To date, I've worked/volunteered in over 20 hospitals in five different countries. Whether different states, cities, hospital networks, or countries, it goes without saying that every hospital is different. For the sake of this article, I'm going to be writing about my experience working in rural/secluded/poorly funded hospitals overseas (a lot of my volunteer experience was in Haiti, Uganda, and Kenya).
For starters, the hospitals are understaffed just like in the U.S., but significantly worse. There might only be a few nurses that work at the hospital altogether. The availability of nursing education is often scarce, and the availability of paying positions can be really hard to come by as well. Sometimes, locals go to college, get their nursing degree, and still can't find paying jobs because the government, which is typically the funding behind the medical system, doesn't offer nearly enough jobs for the medical need or for the available staff in the area. When I was volunteering in Uganda, there was only one labor and delivery nurse for the hospital. She was essentially on the clock 24 hours per day and wasn't at the hospital half of the time. I couldn't believe it — especially in a culture where having a lot of children is common. It kind of seemed like a competition for women to see who can have the most children. With that being said, there was always a mother in a different stage of labor. The nurse would basically just hang out until she heard the mother screaming, then come and assist with the delivery. Crazy, I know!
Then factor in that the same labor and delivery nurse is also the primary nurse for the hospital/village. So, not only is she in charge of deliveries, but she's also responsible for the adult and pediatric specialties too. There was typically another nurse on duty, but there was a constant inadequate amount of help. I definitely didn't see a shortage of patients being neglected or put off. During this particular volunteer experience, I was constantly on the move, trying to keep up with the needs of the dozens of patients who were always waiting in line to be seen. I've gained so much respect for the nurses I've encountered because often, they literally do it all. I've met nurses that see hundreds of patients per week and have a selfless willingness to serve their villages, all while working an insane and unhealthy amount of hours. It's truly inspiring!
This hopefully helps paint the picture of how understaffed hospitals typically are in some rural areas. Though you can't really understand unless you've seen it, you should try to prepare your mind for this possibility. Expect to have your nursing skills adapted to fit every nursing need. This is awesome for growth, but pretty intimidating at first and challenging for sure.
Now, onto the next big struggle of nursing overseas: the lack of resources. It seems well-known that some areas are short the items they need to provide basic care, but it wasn't until I experienced it first hand that I knew the extent of that lack. Things such as soap, disinfectant, IV supplies, medications, beds, and even tape are always unavailable. From what I've experienced, the hospital is given a certain amount of all the supplies each month and that is all. If they run out, it's then the patient's responsibility to provide the resources needed to get treatment (which was often impossible because of poverty). Another major issue is corruption. Often times, the supplies are stolen by the workers at the beginning of the month and used for their own families or sold. As a result, the hospital will always be short on resources. This isn't necessarily a malicious act, but done as a means of survival. Everyone is willing to go to the extreme to feed/protect their loved ones first and foremost. I paid, fundraised, and jumped through every hoop I could find to have the bare minimum of supplies on hand. Even after my “well” was totally dry, I would find myself with another patient that needed something really cheap, but critical; perhaps antibiotics for a sick child or something similar. I can't tell you how many times I gave a patient $5 to get something from the pharmacy, but this is all the reality you may face.
The most important takeaway from volunteering overseas is that people are incredibly sick. Think of the sickest patient you've had in the hospital, and imagine all the patients in the village being that vulnerable. They're malnourished, under-educated, and don't have access to specific medications or supplies. In addition, they don't get adequate care because of the lack of staff. It's a very sad scenario to experience the reality of their lives on a daily basis.
In this article, I tried to speak in literal realities that I've faced. This reflection was speaking for the worst I've seen, but I can't say if it's the worst out there. Though I don't want this article to sound like a horror story, I also wanted to try to be candid. Experiencing healthcare in a third world country is quite the reality check and emotionally challenging.
Let me add, volunteering overseas is a beautiful experience! The gratitude and personal growth I experienced was unmatched by any other part of my nursing career. I will definitely be returning to these areas someday to offer my knowledge and time.
TIP- Invest your volunteer dollars where the money goes to local programs rather than corporate volunteer programs. I have found much smaller portions of my investment and the money I raise goes where it should (to the target people/groups that need the help) when using larger programs to volunteer. Please feel free to reach out to me for help with this. I have several useful resources! @gypsywithpurpose