Switching gears.

Hi All, we're back in Tegus to regroup for a day - head out on the road again  morning early.  This past couple weeks we've been wandering the north/Caribbean coast of Honduras, visiting hospitals and public health clinics, Garifuna communities, other NGOs and people living with HIV.  It's been fascinating, exhausting and informative.

Fascinating:  Beautiful white sand beaches where mostly Hondurans vacation and not Americans.  The cruise ships call this stop "Banana Coast" probably to not scare people who google "Honduras" and find out it's the most violent country in the world outside war zones.

Exhausting:  we drove TWELVE hours from Trujillo to Tegucigalpa.  TWELVE. I'm tempted to sit on a pencil to retain the crack between my buttocks!

Informative:  The northern communities have an incredibly positive view of MSF - starting 40 years ago with Hurricane Fifi, Hurricane Mitch, maternity programs, HIV programs before they were widely available, and the list goes on.  Rarely did we have to introduce ourselves.

The northern area is lush grazing land for cattle - mostly milk production as evidenced by horses carrying big metal containers on either side of the saddle, going to market?  The vast banana palm farms give way to the "African palms" - native forests (I can imagine what this used to look like when covered with native mahogany and other native trees) now cut down for huge scale production of palm oil ... It's not the "slash and burn" of small subsistence farmers as we were taught in school.  This is industrial scale destruction for economic gain of huge corporations.  Sad really.  We still see butterflies, and all sorts of different birds, so maybe not all is lost yet.

The roads are dotted with fruit stands - coconuts, watermelons, mango, all sorts of fruits - cheap and plentiful.  Fish is only a hook toss away.  Yet in this lush landscape, where food is abundant, people still complain of "lack of economic opportunities" as the reason for migrating to the US.  We don't hear "violence" as a reason in the north.  Yet, it costs about $6000 - 7000 to pay a coyote to take them all the way to their US destination, and that's after riding the train La Bestia all through Mexico.  Most have family members in the US who send for them, and few unaccompanied minors other than those who are going to reunite with their parents.

I don't understand this - everyone talks of how poor Honduras is as a country.  How so much is lacking.  Yet, I look around and see morbidly obese people everywhere (not just Americans!), new cars, tall buildings, food aplenty ... I can't say this country is as badly off as many I've been in.  Yet the statistics say otherwise.  There are lots of foreign companies working here, NGOs, foreign governments donating money for construction and programs ... So where is the disconnect?  Corruption?  Is it any worse than anywhere else in Central/South America or indeed, worldwide?

If I can figure it out, I'll let you know :)

We were able to have a little down time - the beaches along the coast are spectacular.  Chockablock full over Holy Week/Spring Break, but otherwise solitary.  Trucks are overloaded with sacks of plastic bottles to be recycled (into what?).  A first time greeting, even with a person you don't know is with a kiss on the cheek and handshake.  Radio music is 80s - Queen, Christopher Cross, Air Supply.  The alternative is the one and only CD in the car which is an oldie of Jose Miguel wailing love songs in Spanish that, after the 50th play, I DEMANDED be removed!  Then turned on my iPod and listened to the entire podcast of Serial.  Saved my sanity!

Hugs to all - I leave you with the beach at Trujillo ("Banana Coast") and a Garifuna woman making and selling pan de coco (bread made with coconut oil that is absolutely delicious).

Sue

More daily life in Sierra Leone...and Momo goes home!!

Hi All, 

Next pic is of me in Triage today. 

 We stand behind 2 meter barrier fences to interview patients, then come within arm's reach to take the temperature - hence the face shield (and gloves).  It's been decided that we nurses can do the triage, screen patients in or out, write admitting orders, etc.  I normally work ICU, but today and tomorrow am in Triage to cover the nurse who's working overnight shift.  I admitted one man who looked sick and indeed is positive with a high viral load, and a pikin who was limp and had a "convulsion" last night and hadn't woken up.  He might be malaria instead cuz no contact exposure.

We ended the day with 18 total patients - I think it's probably a record low.  YAY!!!  The president of SL said schools will open in late March.  Everyone is counting the outbreak over, but it's not yet.  It's not gone.  Cases are not rising nor falling, more holding steady.  I heard Liberia is doing much much better.  YAY. Today there were lots of celebrations as 3 were discharged cured.  And 5 were "no case" - in the Suspected area and blood test negative.  We all breathe a sigh of relief when a test is negative.

Yesterday I had to pronounce a 7 yr old boy dead.  It was especially sad because I'd been with him a couple hours before dripping ORS into his mouth with a syringe.  Poor little guy.

I have to tell you - I absolutely LOVE my Nokia Lumina phone.  Got it just before coming here to be able to stay in touch.  Well, the camera is amazing and I take pics all over the place, and especially for work.  Yesterday, the ICU nurses made the mistake of putting a patient chart inside the bag of medications and sent it "in.". Well, what goes "in" can't come "out" And they were averting their eyes, heads hung, hoping to not get in trouble.  I had one stand inside and hold it up page by page as I took pictures of it, then sat down with the phone and recreated it.  They saw the amount of work it took and came slinking over to apologize.  I'm guessing that's never going to happen again :)

And a prize to whoever can explain the choice of brand names for the latrine covers.

