QuitoGal

jreevish: Sorry to have not seen this message sooner! I have a little baby and just don't really read all of my messages. See the response I put for tlc1015 for more information. What is the reason that you are moving to Quito?

To work in Ecuador as a nurse... 1. All nurses, including foreigners wishing to work in Ecuador, must complete 1 year of rural service. The ministerio de Salud Publica will assign you to a public clinic or hospital. This could technically be located anywhere in the country. 2. Your U.S. License: You can keep it, you just have to meet the reqs to keep it. In most states it is a certain number of continue ed hours - this can be accomplished online. That is how I keep my credentials current. 3. No NP jobs here. 4. Visa: you must have a working visa to be able to get paid for your work in Ecuador. You can volunteer all you want on a tourist visa. 5. The highest quality hospital - which recently was JCAHO accredited - the only one in the country, is an option. The Director of Nursing there speaks English Fluently and she got her RN and MSN in the U.S. She is also the dean of the nursing school, Universidad de las Americas. The hospital name is Hospital Metropolitano and you can look that up on the web. 6. Another good point of Contact would be the nursing department at Universidad de Las Americas Quito, Ecuador - you can google that. The dean and assistant dean both are fluent in English and are helpful. This is the University that I taught at. 7. Papers: besides the visa, you will need to get your diploma's notarized, apostled (see the secretary of state webpage in your state for instructions on how to do that) and then when you get to ecuador you need to do it again with the ministerio de educacion. They also must be translated. 8. There are other options such as applying for a Fulbright scholarship that will allow you to complete a project in Ecuador that is fully funded by the fulbright offices. There is CFHI, www.cfhi.org, then there is missionary work with HCJB - they have several clinics and hospitals - this is an evangelical organization and your beliefs would have to be lined up with their's and you would have to raise your own funds to pay your salary, housing, etc.

When I went to Ecuador, I actually met my husband there and have been living in this country now for 2 years. I have gotten involved in the health care system here. I find it is very diverse. You have clinics and hospitals that are public run and are struggling with resources and funding and then we have others that are top notch, follow EBM, and I feel comfortable getting my medical care there. Unfortunately, the role of a nurse here is likened unto "maids work" and pays full time at about $400 a month!! The role of a nurse practitioner does not exist. I volunteer at one of the clinics with a doctor who understands what a NP is and does and allows to function in that role. I volunteer with a local foundation running a public health program for the poor, and do a variety of other work, currently exploring teaching at one of the univ here in their school of nursing where the dean, who is US trained, has a goal to raise the bar of nursing and care provided in this country. Change will only come slowly. There is a severe shortage of nurses in this country as almost everyone interested in health care goes into medicine. They have hundreds of medical students, so many in fact, that many are unemployed! On the other hand, nurses are undertrained, come from low socioeconomic status, aren't paid well, have little voice, and are not allowed to function in so many of the ways that nurses function in the U.S. Every medical and nursing student in Ecuador must complete a rural rotation. They are assigned by the ministry of health to a rural location anywhere in Ecuador to serve for one year. This is the only way they can staff their rural clinics as the bulk of doctors are located in the urban cities and very few in the rural areas. Unfortunately, that means the ones going out to the rural areas are green. If nurses could raise their standard here and be trained, they could help fill the gaps in the rural areas, but this requires a major shift in thinking! It seems that somethings are coming together so that in the future we may see nurses have a better status in the country - I hope anyway!

You can try an discuss it with the dean of the school. There is always the end of the semester evaluations. I know that those sometimes don't seem to help, but it gives you an opportunity to provide constructive critism. These evaluations become part of their permanent file and are used in their annual employee evaluations as well. One time I was preparing a lecture on child development. The lecture was only going to be an hour and I had about 30 slides. My husband, who is a corporate trainer and lectures for a living, was reviewing it and at the end he smiled and said, "Honey, when I give an 8 hour lecture, I have 30 slides and barely get through them in 8 hours!" I laughed, and cut it down to 8 slides! Sounds like she is sharing "nice to know information", but not necessarily the "need to know information"!

I can certainly empathize with how you are feeling. I graduated from undergrad in 1995 when there was not a nursing shortage and no places were taking nurses unless they had at least 3-5 years of experience! I graduated in one state and was trying to find a job in a different state where I was competing with other grads who studied in that state and already had ins. I was an honor student, with good recommendations so it wasn't an issue about my character or ability. After interviewing at several hospitals for months, I was unable to secure a hospital nursing position as a new grad and despite the fact that my heart was in women's health, latina health, and international health care, I finally took the only jobs that were available - long term care! Quite the opposite of my career plans! However, it was a stepping stone. I worked there giving my 100% for about 1 1/2 years and then the market changed and I was able to change jobs and move a little closer to my dreams. Sometimes, you just have to start somewhere. The beauty of nursing is that the field is wide open. Once you get a little experience under your belt you can head off in any direction you want. I will never forget one of the hospitals I interviewed at as a new grad. This was my second interview there. The HR director sat and looked at me with a scowl on her face, arms crossed, and her first question to me, in a very authoritive voice was, "Do you really think you have what it takes?!!!!" I share that story to let you know that despite what she thought, I did find a job and I did indeed have what it took and I am now working in women's health in South America and love it! You also have what it takes! Believe in yourself, keep pressing forward and be willing to think outside the box and perhaps take a position as a means to build your resume a bit more, knowing you can always move on to something different down the road.

