Many Roads

Nov 10, 2014 at 02:54 pm by steve

Vivian Myers (far right) with her team in Honduras.

Nurses Pursue Diverse Pathways to Fulfill Their Calling

In a changing healthcare landscape, the definition of what it is to be a nurse is evolving and expanding. What remains a constant is that nursing is a profession of service. It is a calling that rewards those who pursue it with a world of opportunities to achieve their personal definition of fulfillment in both their careers and their lives. Here are a few of their stories.


Vivian Myers Going the Distance

For people in four remote villages in Honduras and Guatemala, the only access to health care is the twice annual primary care clinic staffed by nursing and pharmacy students, doctors and other volunteers through a program coordinated between Samford University and local village churches.

“We bring our own medicines and equipment,” Vivian Myers, RN said. “We only have what we can fit into a bag under the seat of the plane.”

Myers, who has been an RN at Children’s Hospital for four years, will be completing her degree next month in the Family Nurse Practitioner program at Samford’s Ida V. Moffett School of Nursing.

“Since we have information from previous trips, we have a good sense of what we are likely to see and need,” she says. “Everyone pools the supplies they bring and we leave them with a pharmacy student to dispense. We write prescriptions on the back of paper bags. Patients take the bag to the pharmacy student to have them filled. We include instructions printed in Spanish with each medication.

“Everyone gets antiparasitic meds and vitamins, since malnutrition is common. Villagers consider Tylenol a miracle pill, because it is the only medicine they’ve had for pain, and in this high poverty area, people do a lot of hard manual labor that takes a toll on their bodies. We also bring antibiotics that are likely to be helpful for the most common infections,” Myers said. “One of the most persistent problems are skin infections, especially foot infections in men who have to work in heavy boots. It’s hard to bring enough meds to help everyone.”

Myers said one of the most effective tools they can bring with them is the knowledge they can share through teaching.

“Headaches are a common complaint. Once we explain about dehydration and the need to drink more water, this sometimes takes care of the problem. Many of the mothers are very young. Some say the babies cry and they think their children have stomach problems, but as you talk with them, you realize the problem is hunger.”

Meyers ran into an even more dire encounter with hunger on a trip to Africa with friends from the Church of Brook Hills. She had planned to do a nutrition clinic, but the situation in a nearby village was so serious, with so many infants and small children near death, she told her friends to go on to the next village without her. As best she could, she set up a one-woman ICU to try to save children who were at the point of death from malnutrition and dehydration.

For Myers, the best part of the trip to Central America was “being able to care for people within their own cultural context. It was good experience in primary care. What I like about primary care is that it gives you an opportunity to see a wide range of conditions and to develop a relationship with your patients. I’m planning to work abroad long term, so becoming a primary care nurse practitioner seems to be the most effective option. “

Even the hours of hanging on to the back of a truck while fording streams and bouncing along bumpy mountain roads haven’t diminished Meyer’s dedication to what she wants to achieve in her life. If anything, working with the villagers she met in Central America has confirmed it.

When she becomes a full fledged nurse practitioner in December, Myer’s next destination is a full time career in international nursing and nursing missions.

“Probably either in Africa or somewhere along the borders in the Middle East,” she said. “Where needs are great, there are great opportunities for doing good.”


Julie Zaharis Practicing What She Teaches

In addition to being a nurse herself, Julie Zaharis, MSN, RN, CPNP, teaches at Samford’s Ida V. Moffett School of Nursing. An important part of her work is helping to set up opportunities for students in nursing and other areas of health care to participate in trips abroad where they can volunteer.

“Nursing is a service profession. Volunteering is a great way to learn to treat patients in a culturally appropriate manner,” Zaharis said. “We typically partner with organizations like e3, that have people on the ground in the country to help with logistics and follow up.

“Students who are studying to be nurse practitioners, or in pharmacy or eye care, help with triage and sit in as we treat patients. In some cases, students can be more directly involved in care with supervision.

“We see a lot of headaches from dehydration, and shoulder and back pain from the heavy manual labor people do. Along more remote areas of the Amazon, skin infections, particularly fungal infections, are more common.

Zaharis has participated in trips to Bolivia, Peru and three trips to Ecuador.

“On our last trip, an Ecuadorian doctor was with us and able to do follow up on more serious cases and conditions that need continuing care, like hypertension, that requires medications beyond the supplies we are able to bring with us.

“Sometimes the issue in outlying areas of Ecuador is geographic access to health care. Perhaps more often, it is being able to afford care. In their system, patients must go to the doctor and pay, then to testing facilities and pay, then come back to the doctor and pay again for a prescription that they must take to a pharmacy and pay to have filled. Follow up means more payments. In a poor country, there may not be enough money to cover the costs.”

Zaharis also volunteers her time to help abroad in times of need. Shortly after the earthquake in Haiti, she went with a plastic surgeon and nurse anesthetist to do facial reconstruction and used her experience from the burn unit at Children’s Hospital to manage post surgical care.

In Morocco, Zaharis was part of the Queen’s initiative to improve the lives of orphans by observing and reporting on differences in children placed in foster care compared to those in orphanages. Children in family settings tended to be better emotionally adjusted but more malnourished, while those in orphanages seemed better fed but suffered from more emotional disorders.

In China, more orphans are girls, since families need sons to care for them in old age, whereas in Morocco, more orphans are boys since the families of boys pay a dowry to the families of girls, and daughters are considered a financial asset.

“Learning about other cultures is an area of growing importance in nursing,” Zaharis said. “I was in Morocco for several hours before someone explained that after shaking hands, it isn’t proper to return your hand to your side, or it will be interpreted as wiping off the hand shake. You keep your hand up for a moment, near your heart.”


