A Nurse Practitioner’s Medical Mission to Africa

This week I am featuring an interview with my sister in-law, Elizabeth Fields.  She recently went to Bora, Ethiopia with the medical mission group Health Gives Hope.  Last week, I interviewed their founders, one of whom is actually a Nurse Practitioner!  Click here to check out the previous post.

To give you a little background about Bruce and Elizabeth Fields, they are quite the athletes and world travelers.  Bruce played professional basketball in Europe for 9 years and now works at State Farm in the Chicagoland area.  Elizabeth played volleyball at Parkland College (where I played basketball for a short time!) in Champaign, IL and then completed her BSN at Indiana Wesleyan University while continuing to play volleyball.  She has worked at Northwestern Memorial Hospital for the last ten years as a registered nurse, working the last two years as a Nurse Practitioner.  She obtained her FNP from Walden University.

These two crazy kids.  They met in Austria some odd years ago and have traveled to the following countries either together or separately:  Turkey, Switzerland, Austria, Thailand, Ethiopia, France, Italy, Belgium, Norway, Spain, England, Philippines, South Korea, China, Russia, Ukraine, Poland, Germany, Mexico, Japan, Denmark, Canary Islands, Romania, and Canada.  Oh, and Bruce has lived in a handful of them as well!  Clearly they know a bit about traveling!  Me, I’m more of anxious traveler (think Monica Gellar going to London).

I decided to interview them to give people a look into the practical side of what going on a medical mission looks like.  As you read, Bruce is not medical.  However, what he lacks in nurse-ness, he makes up with hard work and height.  (He’s 6’5″.)

Please note, answers given below are from Elizabeth, unless otherwise indicated.

Why did you decide to go on a mission?

I went to Bora, Ethiopia because they don’t have access to health care, and this was something I could not only make a difference doing, but I knew it would grow my knowledge and stretch me professionally. I also went on a mission trip to live out something I was taught and believe in deeply: you should use any talent you are given to bless others.  Nursing is a talent that was given to me and I am passionate about sharing it.  

What was the travel there like? 

This is from the HGH website: The team flies from the US to Addis Ababa, and then drives south through the lower rift valley into the Guge Mountains of southern Ethiopia.  The team will then hike 6 miles, ascending nearly 2,000 feet, from where the road ends in Chencha to the village of Bora.

Travel in Africa is entertaining and challenging. We were on planes, boats, buses, and on foot – our baggage traveled up the mountain by donkeys and our road was often congested with cattle, camels, and people.

Tell me what was going through your mind the first time you saw their set up for medical care?

The clinic set-up is smart, efficient, and well planned – their resources are growing – but the first thing you think is – “WOW – they have access to SO LITTLE compared to what we are used to; how am I going to make it work?”. But then, you make it work, and realize how MUCH we have in the States and how profound your assessment skills are!

What are some of the biggest differences between the care you provided there versus in the USA?

We had no access to running water, internet, or specialty consults. We had no diagnostic testing. I had to be excellent in my history and physical taking, and in my assessments so that I could determine differentials and treat appropriately. The creativity needed to get medications into infants, translate reasons, times, importance and information to patients was profound. The translators were amazing, but I have to hand it to the nurses – they had so many amazing ideas to help make these challenges ones we could overcome.

What were your meals like?

AWESOME and different! It was a mix of American food and authentic Ethiopian foods. The people there are extremely hospitable and loved cooking for us. We got to observe and help them cook in a “cooking hut”, and experienced what is like to cook without any modern conveniences. Some of the meals they made for us I have tried to recreate here, and have been moderately successful in accuracy.

What were the sleeping conditions?

We slept in mud huts, on straw, in our own sleeping bags. At first I struggled with the conditions – it is exactly like you would see it in the National Geographic! But looking back, I wouldn’t have wanted to sleep anywhere else; I lived and experience it in the most authentic way possible.

Tell me the bathroom situation, STAT.

Bathroom? You mean tell you what it was like to squat on a gorgeous mountain side and hope no animals or humans saw my southern regions? Two words: wet. wipes.

Tell me about some practical cultural differences.

One of the things that hit us hardest was the reverence and respect for elders that everyone had.  Here in the states the elderly population is often viewed as a burden, while in Ethiopia they are  cherished and consulted for their wisdom. Another shocking difference was how hard the women worked.  The Ethiopian people often refer to women as “provider”. You will see in our pictures that women do the heavy lifting there.

Elizabeth, walk me through one day as an NP there.

I had two interpreters assigned to me. Each patient would come in my exam room, tell me their complaints/history, and symptoms.  I would do an examination, diagnose their problem, and prescribe medications (pending availability). When I had a patient that “stumped” me, I called upon the other practitioners and nurses for their expertise. Because we had no diagnostic testing available (labs, X-ray machines) collaborating was our lifeline; we all needed each other to make each day in clinic work and it was an incredible experience!

Bruce, walk me through one of your days there.

 Every morning we wake up and walk from our hut down the mountain to a place we called “the cliff”. It was an incredible time to enjoy a beautiful view and reflect on our days there. We then returned to our compound to have breakfast that was made for us by the locals.  It consisted of grains, potatoes, sauces, and amazing Ethiopian coffee (FYI, Ethiopia is the birthplace of coffee). We hiked up the mountain a mile to the clinic every morning, with the village children holding our hands the entire way — this experience melted my heart.

My time in the clinic consisted of building shelves, setting up a privacy tent for the bathroom over a hole dug by a previous team, working in the pharmacy dispensing the medication prescribed by the practitioners, and helping teach patients how and when to use them. I often made lunches for the entire team with another group member and did what was necessary to ensure a good flow at the clinic. I was concerned that because I’m not medical I wouldn’t be very useful, but when I got there I found the opposite to be true. We each had a role and without each other it would’ve been impossible for the clinic to be successful.

How much did it cost?

About $2500 a person, and this included flight, ground transportation, lodgings, food/water, two days of sight-seeing. It was the cheapest 2 weeks abroad!

How do you feel this impacted your marriage?  Do you recommend married couples going together?

YES! GO TOGETHER! My husband isn’t medical, but the need is so great and watching him use his gifts in service by building shelves, working in the pharmacy, making team lunches, setting up privacy tents, and playing with the kids was  – well, SWOON. I can’t exactly bring him to work with me to see patients here in the States; watching each other in our own elements was amazing. It gave us greater respect for one another, and made me want to encourage him more in what he excels in.

I know these experiences are hard to predict how they will affect you.  What did you anticipate versus what did you experience?

I didn’t expect to want to stay there longer – but I was so sad to leave. There are days at work when I find myself in the grind of the day, burnt out and discouraged; to feel so needed and impactful in Bora, Ethiopia was priceless, and it took me off guard. I didn’t know I would fall in love with medicine again – I didn’t know that I needed to be there for my own benefit, just as they needed me there.

What did you learn that has changed your practice as an NP in the US?

Because I had to rely so heavily on my assessment skills and collaboration with the team when I was faced with a questionable diagnosis, I have worked much harder to perfect those areas since I’ve been back.  Those areas include knowledge and differentiation of various heart and lung sounds, alternative treatments, and preventative medicine. My desire to be a better provider has substantially increased since going to Ethiopia.

Would you do it again? 

We would go back tomorrow. Without blinking. It was professionally and personally something that humbled us, empowered us, and revitalized my passion for medicine and nursing.