Nursing takes on new "heights" for those who choose to practice the profession at sea. Imagine climbing into a basket lowered from a helicopter hovering over a ship in mid-ocean. Up and away, and you're in the copter. The basket is lowered again, this time to retrieve a sick passenger, now your patient, in dire need of a ship-to-air evacuation.

The scenario is not all that unusual, if you are a nurse at sea, said Laura Vlaadingerbroek, MSN, RN, chief medical officer aboard Holland America Line's Zaandam.

Laura Vlaadingerbroek, MS, RN, helps evacuate a wounded crew member from the Holland America Line’s ms Zaandam.

She mentioned another evacuation at sea in recent memory: A 16-year-old girl needed immediate urgent care, and the ship she was on was too far from land to be serviced by a helicopter.

"The USS Ronald Regan aircraft carrier picked her up," said Vlaadingerbroek. "How often can you get the U.S. Navy to stop by?"

Not Just Dramamine and Aspirins

Of course, day-to-day practice of nursing on board the Zaandam is a little less dramatic, although certainly no less impressive.

"We've handles MIs, we provide lytic therapy on board , we give TNK [tenecteplase]," enumerated Vlaadingerbroek. "The nurses run all the labs. We also do all our own X-rays and we have teleradiology with the University of Texas medical branch so we can have a radiologist review our wet reads from the dock."

Some cruises are more challenging than others - Hawaii, for example.

"It's a 15-day cruise, 5 straight days at sea, going and returning, so there is no way to get anybody off the ship after about 5 hours from port. By then we are beyond helicopter range. If someone becomes sick we totally have to manage and maintain. So, we have a full ICU with two respirators. We do the full gamut until we can get to port," explained Vlaadingerbroek.

    "On almost every voyage we see some type of cardiac arrhythmia that we can manage and stabilize, or passengers with run-of-the-mill MIs who we medically evacuate at the first port. GI bleeds are big - we see them quite often - along with bowel obstructions, seizures, you name it."

En Route to Hawaii

"On the Hawaii cruises the population is older... so we see a lot of chronic things. And especially going into Honolulu, we see older people making a pilgrimage out to the Arizona Memorial as one of the last things [in life] they want to do. We saw a person with bone cancer and just 5 weeks to live who had finished radiation... we saw a person get on the ship with their brain swelling. Sometime I just think, ‘Oh my gosh, your doctor actually said it was OK for you to sail?'

    "We see people who come with caregivers, toting Hoyer lifts. Through the years it has gotten more amazing. We allow dialysis and we also allow hemodialysis when patients bring their own units. And four times a year our ship runs ‘Dialysis at Sea' when a company by the same name comes on with about 12-15 passengers who need hemodialysis three times a week. They bring a nephrologist and nurse and all their own equipment."

    In between all of that, the ship's medical center is- comprised of a large ICU for the most critical patients, a huge exam room and doctor's exam room and exam table, three ward rooms, X-ray room, office and inventory area staff - maintains regular clinic hours, not only for passengers but for staff. ("We're the total primary care provider for any cough and cold... lab, X-rays, simple treatments.")

Throughout it all, mandatory reporting is maintained. "We report to the CDC every time we come into a U.S. port. We have to report numbers... fevers, diarrhea, unusual measles, influenza."

Preparedness Is Key

And has H1N1 raised concern on the high seas? "You bet," said Vlaadingerbroek . "With the possibility of H1N1 looming, I had to order $25,000 worth of supplies and be prepared because everyone on the ship could have it... so masks, gloves, tamiflu, you name it. We regularly carry about a $20,000 supply of medicine, and I order every other voyage."

Noting there is opportunity for other nurses with Holland America Line, she suggests interested RNs check the website at http://www.hollandamerica.com/. And if you come aboard for a vacation she says, "Come on down to the medical center and ask for a tour. Tell them Laura sent you!"

Post script: Read a recent ADVANCE for Nurses' feature story by Candy Goulette about Laura and other nurses at sea  by clicking http://nursing.advanceweb.com/Article/Welcome-Aboard-11.aspx

Until next time: This blogger is signing off for a brief vacation, and yes, I'll be setting sail! When I return, I'll introduce you to an RN from the UK.

Last time we saw Laura Vlaadingerbroek, MSN, RN, she was serving as chief medical officer aboard Holland America Lines' luxurious ms Zaandam. All the while she was living -- and loving --the good life, while traveling to exotic ports-of-call.

Then she found something else to capture her attention: a Dutch officer named Bob Vlaadingerbroek. It had to be true love, because Laura took that tongue-twisting name for her own!

Togetherness on the Ocean

"I met my husband after about a year working at sea," recalls Mrs. V. Trading their mutually footloose status for matrimony, the couple maintains a home in Laura's native Wisconsin, but calls the luxury ship their home-away-from-home.

Bob and Laura Vlaardingerbroek, MSN, RN, find togetherness in Glacier Bay, Alaska.

"We work 3 to 4 months at a time, then take a two month break in between. Technically, we are supposed to work 8 months out of the year, but HAL is very flexible with full-timers. We can pick our schedule and our itinerary. We put in a ‘wish list' for the next season, and the line does its best to make it happen," she explains. If wishes do come true, Laura and Bob will see themselves on a world cruise one day, but she admits, ‘That's a primo spot. Only two nurses get to do the around-the-world cruise each year."

Nevertheless, since tying the marital knot these seafarers have seen the capitals of Europe, the palms of the Caribbean, the sands of Waikiki and the majestic Alaskan glaciers together. And they plan on logging quite a few more knots  - each a memory to build a life on.

"HAL is very concerned about keeping couples together," says Laura. "My planner and his planner, in different cities on different continents, really make an effort on our behalf. We fly out on the same plane together and we come home on the same plane together. For a company as big Holland America is, that really says something. We have turnover of 50-60 crew every voyage ... yet they still can figure out how to make it work for us."

What's life afloat really like? 

"Medical staff are officers," says Laura proudly, "and at HAL that means all the above-board privileges. I eat in the Lido for my meals and I host tables in the dining room twice a voyage. We have all the bar and nightclub privileges; we can socialize with other crew or passengers.

