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Message From the President

Crossing Borders

Cogley, Kimberly MSN, BSN, MBA

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Journal of Pediatric Surgical Nursing: October/December 2019 - Volume 8 - Issue 4 - p 87-88
doi: 10.1097/JPS.0000000000000225
  • Free

Wondering what it would be like to experience how healthcare is delivered foreign countries? We are so used to the routines of the United States—health insurance, prescriptions, and doctor appointments. Having the opportunity to travel with a nonprofit organization, Southeast Asia Prayer Center (, on a couple of medical mission trips was an enjoyable and eye-opening experience. As a master's-prepared nurse and a coordinator of a specialized center, some skills that would be required have not been utilized on a routine basis. The tasks that would be the main focus were taking blood pressures, temperatures, pulse oximeter, and blood sugars; assessing the medical condition; and assisting with any procedures when the physician evaluated the patient. There is a saying in missions: Those that are flexible will be stretched.

For a medical mission trip, there is much preparation that happens before the actual travel day: gathering supplies for the potential patients as well as making sure that the medications that may be required are available, booking flights, housing, and ground transportation because renting a car is not a feasible option in these foreign countries. Usually, the locations of our medical camps are with the unreached people; we travel great distances to hold the medical camps. The most time-consuming piece is communicating with our host to organize where and how many camps we will hold each day.

The first medical mission trip I was invited to go on was to Guatemala. The focus areas are known as the Red Zone. These locations have the most impoverished and most dangerous communities. On one of our first nights there, as we were sitting outside enjoying the beauty, we heard what sounded like firecrackers. They informed us that what we heard were gunshots. Imagine going on daily trips into these hardcore communities bringing a team of seven knowing guns are a standard accessory. The medical team gathered every morning, said a prayer for our safety, and walked out to the van that would take us to that day's destination. Our van windows were tinted, and we were not permitted to open them. If anyone knew that the van contained foreigners, we were at risk of being held at gunpoint and robbed.

The medical camps took place in churches and school rooms. Daily, we were greeted with chaos as we walked into each camp. Patients were lined up for medical care, and they started to arrive 2 hours before our planned arrival. The team had to navigate through many challenges and barriers, including language, backups at the pharmacy, triaging under a tree, anxious people who were afraid we would not stay to see them, and just those patients who required a little extra attention and care. In 5 days, we were able to provide care to over 600 patients. Diagnoses included high blood pressure, diabetes, gastroesophageal reflux, abdominal pain, soft tissue masses, skin rashes, skin infections, headaches, migraines, joint pain, and vision issues. Anyone with a farsighted diagnosis chose a pair of donated reading glasses. In the end, the medical team worked tirelessly to provide care and was rewarded with smiles on the patients' faces.


After a couple of weeks of rest, the team began packing their supplies to start on another medical mission trip, only this time the destination was Nepal. The team endured more than 20 hours of travel via airplanes to reach the destination. Once we arrived in Kathmandu, we had a 7-hour car ride to the location where we would start the medical camps. The first camp was exhausting because of all of the travel and the 10-hour time difference. That day, we triaged and provided care for about 80 patients. Medical camp was a bit more organized, and in addition, the number of children was higher than that of adults. Being a pediatric nurse, triaging these patients was my priority, whereas the other nurse saw the adults. If she finished with the adults, she would then assist with pediatric patients.

The most impressive camp was near the end of our weeklong trip. The van took us to the bottom of beautiful breathtaking mountains, something that we would see in a painting. We were heading to the Makwanpur district. A large four-wheel-drive truck pulled up beside us and instructed us to climb into the back, and we headed for a 2.5-hour drive up and down the mountains to the medical camp. Roads were not cemented, nor were they blacktop. The roads were paths cleared of trees and weeds. We traveled through substantial mud pits and across a river. As we held on tight navigating these very tight paths when a vehicle or tractor is coming the other way, the vehicles get very close to the edge, and they do not have guide rails.

Once we arrived at the medical camp, the people of the village led us 800 meters down a hill to the church where we would be providing care for their people. The wall composition was dirt, and there was some padding on the mud floor and no running water. As we were investigating the accommodation, we came to realize that there was no bathroom; what were we going to do? The leader instructed the villagers to dig a hole in the ground, use some bamboo stalks as support, and wrap it with a tarp, and we now had a “squatty.” The people were kind and very appreciative of our presence. We began to triage patients, and there was no end in sight. Children carried siblings on their backs in slings to ensure that there was an evaluation as their parents were working. Again, the percentage of pediatrics was more significant than that of adults. The clinic ended after 5 hours, and we packed up all of our supplies and started to climb the 800 meters back to the truck for our long trip back down the mountain. By the time we arrived back to our sleeping accommodations, the entire medical team was exhausted, knowing departure was the next day. The days were long and hard, but providing care for almost 500 patients was rewarding.

Although Guatemala and Nepal are very different countries, the types of patients are similar. Diabetes incidence was higher in Guatemala, whereas abdominal bloat and intestinal worms were prevalent in Nepal. High blood pressure, gastroesophageal reflux, headaches, and joint pain have close to the same incidence in both locations. Each day in the medical camps, we encountered various procedures that were needed, including foreign body removal, wound care, insulin injections, and joint injections. In Guatemala, there was a gynecologist, and we assisted with these examinations also.

If given the opportunity, being part of a medical mission trip needs to be a must on every nurse's bucket list. Experiences like these should not be passed up. I encourage each and every American Pediatric Surgical Nurses Association (APSNA) member to take that next step, join the Global Health SIG, and become involved. It may be a scary thought to travel beyond the borders, but believe me, the experience is gratifying.

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