Pandora Hardtman Goes from Bermuda to Rwanda by Way of Birmingham

Born on the island of Bermuda where the British system of nurse midwives is a tradition, Pandora Hardtman, RN, grew up knowing she wanted to be a midwife. She studied at Johns Hopkins, became a certified midwife at UCLA, and then earned her doctorate in nursing practice at UAB.

“UAB offered the Global Health focus and was a WHO/PAHO collaborating center,” Hardtman said.

Today Hardtman and her twin, Josephine Murekezi, Chairwoman of the Rwanda Association of Midwives, are working to improve the health of women and children.

As in many countries torn by civil war, Rwanda’s health care system was among the casualties.

Since ambulances can’t reach many rural villages, and women in labor can’t always reach hospitals, upgrading the training of midwives seemed the most effective way to improve maternal and infant mortality rates.

Hardtman is Professional Standards Advisor for Nursing and Midwifery. “I am working with the Rwanda Association of Midwives paired to the President. We are designing the first-ever upgrade program for practicing midwives,” she said.

Judging by improvements in maternal and infant mortality rates, the strategy is working. “Rwanda is one of the few countries that is on target to meeting the MDG’s related to maternal child health. It is rated as one of the best places in East Africa to deliver,” Zaharis said. “Rwanda seems to be a great option given the major advances in healthcare that have occurred in the recent past.”

In Britain and the US, the TV series “Call The Midwife” has offered a different perspective on having babies. Hardtman finds the portrayal fairly authentic and sometimes reviews the first episode with students to identify the similarities between working in London slums and Rwanda, and looking for clues in the home that may affect care.

“Context is everything. For instance, postpartum infections are rare in the West. However here, with the challenges of clean water, infections are much more prevalent.” 

What Hardtman likes best about being a midwife is that “no two days are ever alike.” She and her sister are now working on a grant to implement a curriculum for specialized fistula training for midwives and physicians in a collaborative model.

For nurses thinking of going into international nursing, there are also considerations for their own physical health.

“You must consider the potential effects of long-term anti-malarial medications and the mental health challenges of daily living. You need a great deal of flexibility. Can you learn to take a cold bucket bath and be ready with plenty of candles for light? Internet is a luxury.

“Learn to appreciate the context of wherever you are--context changes everything. Don't be judgmental. Leave ethnocentric Americanism at home. Identify your motives for wanting to do international work. Accept that we are not here to save Africa or anywhere else. She has to save herself. We are here simply to plant seeds for growth.”

Karen Timmerman, Roads Less Traveled

Working full-time while caring for two small daughters and facing the reality that the extra cash for nursing school tuition isn’t there might make the idea of one day becoming a research nurse at a top medical center seem unlikely.

For Karen Timmerman, RN, however, the question was never if she would go to nursing school - but how. A scholarship partially repaid by working in the med-surg unit of a small town hospital in an underserved area of north Alabama opened the door.

“I gained a lot of experience in general medicine working there and learned more as an ICU nurse in an urban hospital,” Timmerman said. “When my daughters were in school, nursing allowed me to work closer to home by going into public health.”

Her years as a county nurse with the Alabama Department of Public Health also allowed Timmerman to fulfill a personal goal of helping those in need. Like a country doctor in days past who made house calls, she went out with her bag and drove up to 200 miles a day to care for indigent patients who often had little other access to health care.

“One of the best things about the job was also one of the hardest. You tend to become close to some patients and their families. When they are discharged or die, you feel the loss.”

Sometimes emergency calls came at two in the morning, and she responded, driving out on dark, lonely country roads.

“You are on your own, with no other skilled medical professional to assist. You rely on your training and experience, and learn to cope.”

Eventually Timmerman took a job in her hometown ER, where she never knew whether the next case through the doors would be a traffic trauma, a migrant worker with a snake bite, or a high school friend having a heart attack.

“In a small town, you know just about everyone. But you have to be able to focus on the work and do what needs to be done,” Timmerman said.

When her children headed off to college, Timmerman was able to pursue her interests in more advanced areas of nursing. She came to UAB to care for high acuity post op patients.

“Many of the patients had head and neck cancers requiring complex grafting of skin, muscle and bone. Close monitoring of multiple surgical and graft sites, maintaining trach and feeding tubes and hourly doppler checks were necessary. If wounds weren’t healing well, doctors would sometimes order us to apply leeches twice a day.”

The strategy was low tech and old fashioned compared to the advanced health technologies and strategies she was using, but it was often surprisingly effective.

Eventually, Timmerman had an opportunity to transfer to UAB’s Clincal Research Unit.

“I have always wanted to work in research,” Timmerman said. “Our department administers Phase I drugs for the cancer center, obtains blood specimens to collect pharmacokinetic data, and we work with nutritional studies and many other types of research.

“Each protocol is unique and very specific, and everything must be done in a precise manner.”

Research is an area of nursing where the judgment, knowledge and interpersonal skills that come with experience are major assets, and where being on your feet is not as important as being on your toes.

Sometime a protocol may require that nurses work one on one with a single patient throughout the day and into the night. For those with life-threatening conditions, the investigational drug may be the only thing medical science can offer. It can also be an opportunity to build a legacy both the patient and the research nurse can contribute to future generations.

“I feel strongly about the importance of research and that many patients have benefited from receiving the study drugs,” Timmerman said. “Seeing the work that goes into these studies and knowing that someday what we do may contribute to finding a cure is very fulfilling”

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