"Then we also have all the below-board facilities ... officers' bar, movies. Nothing beats Bingo in your sweat pants," she laughs. "Actually, it's a very  busy life."

Asked about the endless food for which cruise ships are known, Laura explains, "You get into a routine, just like at home. You get over that buffet syndrome real quick. There's a lot of choices, and you could go really overboard." [Hmmm... strange phrase for a person at sea to use...] "I eat one meat, one vegetable and I know tomorrow it'll all be there again. No cooking! It is kind of nice."

Laura says there is a surprising sense of community at sea. "We are like a family. Every nationality gets along so well. And there are a lot of married couples on board. It's a real neighborhood. It's worked out fabulously."

Always a Nurse

Now marking about 6 years on the Zaandam, Laura clarifies: The marriage is wonderful, the travel is a bonus, but the career objective on board is quality nursing. Offering a run-down of her usual to-do list, Laura notes, "We've handled MIs [myocardial infarctions], we give lytic therapy on board , we give TNK [tenecteplase]. The nurses run all the labs and we do all our own X-rays. We have teleradiology with the University of Texas medical branch so that we can have a radiologist over-read our wet reads from the dock.

"We see everything on board ship," Laura underscores. "We're all critical care prepared and our doctors are board certified ER. We run like an ED, from a walk-in clinic to anything emergent that comes in ... or a call in the middle of the night from someone with chest pain. We see it all: strokes, heart attacks, GI bleeds -- that's usually our worst, we see them quite often, along with bowel obstructions, seizures... you name it, we got it. Oh, and did I mention we have a walking blood bank on board? It's all of us, each other... we're it!"

Next time: During our final visit with Laura, she'll explain why a cruise to Hawaii proves a particularly strong nursing challenge. It's a true test of assessment, skill and "aloha."

Just for fun: "Love and marriage" in Dutch: Liefde en huwelijk

Who'd Have ‘Thunk' It?

It really was a change of pace this former Level 1 trauma ICU nurse was seeking. "It was the right time in my life," said Laura who had been in intensive care for 17 years. Work was interrupted by a family reunion of sorts, on board the Zaandam. When Laura's father had a medical issue, Laura accompanied him to the onboard medical center. And that's where her life took a surprising turn.

"I started talking to the nurses there. I would never have known about this kind of nursing otherwise. They said, ‘You've got to try this! It's great!' They gave me a business card right  then on the spot. I thought, ‘Wow! This would be perfect.'"

Laura Vlaardingerbroek, MSN, RN, is lead medical officer aboard the ms Zaandam, docked here in Honolulu.

It started out as a part time gig. "I kept my fulltime job. The cruise line had a 14-day minimum commitment requirement. So my first try at onboard nursing was on a 10-day cruise. I loved it. Loved it. Then the cruise line showed me the holes in their schedule - where nurse staffing was needed - and I picked up one here, one there. I thought, ‘Gosh, I love this ... I can travel and work at the same time.' I told the cruise line that if something fulltime came open, I'd consider it."

It did; she did; and the rest is history. And why not? Laura was single at that time. "I was footloose and fancy free and I wanted to see the world. I started on the old Noordam [a newer Noordam has since been placed into service] and I was offered the Mediterranean for my first contract. I cruised from Lisbon to Rome, then Rome to Istanbul. We hit all the Greek isles, and all the Italian ports. It was just fantastic."

Enter The Love Boat

     About a year into her newfound career, Cupid's arrow struck. It also pierced the heart of a Dutch officer, an engineer named Robert whose home office is in Rotterdam.

    Could this multi-cultural couple, home based on two continents, make it work? And what about Laura's real "work"... nursing? Would she have any opportunity to handle the sort of emergent care she is so highly trained to do? That's called a cliffhanger, folks. Stay tuned for the next episode of InteRNational...

Next: Married life on the high seas and extreme nursing make a good partnership.

Personal note: It's been my pleasure to travel on Holland America Line's earlier Statendam and Rotterdam liners. Cruisers take note: The line maintains a polish that is sadly disappearing in some others of the mass market lines. HAL offers a variety of Alaska, Caribbean, Hawaiian and Northern European itineraries, as well as some unusual transatlantic crossings. And if time and money are of no consequence (OK, not likely...) the line also offers an around-the-world cruise in 114 days, sailing from Ft. Lauderdale, FL, and docking in such diverse ports as Buenos Aires, Cape Town, Mumbai, Singapore, Hong Kong, Beijing, Yokahama, Vancouver, Seattle, Los Angeles and many others. We can dream...

Just for fun: Ship in Dutch: schip.

If you live on the East coast and would like to meet Joe Niemczura, MS, RN, known affectionately on this blog as "Joe the Nurse," the time is almost at hand. This affable nursing instructor at the University of Hawaii - Manoa/Nepal nursing instructor/author will greet the public, present a slide show on his Nepal adventures, display various props and offer readings from his book, "The Hospital at the End of the World," during a brief book tour. The following dates have been confirmed:

• Oct. 18, 2:30-3:30 p.m., Wesley United Methodist Church, 5312 Connecticut Ane., NW, Washington, DC, 202-966-5144.
• Oct. 19, 1 to 2 p.m., University of Maryland at Baltimore School of Nursing, 655 W. Lombard St., Room 150, Global Health Group, Baltimore, MD
• Oct. 19, 7 to 9 p.m., Red Emma's Bookstore Coffeehouse, 800 St. Paul St., Baltimore, MD, 410-230-0450
• Oct. 20, 3 to 4 p.m., Roxborough branch of Philadelphia Free Library, 6245 Ridge Ave., Philadelphia, 215-685-2550
• Oct. 20, 7 to 9 p.m., Wooden Shoe Bookstore Coffeehouse, 704 South St., Philadelphia, 215-413-0999
• Oct. 21, 7 to 9 p.m., Thakali Kitchen, 74-14 37th Ave., Queens, NY, 718-898-5088
• In addition: United American Nurses are planning an appearance by Joe for a nurses' group in Mahattan on Oct. 21, 1 to 3 p.m. Further details to follow...
• An additional date may be set in Philadelphia and will be reported when finalized.

