More American nurses are venturing out into the world to offer their skills, even if only for a short period of time. Maybe it’s earthquake or cholera relief in Haiti, rural community health in Latin America, military duty overseas, or a short-term mission trip to Africa. No matter where you go, you need to prepare so you can make the most of your experience.

Inside the bubble

We all exist in an invisible “bubble”—an insulating set of comforts and expectations to make daily life easier and predictable. The “bubble” consists of familiar routines. It’s also a set of cultural assumptions, most of which are taken for granted. For example, whether which side of the road you drive on, the way a toilet operates, table manners, or the proper greeting when you meet a stranger.

To use your nursing skills in a foreign location is a challenge unlike any other. A trip to a low-income country off the beaten path qualifies as “adventure travel” with unpredictable elements. When you combine travel and nursing practice, you are going behind the scenes, to the places the usual tourist does not go, and meeting people on their own turf, in settings not in the guidebooks. You’ll need to learn a whole new set of travel skills. Here is a short list of things to consider.

Choose an NGO. NGO stands for “Non-Governmental Organization.” The most well known are Doctors Without Borders and the Red Cross, but there are literally thousands of groups working all over the world. An NGO will pave the way for you to use your skills fully. Often, you’ll be plugged into an existing program that will fit your needs. Some NGOs also help you with in-country travel and such things as food shopping.

Learn the language. Take language lessons. This is the single most important long-range skill required for most global health experiences. Nursing depends on making a person-to-person connection and dealing with the patients face-to-face. In a clinical setting you can’t always count on having an interpreter. Being able to say hello, navigate the local bus system, and order at a restaurant will ease your transition.

Meet somebody who is from there. In the largest American cities nowadays, you can find small pockets of people from nearly every society on earth—this is an amazing resource. Use the Internet or go to your local college to find somebody who is from the country you will be visiting. They can become a source of valuable information in all sorts of ways. Before I left for my first trip to Nepal I found a Nepali language tutor by posting a small flyer on the wall of the only South Asian grocery store in Honolulu. She taught me about language and customs such as table manners and greetings. Befriending a person from a different culture is a two-way street and has many advantages. It is something we can all do even if we have no intention of leaving home.

Go camping. Learn how to get by with fewer creature comforts than the typical American. If you have never prepared food using primitive equipment over a wood fire or used a privy, these skills will open your eyes to the daily challenges faced by rural people all over the world. Start to walk or hike regularly—if the transportation system is poor, you may find yourself walking a lot more than usual. Know that in some cultures, coffee is not a daily menu item. If you must have coffee every day, learn how to make it using a wire mesh filter.

Eat the food. This starts with going to an ethnic restaurant if there is one available. Be aware that in countries where cooking is the role of women, you can better understand this role by familiarizing yourself with food preparation and the time it takes.

Read the literature of the country. Start with a Lonely Planet tourist guidebook; these usually include the elementary rules of etiquette. You can learn about religion, politics, gender roles, customs such as those surrounding funerals, and body language.

Plan for culture shock and re-entry shock. Culture shock arises from the inevitable comparison to your home. Re-entry shock is something that sneaks up on you—it happens when you return, expecting to take up your life where it left off, but realize that you have changed in unexpected ways. It is not unusual after a global health experience to feel disconnected from your home culture.

Minimize your baggage. I have a friend who has led 10 trips to rural Nicaragua. She blushingly confessed to me that she brought a hair dryer with her the first time. On each subsequent trip she learned what she did not need. Nowadays, she travels very lightly, with only as much as she can fit in a daypack, for a 3-week trip.

Plan to share from the beginning. We owe it to our fellow Americans to educate them about global health, and a firsthand account is powerful. Get a camera and practice with it before you go. No matter how much you tell people, they will never understand what it was like unless you have photos when you return. If you buy souvenirs or artifacts, choose ones that tell a story about the daily life of the people. Keep a journal.

Learn about hospital and clinic standards. Many of the health problems in low-income countries are directly traceable to lack of public health infrastructure. There will likely be more problems with infectious diseases. You may end up learning how the local providers deliver care even though disposable supplies may be limited or they may not have new equipment.

Practice “water discipline” and food sanitation. Clean water is something we take for granted. Food- and water-borne illnesses are the single biggest problem encountered in foreign adventure travel. In many countries the water from the tap is unreliable. It is helpful to practice safe ways to use water that will become firmly engrained habits before your trip. Visit a travel clinic and start getting immunizations in advance.

Pop the bubble. Even if the primary purpose of foreign travel is vacation, and you aren’t planning to use your nursing skills, there are some things you can do to gain wider experience with other cultures. For example, if you go to the Caribbean, you can get out of the bubble by spending a half-day touring a local hospital. Often, somebody will gladly show you around even if you give limited notice. In low-income countries, up-to-date nursing textbooks are beyond the reach of local healthcare workers. Pack one with your luggage as a gift for the hospital library, and you will contribute to local health care even if it is a small way.

A global attitude

An experience in global nursing can be very rewarding if you prepare properly. Even if you never leave home, you can benefit from adopting a global attitude.

Joe Niemczura, who is a faculty member at the University of Hawaii, is planning his fifth summer-long trip to teach nursing in rural Nepal. His is the author of the book, The Hospital at the End of the World. Nurses are invited to visit Joe’s blog to see photographs and videos depicting hospital care in a low-income country.

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