Is a Medical Mission Right for You? A Nurse Reports from Nicaragua
Way outside my comfort zone
Some time ago, my nursing career had advanced to a stage where my duties were mainly administrative and it had been decades since I’d worked as a bedside nurse. I began to wonder if all the knowledge and skills I had honed over the years were still there, and whether the charts and reports that I worked on each day were really helping anyone. As I wrestled with these doubts, some unfocused but intriguing thoughts came into my head. I found myself perking up whenever I heard anything about medical mission trips, good or bad.
The idea of medical missions had never really grabbed me before. In fact, it had been years since I had even thought about sleeping in anything smaller or less comfortable than a queen-sized bed, much less traveling to a country that might not even have reliable running water. However, as my sense of stagnation grew, I started musing, “What would it be like if …?”
While I was still in this “just thinking” phase, I heard that a local youth group was sending volunteers to Nicaragua to build a cottage for Mustard Seed Communities, a nonprofit which operates an orphanage outside Managua for children with cognitive and physical difficulties. While the trip was not technically a medical mission, the focus on young people and children was the hook that slowly drew me in.
Initially, I offered to go along to provide first aid and emergency care, picturing the kinds of hammer- and pickaxe-related accidents that can occur with volunteer physical labor. I also envisioned that the suburban college kids might become so traumatized by the surrounding poverty that they could use some mental health advice.
Since I already worked at a college health service, I was comfortable with that age group, so I thought this might be a good fit for me.Initially, I offered to go along to provide first aid and emergency care, picturing the kinds of hammer- and pickaxe-related accidents that can occur with volunteer physical labor. I also envisioned that the suburban college kids might become so traumatized by the surrounding poverty that they could use some mental health advice. Since I already worked at a college health service, I was comfortable with that age group, so I thought this might be a good fit for me.
By chance, a physician had also volunteered his services, so Mustard Seed recognized that they could put the two of us to work doing physical examinations for the orphanage’s resident children. Behind the scenes, the administrators discussed the possibility of having us also see children at another Mustard Seed facility in Diriamba, Nicaragua.
As it turned out, I ended up doing everything from assisting with physical exams for wheelchair-bound residents and caring for a volunteer who came down with food poisoning so severe she lost conciousness to working in the laundry, garden and construction site. We rolled up our sleeves and did whatever needed doing.
My husband likes to say that when I was preparing for the trip, what I was most worried about was what to wear. That isn’t completely true, but I cannot deny that I did spend a lot of time deciding what to pack, having never been to a tropical country before. Being restricted to carry-on luggage for a whole week also gave me pause.
I was able to work out my wardrobe struggles, but two weeks before leaving, I found out that several of the students going on my trip were taking significant psychiatric medications and more than a few had chronic medical problems. That was when it really hit me that I would have a real responsibility to the students as well as to the orphanage.
Everything about that trip was outside my comfort zone: traveling with a large group of people (there were 25 of us), most of whom were nearly strangers; drinking nothing but bottled water to avoid unfamiliar bacteria; being confronted daily by national police carrying AK-47 assault rifles; and seeing wild tarantulas on the ground.
The Mustard Seed facility outside Managua was surrounded by a high wall topped with concertina wire. The director told us not to worry about safety because there were always three guards on duty at any time, adding, “and one carries a gun.” Of course, from that point on, all I did was worry about our safety! (Nicaragua is the second-poorest country in the Western Hemisphere, so foreign tourists and volunteers can become targets.)
Although Mustard Seed provided translators, my inability to speak Spanish added to my culture shock. There was no cellular service, so there was no way to call home or get any news. It was also disconcerting to have almost no control over any part of my day. Our group was together 24/7. Personal time and personal space were nonexistent. We had no opportunity to sightsee or to buy anything other than what we’d picked up at the airport.
Managua in July is hot and very humid, and there was no air conditioning. We also had no hot running water, although we did have very good coffee.
I slept in a bunk bed in a room shared with 18 other women. There was so little space that our suitcases had to be kept under the beds, which were so close together that we sometimes had to pull out everyone’s bag to find one that was close to the wall. Despite these difficult conditions, I slept really, really well. I was just so tired.
Only part of each day was spent doing nursing work. I spent whole mornings working in the laundry, hanging clothes on the lines and scrubbing pots in the kitchen. I also did some tedious but useful nursing tasks. For example, I was directed to take inventory of all the drugs and antibiotics, since I was a healthcare professional who understood the drug names, how often they’d be used and their expiration dates. I took joy in the fact that I was doing something valuable that few other people onsite could handle.
At home, I was accustomed to a daily dose of college students complaining that they had too much stress and needed a note to skip an exam. During this trip, I was instead confronted with children who had been abandoned by their poverty-stricken families due to problems like cerebral palsy. Many of the residential children were nonverbal and some were unable to feed themselves. Even so, they still managed to smile at me when I smiled at them.
The volunteer physician and I spent about an hour devising a way to see all of the children, order tests and review the results using only the equipment on hand, much of which was donated and out-of-date. (Having to improvise when medical supplies we normally take for granted are scarce or unavailable seems to be a common theme of medical missions. When a friend of mine took a sabbatical to teach at a nursing school in Nepal, he found that vinyl gloves were so expensive that the nursing students had to create a washing station — without running water — to enable them to reuse their gloves.)