Those interested in purchasing his book can click here.

"I spent 15 years of my career doing critical care," said Joe Niemczura, MSN, RN. "Sure, I can run hemodynamic monitoring ... But, if you have a high-tech background in nursing, just throw that out the window. In Nepal, they don't have hemodynamic monitoring, they don't have PIC lines. They don't do TPM. They're new at giving insulin because they have trouble with refrigeration. The amount of  technology an American hospital has is roughly the same amount they don't have in Nepal. Amazing."

A Magar woman stays with her child, a hospital patient.

Spending three summers, most recently this past one, in Nepal has been an eye-opener for this nurse who spends most of his time as an instructor at the University of Hawaii-Manoa, on the island of Oahu. He takes that same teaching expertise to Nepal, with some revisions. "[In Nepal] I supervise students in the clinical area," explained Niemczura. "The nursing system there is built around very old-fashioned, functional nursing; it's task-oriented. I help to teach the tasks." He also tries to hone emergency response skills among the nursing students. "I want them to get beyond functional tasks, and learn to be responsive to changing conditions."

Burning Changes

Changing conditions are exactly what Joe encountered himself. Despite being heralded as a "snake bite expert," Niemczura found himself moved to the pediatric burn care unit. Ah, burn care. It comes up often in conversations with nurses working in challenging healthcare environments. You may recall a recent blog series about Haiti. One of the nurses there also told me pediatric burn care was a big issue. It's a common thread, stunningly similar when detailed by Niemczura on the other side of the world.

"There's no electricity in large areas of the country. People have wood stoves, and a lot of food has to be boiled," he began. And, they are closer to the equator than we are in the U.S., so that means they have long 12-hours nights, all year long. In summertime the days don't get longer like here. If they want light at night it's customary to take a soda can and fill it with kerosene and stick a cloth in it; it's used as a crude lantern. When that gets tipped over it's like a Molotov cocktail going off in your house."

A steep street challenges Tansen pedestrians.

There are cultural issues that come into play, too. Women get burned, men not so much. "Domestic violence is an issue in Nepal just as it is in America," said Niemczura, "and burn injuries are sometimes inflicted during the course of a domestic violence episode, which seems to account for a higher proportion of adult burn victims who are female."

LIfe Altering Experience

An American nurse in Nepal, who hasn't previously done pediatric burn care, is in for a big shock, said Niemczura. "I went from the incredible high of the snake bite thing to questioning the meaning of the universe with the pediatric burn care. In fact, that's what has changed my life.

"Here in the U.S. we're so far ahead in so many things. I've learned to appreciate more what we have. I stopped buying stuff years ago; I live a much simpler life now. When you start to understand how privileged we are in this country, it makes you a much more humble person. You really can't do this kind of work and not think about the metaphysical questions of why are we here, what are we doing, what are our obligations to each other? A lot of nurses are motivated by these altruistic things," said Niemczura reflectively. "You always have this fantasy of wanting to help. Nurses have to be in touch with that motivation to get up and do their nursing every day. Nepal has affirmed that for me."

A Big Thumbs Up

Joe Niemczura has captured his experiences in Nepal in a book, The Hospital at the End of the World. In it he details his impressions of the geographic area, its people, medical experiences and sometimes the meaning of life itself. Often, it's the smallest details that make the reading so fascinating (..."Nobody will get into bed between two white sheets, not for a million rupees. Sheets are blue or pink. White is the color of a shroud.") He also offers photographs that bring his fully engaging text to life. The book is available at Amazon.com (use a title search) or at  http://www.plainviewpress.net/zencart/ .

Cover from The Hospital at the End of the World, by Joe Niemczura.

If you'd like to meet Joe personally, he'll be greeting the public during a brief book tour this fall.  He'll be in Washington, DC, at Wesley United Methodist Church, in NW, On Oct. 18, 2:30 to 5 p.m., and at University of Maryland, Baltimore, on Oct. 19, 1 to 2 p.m. Dates will be announced for Philadelphia and New York City.  And if you become a fan, he'd love to "see" you on his Facebook wall.

Next time: Anchors aweigh! Let's cruise with a nurse who found a career, and a marriage, on the high seas with Holland America Line.

This is not the next "official" installment of this globetrotting blog. Next up in just a few days, as promised, will be more of the adventures of Joe "the Snake Man" Niemczura, MS, RN, in Nepal.

Instead, this is just a shameless plug for a story that I had the pleasure of writing about RNs from Flying Nurses International (LLC) who accompany patients on commercial flights around the world. I've never met a nicer, more engaging group of nurses, with stories of adventures -- and misadventures -- that seem to go on forever.

These valiant healthcare AND travel pros drag all sorts of equipment onto commercial jets, fly thousands of miles (in at least one case they circumvented the entire globe) to help someone stricken in some far-off corner of the world get home. They deal with tough airline regulations, remote locations -- even some hostile to the U.S. -- to safely retrieve their clients despite all odds (as in Haiti when a nurse had to find a patient without the "convenience" of communication or even road signs!).

So, I hope you check out the story, "Come Fly With Me," at http://nursing.advanceweb.com/Article/Come-Fly-With-Me.aspx

On his first nursing mission to Nepal in 2007, Joe Niemczura, MS, RN, wondered how he would make his mark on the indigenous people. "I wasn't there to do the nursing, I was there to teach the locals what they need to do," he explains. But as he arrived at the host hospital in the town of Tansen, he had no idea how he would build relationships and establish adequate credibility to be able to reach that goal.

Hmm. Would becoming an "international snakebite expert" do the trick? You bet.

Joe Niemczura, RN, MS, is surrounded by his nursing students in Nepal.

An Unlikely Expert

"Yeah, I'm considered a snakebite expert in Tansen," says Niemczura in an I-dare-you-to-believe-me proclamation, "even though there are no snakes in Hawaii and I've never taken care of a snakebite victim in the United States."

In Nepal, snakes pose an enormous threat. "Less than a dozen people die from snake bites per year in North America," asserts Niemczura, "but in south Asia, about 100,000 people die each year. That's an astounding number."

