One
day we were in a ghetto in Cap-Haitien, and we were down to our last syringe.
It was a big one tooan 18-gauge needle. We had to save it for the
sickest person we could find. So for the rest of that afternoon, we used
alternativesoral medication and what have you. There were many people
who needed it, but we finally used the syringe on a little kid with a
temperature of 104. We had to make some hard choices. The hardest part
of the experience was that every day we either ran out of time, drugs,
or both. We could never see all the people who came. When we arrived in
a town early in the morning, there would be a line of people out the door
waiting to be seen. They waited for hours. Almost every day, we left with
people still in line.Eddie Gammill, 01N
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Haiti is a place where
desperation is palpable and need seems endless. Virtually everything is
lacking except children, hunger, ill health, and misery. Relief workers
and drug smugglers alike are pulling out.
It was here, on this tropical island of charred palm trees and ruined
pastel-colored houses, that Emory nursing student Eddie Gammill came to
understand the stark realities of life and health care in a developing
country. The experience was jarring, eye-opening, and ultimately transforming.
Flying into the coastal city of Cap-Haitien, Gammills first glimpse
of the Paris of the Antilles was a blackened and desolate
landscape.
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Eddie
Gammill, 01N, was among the students who traveled to Haiti last spring.
He is the founding president of the Emory International Student Nursing
Association. |
The place looked
like it had been bombed, says Gammill, president of the class of
2001 and founding president of the Emory International Student Nursing
Association (EISNA). I later found out that people had burned the
trees to make coal for fuel. You dont see a lot of beauty in Haiti.
You see a lot of filth and squalor. The people there have absolutely nothing.
Its an unbelievably sad place right now.
For nine days last April, eight BSN and MSN students traveled from their
base in Cap-Haitien to towns with melodious names like Lemonade and Milo.
What they encountered was almost beyond comprehension. Babies with scabies.
Women with six, seven, and eight malnourished, worm-riddled children in
tow. People carrying elderly relatives with diabetes or congestive heart
failure. Adults and children with malaria, tuberculosis, HIV.
We would examine them and see what we had with us that could help
them, says Gammill. We did a lot of hands-on work ourselves,
although we were supervised by instructors, physicians, and graduate students.
We gave patients head-to-toe assessments, and we quickly learned to take
cultural factors into account. Haitian women would not talk about womens
issues if a male was translating. We had to be aware and work around these
things so we could give the people the care they needed.
Gammill quickly realized that the Haitian people need much more than the
group of Emory nursing students could possibly give in nine days.
I would look at these people living in this desolate, destroyed
place, and think, This is hopeless, he says. In
order to go on, I told myself at the end of each day, I did some
great work today. I couldnt help everyone, but I did what I could.
Then I visited a Haitian nursing school that had only chalkboards
and a few chairs, and I had a revelation. I thought of the old saying,
If you give
a man a fish you feed him for a day. But if you teach him how to fish,
you feed him for a lifetime. I suddenly realized how egotistical
it is to think youre going to change the world in a day. People
like Gandhi and Mother Teresa changed the world, but it took them a lifetime.
The big picture
Lasting, sustainable improvements to health in developing countries is
the objective of a new graduate major the School of Nursing will soon
offer in coordination with the Rollins School of Public Health. The international
masters of science in nursing/public health degree aims to develop
three types of nurse leadersthose from other countries who will
return to their home countries and improve health care systems there,
those looking to work internationally outside of their home countries,
and those who will work with exploding immigrant populations within the
United States. Current MSN/MPH programs focus on clinical specialties,
such as family nurse practitioner or midwifery. This new MSN/MPH program
offers students a big-picture perspective that focuses on
changing health care systems and policies that could potentially impact
entire nations of people.
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Grace
Anne Turner (center) and Monica Crolle, both 01N, assess a young Haitian
boys condition. |
Nurses are the
largest body of health care providers throughout the world, says
Joyce Murray, nursing professor and a member of the curriculum committee
that planned the new two-year program. This program will help nurses
build capacity within their own countries, sustain health care there,
and fight for the resources needed to deliver health care.
Elizabeth Downes, academic program coordinator of the Lillian Carter Center
for International Nursing (LCCIN), says this new program offers the potential
to create lasting contributions to health care in developing countries.
I see training as the place where nurses can make the biggest difference.
Whether its teaching hygiene to a group of mothers or CPR to nurses
or developing curriculum at a nursing school, we hope to develop programs
at the Lillian Carter Center with sustainable impact.
