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Nurses Answering the Call for Help

“I’ve worked in a lot of developing countries and it was the harshest environment I ever worked in,” she says.

In 2010, Mamie Guidera, MSN, CNM, Advanced Senior Lecturer at Penn Nursing, looked out the window of a car driving on a rugged road in rural Haiti. Her view was of streets lined with tents housing refugees who had fled the capital after a devastating earthquake. Everywhere she looked she saw signs of extreme hardship.

Guidera’s mission was to work with and train midwives in birth emergencies in Hinche, a town in central Haiti. Shortly after arriving, while on call at St. Therese Hospital, she helped deliver a baby at 28 weeks old and weighing 2 pounds and 2 ounces. The baby was named Anton and Guidera remembers him as a feisty baby who grabbed the edge of the scale.

“In the United States a 28-week baby often lives,” she says. “We have what we need to take care of them.” But this was not the case in Haiti.

Working in an under-resourced country such as Haiti creates multiple ethical issues for visiting healthcare providers like Guidera. She used her Blackberry to ask a colleague in the U.S. what it would take to sustain the baby via IV or feeding tube. This type of immediate consultation with experts in the U.S. isn’t typically available and wouldn’t be available to the Haitian staff in the weeks to come. Even if it worked, Guidera didn’t know what would happen to Anton after he left the hospital.

“I knew I had the capacity and the tools to intervene but those would not exist when I left. The dilemma,” she says “is if one should intervene or not.” While relief work provides care and support in the short term, for Guidera and other nurses, the real goal is to create sustainable improvements so you will not face that same ethical dilemma again.

Guidera put the makeshift formula together to feed Anton. A week later, his 17-year-old mother took him home. After arriving back in the U.S., Guidera called the hospital to ask if Anton was alive. No one knew. To this day, she doesn’t know what happened.


Nursing’s critical role in disaster relief

Whether it be war, disease outbreak or natural disaster, catastrophic events occur globally. Often, nurses are on the frontlines, providing immediate care and long-term health restoration.

Lisa Hilmi, MPH, RN, pre-doctoral student at Penn Nursing, has aided in disaster relief across the globe. She’s assisted in the Rwandan refugee crisis, provided relief in the aftermath of an Asian tsunami and come to the aid of those affected by the Sri Lankan civil war. In her years of experience, she’s seen nurses’ heroism on many levels.

“I’ve seen nurses take care of patients with no electricity and bombs falling outside,” she says. “Nurses that stay to help patients instead of thinking of their own lives. And nurses who work with whole communities to advocate for them when no one else will.”

Nurses have always been counted on as first responders who participate in the rehabilitation phase after a disaster – which can sometimes stretch out for months or years. It’s these situations that often illustrate nursing’s importance and influence.

“Nurses can do more than just clinical care,” Hilmi says. “Nurses are multi-skilled, used to working in interdisciplinary environments and take a holistic view of giving aid. I’ve seen nurses take management and leadership roles in disasters.”


A history of helping

Over the years, Penn Nursing students and faculty have stepped in to make a difference after catastrophic events. Faculty members have gone on sabbaticals to aid in relief efforts. Student groups regularly raise awareness of and funds to support critical services after natural disasters.

The School also prepares students for disaster relief. Penn Nursing offers a “Global Health Policy and Delivery” class where students study how inequalities and public policy influence health status and issues such as maternal health, HIV policy, and refugee health. Disaster simulations are also offered in the Community Health clinical, and Hilmi teaches a Global Health First Responder course where she includes important issues such as how to assure personal safety and how to work in partnership with local organizations and populations.

Guidera, who has established long-term relationships in communities in Guatemala, Honduras, Haiti and the Dominican Republic that have experienced disasters, has two recommendations for nurses interested in disaster relief.

Disaster relief is not for the faint of heart. But even the most basic care –like the provision of clean water – can go a long way as evidenced by thesmiles Lisa Hilmi coaxed from these children in a Rwandan refugee camp


“The first one is to get experience,” she says. “You have to bring something to the table. I didn’t get involved as a midwife in Guatemala until I’d been a midwife for 10 years. It’s not work for the novice.”

Her second piece of advice is to apply your experience in a focused area.

“Nothing can really prepare you for what you’ll see. The environment can be very harsh and you have to be prepared to focus on a specific area of need to effectively help the people there.”


Planning for the worst and preparing communities

Advanced planning and simulation exercises have great potential for reducing the effects of a disaster. Nurses can play an important role in helping local and international communities be better prepared before a disaster, and coordinate effective response plans.
“What I find time and time again in developing countries is that they’ve never done simulation
exercises,” says Hilmi.

The earthquake that devastated Nepal earlier this year is an example of this. Because of the natural seismic fault there, scientists had been concerned about a serious earthquake for years. “There was an earthquake simulation exercise planned for the next year,” Hilmi says. “If that had happened earlier, the relief efforts may have been better coordinated.”

But one of the effects of the Nepal earthquake may be to set up better future preparedness. That happened after the 2004 Indian Ocean tsunami,when warning sensors were set up to help detect tsunamis as early as possible.

“In many of these countries, there is a great civil society response,” Hilmi says. “A lot of times, they just need some capacity building and support to make everything sustainable. That is where nurses come in.”

Guidera says using a combination of training for the local population and long-term planning can be a successful strategy.

“You want to work with people and train the trainers so they can do the same in kind,” she says. “There’s the expression ‘Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime,’ and I think it’s true in this case.”

For Guidera, that means training midwives in the countries she visits to provide the skilled care that has been lacking for pregnant women. By empowering these women to care for their own communities, better care can be assured long after Guidera and her teams leave.


Wanting to help

Disaster relief isn’t something all nursing students want to do. But it’s often the case that they want to do something to help even if they can’t go to the scene of a disaster. Hilmi offers some important advice.

“During the immediate response time, people want to help and often send food, clothes and other supplies,” she says. “Every box of supplies has to go through administrative checks and that actually becomes a bottleneck.”

Instead, Hilmi recommends sending monetary support, and encourages nurses to use their
networking skills to enhance the effort.

“It’s best to send donations to vetted agencies and known entities, like the School of Nursing, that support relief efforts,” she says. “Give what you have, or plan a fundraiser. Nurses are incredibly organized, so this is an area where we can really have an impact. We’re good communicators, so we should help others know the importance of monetary donations
as a sustained way to help after a disaster.”