One of the first questions Betsy M. Tirado Ortiz, RN, AAS, asks parents of the Dominican babies she treats in the pediatric intensive care unit at Morgan Stanley-Children’s Hospital of NewYork-Presbyterian in New York City is whether theyve given their infants anything to drink other than breast milk or formula.
Its not an unusual question, says Tirado Ortiz, who has spent years working in the Dominican Republic on medical missions, but the answer often is atypical.
In the Dominican community they will use certain teas if the baby is colicky and that will sometimes cause a lot of problems, says Tirado Ortiz, who has been on more than 30 medical missions in the past 15 years. They use anise teas that treat colic, but the problem is they use the wrong anise the one they use at home is not readily available in the United States, and the anise teas here also cause arrhythmias.
Similarly, the time Tirado Ortiz has spent in Guatemala has taught her to ask parents of Guatemalan patients whether theyve given their children baby aspirin.During a mission trip in Senegal, Jillian Kirkpatrick, RN, (right) a pediatric cardiac nurse at NewYork-Presbyterian, works with the local healthcare team at a hospital.
Wed never thought of it here until we found that in Guatemala they were using baby aspirin as candy, which was a big eye opener, Tirado Ortiz says. We started asking parents here if they give aspirin for anything other than fever, and we found in some cultures they do.
Because of their experiences caring for patients in other countries, countless nurses such as Tirado Ortiz are developing a cultural savvy about medical idiosyncrasies that serves them well in their domestic practices.
You see so many different things over there and it changes you, says Beth Goodheart, RN, BSN, DNOR, who has been on two medical missions to the Dominican Republic. Every experience you have definitely opens your eyes, gives you an awareness, and makes you a little more accepting that theres not just one way of doing something theres not just one way of caring.
Her work in the Dominican Republic has equipped Goodheart, an operating room nurse at Overlook Hospital in Summit, N.J., with a sensitivity to the cultures social and religious beliefs that undoubtedly helps her care for her patients.
Its made me more comfortable with patients, and when you are comfortable your patients recognize and appreciate it and will feel more comfortable, Goodheart says.
That cultural acuity can only develop as a result of living and working within another culture, says Dula Pacquiao, RN, CTN, EdD, associate professor of nursing and director of the center for multicultural education, research, and practice at the University of Medicine and Dentistry of New Jersey in Newark.
The idea of cultural competence has to be experiential. You dont necessarily learn it from reading a book, says Pacquiao, who has extensive experience working in different countries. I think you need to experience being a minority. When you go to another culture, youre not with the majority and you learn certain differences very quickly. Youre forced to negotiate with those differences, whereas if you stay in your own culture … its hard to see the differences.
Sometimes, those differences illustrate that the way things are done in the U.S. are not always better, so nurses who return from missions attempt to incorporate what theyve seen and learned into their practice.
For instance, the recovery protocol for pediatric cardiac patients at NewYork-Presbyterian has become more aggressive through the years as a result of numerous staff physicians and nurses who have conducted heart surgeries on medical missions.
What we had to do out of necessity because we didnt have a ventilator, and doing that time and time again and realizing that the outcome has been better has pushed us to be more aggressive in our practice here, says NYP pediatric cardiac nurse Jillian Kirkpatrick, RN, BSN.Beth Goodheart, RN
The less-is-more way of living translates in many other ways, adds Kirkpatrick, who has been on medical missions in Guatemala, the Dominican Republic, China, Cambodia, and Senegal.
I get frustrated coming back because of the amount of waste and stupid tests we do that are completely unnecessary, but done just because we have them, Kirkpatrick says. Here, well rip through 50 alcohol swabs a day and meanwhile, when I was in China, we didnt have one single alcohol swab and I had to go back to another room, open a huge bottle of alcohol with tongs, dip the swaps individually, and take them back to the patient. It really makes you think twice. Over there, each piece of gauze, each needle, each syringe is handed out separately and treated as a valuable item.
So treasured are such disposable goods that Tirado Ortiz saves, collects, and takes with her on missions many unused items that would ordinarily be thrown away.
Its an attitude and practice born out of repeated ventures into divergent cultures.
Its a valuable experience to be able to go somewhere and have to ration things and think about it before you go ahead and do it. You really have to be a MacGyver sometimes because you dont have the tools you would have here and you have to get creative with tons of things you need to deliver, Kirkpatrick says.
Undoubtedly, the characteristics nurses develop on mission trips in other countries make them better caregivers, whether their patients are American-born or living in a Third-World country.
Seeing where I imagine many of them come from a little hospital in Senegal and to all of the sudden be introduced to this American system, I think I have a lot more empathy for them and a lot more patience with them for not understanding what’s going on and being overwhelmed, Kirkpatrick says.