Dialogue: Volunteering time and medical expertise overseas
Beverly Small, RN, nurse manager, Cardiac Intensive Care Unit
When and where did you first volunteer your nursing skills overseas?
My first trip was to Nicaragua about seven years ago. One of our former doctors, who's now at Duke University, was looking for an experienced nurse to go as part of a team to provide post-operative cardiac care to kids. They try to go twice a year to do open heart surgery on anywhere from 15 to 18 kids each trip. The team is sponsored by Variety—The Children's Charity.
How many clinicians go on the trips?
There are about 25 people—a combination of nurses, doctors, pharmacists, and respiratory therapists from Children's, Duke and other places. In the seven years I've been going, we've tried to pull in additional people because it takes a large team to make two trips each year, and you can't expect the same people to always have the time to go. We even brought our very own Sister Carlotta [the hospital's Catholic nun] with us one year. The kids just loved her.
How would you describe your first trip to Nicaragua?
Overwhelming—I cried every day. We work in a very small hospital that is extremely dirty, with very limited supplies. You find that you become very creative with your nursing, reverting to "way back when" nursing, which is actually fun to do. It's such a reality check and really puts things into perspective.
What types of things do you do there?
We only stay for a week, so we try to do as much as we can. Our surgeons perform heart surgery on children who have conditions that can be repaired in a single procedure, since follow-up procedures aren't possible. Part of my job is to train the Nicaraguan nurses so that we're eventually not needed. But our time there is limited, and it's challenging for them to keep their skills fresh between our visits. Fortunately, we see a lot of the same people each year, so that helps. And they save everything we bring down as teaching tools, every handout, book, etc.
How does the training you provide differ from the training these nurses typically receive in Nicaragua?
One example is the conference that Children's sponsored for the nurses in which we provided breakfast and lunch, and provided an educational program with handouts, etc. The nurses in Nicaragua earn an average of $30 a month, so they were really amazed by the conference. It was an open-air conference, held outside under a tent. For many of them, it was the first time they'd seen a computer.
We focused a lot on teaching them CPR. They thought it was pretty comical—having never seen a CPR dummy before—until we explained what we were doing. Then they wanted to learn even more. And that's truly the ultimate goal—to teach the people and help them to teach their own.
How do you handle the language barrier?
Their native language is Spanish, so we travel with interpreters. But it's amazing what you can teach using sign language, and of course I always bring my English to Spanish dictionary. Recently, we've had some women from the village come help us translate, which has been great.
Do you have any memorable moments or anecdotes from your time there?
I can remember one little boy, he was 11 years old, who had heart surgery one trip. When he woke up, he kept giving me the thumbs up sign. So there I am, giving it back, saying "Yah! You're okay." Come to find out, what he was doing was looking to see if his finger was pink. His fingers had always been blue because of his poor circulation.
And he was so excited because now he could go play soccer and the other boys wouldn't make fun of him because he had blue fingers. It's fun to see those little things.
And the parents are so thankful. I can remember them giving me a little bottle of rum that was wrapped in toilet paper. They gave up a lot to give me that gift, and they were just so proud of it. It was incredible.
What would you say you've gotten out of this experience?
I get more out of it than I feel I give every single time I go. I think it really brings you back to the basics, and reminds you why you went into nursing in the first place—to care for kids.
Do you have any advice for clinicians considering volunteering overseas?
Don't hesitate to go. Take every opportunity and make sure your passport is always ready. You'll see a part of the world that, until you're actually there, you truly have no clue about. I try to tell people about my experience, show them pictures, but until you smell it and see it, you have no idea.
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