By Ian Morlock, BSN, RN
I remember very clearly what the first day of classes were like when I began my BSN program at the Denver School of Nursing. It was April 1, 2013. I sat in a pathophysiology class, wondering “What have I done?” as each student took turns introducing themselves. All of us shared what type of nurses we planned to become. My instructor, Micah Hughes, MS, BA, PhD candidate, professor of pathophysiology at DSN, listened to the proclamations from new students about how they were all going to become high-functioning ICU, ED or Flight-for-Life nurses. It seemed like everyone was determined to work in the hardest places possible. As my turn came, I remember feeling frightened about not having an answer to this question, but I blurted out that oncology was my path. Interestingly, that discipline stayed with me throughout my education.
Because I was completely changing careers, after working as a chef for almost 20 years and playing drums in bands — both ego-driven environments — I decided that for the first time in my life I would experience as much as possible in nursing, where the patients are at the center.
Nursing school was something completely new for me. In the beginning, my goal was just to keep my head above water. Micah stayed with me the whole way. He had a genuine interest in me as a person and in my success as a student. I never imagined how Micah, who also is director of Global Health Perspectives at DSN and is on the board of directors for The Mango Project, was going to facilitate changes in my life by exposing me to the wonders of global community health.
I joined the Global Health Perspectives group at school, and at one meeting the prospect of traveling to an international location as a nursing student started to become a reality. Little did I know that opportunity would come in the form of my first two-week internship in 2014 to Yumbe, Uganda. Yumbe is located in the northwestern corner of Uganda, just south of the Sudanese border and a few hours’ drive from Arua. It is one of the poorest and most food-insecure areas in Uganda, which also means they have some of the highest mortality rates from diseases that are otherwise survivable. The lack of access to proper nutrition starts a cascade of negative effects, which have ravaged communities in the area for decades.
The Mango Project is a nonprofit organization whose board of directors advises a Ugandan-led team of agriculturalists working to grow a business known as Mikiga, a family-owned and operated mango orchard outside of Yumbe. Mikiga’s goal is to alleviate the suffering that comes from malnutrition. Mikiga preserves mangos that are either grown or bought from surrounding villages or from local villagers. Workers then store and distribute the mangos at the local markets during the dry season when there are no mangos or deliver canned mangos to some of the clinics in the area to supplement their nutrition programs for young children. The Mikiga team does all of the work at the farm and also reaches out to the communities and to the clinics to teach about nutrition and growing mangos so people have some knowledge and some drive to produce fruit for income.
As an intern with GHP, I was able to spend many days in clinical situations at a rural hospital in Yumbe, but outside of that, I had the opportunity to dig deeper into the community health aspect of this journey.
During my recent mission trip to Uganda this fall from Sept. 19 to Oct. 4, my days started out at the Yumbe Hospital in the nutritional feeding center, where we weighed the inpatient babies who are suffering from marasmus or kwashiorkor. We recorded the babies’ weights and calculated the morning feedings so they could receive the appropriate nutritional support. Then, we moved to the pediatric ward, which can have anywhere from 60 to 125 children at any given time. Ninety-five percent of the children had a diagnosis of severe malaria, but they usually had a secondary diagnosis of upper respiratory infection, dermal fungal infection or even bacterial meningitis. On top of those illnesses, there were plenty of wounds being cared for with the use of home herbs prescribed by the village healers, but still were in serious need of proper cleaning and dressing. The team assessed every child and searched for critical cases needing immediate attention. There always is death, which requires a strong heart and stern emotional response, but there are plenty of successes along the way. The reality is people do not come to the hospital until the situation is emergent, and sometimes it is too late. Throughout the day, we traveled among the units, observing surgeries, assisting with laboratory collections, speaking with everyone we see and even jumping in to help deliver babies.
For nursing students, instructors or even academics conducting research, there was never a dull moment. There was always a child in need of an IV insertion, so they can begin anti-malaria treatment. If you ever wondered what it is like to discharge 50 patients before lunch and turn right around and admit 50 more new cases to the unit, take a journey to a rural clinic, and you will have your chance to find out.
Community health has taken a front seat to how I approach my own practice as an oncology RN. To me, community health means understanding the experiences within the culture you are both learning from, and simultaneously educating, to address the disparities among the people you are serving.
It means understanding the significance of a child left to starve because the father does not approve of him or because the child was born HIV positive, and is considered too great a burden on the family. It is knowing the concept of good nutrition may be easy to compartmentalize when you come from a country which lives with excesses, but the reality of implementing good practices in a community where people eat because it takes the pain of hunger away is breathtaking. Community health means uniting as a team to accomplish small goals, and it is knowing that, as a nurse, understanding the realities within your community takes intuition and empathy.
Without organizations such as The Mango Project, American Assembly for Men in Nursing, GHP and many others, I would not have known how much is out there for nurses to experience. Our charge is to advocate for the health and wellness of our patient population, which means we need to see every interaction as a brand new one, and we can never discount another human because of how we may perceive or, sadly, judge them. The only way I was able to learn this lesson was to give of myself in every experience and to remain willing to make mistakes and say, “I don’t know.”
I hope to continue exploring global health as I continue to grow as an RN. The needs in developing countries are great and to have the opportunity to connect with such amazing people is what makes being a nurse so special to me.
Ian Morlock, BSN, RN, is a chemotherapy-certified nurse on the oncology/urology unit at Boulder (Colo.) Community Health. He started a chapter of the American Assembly of Men in Nursing at DSN and also served on the board of the Student Nurses Association.
Find out more about The Mango Project at TheMangoProject.com.