Most useful advanced degree for working in a third-world country

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    Hello All,

    My name is Cameron, and I'm a male undergraduate nursing student. Here's the deal: I am set on becoming a medical missionary to a third-world country, preferably East Africa (an area where the living conditions are perhaps some of the worst in the world). Before this happens, I would like to obtain an advanced nursing degree to best prepare me for serving others.

    I have a strong interest in working with orphans, though I am open to all scopes of practice. I would like to have the freedom to venture outside of the hospital itself to seek out those who do not have the luxury of medical care- be it monetary limitations, physical distance from a hospital, or family responsibilities that render such a venture impossible. Given these parameters, I believe that (in my extremely limited knowledge) it may be best to pursue a nurse practitioner degree... maybe family practice or pediatric practice. So my first question is: what are the most significant differences between FNP and PNP, and would it really make all that much of a difference when working in a third-world country? Which degree, in your opinion, would allow me to practice nursing on a greater, far-reaching scope? Keep in mind, East Africa has some of the highest fertility rates in the world, and consequently, pediatric nursing may be a more useful degree in a country where 50% of the population is children.

    Although I have listed these specific interests of mine, I am no expert in the area of administering healthcare to third-world countries. Please, if you have knowledge or expertise in the matter, tell me how I can be most serviceable to those who need it most.

    Thank you all for your opinions and insight. You will undoubtedly help shape my future as a nurse. God bless.

    In Him alone,
    Cameron
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  4. 1
    BSNs are nearly universally accepted by aid agencies, and so are advance practice degrees in nursing.

    Personally, I would go with the FNP. Aid agencies will put you where the need is greatest, and many times you will be wearing multiple hats: you might be placed at an orphanage, but it may also run the only health care clinic available, you will see people of all ages for health care. Or you may work mornings at an orphanage, and afternoons at a prenatal clinic. The political situation in your area may quickly deteriorate, and you may be pulled from your orphanage and dropped into a hospital medical ward in a nearby area.

    As an advance practice nurse, you will probably be expected to have many administrative duties in addition to providing care: organizing other volunteers, organizing the actual building of your clinic or orphanage site, dealing with groups, creating and monitoring your budget, etc. You also may be the only practitioner in the area, and may be called on to do things that would be outside of your scope in your home country (it depends upon the aid organization and the laws of the country in which you are practicing). I know of BSNs who have gone on mission trips and ended up delivering babies, setting bones, suturing lacs...things you would not expect nor be allowed to do here as a basic nurse. With that in mind, I would get some ER experience as an FNP, if possible, prior to leaving for your mission.

    Do you have a specific organization in mind already? If so, check with them. If not, Doctors Without Borders, the Mennonite Central Committee, and the UNHCR: the UN Refugee Agency, and the Albert Sweitzer Foundation (with hospitals in Haiti and Lambarene) would be good starting points.
    hiddencatRN likes this.
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    I second the FNP over the PNP. With the FNP you'll be trained in care throughout the lifespan, which includes children. Good luck to you- the work of Doctors Without Borders is one of the things that inspired me to go in to nursing in the first place. They have a pretty long minimum commitment so I'm not sure if I'll ever be able to work with them, but I do hope to do work abroad someday as well.
  6. 0
    This is exactly what inspired me to pursue nursing. My dream is to help those who have no access to the luxury of a hospital.
  7. 0
    Thank you Cameron, BluegrassRN and others. I'm so happy to have found this thread. I have been looking for international nursing positions in underdeveloped and underserved areas of the world throughout nursing school and found that I cannot serve without experience.
    It is nice to hear like minded people and get renewed hope for my goals. Cameron you sound like the male version of me.
    Yes, FNP with a strong emphasis on maternal health seems like the most needed knowledge base out there especially with the high maternal and infant mortality rates in these areas and the high incidence of fistulas and their complications. Trauma experience is definitely a plus also.
    I also plan on pursuing an NP and some coursework in global health, some courses on tropical diseases would be great as well but those are hard to find in the U.S. Of course AIDs and TB knowledge would be helpful too.
    I just graduated this summer and am trying to get a job to get the two to three years of experience that most organizations want from their nurses, which I understand. I just wish I could go the refugee camps in Jordan, Lebanon, Kenya, Ethiopia and other right now and work there. It will happen, just have to be patient and not let the dreams, goals and passions fade away.
    Anyway, thank you for this great post, I am rambling because I am excited to find this. Please lets keep each other posted so we can get out there and serve soon.
  8. 1
    Hi!

    I'm currently working in Africa again.

    For those who want to work in this continent here is my advice about the experience you should have before coming.