Certain snake bites cause a victim to die by paralyzing breathing muscles, "...just as if you were given anesthesia," says Niemczura. "So, if you could just put a tube into the victim's trachea to allow the victim to breathe for about 3 days when the snake poison wears off, he'd be fine. You're home free."

So there was Joe, in the middle of monsoon season, sitting in on an inservice, presented by the Tansen doctors, on the topic of administering snakebite antidote. One of the doctors mentioned they do have a mechanical ventilator on premises, but the doctors didn't know how to use it. They said even though they received some of their medical training in the west, that particular job fell to nurses, so they never learned how."

Eureka! "I'm sitting there in the back row thinking, ‘Wait a minute! I've used these things since 1978. I've trained people on these things," recalls Niemczura. "How damned difficult could this be?'"

Providential ‘Gift'

Niemczura had no sooner trained the Tansen healthcare providers than "...this patient rolls in. It was a gift!" exclaims Niemczura. "I managed the case. All together we put him on the ventilator, waited three days, and by the time he walked out of the hospital I was being hailed as a local hero... I was Mick Jagger, Elvis Presley, the Dalai Lama and Billy Graham combined!"

Fast-forward to 2008, when Niemczura made his second nursing mission to Nepal. "I get off the Buck," a vehicle so-named because it was a cross between a bus and a truck, he explains, "and what do I hear someone say? ‘The snake man has returned!'"

Beware the Fantasy

Niemczura cautions other Westerners: "We have this fantasy of going to a remote place, thinking we're smart and that we have all the right stuff to teach these people what they need to know. In reality, it almost never works out like that. What I learned is that these are very, very smart people and way more dedicated than the average American healthworker. They get up early every day in the most difficult circumstances to apply what they can; they take what you tell them, remember it and put it into play. Wow, that's gratifying from a teacher's point of view. At an American university you may have students just going through the motions. You don't see that in Nepal."

Next time: What Joe DID see in Nepal.

Get to know Joe: There are at least four ways I can suggest to help you get to know fellow RN Joe Niemczura better. First, keep reading this blog. Second, you can visit his Facebook page at: http://www.facebook.com/profile.php?id=19508950#/pages/The-Hospital-at-the-End-of-the-World/46029670798?ref=nf . Third, you can buy his book (I eagerly devoured every page) at http://www.plainviewpress.net/zencart/ or at http://www.amazon.com/ (then do a search by author). Finally, Joe will be doing some book tours this fall. When I get the details, I'll pass them on to you.

 Ah, Waikiki. It is the stuff dreams are made of. Pacific surf pounding down on sandy shores, magestic volcanic mountains - blanketed in tropical greens - jutting up toward the heavens.

But Joe Niemczura, MSN, RN, was dreaming of another destination when we first chatted by phone - he gazing out to nearby Diamond Head, sipping some Kona java - while I was in sensory overload just listening to him describe the view. "It's everyone's fantasy paradise," said Niemczura as NPR radio played in the background.

Joe Niemczura, MSN, RN

From Maine to Hawaii and Way Beyond...

An instructor at the School of Nursing and Dental Hygiene, University of Hawaii, Manoa, Niemczura was once about as far from Hawaii as a mainland American could get. Think cold, northern Maine... pines, not palms; critical care nursing, not teaching. Niemczura was active with ANA while there, serving as CE chair, then as CMA President and a delegate to the House of Delegates.

"But things happened, and here I am," said Niemczura. "Things" included a divorce, kids growing up, and a mid-life urge to make a switch.

But relocating to what has been called by some the most remote island chain in the world wasn't enough for Joe. With a three-month hiatus from teaching and a round-trip air ticket to anywhere earned through the university's Office of International Programs, Niemczura decided to volunteer his nursing expertise to the people of Nepal. Yep, Himalayas. Toward that end, Niemczura has now made three summer trips to what he refers to in the title of his newly published book as The Hospital at the End of the World. http://www.plainviewpress.net/zencart/

On the 'Lunatic Fringe'

Traveling there (which, incidentally, takes him four days) under the aegis of a Christian aid organization, Niemczura was confronted by what he calls "...one of the poorest general sets of health outcomes in the world. One out of seven children die before the age of 5; infant mortality is more than 12 times what it is in the U.S.," he told me. "There is human trafficking ... women are sold into brothels in India and come back to Nepal with AIDS. They have multi drug-resistant tuberculosis. That's just the beginning of the picture. Life expectancy is in the 50s."

Why would Niemczura leave "fantasy paradise" for Nepal? "I realize I'm on the lunatic fringe," he said through a laugh, explaining that he simply isn't the beach/cruise/same-place-every-year type of traveler. "Besides, it changed my life."

Next time: How Niemczura became "the snake man" and gained credibility in Nepal.

Answer to question posed last time: Devanagari is the script used in written Nepali, similar to Sanskrit.

Just for fun: Thik cha (Nepali phrase meaning "okay," cited in Niemczura's book.)

Pick a Language, Any Language

How many languages do you speak? If, like most of Americans, your answer is "one," it's time to adopt a new one. After all there are enough to choose from - about 6800 on planet Earth, spoken in some 257 countries. Believe it or not, North America alone has 165 indigenous languages!

Certainly the best reason to study a language is to be able to communicate with a diverse population. In nursing, that translates to better care for non-English-speaking patients and their families. But there are other personal reasons to indulge in linguistics. For example the human need for brain plasticity - the emergence of new brain cells, new synaptic connections urged into life by a person's willingness to learn something uniquely new.

According to Dr. Paul Nussbaum, associate adjunct professor in neurological surgery at the University of Pittsburgh, learning a foreign language is one of the best ways to encourage "brain fitness." So get over your fear of French 101, forget the struggle of past-perfect conjugations in high school German class. Jump into the diversity of conversational languages.