Sometimes, we would find problems beyond what we could address ourselves, like a mass on one patient that required further testing. Mustard Seed had an arrangement with a local physician to whom we could send findings and requests, but that doctor was only available on a monthly basis. My fellow volunteer doctor and I were both discouraged that we wouldn’t be there to hear the results of the testing or what was done with that information.
Aside from assisting the physician with physical exams, my duties including keeping the residential children calm during the examinations and feeding those unable to feed themselves. I spent a lot of time rocking, holding and soothing the children.
Each day, we discussed what we were doing as well as dealing with the other volunteers’ own reactions. As I had suspected going in, the work hit some of the students very hard, so I also had to help manage their physical and emotional health.
Despite that stress, and despite being generally physically uncomfortable much of the time (hot, sticky and exhausted), I can honestly say that it was all good. The trip was a refresher course in patience and flexibility. It was surprisingly fun to work with people who shared common, sometimes seemingly impossible goals.
Better still, for the first time in quite a while, I went to bed each night knowing that I had done some real good for the people I was serving. It might seem like a platitude to say that the trip changed my life, but I have no hesitation in reporting that it did. Although it may take years for me to process it all, it was a rewarding experience that I will never forget.
KNOW BEFORE YOU GO
If reading this has made you want to volunteer abroad, there are many things you should consider before you go:
Do Your Homework
Before you sign up for a medical mission, you should do thorough research, starting with the group that’s organizing the trip. Who runs the organization and what is their history? What are their goals and philosophy? What kind of reputation and relationships do they have at the destination?
Try to talk frankly with some people who’ve gone on previous missions. What pitfalls did they note? How well did the organization handle any problems that cropped up?
You should also research the area in which you’d be working. What is the political situation? How is the weather? If the destination is in the Southern Hemisphere, remember that it’s winter there during our summer and vice versa. Also, traveling to a tropical locale during hurricane or tsunami season could make your trip a lot more exciting than you bargained for.
Most organizations have translators, but it’s a big help if you speak at least one of the dominant languages of the area to which you’d be going. Speaking only English could limit your options and might leave you much more vulnerable in a crisis or if you’re unexpectedly cut off from the rest of your group. On the other hand, if you’re very fluent in the local language, you may be asked to translate for others in your group, perhaps at the expense of other duties. You should decide ahead of time whether or not you’re comfortable in that role.
Length of Commitment
Some organizations require a minimum commitment of two weeks or even a month, so you might have to start planning well in advance to make sure you have enough vacation time to spare. Each of the two trips I took was only a week, which was easier to schedule. However, in many respects, a week is not long enough to develop any level of proficiency for a skilled nursing assignment. A shorter trip also leaves less time for orientation.
You might be willing to devote a week or two of your vacation time to volunteer work, but remember that you’ll also need transportation, housing and food. Many groups will expect you to pay for yourself outright, or at least participate in fundraising as part of a group formation exercise.
Traveling abroad can be hazardous, especially in developing countries. The two most common causes of death for Americans overseas are drowning and motor vehicle accidents.
In some nations, the roads and streets are very dangerous whether you’re on foot or in a motor vehicle. Cars and trucks may lack seatbelts or have been on the road for far longer than they should without repairs or inspection.
When you’re far from home, you could get sick if you drink the local water or eat raw fruit, vegetables or nuts washed in it. You may also be exposed to parasites and a variety of insect-borne diseases, including Zika and some you haven’t even heard of, like chikungunya or tick-borne encephalitis. You’ll need insect repellant as well as plenty of sunscreen and lip balm. Relief work following a natural disaster or in a war zone carries its own hazards.
If you’re seriously considering a mission trip, be sure to read the fine print of your health insurance before you commit. You might need to buy special travel insurance that will cover care outside the U.S. and pay for evacuation in the event of emergency.
You should also keep a close eye on the unfolding developments in U.S. immigration policy. Depending on where you’re from, what you look like and where you go, getting back home might be harder than you’d expect, even if you’re an American citizen. If you bring electronics like smartphones, laptops or cameras, they may be searched or even confiscated when you reenter the United States.
Think Globally (and Locally)
There are hundreds, if not thousands, of possibilities for medical volunteering. One place to start might be www.MedicalMissions.org, a nonprofit that seeks to “connect medical volunteers and other volunteers with organizations sponsoring medical missions all over the world.”
According to their website, they have registered 4,200 individuals in 217 countries and posted thousands of jobs.If you’re really interested in volunteering to help those less fortunate, remember that there are also plenty of opportunities closer to home.
There are lots of local organizations that help poor, homeless or otherwise disadvantaged populations here in Southern California. Many of those organizations would be overjoyed to have licensed RNs willing to donate their time. It might not stretch your comfort zone in quite the same way (or make as good a story for Facebook and Instagram), but it would let you make a difference in your own community — and sleep in your own bed when you’re done!
Christine Contillo, RN, BSN, PHN, has had a long and varied nursing career. She splits her time between Student Health Services at Columbia University in New York City; the Bergen County Department of Health Service in New Jersey; and the Bergen Volunteer Medical Initiative, an all-volunteer free clinic.
This article is from workingnurse.com.