    First and foremost You'll often be the ONLY western trained staff on site. So people will consider you as a doctor most of the time. They'll expect that you'll have an answer for almost anything, be able to perform surgery, deliver babies, cure about anything. That's particularily true in remote areas where the nearest hospital is over 1 or 2 days travel away .
    Quite often you won't have any support other than your knowledge, skills and books (don't dream too much about using Internet or your Ipad, electrical power is very often a luxury in remote settings.

    This leads to the second point

    You work in an underdeveloped country

    That means that you'll be lucky to have microscope enabling you to perform or having performed very basic lab tests.
    The KISS acronym is always in use.
    Think basic!
    And by basic I mean that unless you work for a larger organisation, you won't have a lot of choice in terms of sutures, antibiotics and other medications, detergents and desinfectants (potassium hypochlorate works miracles and is easy to come by!). There'll be a shortage of about everything you might think of, medications are often past due date of use ( but they still work!), for instance ATBs past date for injection can be used directly on wounds...

    Third point experience needed (this reflects my opinion from my practice)

    Internal medicine

    You got to learn to diagnose diseases like liver cysts, GI problems, pneumonia, infections...

    Tropical medicine

    Best to get a degree in that, a REAL good one is the one from the Institut du roi Leopold in Anvers Belgium. Otherwise, try to get one online.


    Surgery


    You'll have to be able to perform sutures, treat infected cysts. Sometimes amputations due to trauma, treat wounds due to bullets, knives, machete, burns (trauma is quite common in war riddled places). Remember that appendicitis kills (better be able to remove one). Spending some time in an O.R. IS useful. Knowledge of basic dental surgery is good to have too ( you won't want to break the jaw while pulling teeth : would be bad for your karma)


    GynObs

    You got to be able to assist or to deliver babies, sometimes do a C-section if things turn bad.
    Treat Gyne infections due to mutilation (excision are VERY common in East Africa), AIDS, STMs (condoms are too expensive), rape and domestic violence.

    ENT

    Otitis are common, usually you'll see them when they're really infected (local treatment can use things like intra ductal tobacco..Seen in Burkina Faso). Knowledge of the use of an otoscope is good, how to use it to clear ear ducts, or perform paracentesis is better.

    Ophtalmology

    Infectious problems are common. You won't be able to treat ARMD (too expensive).

    ER

    That'll help you to order your priorities. Learn to manage your stress.

    PACU, ICU, CCU

    They'll give a knowledge of the use and effects of useful drugs. Depending on the setting where you are, you can learn how local and locoregional anesthesias are performed. (lidocaine is cheap and really helps).

    Pediatrics

    Examinating and treating a child is very different from an adult. Knowledge of their specific pathologies is a must have in remote settings.

    Conclusion

    Working in remote areas can go from difficult to really hard to oop:.
    It's very demanding but really rewarding.
    Never forget the cultural differences some things that are unimaginable in western countries are normal where you are.
    The way people see death or diseases varies greatly from one place to another.
    Be flexible and creative, that will enable you to face the difficulties you'll have to face.
    Always prepare for the worst and hope for the best. Knowledge is always light to travel with but sometimes hard to get. Learn as much as you can, wherever and whenever you can (local treatments cure some illnesses)

    Last thing

    Although you might be considered as somebody next to a God in some places, never forget that are only a human and not almighty.
    Keep your mind open: you'll be surprised about how much one can learn from others.


    Be modest, never forget that your cultural background is completely and often radically different from the one of the people you work with and treat. You better not go there as the one who knows everything better unless you want to be really disappointed (people can react in ways you and your body won't like...)

    You were lucky to be born in a country that enabled you to go to school and learn a (really good) job. In remote places people are at the bottom of Maslow's and Henderson's pyramids.

    You can do only as much as you can within the limits of the knowledge, the skills, the wits and your abilities you learned and got.


    I hope my little post will be of some help to those who are interested in working in remote areas.
    I tried to cover about all the topics I could think of, if I forgot some please forgive me: I'm not that young and Alzheimer is a and b.... ...

    Last edit by pyocianik on Jan 9 : Reason: change of words
    Fiona59 likes this.
  9. 0
    Thank you for the time spent writting that long article
    But in one way or another it has realy helped those who wsnt to become
    Better nurses,

    Feeling depended on gives peace in ones heart.. ive just learnt that
    It can better be felt in the remote area.

    Thanks again pyocianik for your knowlege.
  10. 0
    My suggestion is to graduate, spend a year in Med-Surg, then move to Emergency.

    Then do a distance learning course while working, maybe with a reduced workload, possibly at the hospital's expense and became an Family Nurse Practitioner.

    The path will set you up to deal with anything. And as a side shoot, though others may squawk, which is fine, I'd suggest, if you can to become an EMT-B followed by at least EMT-I.

    In Africa you WILL run into everything, including cases where you will NOT be able to save the person. The above 4 year plan will prepare you to: 1) Save the person if possible 2) Feel comfortable when you can't.


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