Medical Humanitarian Missions: A Vacation With a Purpose

The team staffs a pharmacy in Ecuador.

In honor of International Year of the Nurse and the Midwife, hear from AANP Fellow Lorna Schumann, PhD, NP-C, APRN-BC, FNP, ACNP, CCRN-R, FAAN, FAANP, on her work caring for patients while on humanitarian missions:

Humanitarian missions have become a passion of mine. Just like Florence Nightingale, when the opportunity arose to help others, I took the challenge — and you should, too. Ms. Nightingale experienced much hardship and long hours of work. Traveling to Ukraine and working in the area where Ms. Nightingale traveled during the Crimean War was a memorable experience for me. That trip was followed by one to Istanbul, which was even more memorable as I was able to visit Scutari, where Ms. Nightingale helped to set up a hospital. It is truly amazing what she was able to accomplish.

Today’s humanitarian trips are less arduous than what Ms. Nightingale experienced, but probably just as exciting. Health care teams are made up of volunteers from the U.S., the European Union and the country of care delivery who are interested in helping others. Students from all practice disciplines are encouraged to join teams. On some trips, the teams are often hampered by their inability to work long hours due to safety concerns. In Ecuador, for example, you can work up to 18 hours if you are staying in the village and have adequate lighting. In some other countries, you may see up to 500 patients per day.

In the 1990s, a nurse practitioner (NP) student asked me to go to Honduras to work in an orphanage and supervise her seeing patients. The trip was amazing, because it allowed us to provide health care in the clinic to the children and people from the community. On weekends, we traveled to provide care remotely, seeing patients who travel long distances on mules or by foot. Some individuals, with their families, travel as much as 30 miles to be treated. One patient in Myanmar traveled 60 miles on foot to be seen at the border town in Thailand — amazingly, his foot had been bitten by a piranha-like fish and was infected.

Diet

How you are treated as a health care provider while working internationally is heartwarming. Often, the villagers are thankful for the care and bring you all types of exotic fruits, even though many cultures only have rice and beans as their daily diet. When mission teams go to South and Central America, they usually are served a diet of chicken, rice, beans and plantains. Ecuador has tilapia and frogs, which are farmed as favored treats. India has some of the best spiced food in the world. Thailand is one of my favorite places to go, where villagers serve the best pad Thai with shrimp for about $1.25.

As you can tell, food from around the world is a favorite for team members who have seen patients for 12 to 14 hours a day. Even our vegan team members delight in new foods. However, it is always a challenge to keep other team members from eating the vegans’ peanut butter sandwiches.

In my opinion, the best food dishes I’ve had internationally were the same as what is served in the U.S., and the worst dishes were in southern China, where the Communist party served deep fried baby birds, which were fried alive, and worm soup. On one trip by mule into the jungle, we were served guinea pig (cuye). I just kept looking at the little guy on my plate and finally my translator said, “It’s just like eating any other rodent.” It was quite tasty!

Transportation

Providing care after a 2018 volcano eruption in Guatemala.

Transportation is always a challenge. You do not know whether you will be crammed into an overcrowded bus or the back of a cattle truck. On several trips, my team and I have used mules or scooters for transportation. The roads are sometimes washed out, and you may need to get out and walk for some distance to catch another means of transport. You can plan on dugout canoes for the Amazon basin, while bamboo floats are an adventure in Thailand — and you may ride an elephant from Thailand into Myanmar. As you can tell, team members need to be prepared for any mode of transportation.

Treatment and Medical Mission Challenges

Some challenges are unfortunately above what we are able to manage. On almost every trip to Guatemala, my team and I need to send someone to the hospital to be treated for diabetic ketoacidosis (DKA). We have had challenges with patients who experience seizures or who have been diagnosed with human immunodeficiency virus (HIV). Many countries have the same diseases that are seen in the U.S., although patients’ conditions are much worse. Some people refuse to go to the hospital because one-fourth to one-third of individuals who are admitted die. My team carries all of their patient medications with them, and certain airlines often allow us to take two to three 50-pound bags with us. The team pharmacist, health care providers and nonmedical volunteers work to deliver the best care possible.

Organizations, such as action medeor in Germany, supply us with medications from the World Health Organization’s (WHO) suggested medication list that are produced at cost for countries with low resources. In the U.S., organizations like AmeriCares, Heart to Heart International, Operation Blessing and Kingsway Charities sell quality medications in bulk for medical missions and disaster relief. Some of these organizations will only allow physicians or pharmacists to sign for the medication because the organization is located in a state that does not allow NPs to purchase medications in bulk or for dispensing. You can order 25,000 multivitamins for $450 from one of these sources — that is a lot of vitamins; however, it is not much if you are seeing 500 patients per day for seven to eight days.

Another great challenge is not being able to fix starvation, such as what I’ve seen in India’s slums, where 20,000 people live on an acre of land. Treating a 16-year-old pregnant female that weighed 70 pounds and had three small children with her was heartbreaking. Although we always buy food and distribute in each slum area, it only lasts for a short time. Many nongovernmental organizations (NGOs) have donated a great deal of money and food to meet the challenges of COVID-19 in the already overcrowded slums of India. Clean water is also a great challenge in India and is compounded by the unrelenting heat. On the warmest day during our time there, we treated patients in 115-degree Fahrenheit weather. I was whining about the heat and one of the translators said, “Be glad you were not here last year when it was 131 degrees.” Needless to say, I stopped whining.

In the first photo, a 17-year-old with dengue fever and a temperature of 106.9 degrees came to see the team, who sent him to the hospital. The hospital had no room and so returned him to the village. The hospital sold the team a bag of IV fluids with an IV start kit to use. The second photo shows this same man, who survived with no residual defects, just one year later.

Treatment and Medical Mission Rewards

Besides the excellent home-cooked meals, it is always rewarding to see the same patients the next time you go to that country. A memorable event for me was in a slum in New Delhi, where a patient I had seen the year before with tuberculosis came back to let me know that, after nine months of treatment, he was cured.

Being able to serve the Buddhist monks, both male and female, in Thailand was an amazing experience for all of team members. The monks are such kind and caring people.

For me, the best reward of all is to watch the team provide quality care to needy people. The people treated are so appreciative of the care. NP students often comment, “I learned more on this trip than what I learned during my rotations in the U.S.” I think the reason for that comment is because they are able to work with a multidisciplinary team seeing patients in rapid succession over a short, but intense, period of time. As a team member, you encounter diseases that are rarely seen or never seen in the U.S. You also learn about local treatments that work; for example, drops of breast milk in each nostril to treat migraines. There are amazing treatments being used around the world that could help us in the U.S.

Summary

Take the challenge of joining a medical mission and serving in low-resource countries. Although you will give a lot of yourself, the rewards you will receive are unmeasurable. COVID-19 has disrupted four of the planned humanitarian missions for this year, and my team members and I are eager to get out there and serve.

Join the Celebration: International Year of the Nurse and the Midwife

The World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife. The American Association of Nurse Practitioners® (AANP) is committed to building awareness of the role of nurses, including advanced practice registered nurses (APRNs) and is working to develop the next generation of nursing leaders through training and leadership opportunities. AANP is pleased to announce its participation and encourages you to get involved by sharing your story!

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