Photo via Flickr / Andrew Smith
Each summer, many nurses and nursing students join humanitarian aid missions, traveling to countries where health resources are scarce in order to work in medical clinics, on surgical teams, or as part of a public health brigade to serve impoverished communities. They work alongside local health workers, often under crisis conditions. We tend to take for granted that there are no downsides to these efforts. But how do local nurses feel about working with (and usually under the supervision of) nurses from other countries?
In 2014, nurse Debbie Wilson worked in an Ebola treatment unit in Liberia. It wasn’t her first overseas medical mission. But under the particularly intense conditions of the deadly Ebola outbreak, she worked very closely with the Liberian nurses in the unit—nurses whose own family members, friends, and coworkers had died of the disease. (Read about Wilson’s experience here.) Over time, these nurses shared with Wilson their stories of positive and negative experiences working with other expatriate nurses in the center.
Since that deployment, Wilson has teamed up with her Liberian colleague Darlington S. Jallah to formally explore the working relationship between expats and local nurses. They share their findings in Exploring Working Relationships Between National and Expatriate RNs on Humanitarian Aid Missions: The Perspectives of Liberian Nurses in the June issue of AJN.
Wilson and Jallah led focus groups with Liberian nurses to gather their thoughts on working with expat nurses. While it’s clear that Liberian nurses appreciated the opportunity to learn new things from nurses who work in more resource-rich health care systems, not all interactions were positive.
“…they feel that they are the boss. So they always want you to take command from them.”
“As we are both nurses . . . I expect to gain a little extra knowledge from [the expat] and she [to] gain a little from me.”
In the ever more interconnected global nursing community, Wilson and Jallah’s exploration makes for very interesting reading. They have given a voice to nurses who work in conditions that are very different from those in U.S. health care facilities, and their study provides us with some insight into, as they note, “what works and what doesn’t in national–expatriate RN working relationships.”
Read more in this month’s AJN.
This article provides information with a different focus, which is human relations among nurses. I found the topic exciting and original. As nurses, we always talk about patient-nurse relationship and the importance of cultural sensitivity; however working with culturally diverse staff can also be challenging. In this case, nurses working under stressful conditions (Ebola crisis) in another country with native nurses can be extremely different and demanding. Working for NGOs is such a rewarding experience. I participated in a medical mission trip to India last year, and I am planning to go next year again. The face of the patients receiving treatment is a priceless experience. We treated mainly malaria cases while working in north India. There is so much that is being done globally to eradicate diseases and pandemics. Fortunately, more efforts are still developing and on their way to aid those in need.
In this day of acute collegeadmissionosis, many high school students take “enrichment” trips to “underserved” areas; admissions officers are then besieged by essays saying how as a result of this life-changing trip these overprivileged 17-year-olds now “understand poverty” and humblebrag about the things they did to ameliorate it, like, oh, helping dig a well or build a wall. I find a related syndrome in many new nursing grads, or almost-grads, who think it would be praiseworthy, resume-building, or even just personally gratifying to volunteer on a “mission” to deliver healthcare in a third-world country. They are often shocked to learn that unlike organizations that sponsor paying high schoolers, disaster relief and healthcare organizations have little use for anyone with little or no advanced assessment skills or ability to deliver effective care autonomously. This study and the ones it references looked at participants in experienced relief organizations. It might have been useful to make some small mention of this to encourage aspirants to get useful solid clinical judgment, clinical skills, and collaboration in their toolboxes before venturing forth, hopefully avoiding the triple menace and ethical conflicts highlighted in this research.