Worked on Arts and Crafts between patients in Triage today - trying to create a new system for stocking/inventory control for the items we need at a moment's notice inside ICU.  So I cut up empty gloves and masks boxes and taped them together to create my masterpiece.  Tomorrow will talk with The Powers and see if we can trial it.  Also working on a training for nurses of how to mix IV meds, hang them, count drip rates, etc.  Amazing that they don't uniformly know this stuff, but ... One of my daily lectures is about 3 way stopcocks..

The last picture is to make you smile.  This little girl was sent home yesterday cured.  All possessions taken inside are burned (including cell phones, clothing - anything that can't be sterilized with 0.5% bleach), so they shower and we give them clothes and shoes to go home.  She and her mother were admitted when I first arrived.  Mother died within days, but the pikin survived.  She will now be cared for by an uncle and his family ...

Wish I could have been there to cheer when Momo went home, but it was on my day off.

Thanks to all of you for writing and sending your encouragement and positive thoughts our way.  Day by day, we do the best we can.

Much love, 
Sue

Another day in Sierra Leone - and some good news too

Hi All!
 
Plan for the day:  
 
1.  Sleep in.
 
2.  Go to "Super Market" - can't wait to experience a Sierra Leonean super market!
 
3.  Have lunch with an old Ethiopian pal from my mission there in ... 2008?  He was a lab tech and went to med school and is now in Freetown working in a pediatric hospital.
 
4.  Skype with Pete in the evening (morning in Seattle).
 
5.  Go to bed early and start 6 in a row before another overnight on Super Bowl Saturday (Go Hawks!)
 
Two pieces of GREAT NEWS!!!  Our 5 month pregnant patient was successfully induced and survived!!!  HURRAY!  She is the 19th documented pregnant Ebola survivor for MSF since the outbreak began nearly a year ago.  She is glowing, happy, laughing and thankful.  
 
Second thing - Momo tested Ebola NEGATIVE yesterday - WAAAAAHOOOOO!!!!!!!  He's still a bit foggy and rummy - I think still a bit fluid overloaded and perhaps a bit tox from liver and kidney failure.  His hands and feet are still swollen, so I can imagine his brain is as well.  But he's asking to move to the other tent (they all know going to the other tent is a step in direction of survival and going home) and is eating, drinking, walking without staggering, making sense, following directions and even initiating conversations.  Thanks to everyone who has sent such strong positive vibes his direction and prayers - it's all worked and he's improving right before our eyes.  From being chased back into his room with a stick to survivor.  Wow.
 
A couple pics to share with you - one of a survivor hired as a caretaker to watch/feed/clean the pikins (small kids).

  And one of a ladder - there is lots of construction going on.  Amazing these men can do hard physical labor in this heat.

 
We are now up to about 60 survivors since this ETC began Dec 10.  About 300 total patients, about 30 still in now.  The 300 includes patients that are brought into "suspect" but get ruled out with lab tests.  Probably half are discharged as not Ebola.  Some are malaria, some are just symptoms we don't diagnose a cause.  We are not a hospital nor do we diagnose or treat anything other than Ebola.  No meds, no time, no space.  We try to get the "negatives" out of the facility as quickly as possible so as to not expose them to the virus in any way.  There is always a risk.
 
Still teaching at every opportunity and enjoying seeing the nurses get a bit more empowered every day.  After all, we will leave and they will stay.  One gift is to leave behind as much knowledge as possible.  
 
Hope all's well at home.  Keep sending your happy thoughts to these people.  Keep spreading the word - Ebola is not over.  We have hope.  We're all working hard to overcome.
 
Love to all,
Sue

Ebola Treatment Center, Day One

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mosby's 3rd Annual Superheroes Nursing Contest

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

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

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

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

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

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

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

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

Nurse.com announces Mountain West Nursing Excellence Awards!

On the night of August 10^th celebration and recognition for the 24 regional finalists of Nurse.com’s 2012 Nursing Excellence Program was held at the Wild Horse Pass Hotel & Casino in Chandler, Arizona. Judith G. Berg RN MS FACHE, was the host of the evening as well as the former vice president and nurse executive of Nurse.com West and Heartland/Midwest editions.

From Nurse.com’s website:

“We consider it a true privilege to recognize nursing excellence in this beautiful way,” Eileen Williamson, RN, MSN, senior vice president and CNE at Gannett Healthcare Group, publisher of Nurse.com, said about the program. “We wait with great anticipation for this night all year; truly it is one of the highlights of the year for us at Nurse.com.”

Each of the 24 Nursing Excellence regional finalists was given a corsage and received a plaque bearing his or her name and regional achievement. Of those 24, six extraordinary nurses were chosen to represent Mountain West in the national Nurse Excellence awards to be announced this fall. The six regional winners each received an elegant sail-shaped, etched-glass award to commemorate the evening.

The program's national sponsors are The Johnson & Johnson Campaign for Nursing's Future and University of Phoenix College of Nursing. 