CFHI is a particularly costly program. I did it during grad school so applied a school loan towards it; however, there are lots of other international nursing opportunities available. I read on a thread somewhere that under the specialty tab on this website, select nursing specialities, you can scroll down and there is a section devoted to volunteer nursing opportunities. Perhaps you can find something more reasonable. There are also short term trips available with different programs that enable you to go for 1 -2 weeks which cuts the price down significantly.

Child Family Health International. http://www.cfhi.org

The first week was rough. My luggage did not arrive for 4 days, it was cold and wet, I was battling the high altitude at 10,000 feet, and to make matters even worse, I had a gnawing, stabbing pain in my ribs that made it difficult to sleep, breath, and move. Within my first week of being in Ecuador, I found myself experiencing the health care system first hand. I had to go to a local hospital and get chest x-rays, purchase an unknown medication that I was given a prescription for from a local doctor whom I hardly knew, and place my trust in the hands of a health care system that I did not yet trust. In fact, trusting in the health care system was a challenge in and of itself. Although I have spent some time volunteering as a nurse internationally before, I found myself completely unprepared to deal with what I would soon experience both personally and as a nurse practitioner. My perspective of global health completely changed in "Sala de Partos," the labor and delivery unit at a public hospital in Ecuador. "Sala de Partos" was a basic operating room that had several stretchers lying side by side. Women were admitted here for various reasons: they were in active labor, they had problems with their pregnancy, they miscarried, or they had a fetal demise. They had no privacy and the environment certainly did not give them a sense of dignity. They were young, scared, and alone in this process. Taped on the wall, as if it were an afterthought, but definitely not a practice honored at this facility, was a journal article citing that there were less birthing complications in women who had the support of their family during the labor process and furthermore, that it was the right of a woman to have the support of her family during this time. Each woman was assigned a stretcher, where she would lay on her back with only the package of maxi pads she had brought with her to serve as a pillow. If she were lucky, she had a sheet to cover her. There were no pain meds, no epidurals, and their IV poles served as the one thing they could grasp onto when the intensity of labor struck them. They would arch their backs and cry out saying "No puedo! No puedo!" ("I cannot! I cannot!") This was a task that they would have to complete alone. It was in this place that I met Ana. Ana was a 29 year old G1 P0 who had ruptured her membranes almost 24 hours prior and was now facing the sting of intense contractions as her baby desperately tried to enter this world. She grabbed hold of the IV pole and her face turned beet red as she cried out in pain. She lay on her back, sitting in a pool of blood, urine, and feces, her thin blue gown had been pulled up revealing her perineum to the group of first year students who stood around talking about her case as if she wasn't there. I, too, was among that group. This was rounds after all. I had to analyze the case and try to answer the questions right. Yet, something in me hesitated. I walked up to her; she looked at me, sweat was dripping down her face and her eyes were full of fear as if to tell me she could not go on anymore. I grabbed hold of her hand. It was as if in that instant it didn't matter that I was a white woman from a strange country who has never experienced child birth; I was a presence to her, a comfort in a time when comfort simply did not exist. For a moment, I had set aside my note taking and question asking role and became her source of support. She held onto my hand tightly and I coached her through labor all the way until the delivery of her son. She had never let go of my hand and she turned to me with a smile on her face and simply said, "Gracias" with tears streaming down her cheeks. Ana's lesson to me was that often it is the simple things that make the difference in the lives of our patients. Sometimes, we get caught up in all the data and facts and forget that we are dealing with a human being who isn't as concerned about data as much as whether they are going to live to see the next day. They are not as interested in our medical rounds as they are in keeping their dignity and being respected. We are here there for them; they are not here for us. Sometimes all they are asking for is a hand to hold and a comforting presence. Ecuador was a place that many times, challenged my educational foundation and personal values. There were a times that things were said and done that I didn't understand. It was so easy for judgment to creep up into my heart. It became very evident that I was dealing with a system that faced severe challenges: lack of resources, widespread poverty, infectious diseases, and poor sanitary conditions. Perhaps some of things I saw could have been handled differently, or perhaps everyone was just doing the best they could given the circumstances. Studying in Ecuador was more than just learning clinical practice, it was about learning the culture and expectations of this population and the relationship they have with their doctors. It was about learning that our ways are not the only ways; they are just different ways, like how to care for people when you don't have the luxury of diagnostic testing and monitoring. It was sometimes about setting aside my opinions and being open to learning and understanding their ways. My time in Ecuador was an experience that I will recall for years and that will forever influence the way I practice health care.