The new MSN/MPH major aims to accomplish just that. Students from other
countries will enrich and diversify the Emory student body. Training them
and US students will offer lasting contributions to health care systems
in developing countries, where nurses are often the only health care workers
around. These nurses are dear to Downes heart.
They are tireless, dedicated, caring, and hungry for education,
she says. I have seen nurses who walk six miles to work, complete
a full shift, go homeoften on footand then cook dinner from
scratch. We are talking firewood and pounded corn. It is hard not to be
in complete and utter awe. It is also hard to turn your back on them.
A gift of opportunity
The fledgling EISNA is a sure sign that students are taking a growing
interest in international nursing issues. Gammill, the groups first
president and now an emergency room nurse at Emory University Hospital,
was determined to make the Haiti trip more than just a spring break jaunt.
He worked with Dean Marla Salmon and Helen OShea, baccalaureate
program coordinator, to make sure
students who worked in Haiti earned academic community nursing credit
for it.
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EISNAs
founding members from the Class of 2001: (top row, LR) Dallas
Regan, Eddie Gammill, Sarah Pawlik, (bottom, LR) Erin Brantley,
Brittany Holley, and Deborah Osgood. |
We wanted the
school to recognize the value of what we were doing, says Gammill.
Its a good thing Dean Salmon was behind us every step of the
way, because we never intended to take no for an answer. In making international
work part of the curriculum, we created an opportunity for future students.
Community health nursing instructor Brenda Cobb says the Haiti trip met
the academic goals for the course and beyond. They learned firsthand
about culturally appropriate ways to care for patients, she says.
They also gained an appreciation for the importance of cultural
influences and social, economic, and political factors on health. As a
faculty member, it was gratifying to see them put together all the pieces
of the nursing curriculum to use.
Watching the students personal growth during the experience was
equally meaningful. As people, they recognized the realities of
living in such a difficult, devastating environment, Cobb says.
As nurses, they came to understand how that environment influenced
the health and health-related lifestyle choices of the patients. Above
all, they learned the importance of working together in cohesive teams.
We all needed that support to work under the conditions we found in Haiti.
When worlds collide
Nursing senior
Anu Gopalan lives with one foot in the high-tech, fast-paced world of
the United States and the other on a dusty road in rural India. EISNA
president for 20012002, Gopalan brings an international perspective
to the School of Nursing through her own life experience.
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We
have so much here, and the developing world has so little. We
are citizens of the world, and we have a responsibility as such.
Anu Gopalan, EISNA president |
Her childhood was
split between India and the United States, and she returned to India when
she was 15, after both parents were diagnosed with terminal cancer. They
died soon after, within three months of each other. Gopalan remained in
India to finish high school and attended college in the United States,
earning a degree in biochemistry from Rutgers. She says its easier
to accept her parents deaths as an Indian than as an American.
Americans tend to think optimisticallythat things will always
go well for them, she says. But in places like India, lifeeven
survivalis a day-to-day proposition. You have to live in the present
in a place like that. After my parents died, every day on my way to school,
Id step over people sleeping in the streets. It occurred to me that
many of them could have been dead. In a place like India, theres
a very thin line between death and life.
Indeed, people die every day from preventable diseases in developing countries
like India. Leprosy, tuberculosis, malnutrition, and diarrhea are rampant.
Life is often cut short by illnesses that these days rarely kill anyone
in the United States. Gopalan believes EISNA will encourage her classmates
interest in life outside US borders.
Nurses are the answer, she says. We have so much here,
and the developing world has so little. We are citizens of the world,
and we have a responsibility as such.
EISNA hopes to organize student trips to Cuba, Mexico, and Haiti during
20012002. Our goal is to get at least 10 students to another
country, Gopalan says. An understanding of developing countries
is not something that can be taught in a classroom. It comes from experience.
Going to another place and being immersed in a different culture opens
the mind.
After graduation next spring, Gopalan plans to earn an MSN/MPH and become
a pediatric nurse practitioner. She then hopes to return to India, where
she would like to run an orphanage or clinic in a rural area.
Her single-minded resolve to pursue a career in international nursing
stems from a moment of clarity back in India.
I was riding a bus one day when I was about 18, and I sat down next
to a woman with severe leprosy who was breast-feeding a baby. She had
lost her eyesight, and her hands were a mess. It struck me that she couldnt
even see her baby or really even feel what it was like to hold herall
because of a preventable, treatable disease. At that moment, I decided
I would become a nurse and come back to India. This is the work I was
meant to do.
Valerie Gregg is assistant director of Health
Sciences Publications at Emory University.
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