Gateways Hospital and Mental Health Center
Gateways Mental Health Hospital
St. Vincent Medical Center
Disaster Relief Nursing
A challenge not for the faint of heart
Serving as a disaster relief nurse can be a life-changing experience. It is a challenging undertaking, and not everyone is physically, emotionally or professionally prepared to assume such a role, be it short- or long-term in nature. But for those who can, the rewards are many.
Some nurses work full time for organizations whose only mission is to assist in relief efforts, while other nurses volunteer when disaster strikes, such as the recent earthquakes in Haiti and Chile. Being deployed to such areas can be disorienting and overwhelming. Volunteers may face primitive conditions, lack of running water, inadequate food and shelter and any number of challenges. Although deployed nurses may expect to be utilized clinically, they may sometimes find themselves taking out trash, sweeping a floor, distributing clothing or leading support groups.
A Nurse Practitioner With a Mission
Betty Woods, a family nurse practitioner from Sonoma County, has an impressive disaster relief resume. In her daily life, she volunteers as a family nurse practitioner for the Jewish Community Free Clinic in Rohnert Park, Calif.; in her weekly life she also takes part in construction projects for Habitat for Humanity.
Woods has staffed Red Cross shelters in Northern California during periods when the Russian River caused widespread flooding and devastation, and she has served in many crucial capacities in troubled areas around the world.
In 1986, she traveled to San Salvador, the capital of El Salvador, to work with the Catholic Archdiocese there following a devastating earthquake. Arriving two days after the quake, she was responsible for evaluating the need for latrines, clean water and food at a time when sanitation and proper nutrition was critical. “It was rubble in most parts of the city,” she said, knowing full well that public health can be severely compromised when crucial infrastructure is damaged or destroyed.
For eight months in 1988, Woods lived in Nicaragua during very tenuous and volatile times, working with the Nicaraguan Health Department to provide women’s health services.
Following Hurricane Katrina, she traveled to Houston under the auspices of the California Nurses Association, supervising 52 volunteer nurses deployed to staff a makeshift hospital and clinic serving more than 10,000 refugees temporarily housed in the Astrodome.
When considering the challenges of this kind of work, Woods said, “I believe you need to do a self-inventory of why you want to go and what you’re going to expect to do there — and if you are capable, both physically and emotionally, to do it … You have to be in good health physically; you may not be able to endure what it takes. And you have to be emotionally balanced.”
She warns would-be volunteers that conditions may be austere, food may be substandard, the hours will be long, and nurses may be asked to work in ways that do not necessarily correspond with their training and expectations. Flexibility, a positive attitude of cooperation, and a willingness to “go with the flow” are crucial during times of disaster.
“People come with very high expectations of what they can do and sometimes that’s shattered very quickly,” she said. “People sometimes leave quickly because they can’t do nursing and medical care the way they do it back home. You cannot be stringent about how you do things and what your expectations are.”
In terms of cultural sensitivity, Woods said volunteers must “be aware that you are going into a culture that may be very different than yours, and emotions are running high. You have to respectfully work within the culture, the situation and the community that’s there.”
Clothes, tone of voice, eye contact, the way in which one addresses people and even body language — all of these factors contribute to how the volunteer will be perceived by the very people who they are there to assist. Folk medicine and other traditional practices must also be taken into consideration.
“Even if you don’t speak their language, people get a sense of who you are very easily,” she said. “You do not need linguistic skills to convey concern, human kindness and empathy."
Woods said she often returns from her volunteer work “not only with new perspectives about different cultures, but also with questions about our own culture and the way in which we as a society interact with the rest of the world.
"You meet people from all different countries and cultures, and you get their perspectives on life," she continued. "You just learn and gain so much from doing relief work. It’s a great privilege and an extremely rewarding and valuable experience."
Disaster and Mental Health
Mary Chasin, RN, is the supervisor of health services and disaster mental health for the Los Angeles chapter of the American Red Cross. She coordinates disaster relief activities for professionally licensed volunteers, including RNs, LVNs, MDs, EMTs, LICSWs, MFTs, psychologists and psychiatrists.
Chasin emphasized that the Red Cross views survivors of disaster as “clients” rather than “victims,” a distinction that mental health professionals — including nurses — see as important to their work.
One of the most crucial services offered by the Red Cross is psychological first aid, which can be provided by all licensed professionals, as well as specially trained lay volunteers. Chasin defined this service as “the immediate care and comfort that all of us can provide to people in crisis.” She continued, explaining that it provides “a compassionate presence for people facing a disaster, helping to meet their basic needs, and listening with a compassionate ear.
“We base our mental health services on the resiliency model,” she said, “which helps our clients tap into personal resources that have helped them through crises in their lives. We help them connect with people and draw on their inner strength.” The resiliency model takes into account how clients have coped in the past with difficulties in their lives, who has helped them, and what strengths they can bring to their current circumstance.
Red Cross volunteers — including nurses — are trained to recognize when clients need professional services beyond the scope of the immediate care provided by the disaster team, and referrals to outside agencies are frequently made for those clients in need of long-term counseling and support, which is received in a timely manner.