Personal Hijinx

My own friends find it screamingly hilarious that I have embarked on Dutch lessons. A beautiful blonde woman named Marjo [from Maastricht, a city in the south of The Netherlands which was recently voted the best city for restaurants in the country], relocated to the Philadelphia suburbs when she married a Pennsylvanian. In addition to being a skilled graphic artist, Marjo is now a willing teacher, tediously instructing me on how to recite a menu, the food on my plate, or social niceties when I dine with her during our standing Thursday night dinner lesson.

Hilarity invariably erupts when I attempt to talk to an unsuspecting waiter at our restaurant/classroom in my highly-American-accented Dutch. (Apologies to native Dutch speakers! I am quite sure you would not recognize your mellifluous language when it comes through my lips.) Who knew linguistics could render me doubled over in laughter?

I speak a bit of fractured Spanish, which in turn prompted me to take one year of Flamenco dancing lessons (great exercise and terrific for stomping out frustrations) and I ooze romanticism when murdering college French over a glass of Beaujolais. This, in turn, sent me on a search of thrift shops for French haute couture and to date I have scored exactly one silk blouse from the house of Chanel. C'est vrais! My point is: Languages are a roadmap to new experiences and a larger circle of friends.

It's All Greek to Me

So... get started! Here is how to say "I am your nurse" in 21 languages. I bet you didn't know you were a "verpleegkundige" in Dutch, or a "Krankenschwester" in German. It's only the beginning.....

I am your nurse                     English

أنا ممرضة الخاص بك                      Arabic

Аз съм ти сестра                    Bulgarian

我是你的护士                          Chinese

Ja sam tvoja sestra                  Croatian

Jsem tvoje sestra                     Czech

Jeg er din sygeplejerske           Danish

Ik ben uw verpleegkundige        Dutch

Olen sairaanhoitaja                   Finnish

Je suis votre infirmière              French

Ich bin Ihre Krankenschwester   German

Είμαι νοσοκόμα σας                  Greek

Io sono il vostro infermiere          Italian

私はあなたの看護師です           Japanese

Jeg er din sykepleier                  Norwegian

Ja jestem waszym pielęgniarki    Polish

Eu sou seu enfermeiro                 Portuguese

Sunt asistentă dvs.                      Romanian

Я твой медсестра                       Russian

Soy su enfermera                         Spanish

Jag är din sjuksköterska               Swedish

CHALLENGE: Can you say "nurse" in Devanagri? Do you know where that language is spoken? We'll be going there shortly; get packed!

"Some people thought this would be a dinky little school," laughs Ruth Barnard, PhD, RN, former University of Michigan professor who, upon "retirement," accepted the challenge of helping to establish a BSN-granting nursing school on the island of Haiti.

Working through the non-profit Haiti Nursing Foundation, that's exactly what she and others dedicated to turning a dream into a reality did. Today, Faculte des Science Infirmieres de l'Universite Episcopale d'Haiti (FSIL) in Leogane stands as a testament to Barnard's iron will and what she considers Divine direction.>

Learning the basics

 "I never envisioned a dinky school, never! The vision that God had given me was a baccalaureate school. Nothing less," she recalls.

That was quite a leap from the then-standard Haitian nursing norm: nurses who were licensed but had no real assessment or clinical skills and who, in fact, shied away from hands-on care.

Jumping Hurdles, One by One

"There were hundreds of hurdles," says Barnard. "In the beginning we just had to figure out what our priorities were... where to begin."

Barnard joined forces with Jack Lafontant, MD, director of Haiti's Holy Cross Hospital (Hopital Ste. Croix), who had long dreamt of a nursing school which could support and improve care at island hospitals. Leading arrangements for a medical doctors' conference in Haiti in 2003, he suggested a concurrent nursing conference.

Barnard and team (including Donna Martsolf, PhD, RN, curriculum director; Jessie Colin, PhD, RN, nursing consultant; Mary VanMeter, MSN, RN; Jerry Veldman, MD, FAAP; architect James Hite, and others) liked the idea, but where were the nurses? Who were they? How could they get them to show up?

Dressing the part

It took a lot of legwork, canvassing neighborhoods and asking questions of islanders: who are your nurses? A meeting with the Haitian American Nurses Association in Miami helped ferret out more conference attendees. By time conference doors swung open at the Montana Hotel in Port au Prince, there were 50 nurses ready to attend the admission-free confab, complete with free luncheon.

"We paid for tap-taps [little busses that stop when you "tap tap" to get off]," explained Barnard, "to carry the nurses halfway up the mountainside to the conference site. And they had no equipment of their own, so we gave each one a stethoscope and an onoscope. We talked to them and were able to determine their greatest needs: training in emergency care, delivery/maternity, burn treatment, and spirituality. Our message of education was very well received."

Building First, Then a Faculty

A physical site was identified and procured. Working with the Medical Benevolence Fund (MBF), associated with the Presbyterian Church (US), Lafontant received funding for the building and dormitory from the United States Agency for International Development, Office of American Schools and Hospitals Abroad and additional funds from MBF donors.

Then there was the issue of a faculty. "Did we have trouble getting a faculty? Sure we did," admits Barnard. "Our dean is nothing short of a miracle."

Dean Hilda Alcindor, BA, RN

That human miracle is Hilda Alcindor, BA, RN, who had been working in the U.S. for 30 years, but decided to return to her native Haiti and help her people.

"Hilda accepted the job as dean, and marvelous woman that she is she got the school property all cleaned up and ready for dedication in 2005," tells Barnard of this largely hands-on project.

A curriculum was rolled out: Humanities and science in the first year.... Then things started to build: PhD-prepped instructors would teach chemistry and microbiology; island physicians came in to lend a hand with science studies. Up-to-date textbooks were Xeroxed, because there virtually no current books available. Still the dream persisted. And grew.

If You Build It they Will Come

Word got out about the school, interest was stirred, and in 2005 a class of 35 was admitted. But this was unlike any freshmen class known on U.S. campuses. "Many of these students were from the most humble of settings," says Barnard. "Dean Alcindor had to set them straight about basic things... how to eat in the cafeteria, table manners. She required that they unbraid their hair so that it could be thoroughly washed. She taught the young women about shaving under their arms. Basic cleanliness. She had to start from scratch, and very basic scratch at that."

