Nursing across the globe

A personal reflection – by Libby White

The first time I attended the Global Emergency Care Symposium at Alfred Hospital several years ago, the presenters peaked my interest about working in an international capacity.  Listening to the experiences of healthcare professionals working in other countries, especially developing countries, really appealed to me.  I felt like I had exposure to world class nursing training in New Zealand, that allowed me to travel to the United Kingdom and work there, then move to Australia.  The nursing foundation I had gave me opportunities to move around the world and develop my skills.  I loved the idea of sharing these skills and the knowledge I had with my nursing colleagues, as well as learning about what nursing is like in other parts of the world. 

I had the privilege of going to Myanmar twice, to deliver a two week Trauma Team Training program to staff in the Emergency Department at Yangon General Hospital.  This was a real eye opener – seeing the limited space and resources the staff had to work with, but also the extended scope of practice and extra skills the nurses had.  As in many countries, there were not enough healthcare professionals, which is often because the systems are government run and the funding is not available.  So, the staff that are working in the Emergency Department share skills and teach each other to deliver care.  I watched the nurses identify a type of snake bite a patient had simply by putting some blood in a small bottle and leaving it for 20 minutes.  If the blood did not clot, then the snake was a viper and the patient could receive the appropriate anti-venom.  Such an amazing low fidelity test to save a patient’s life!  I had to watch on as a ten year old boy presented with rabies after a dog bite months earlier and I learnt there was nothing that could be done to save his life.  This was really confronting and I had to ask a lot of questions of my Myanmar colleagues to help process this situation. 

Returning to my job at The Alfred made me very grateful to have been born in a country with free healthcare and to have access to so many resources.  But it also cemented in my mind that because Emergency Care is such a new specialty, it was part of my responsibility to ensure that my international nursing colleagues had the opportunity to acquire the same skills and knowledge as me, to provide the best care possible to their patients.  Emergency Care only became a specialty in Australia in the 1970’s, which makes it so young compared to most other medical specialties.  After working in Emergency for 15 years I wanted to keep learning and what better way than to learn about Global Emergency Care.  My idea was to continue teaching and learning in different environments.

I attended the GECC and networked with experts in this field.  I applied for volunteer jobs and basically could not stop talking about working internationally!  Being vocal paid off and I eventually secured a job in Tanzania, East Africa.  The Nurse Mentor Program is a collaboration Alfred Health has with the Emergency Medicine Association of Tanzania (EMAT).  The objectives are to support the nurses to develop their skills and knowledge as they pioneer Emergency Nursing in their country. 

Imagine a place where Emergency Nursing is so new that you did not hear of it as a specialty at university and you did not learn any basic life support skills.  You had no exposure to emergency equipment, like guedel airways or bag valve masks.  When you do start to hear that there are a group of healthcare professionals that have skills and access to equipment, you and every other healthcare provider scrambles to get access.

All over the world, nurses have the universal goal of providing the highest standard of care possible to our patients.  We want to see patients improve when treatments are implemented.  We want to see convulsions cease when diazepam is given, to see the conscious state of a child improve when you administer glucose or to watch a grandmother relax after she receives analgesia for her broken hip.  There are many challenges for nurses in developing countries that make this much more difficult to achieve, including access to medications, resources and information.  I believe that by sharing knowledge and role modelling behaviour and providing care for patients, my international nursing colleagues will find ways around these challenges, as they are so resourceful.

Working at Muhimbili National Hospital (MNH) as part of the Nurse Mentor Program was such an honour.  MNH is the national referral hospital, so the sickest patients in a country of around 50 million people flow through here.  We were performing CPR multiple times every day due to patients not receiving emergency interventions from the previous hospital they were at and because they were not receiving care in the ambulance that had often carried them for several hours.  There were no trained paramedics and very few specialist Emergency Nurses.  It seems like such a massive job to implement new systems, but the team at MNH had a plan and they are forging ahead, making incredible changes in their country.  Just inspirational.

One year of working with the incredible team at MNH turned into three years of incredible work and knowledge sharing – I basically had to be dragged away because I could have stayed there forever!  When I got back to Australia, I knew I needed another challenge and I looked to the Australian Volunteers Program for an opportunity.  As most projects had called volunteers home because of the pandemic, an Emergency Nurse Educator job in Vanuatu was a rare find. I applied for this and left for this small group of tropical islands in the Pacific just before Christmas 2020.

This was another wonderful experience, collaborating with a group of Emergency Care professionals in Australia and New Zealand to contribute to long term plan of improving services at Vila Central Hospital (VCH).  I was working alongside my NiVanuatu nursing colleagues (which also included some nurses from the Solomon Islands, who have been recruited in Vanuatu to fill the nursing shortfall) and supporting them to implement a triage system.  After several weeks of training nurses and doctors from different departments within the hospital, I arrived at work one Monday morning to discover the nurses had started triaging!  They really took ownership of this process and could see how triage would benefit their patients.  What a rewarding finish to a fantastic time working in a covid-free tropical island paradise.

The Emergency Nurse Educator job in Vanuatu is on-going and there are several opportunities to work at VCH, so please get in touch with myself or the Australasian College for Emergency Medicine if you are interested in working in the Pacific right now!

I feel very privileged to have had these wonderful experiences overseas and it is so exciting to be part of Emergency Care development around the globe.  I am looking forward to this years GECC to learn about collaborations that are occurring in developing countries and see how I can get involved.  I hope to see you there!  

Libby White presenting at the inaugural Tanzanian Conference of Emergency Medicine (TACEM) 2016

From left: Nykanda Marwa, Irene Kubola, Sister Angelina Sepeku, Brittany Murray, Pendo George and Libby at the newly opened hospital in Dar es Salaam, Tanzania

Libby White presents her manager Marwa Obogo with a certificate after his presentation at TACEM 2016

Libby presenting to nurses at MNH

Libby presenting about care of the patient with rabies during morning teaching at Muhimbili National Hospital as part of the Nurse Mentor Program

Organisations to acknowledge:
EMAT
http://www.emat.or.tz/ 

Australian Volunteers Program
https://www.australianvolunteers.com/

Australasian College for Emergency Medicine Global Emergency Care
https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Global-Emergency-Care 

Global Emergency Care Conference
http://www.emergencyeducation.org.au/program/global-emergency-care-conference-2021/