M2H Trip Reflection - Lizette Mationg DNP, RN, CRNFA, CNOR
When I return from a mission trip, I am often asked what I did, with the expectation that I have accomplished a list of fabulous action items. An impressive headcount of people fed, buildings built, or surgical procedures completed marks the quantitative value of a trip. However, quantity can't be achieved as effectively if a one- to two-week trip is the extent of the mission goers' contribution.
With my training as a nurse, I know that I can positively affect the life of every patient assigned to my care. Yet I am limited by the capacity of my being one person and the amount of care I can provide in my workday, week, month, and career. However, if I can teach what I know to others, I can exponentially extend the influence of my care beyond what I alone could do. If I can impart my practice principles to multiple students, their influence will extend to all of their patients along with mine. Populations that are beyond my limited sphere of influence can be reached effectively...even beyond my lifetime! This multiplying effect is what can make an individual's limited contact on a short-term mission trip profoundly significant.
Mission to Heal is an organization that provides the opportunity for participants to expand the reach of their personal impact. All volunteers come with their own set of professional training, skills, and patient knowledge that can be taught to other practitioners. The mission strategy is to provide this training to people who can meet the needs of communities that have limited or no ready access to surgical care.
Proper surgical care, as described by Dr. Glenn, is not just about performing the procedure itself but about the decision-making involved in determining if an operation is even appropriate. Discernment considers adequate supplies, technical knowledge of the learning providers, health of the patient, available follow-up, and even identifying unwarranted procedure initiation. Teaching providers how to use proper clinical judgment is essential to providing appropriate care.
The mission held at Laisamis Sub-County Referral Hospital provided an opportunity to interact with the local population of patients and providers. Topics of interest were discussed among those of us who were visiting health providers and the medical and nursing officers in that region. Because there were limited patients who warranted the need for a surgical procedure, much of our time was spent on information exchange and teachable moments when they arose.
For example, as I was demonstrating the skill of instrument tying with a suture I brought from my area of practice, the health workers there showed me the suture they were provided with. It was discovered that they were routinely using a braided stitch with a large-gauge taper needle for skin lacerations. This discovery prompted us to discuss optimal choices of monofilament cutting needles for subcuticular closures. They may likely be limited by the sutures that their sponsoring government provides. However, this interaction offered additional knowledge that would allow them to recognize and perhaps request supplies that would be less prone to infection.
This contribution may seem small. But if one considers the consequences of a nonhealing wound for a person in this region, the effects can significantly deteriorate the health of that individual as well as the family that this person may be supporting. Other examples of shared tidbits that could prove to have longer-term influence include: suggestions to use silver sulfadiazine (Silvadene) application for a mycetoma infection, having a bulb suction routinely available during baby deliveries, considering ginger chews to help alleviate first-trimester nausea, opting not to pursue expensive diagnostic tests when the patient outcome would remain essentially the same regardless of test results, and considering the incorporation of palliative care and grief counseling when warranted.
So in summary, did I participate in an impressive number of surgical procedures during my week at Laisamis Hospital in Marsabit County, Kenya? Not particularly. But did my team contribute to teaching the local providers strategies that promote healing? I believe so. And the inspiration that their medical workers might have had from us is mirrored by our team's inspiration from their continued dedication, resilience, and steadfastness in caring for their people despite limited resources. And with these transformational encounters, I do believe the mission was qualitatively and quantitatively a success.