Despite all odds, the vision of a baccalaureate school not only became a reality, it graduated its first class of 3 men and 10 women in 2009.

Education is a privilege

"It was especially trying for the men," says Barnard. "Men don't go into nursing down there. Big stigma. One male student said the first year his classmates called him ‘miss.' He put up with it. He realized the power of knowledge and how he could really do good for his people."

A Student's Point of View

That student, Jean Chrisnel Bernard, speaks publicly - eloquently - of the his experience on the school's Web site:

"In the first year my colleagues called me ‘miss,' reminding me that nursing is a profession for women. However nothing shook me. I kept my composure and my self esteem has not fallen. As a measure, I have come to realize that it is important to make a difference in this country sick from the lack of quality care.

"Since then I have given wholeheartedly in my soul to study, to apply everything that I received at school. I feel the need to help, to serve others, to ease suffering, to treat the dying. For me it is the largest of the work, the greatest gift that we can offer to someone. When I give care I feel useful; I see what is my most beautiful and great mission on earth.

"Through my studies I made a lot of achievements: Animate on the radio, present lectures on health problems such as sanitation, personal hygiene, community development, hypertension, diabetes, HIV-AIDS... Hope grows by the day.

"I thank God, and the dean for giving me the opportunity to study in this great school this noble profession.... I am a professional and my future is assured. And I think that possibility is available to other young people of Haiti who believe in education -  the key to development in any country.... I want to go further, get a master's, then a doctorate in nursing in order to better serve, teach.

"May God bless all the personnel [of FSIL]; it multiplies his days so that light will continue to shine on everyone! Another Haiti is possible."

Hope for Haiti

Barnard agrees. "There is hope for Haiti. I've seen improvement over the years. Garbage piles are getting cleaned up with help from UN troops. HIV rates have been cut in half from 10 years ago. And age span has increased to about 54, it had been down at 50. Median age, too has increased; it's 20 now, but it was only 18 in 2000."

Still, Barnard says, "More help is needed. This country has been overlooked, ignored by much of the world. And yet we have established this school. I think you could call it a miracle. This is for Haitians. And it is very hopeful."

Next time: Let's have some fun. How many ways can YOU say "nurse"?

Talk back: The Haitian graduate nurse told us what nursing means to him. What does it mean to you?

Ruth Barnard, PhD, RN, was about as far away from Haiti as a person could get in her cold, blustery hometown of Ann Arbor, Michigan. Newly retired from her professorship at the University of Michigan School of Nursing in 2000, she was ripe for a new challenge. But she didn't choose it -- it chose her.

Barnard explains, "The senior pastor at First Presbyterian Church of Ann Arbor asked me if a school of nursing could be built in Haiti. I said, ‘Sure.' He asked a question, I answered it. That simple. Then he asked me to lead the effort. I decided yes, I'd try. I knew nothing about Haiti. It's been a real eye opener."

Indeed. Barnard is something of a go-to authority on the state of nursing education in Haiti. She says there are several nursing schools on the island, but the quality of education "varies greatly -- generally, they're not very good."

Time Stood Still

When she started her newfound project in earnest, in about 2001, she found healthcare in Haiti to be equivalent to US healthcare circa 1940.

Barnard says the first nursing school in Haiti opened in 1915 when the U.S. Navy occupied the island. Navy nurses kept things going until the early '40s. "That's when World War II got in the way," quips Barnard. "They had gotten off to a good start, but that's where it was left. Textbooks, when I got there, were still from that distant time. It was a living time warp. Medical capabilities were not keeping pace with rest of the world.

"Hospitals didn't have much equipment -- they had to lock up their mattresses because they would be stolen," recalls Barnard. "Empty beds were just old metal frames, hand-cranked style. There were no electric beds because often there was no electricity!

"Central supplies were a mish-mash. Patients' families had to supply their own food, basic care. They had to go to a pharmacy to get medications, IV supplies. So the hospital I saw at that time was a shell of a building -- a dirty shell at that. Each time I went, my eyes opened wider."

A Few Rich, Many Poor

A further frustration, says Barnard, was the social and professional stratification of Haitians, "...bright, charming, wonderful people." With no middle class, Haitians are either the minority select elite, or the poor. Very poor. And nursing, it seems, has always fallen to the lower strata.

Haitian nurses-in-training typically struggled to get a real feel for their chosen profession. "Clinical training consisted of taking students and dumping them in a hospital and hoping the staff would teach them what they needed to know to be a nurse in the clinical areas. That didn't always happen," says Barnard. She remembers when one of her associates traveled to Haiti to visit a hospital. "One nursing student was found hiding in fright in a closet because she simply didn't know what to do. Because of poor preparation, the trend has been for nurses to remove themselves from hands-on care."

Barnard offers an example. On one hospital visit Barnard's associate saw a stretcher coming from an emergency room, carrying a male patient writhing in pain from a blocked catheter in his bladder. "The hospital nurses couldn't -- didn't know how to -- unblock him, so they were going to send him home," tells Barnard. Her associate showed them how to remove the catheter and put in a new one. "That patient went home and had a life. If he'd gone home with a blocked catheter he would have died -- and not in a nice way."

She pauses, then pleads, "Please don't make these wonderful people sound bad, please don't put them in any bad light. These are open, warm, brilliant people. They simply had no opportunity to learn."

But all of that is changing and hands-off, haphazard nursing is disappearing in Haiti. The winds of hope have already started to blow through island palms.

"It is really a miracle to see what has happened," says Barnard. "God wanted this. I don't usually say things like that." "This" is a sturdy growth with flowering branches. It is all rooted in The Haiti Nursing Foundation (HNF), incorporated in Michigan in February, 2005, to support the advancement of nursing in the Republic of Haiti... especially on Faculté des Sciences Infirmières de l'Université Episcopale d'Haïti (Faculty of Nursing Science of the Episcopal University of Haiti - or FSIL), located in Léogâne, Haiti. It is, indeed, the first BSN degree-granting nursing program on the island of Haiti. The foundation also lends help to Haiti's Hôpital Ste. Croix and provides tuition for one of the hospital's nurses to gain advanced study at Haiti School of Public Health. It would seem Nightingale arrives in the form of education, and nests in a burgeoning tree.