“The truth is that many reactions to disaster are very common,” Chasin said. “We expect that. Our volunteers are trained to recognize those people who may have preexisting issues that impact their reaction to a disaster and their ability to recover fully.”
The Red Cross also provides a “welcome home call” from a trained professional for any volunteer who serves outside of the local area in large-scale regional or national disasters and for local volunteers involved in mass fatality incidents. If the volunteer is experiencing residual trauma in reaction to their time in the field, referrals are made for follow-up care.
Recruitment, Screening and Preparation
Deborah Burger, RN, of Sebastopol, Calif., has spent a number of years recruiting and training nurses who volunteer to travel to areas of disaster. She was helping to screen more than 12,000 volunteer nurses for the Haiti relief effort up until the time of this interview, then joined the ranks of those awaiting confirmation that a trip to assist in Haiti was in their future. She had never been deployed as a disaster relief nurse, so this would be her first time in the field.
As one of the presidents of National Nurses United, The National Nurses Organizing Committee and the California Nurses Association, Burger is deeply steeped in the culture of nursing and volunteerism. Working with Kaiser Permanente in Santa Rosa as a specialist in conscious sedation for gastroenterology procedures, Burger’s credentials as a nurse clinician are strong, and she understands what it takes to be in such a line of work and to perform one’s duties with skill and clinical acumen.
Following on the heels of Hurricane Katrina, Burger was a key figure in California when it came to recruiting, screening and orienting nurses who volunteered in droves to assist in the Gulf States in the aftermath of the storm. She understands disaster relief and what it takes to make sure nurses are ready for their assignments, and she holds a wealth of information for nurses who think they may be ready for such an experience.
“You really do have to be flexible in how you’re being utilized, and that’s key to a successful deployment,” she said. “We had a few nurses who felt disappointed that they weren’t being utilized as a nurse.”
When signing up to volunteer for disaster deployment, Burger warns that nurses must be honest with themselves and the organization to which they are applying about their level of skill and expertise. Overstating one’s capabilities or skills can have far-reaching negative consequences, and giving accurate information as to what you are truly capable of doing is crucial to the planning and execution of the relief effort.
When it comes to a situation like Haiti, Burger has been involved in creating lists of supplies — enormous in scope and detail — that volunteers should consider bringing. “It’s a work in progress,” she said apologetically, but one could easily see that Burger and her colleagues had given great thought to what a volunteer nurse might need at his or her disposal when deployed to a chaotic landscape. And it is dedicated and skilled professionals like her who make sure volunteers are prepared and realistic in their expectations of what a deployment may actually entail.
A True Calling
Disaster relief nursing is not for everyone. We cannot all be ready or capable of working in the potentially extreme conditions that disasters frequently present. But if volunteering or working full time in disaster relief is a calling that tugs at your heart, there are dozens of avenues through which to make that calling a reality.
If you are willing to volunteer your time but are not necessarily ready or able to be deployed to the scene of a disaster, many organizations can still use your help at home. Like Burger, there are nurses who specialize in recruiting, screening and training volunteers for disaster response, and although having “boots on the ground” is crucial, the nurses and others who work behind the scenes are equally as important.
Whether you volunteer your time, donate money or support others in their work, you can contribute in the way that best suits your particular life circumstance. Every contribution is highly valued, and the rewards of disaster relief are beyond measure. Helping others in their time of need is one of the hallmarks of the nursing profession, and responding to disasters is one way in which nurses continue to go above and beyond the call of duty, both here and abroad.
Southern California Opportunities to Help:
The websites of both the California Nurses Association and National Nurses United provide links for nurses wanting to get involved with relief efforts. Both sites link to the Registered Nurse Response Network, where nurses may sign up to volunteer for deployment or simply donate money to send another nurse to an area of need.
The Medical Reserve Corps (operating under the auspices of the Surgeon General) is also an excellent way for nurses to become part of the local, regional and national disaster response and emergency preparedness infrastructure.
To become a disaster relief volunteer with the Red Cross, nurses and other health professionals can contact their local Red Cross chapter and request to be scheduled for a volunteer orientation and training.
Doctors Without Borders, Partners in Health and dozens of other excellent organizations are frequently in need of nurses willing to go the extra mile and work in areas where others dare not go.
The Johns Hopkins Office of Critical Event Preparedness and Response offers courses and education for nurses and health professionals seeking opportunities for advanced training in disaster response.
If You Go...
In many disaster scenarios, volunteers are expected to bring everything they may need to assure their own comfort, including personal toiletries, a sleeping bag, water purification tablets, mosquito repellent, and emergency medications for dysentery and other diseases. Nurses traveling abroad — especially under circumstances where the sanitation infrastructure has been damaged — must be sure that they are up to date on recommended vaccinations.
– Disaster deployments can last weeks at a time
– Living and working conditions can vary dramatically
– Work days will be long and stressful
– Volunteers must be in good physical condition and be able to work in a variety of settings
– Volunteers should be able to handle strong emotions like shock, anger and panic
Keith Carlson is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is currently an expert blogger and editorial contributor to BlackDoctor.org. His own blog can be found at http://digitaldoorway.blogspot.com.