Our very own Sue Averill won the Mountain West Nursing Excellence Award for Volunteerism and Service.

Here is what Nurse.com had to say about her:

Sue Averill, RN, BSN, CEN, MBA, president and co-founder, One Nurse At A Time, and ED nurse, Swedish Medical Center, Seattle

When faced with the choice of continuing to work for a luxurious cruise line or working in undeveloped, inhospitable and far-flung places, Averill chose the work that paid her nothing. 

A nurse for 33 years in the ED, her own home care company, hospital management and business operations for Holland America, Averill changed course midstream in 1996 when she decided to work as a per-diem nurse stateside and as a volunteer nurse anywhere else that needed her.

Averill’s humanitarian work began with the 1985 earthquake in Mexico when she and 19 others grabbed their gear, flew south and helped set up a free clinic. Some time later, Guatemala called. Then Liberia. Then Ethiopa, Uganda, Nigeria, Cambodia, Darfur, South Sudan, the Philippines and Pakistan, where mothers and grandmothers of girls having surgeries wanted to take care of her.

“They were so kind and so loving and wanted to take me in,” Averill said. “They’d say, ‘Come up here on the bed with us,’ and we’d sit around together. I had a lipstick with a mirror. I’d take it out and put on the lipstick and then pass it around. Pretty soon everyone had on bright red lipstick and there was this huge bonding over it. Lipstick was not allowed in Pakistan society, but we could do that as this secret little group of women at the hospital.”

Averill said every country and group of people, no matter how different they were in terms of security concerns or heartbreaking situations, became a passionate interaction that made her feel alive. “Your focus is totally different,” she said. “Everything is new and you notice every little thing. Stepping away from our routine makes us feel alive. I come back from missions a better person, and then I also like nursing better.”

To connect other nurses to the satisfying experience of humanitarian work, Averill founded One Nurse At A Time, which links nurses with volunteer opportunities, offers scholarships for travel costs and provides preparatory information on international work and diseases uncommon in this country. Tens of thousands of underserved people across the world have received medical services through ONAAT’s support of nurses, her nominator said, and it is the go-to resource for volunteering information.

Averill, however, believes she is the lucky one. “I’m just this little nurse in Seattle and look at this amazing life I’ve been allowed to live,” she said. 
 

Cheers-

ONAAT 

Nursing Excellence Award

Congratulations to our very own Sue Averill, as she received an award from Nurse Week, www.nurse.com this last Friday for Volunteering and Service. 

Nurse week recognizes registered nurses who have given themselves in outstanding humanitarian or heroic ways by providing nursing care, skills and expertise in outreach to the community, either at home or abroad, to improve the lives, well-being and health care of others.

Gannett Healthcare group (who publishes Nurse.com, Nursing Spectrum, NurseWeek and others) is a nursing and healthcare communications company. Nurse.com is a great resource for nurses, as it provides local and national nursing news, job information, nursing continuing education and a large thriving nursing community.

The mission of the company is fairly simple – to enrich the professional lives of nurses and healthcare professionals, as well as celebrate their unique contributions to society.

So, each year, Nurse.com seeks nominations for Nursing Excellence Awards in six categories:

                Advancing and Leading the Profession

                Clinical Nursing, Inpatient

                Home, Community and Ambulatory Care

                Staff/Patient Management

                Education and Mentorship

                Volunteerism and Service

Nurse.com has created a great national program of recognizing extraordinary contributions nurses make to their patients, each other, and the nursing profession.

Please join in congratulating Sue in receiving this award!   So, thanks Sue! We wouldn't be here without your hard work and tremendous dedication. 

Cheers!

                 - Crew at ONAAT

Congratulations Sue Averill, Nurse Week Nursing Excellence Award Nominee!

Congratulations is in order to Sue Averill, RN!  She has been nominated by a colleague and was notified that she is a finalist in the Nurse.com/NurseWeek Nursing Excellence Awards 2012 in the category of Volunteerism & Service.  As a finalist, she has been invited to the Nursing Excellence Awards Gala which will be held at the Wild Horse Pass Hotel & Casino in Chandler, Arizona on Friday, August 10,2012!  


An excerpt from Sue's nomination form, "On her many missions, Sue learned "up close and personal" how others live and how they provide health care, however meager.  She adapted her practice to fit within the culture and resources available to her.  More than once the TV character Macgyver was an inspiration!  Teaching and sharing has been key.  Her favorite story is helping a well-meaning group of non-medical staff in Darfur transform from not knowing how to feel a pulse to a team capable of emergency blood transfusions and even minor surgeries.  Showing A-B-O blood typing on the back of a metal emesis basis was the aha! moment.
Tens of thousands of under served across the world have received medical services from One Nurse's support of the "boots on the ground" nurses who have received assistance on their journeys.  Hundreds of nurses have been directly helped and thousands have been inspired to serve locally, nationally and internationally."

Congratulations Sue! We will be rooting for you!

To read more information about Sue visit our website: http://onenurseatatime.org/about/sue-averill-rn/