Nursing experience abroad offers career-defining moments, valuable new perspectives and the chance to teach

During a summer spent volunteering in the rural wilds of the Dominican Republic, neuro critical care nurse Jeanesse Rodeffer made home visits with a local doctor. One encounter forever changed the way she approached her profession.

That muggy day, as they neared the modest, three-room house, Rodeffer learned it was home to a young mother and her teenaged children. The woman greeted them at the door with a warm hug.

In the corner was her son, looking frail. The boy had leukemia. Yet unable to afford treatment, he was spending what time he had left with his family. “His voice was weak,” remembers Rodeffer, “but I never heard so much strength.” The teenager asked her to comfort him. She nodded and took his hand.
 
Rodeffer brought back to Hopkins the understanding that the most humble of gestures—a touch, a smile—can make all the difference to a patient. “I’ve learned to forever incorporate that into my practice,” she says. “It’s comfort beyond the medical. It’s the ability to empower the sick by showing them they’re still human.”

For years, international volunteer opportunities like Rodeffer’s were mainly geared toward medical students. Even when faith-based groups or charitable organizations such as Operation Smile (see sidebar below) had openings for nurses, they weren’t always well-advertised.

Today, though, in this increasingly global society, Hopkins is doing more to match nurses—both homegrown and international—with opportunities to practice, teach and train abroad. Hopkins Hospital’s revitalized effort to recruit nurses from overseas is one indicator of that trend. The success of January’s week-long School of Nursing program for nurses interested in international emergency relief is another.
 
So too is the creation of the Office of Global Nursing, a new partnership between the School of Nursing and the Department of Nursing. Its mission, says director Jane Shivnan, is to position Hopkins Nursing as a global leader by sharing its expertise and knowledge with the world. A top priority: linking interested nurses with the programs and regions that desperately need volunteers.

Kevin Driscoll, for one, is thrilled. The surgical intensive care nurse spent countless hours researching volunteer projects in Thailand, finally connecting with a British charity organization. Last January, he headed off to Phuket to set up an orphanage for children displaced by the tsunami. But as aid poured in, Driscoll’s contact advised him that his skills would be more valuable in a remote jungle hospice further up the coast.

The hospice, housed in a Buddhist temple crawling with termites, served mainly prostitutes, fishermen and orphaned children with HIV/AIDS. There are growing numbers of these temple-hospices throughout Thailand—the monks’ attempt to manage the burgeoning epidemic in the absence of a government solution. Sadly, a lack of resources renders them more final destination than treatment facility.

Driscoll was the first Western male anyone there had ever seen. For close to a month, he cared for sick and dying patients who lived on the ward or in two barracks segregated by gender. No one spoke English.

Each day, he’d wake early to bathe patients with collected rainwater, treat their wounds with homemade dressings and disinfect the mattresses with alcohol. The caretakers, a local couple who ran an adjacent rice farm, had a practice of putting the people they thought were near death in the beds closest to the restroom. “No matter what their condition, the people in those beds would lose the will to live,” says Driscoll. “They knew they’d been moved to the death beds, so they adopted that role.”

Driscoll respectfully put a stop to that. Slowly, the patients’ spirits lifted. Instead of hiding in a far corner, they approached him, pointing hopefully to their wounds. His lesson in palliative care followed Driscoll back to the SICU. Now, when he withdraws care from a dying patient, he removes any equipment that blocks the family from making physical contact.

He also uses his story to encourage colleagues that their skills and compassion are in demand abroad. “It’s not portrayed nearly enough that going overseas is an option for us,” he says. “The opportunities are endless.”

Michelle Mays recently discovered that for herself. With less than two years’ experience on the school-age children unit (CMSC 4), Mays never dreamed she’d see a classroom from an instructor’s perspective. Yet in February, on a month-long volunteer trip to eastern India, she taught anatomy and physiology and med/surg to first- and second-year nursing students at a junior college.

The college is part of a local Christian ministry, which also runs a children’s home, medical clinic and other welfare centers in the port city of Visakhapatnam. Women come from all over the region to attend its diploma nursing program. Though most speak some English, their official tongue is Telugu. Mays says the medical terminology presented a challenge. “How do you explain pH in plain English?” she says.

Another conundrum: Nursing there is oriented more toward practical skills rather than assessment. “I tried to introduce critical thinking,” says Mays. “At first it intimidated them, because that’s what the doctors do. But I explained that if the doctor isn’t around, they need to be able to think through why a patient is short of breath.”

Posing as the patient, she had the students listen to her breathing, imitating different sounds like asthma wheezing. “I wanted to give them the same experiences I had in nursing school,” she says.

At first, Mays spent each evening outlining what she would cover in the textbook. Soon, though, she realized that just as important were the things that aren’t in any book—tips learned from seasoned nurses on the job and what it really means to be a nurse. “Nursing isn’t like any other job,” she says. “It’s about connecting with people. It’s about caring for them when they’re really sick and even once they’re better. Pinpointing those details and sharing them with the students made me so proud of my profession.”

-From Hopkins Nurse, Spring 2006

PHOTO: Jeanesse Rodeffer, neurology, Kevin Driscoll, surgery, and Michelle Mays, pediatrics, hope more nurses will take advantage of humanitarian opportunities abroad.