any words, he stood up and patted the top of the stool for me to sit down. Not knowing Spanish very well, I got it across to him that I would not take his chair from him. He insisted and then ran off, quickly returning with a second stool that he sat right next to mine. We sat together while I sung and he listened. His dad looked on from the back of the room and gave me a quick smile. It was a small gesture, but it was grand in my eyes as I felt connected to not only him, but the other pediatric patients despite our language barrier.

Now that I have been on a medical mission, my nursing career will never be the same. I am grateful for the opportunity I was given to go help others, but I know I am blessed because of what the people of Guatemala gave me. It’s hard to put into words, but I feel like they gave me more than I gave them. They gave me a deep happiness as well as an appreciation for what I have. Their graciousness and spirit will never be forgotten, and I am thankful for all that they taught me about family, love and perseverance. I know that I will not be able to have this be a one-time event—I am hooked and can’t wait to go back as soon as I can. I will for now on, incorporate medical missions into my future planning.

Jo's Nurses in El Remate, Guatemala

I initially applied for Jo´s Nurses because I wanted an experience that would change my life forever, cement my desire to get involved in humanitarian nursing, and to make a difference. I knew that this trip would make me appreciate life in so many more ways and so far, it certainly has. As nurses we are inherently compassionate people, but experiencing poverty in another country really forces you to open your heart, your mind, and your soul in a way you never thought was possible.

I was extremely excited prior to leaving for Guatemala. I don´t claim to be a seasoned traveler by any means, but I have traveled internationally in the past so I wasn´t too worried

about what I was going to be faced with. When I arrived in El Remate however, I had such complete culture shock. I wasn’t nearly as mentally prepared as I thought I was. I think as people we tend to shelter ourselves unknowingly, constantly gravitating towards familiarity and comfort. But the beauty of being human is that we have the ability to learn from all of our interactions with every single person that comes into our lives, even if it´s through a passing moment. Being a nurse is so incredibly rewarding because as much as we touch the lives of our patients, they touch ours as well. Everyone has a story. And the people of Guatemala certainly have their own to share.

Working at Ix-Canaan has been an unbelievable experience. It has been challenging, because there are no physicians here. What this means is that JP and I have been solely running the clinic, diagnosing, prescribing medication, and managing care for the people we have been seeing. We´ve seen everything, from a woman who had a systolic blood pressure in the 200s, to a woman who came in with a UTI. I think the most exciting experiences I have had so far was listening for a fetal heart rate using a Doppler and helping JP suture a full thickness laceration on a young man who had gotten into a bar fight the night before. These are things that I haven´t had the chance to do back at home. The most difficult part about this has been trying to think outside the box. Supplies are really limited here. It´s amazing how much we take for granted sometimes - things such as normal saline or syringes are so hard to come by. And so we have to be creative. We have to be resourceful. I have to think

in ways that I wouldn´t normally have to back at home. When a 15 year old pregnant teenager walked into the clinic, and I was told that this was very normal in Guatemala, I was forced to reevaluate my own expectations, judgments, and values.  I have, without a doubt, not only grown as a nurse here, but as a person as well.
I don´t think I was quite prepared for the level of poverty that I am seeing here in Guatemala. You hear about it and you read about it, but until you´re actually standing there, the reality of it just hits you like a brick wall. What I find incredible though, is that those that have nothing, in my opinion, have everything. They have so much happiness, love, and warmth. They are so full of life. The Guatemalan people have been such amazing hosts to us. They enjoy life´s simple pleasures and the beauty of every moment. It has been a true blessing to have this opportunity, and it´s something that I will never forget. The best part about all of this though, is that without a doubt in my mind, I will be back.  

Meet our latest scholarship recipient.

Hi!

My name is Anita and I'm proud to be a recipient of One Nurse At a Time scholarship. I've been an active participating nurse for approximately 30 years at University of Maryland Medical Center. Of those years, 25 was spent in the neonatal intensive care nursery. I'm currently working in the pediatric post anesthesia recovery unit. I provide pre and post anesthesia nursing care for infants to 18 years  in a out patient and in patient setting. I have dedicated my entire nursing career to pediatrics. I received my Associate of Arts degree in nursing from Catonsville Community College. I have volunteered with my community church by providing meals for the homeless, gathering donated and packing of non-perishable items for families during the Thanksgiving and Christmas holidays. It has always been a passion of minds to volunteer on an international level. Now that I have two adult children, I feel it's my time to fulfill that dream. I enjoy spending time with my family and friends, going to the movies and dining out. I took  ballet in college and just decided to resume as a recreation . I'm looking forward to helping others around the world. I know they will give me far more than I could ever give them. Blessed for this opportunity.