Next time: Hurdles are jumped, miracles are counted, and the first class graduates.

Talk back: Where in the world would you like to go? Tell me about it: vnewitt@advanceweb.com or post a comment.

Mwen se infimye ou ("I am your nurse," Haitian Creole)

Canadian Kyra Abbott, BScN, RN, grew up in the small town of Perth, Ontario, and now makes her home in the city of Ottawa. And while this Magna CumLaude graduate of the University of Ottawa could have opted for any number of relatively comfortable nursing opportunities, she chose to spend more than 4 years living and working in Haiti.

Kyra Abbott, BSN, RN, with coworkers at Saint Damien Pediatric Hospital, Port-au-Prince, Haiti.

Why Haiti?

Why would an RN go to an under-resourced country like Haiti to practice a profession already rife with physical and mental challenges?

"Well, it certainly wasn't for the cold showers and lack of water in general," explained Kyra speaking before a church congregation. "It wasn't for the large cockroaches or spiders in my bedroom and sometimes in my bed... or for the enormous rats that come out at night. It wasn't for the staple diet of rice and beans or for the stench and filthiness of the streets. It was not for the toxic air pollution from old diesel vehicles, nor for the lack of electricity or the insecurity and corruption. 

"It was not for the relentless humid heat nor the overcrowding," she recounted. "It is not for the infections that come along with the work - I have had scabies twice, malaria once, giardia countless times, and ciguatera poisoning..." Upon further reflection, Kyra said, "I think what keeps me going back is the mere fact that I've seen the misery of these people... the struggle they must fight to merely stay alive, the practical problems of existence and the hardships they go through each and every day without exception.  I see their pain.  I feel their pain.  I am compelled to react," she said, personally summarizing her call to nursing.

Observing the Unthinkable

Kyra worked first as a volunteer at Haiti's largest pediatric hospital, then later on as staff at the Maison de Naissance  (French for ‘Birthing Home') Foundation as their first-ever fulltime expat in the position of program development and sustainability officer.

Along the way, she observed the unthinkable.

"I've seen four newborn babies die from neonatal tetanus because their umbilical cords were cut with dirty tools and because their mothers had no access to the tetanus vaccine. I have seen babies whose ears, noses or toes have been nibbled off by rats. I have cared for severely burned children who scream in agony as their dressings are changed without the luxury of any pain medication whatsoever," she recalled.

Pediatric burn injuries are prevalent on the island - with a lack of electricity, dangerous open fires and hot cauldrons for food preparation, as well as kerosene lanterns and candles inside the small homes are the norm.

Nursing Haiti's Children

Kyra has nursed too many children who have fallen innocent victim to Haiti's shortened life expectancy. Meet

Kyra Abbott, BSN, RN, spends precious time with patient Sebastien.

"Cancer treatment is rare and the field of oncology only just emerging in Haiti," explained Kyra. "The basic diagnostic tests, treatments and care that are available (i.e. CT scans, a very few oral and parenteral chemo drugs) are generally only accessible to the upper class due to their costs.  Still, most upper class Haitians would opt to travel abroad for any specialized medical care."

Kyra noted that Sebastien was "lucky" enough to receive care at Saint Damien Pediatric Hospital, a Catholic mission hospital for the poor, "where he received free care including painful chemotherapy - no central lines in Haiti -and also had a kidney removed. He traveled to Dominican Republic for radiation therapy (also paid by the mission hospital).

"His cancer metastasized and more chemo treatments were trialed," explained Kyra. "At various times his eyes swelled out of their sockets and eventually he lost vision in both eyes. Sebastien had a million dollar smile and dimples that would melt anyone's heart. He fought his illness with courage and patience and grace...."

Sebastien died in March, "after incomprehensible suffering. He was only 9 years old. He is certainly resting in well-deserved peace," said his devoted nurse.

A Haitian mother holds her newborn at Maison de Naissance. A proud sibling shares the moment.

Looking Forward

So again, I ask while pondering Kyra's testimony, "Why Haiti?"

"Now that I have born witness to the plight of these people, now that I have seen first-hand the gross injustices of their lives, now that I know they are out there, I cannot possibly turn my back on them," said Kyra. "I have seen too much preventable suffering."

Ah, "preventable." It is a word that breathes hope for the future.

Next: A Haitian nursing school is called "a miracle."

I first sailed into Haiti on a little Brit ocean liner. It was nothing like the ones you see today... no water slides, casinos, spas or rock climbing walls. Just 500 passengers, a British-accented crew and an environment so innocent that the rooms had no locks or keys. Risky by today's standards, but carefree by yesterday's. In my mind it was a floating slice of heaven.

It stood in stark contrast to the island reality that I first glimpsed through a fogged porthole. I remember making my way to the outside "promenade" deck after docking. Peering down into the harbor I saw young men -- hardly more than boys -- in rag-tag rowboats, dwarfed by our ship, yet doggedly, persistently rowing closer and closer. Once within earshot of the passengers still waiting to disembark, they started their calls for money.

"Throw down your coins! No copper, silver!" Not realizing the poverty that brought them to this display of desperate child's play, we starting pitching nickles, dimes and quarters over the side of the ship. The young men would make wild dives or great flying leaps from their boats to catch the coins and retrieve the spendable prize, much to the delight of well-heeled passengers. If one showed particular athleticism, more coins would be thrown in his direction.

Next, another plea: "Soap! Throw down your soap!" Dutiful child that I was, I ran full bore back to my stateroom, to gather up tiny bars of soap supplied by a kindly room steward. I remember the boys yelling, "Hey lady, hey lady!" at me, in hopes I would fling a bar their way. I was only 12! I had never been called a "lady" before. Finally, an urgent request, "Cigarettes!" And while I had none of those, plenty of passengers darted down tobacco torpedoes which these boys grabbed right out of the air before they ever hit water.

