Update Fall 2014 from Marcia Male, RN, MS, MTCM:
Marcia Male's background educationally includes a Bachelor of Science in Nursing degree 37 years ago (1977), a Master of Science in Nursing Education (2014), and somewhere in between, a Master's Degree in Traditional Chinese Medicine. How did that background prepare her for Alaskan Public Health? Read on!
Starting out with fascination for diversity
"Growing up in a Polish-speaking household and in a diverse city of ethnicities, I have developed a fascination with cultures and people," says Marcia Male. "Acquiring my degree in Chinese Medicine was another immersion in culture, even though it took place in the United States. All my teachers were from Asian countries, most taught through interpreters, and we teamed up to provide care for 120 patients a day over the space of three years.
Continuing with a goal of an international nursing career
Male continues: "We each find our place in the world over a period of time, and after nearly 40 years of patient care, I wanted my last ten years of full-time work to be international, full of adventure, and providing support that is identified by the host country. I decided to work with nurses from other countries with the intent to provide the highest quality of nursing care we can globally. Systems don't always work, government can hinder progress, and budgets can limit growth, but nursing can always be delivered at a high level of respect and caring for the person.
"I have always thought globally, with a vision of my life work in the world, not just my home community. I realized the greatest impact is within a community of focus for a longer period of time, contributing through presence, offering what you have learned from other experiences. The ability to immerse culturally and work side by side sharing knowledge to strengthen nursing's identity and impact is a great desire for me now.
"Having been a mountaineer, I discovered that living with limited resources and sleeping in unusual places does not bother me. I have always looked for experiences where I had to immerse within the culture, trying new foods, learning what is important to the people, and how they have adapted to their situation. So my first journey out of the US was to Nepal, where I stayed for three months. I did an observation of lowland vs. highland diseases in the pediatric population. The immersion changed my life.
"The last journey was as a nursing faculty to Honduras with the University of Wyoming's Healthcare brigade [all pictures to the left of this story were taken during that trip]. I saw our United States students struggle with the purpose and outcome of our presence in Honduras; that is the beginning of the global health journey. I truly believe that caring support through consistent presence in a community is the greatest benefit."
The next step
"My current interest," says Male, "lies in the Human Resources for Health Program in the Republic of Rwanda, Seed Global Health (Peace Corp Global Health Service Partnership), and to support the opening of the new Sidra Women and Children's research. Participation in those programs takes months to set up, and there is a selection process that occurs to ensure a good match. So I began looking for the next step [something that would prepare me toward the Seed Global Health position]."
That first step came this fall 2014: "I took a position in Alaska as Itinerant Public Health Nurse III," Male notes. "Based in Juneau, I am responsible for six island communities. I travel to work via ferry, boat, or seaplane. The job required the MS degree and prior Public Health experience, so my work with Teton County Public Health in Jackson, Wyoming was a good preparation. I will get to apply many of the rural concepts we studied in my master's program at UW, such as disparities of health issues, epidemiology, and informal community health assessments. The job includes immunizations for all ages, support for women and teens in pregnancy through newborn nutrition, pediatric growth and development and nutrition, screening and support set-up for domestic violence, drug and alcohol, and STD's [sexually-transmitted diseases]. I also provide nutritional counseling for obesity prevention.and much more. Alaska Public Health is designed to look at the individual, community, and systems. I feel very prepared for this role from my MS degree. This will be a great preparation to later work with Seed Global Health."
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For those nursing students at UW who are considering going on one of our Honduras brigades or desiring to explore international healthcare, Marcia Male shares what she sees as the main differences in healthcare between the US and places such as Honduras:
Access to Care. The primary issue worldwide is always about access to care. Distance, the environment, and adequately trained health care practitioners with adequate equipment is limited, and a limited budget all impact healthcare. The problems are the same whether you are in Boulder, Wyoming or a village in Honduras or Nepal; it's to what degree are the issues. In remote environments snow, method of travel, mud slides, lost bridges, high water can all prevent or delay access. A home birth in Honduras that suddenly needs medical care requires villagers to carry the laboring woman in a hammock down the mountainous terrain to a rough road where a vehicle or a horse can bring her miles further to a hospital. The same occurs if someone falls from a ladder or a tree. In the US its the risk we take living rurally but in countries with limited access there is no choice.
Training, Budget, Equipment. Honduras trains their nurses to a high level, but there is not a budget to support the numbers of nurses that are actually needed in the hospitals and clinics. The nurses also express the lack of equipment. There may only be three IV pumps for 30 sick infants. The nurses learn to improvise and share equipment while still keeping their patients safe.
Cleanliness. Cleanliness was another problem. Toilets in the Honduran hospital are never cleaned. We were warned for our health to not use their bathrooms. Patient care areas were clean. With limited budgets, you have to prioritize.
Medical Records. Medical records are also still in paper form. With many patients carrying the same name and unknown birthdays, there are volumes of space taken up by new folders of charts. This prevents continuity of care.
Cultural Beliefs. Cultural beliefs may also affect healthcare. In Nepal there is fear of bringing a newborn out on a trail as their spirit may be stolen. Families wait so long that the ill baby is beyond saving by the time they take the risky journey to a clinic one or two villages away, only to support the cultural belief when the infant dies at the clinic or shortly after.
Male notes what she enjoyed most about her experience in Honduras:
No one complained. It was quite remarkable. In an appropriate setting people would discuss problems, but as a culture, acceptance and tolerance are heightened by a choice to live a happy life regardless of the situation. It was deafening when I returned to the US. discontent with daily life
Male's advice for nurses thinking about doing work in global health:
If working in global health is calling to you, don't wait. People need help now.
You can find a one-week or one-year setting that works for you; it can be locally or internationally. Just get started, learn the issues, and spend a lot of time searching and reading online about global health. It takes a lot of research and discussion with other nurses to educate yourself and find your place.
Look for support programs that keep going back to the same location, as the consistent support and relationship development make the greatest impact.
Identify your priorities to help you focus when deciding which way to go. Any direction you go will build on the past experiences, and they will all be different.
Going international is challenging, think about how open and adventurous you are. Some organizations are all set up and you just go along, others you are more on your own.
Upon return, then share with your local nurses that global health is simply issues that are the same for all of humanity--it's the degree and specifics that vary.
December, 2014