It's a faded memory, a clue to the state of life in Haiti in the 1960s. And now, more than 40 years later, has it improved? Finding out for yourself is no easy trick, mind you. The U.S. State Dept. sternly warns Americans to stay home, or risk the dangers of civil unrest, kidnappings, murders and other violent acts on an island where law enforcement "isn't." But I've noticed that some of the cruise lines have indeed started to put Haiti back into their itineraries. Could be a hopeful sign. Let's take our own look at the bruised Pearl of the Antilles, through the eyes of nurses in the field. But first, some background...

Ki laj Ou? How old are you? (Haitian Creole)... A baby born in the United States has a reasonable expectation of living to 80. Some will succumb earlier, others will travel well into centenarian territory. But if your human journey begins in Haiti, pack light. Life expectancy is just 57. Only 720 miles from Miami's South Beach -- where "beautiful people" primp, parade and outpace paparazzi -- Haitians toil to make ends meet and avoid succumbing to all-too-early statistical demands. At a point Americans consider vibrant middle age, many Haitians are rendered "old" from the exhaustion of daily living.

Ki sa ou genyen? What's wrong?... It isn't any one malady, but a confluence of threatening circumstances that have come to oppress these people. Granted, life is never fair. But it seems a little less fair in Haiti. "What's wrong" began after an unprecedented slave rebellion, 1791-1804 -- the only successful slave revolt in the history of the world, says Wikipedia. Yet in this first Black-led republic, and first Caribbean state to achieve independence, things went terribly wrong. Wealth fell to a minority (5 percent) Mulatto elite, foreign business interests, and eventually greedy and brutal dictatorships. There were no worse than voodoo physician Francois "Papa Doc" Duvalier (who ruled from 1957 until his death in 1971) and his son Jean-Claude, dubbed "Baby Doc" (in power from 1971 until overthrown in 1986. Having gone through his ill-gotten fortune, he lives in exile in a small flat in France, largely on handouts from others). During three decades of Duvalier rule, some 40,000 political opponents were killed at the hands of their Tontons Macoutes militia, while the reigning tyrants raped the Haitian economy through decadent personal indulgences and unthinkable, unedited spending sprees. It's no wonder violence and political instability became par for the course -- perhaps a reactive cry against human rights abuses, illegal drugs and arms trading, human trafficking and kidnapping.

Mwen grangou. I'm hungry... It's painful to imagine what great good might have been done for the Haitian people with the Duvaliers' misdirected wealth. Instead, Haitians today live in what is described by the CIA in its World Factbook as "the poorest country in the Western Hemisphere, with 80 percent of the population living under the poverty line, 54 percent living in ‘abject' poverty."  About half of the population is illiterate; there is no public education. Per capita income is about $560 per year (according to UNICEF. Some agencies put that figure much lower.) Two-thirds of the labor force are "freelancers"... meaning unemployed, or without a formal job. Most families live in tropical heat without electricity (think of that the next time your air conditioner goes on the fritz), and there is not enough potable water to go around. Most Haitians transport water, often contaminated, in buckets... on foot. Think you'd hop into a car and ride over to the next town to get some supplies? Think again. There are slightly over 4,000 km of roadways, and over 3,000 of them are unpaved.

Sa k'genyen? What's the matter?... And then there are the insults added to injury. Haiti lies in the midst of the hurricane belt. In 2008, Fay, Gustav, Hanna and Ike all paid their windy respects and deposited torrential downfalls on the island, leaving behind heavy flooding, mudslides, "physical and economic devastation," according to the U.S. State Department -- and 300 dead. Haitian mountains may have stood strong against hurricane-force winds, but they  have fallen prey to the power of poverty. They have been deforested because the poor cut trees for fuel. The offshoot is: precious topsoil is swept into the sea, leaving little raw materials for those who subsist on meager crops of rice, beans, corn and bananas.

It should come as no surprise that Haiti's high population density (9 million people in 11,000 square km of land) teamed with grossly inadequate healthcare has opened the door to tuberculosis, malaria and HIV. And yet, Haiti calls to some. Kyra Abbott, BSN, RN, answered the call.

Next time: Mwen se infimye ou. I am your nurse... Why one Canadian nurse took on the challenge.

Let's talk: Post a comment or email me at vnewitt@advanceweb.com

I say it all the time.

But recently, when I was researching conditions on the once-idyllic "Pearl of the Antilles," I realized that maybe what I actually mean is: "I want to do more vacationing."

Travel isn't always piña coladas and clear blue waters. It isn't always smooth sailing.

The aforementioned "pearl" is Haiti, western third of the island of Hispaniola, connected by land to a distinctly different Dominican Republic. I went there once, at the innocent age of 12, with my family, "on vacation." We sailed into Port-au-Prince on an old British cruise ship - The Ocean Monarch (Furness Lines). After a half day's tour, some Calypso music banged out on steel drums, and shopping for native wood carvings on the pier, we piled back onto our air-conditioned ship and sailed into a Caribbean sunset. Can anyone say "midnight buffet"?

Trouble is, we were oblivious to the plight of Haitians, residents held economically captive to an island world that would become storied for its degree of human sorrow. We didn't have a clue to the disease, hunger, violence or despotic rule that clamped shackles on a population descended from slaves and proud to lay claim to the world's first Black republic. The heat-soaked, tropical port-of-call I experienced was no more akin to the real Haiti than the glitz of the Taj Mahal is to the slums of Mumbai.

So, this blog is devoted to travel, with one important twist: we'll experience it through the eyes and voices of nurses the world over - some in Third World countries, others in countries with a long history of universal healthcare. They will serve as our guides to a global view of the profession we revere. We'll start our trek in the Caribbean, but we'll follow an uncharted course, crisscrossing oceans and borders, languages and customs to find human challenges shared by those who seek to give care to others.

Accompany me.

Better yet, steer the ship. Join in conversations, ask questions and know your input will always be the most important markers along our passage.

Come with me, back to Haiti.

It won't be postcard-pretty. But amidst the poverty and struggle of what is now the poorest nation in the Western Hemisphere, we will also, indeed, find hope.

Next: How the "Pearl" lost its luster.

Meanwhile: How about you? Any nifty travel stories to share? Post a comment or email me at vnewitt@advanceweb.com. Let's talk.