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Nursing abroad stirs the soul

AORN Journal, July, 2003 by Zarina Varma

Growing up in Tanzania and Kenya, I often wondered about my ancestors, who were from India and Pakistan. After spending time in the United Kingdom and Canada, I finally settled in the United States and obtained my US RN license and CNOR certification. After working in the OR for many years and with my children grown and out on their own, I had an urge to see and work in the countries of my ancestors.

I had learned to speak Hindi-Urdu and Swahili in Africa, so I applied to FOCUS International to work as a volunteer anywhere from east Africa to India to Pakistan. I was asked to go to northern Pakistan via the Agakhan Health Services of Pakistan. I was so excited. I quit my job, boarded a plane, and eventually landed in Karachi, Pakistan.

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THE ADVENTURE BEGINS

For the first time in my life, I was in the country where my father was born. From Karachi, I flew to Islamabad, Pakistan. I then was supposed to take a flight to a place called Gilgit, which is in the center of a region known as northern Pakistan. Unfortunately, this flight was cancelled two days in a row because of bad weather. Unwilling to wait anymore, I hired a driver and a jeep through a tourism agency.

As we were about to leave for Gilgit, monsoon rains set in. Having come from Africa, I was familiar with the intensity of monsoon rains. The water was up to my knees, but the sky looked clear to the north, so I told the driver, "Let's go."

As we were leaving town, we saw cars stranded everywhere, but our jeep kept rolling. I must have looked a little tense, and the driver, whom I called Cha Cha (ie, uncle) out of respect for my elders, assured me that he would get me to my destination safe and sound. He had been driving for years on the Karakorum highway, which runs between China and Pakistan. The highway was built by the Chinese to facilitate importing and exporting. It is a narrow road with no protection on the side where the river Indus runs down a narrow valley. There are striking mountains on the other side. The drive was beautiful although a little wet, because the rain did not stop until we were three hours into the journey. I later found out that two of the villages we passed through were washed away by the heavy rainfall; 200 people died.

After a 15-hour drive with an overnight stay in a town called Bhisham, Pakistan, we reached Gilgit. Cha Cha had brought me through safely. The town of Gilgit is surrounded by the Hindukush Mountains and directly at the base of a mountain called Rakaposhi (Figure 1). I immediately reported to the health center for further instructions. That night, I stayed at a five-star hotel, which was discounted because I was a volunteer. After a heavenly hot shower, I crawled between the clean sheets and passed out until the next morning.

[FIGURE 1 OMITTED]

MY FIRST ASSIGNMENT

I was assigned to a town that is called Aliabad, Pakistan, which is in a rural area in the mountains in northern Pakistan. The health care facility there is an extended care unit that is run by two physicians who see approximately 60 outpatients every day, attend emergencies, and visit with eight inpatients. The staff consists of two RNs, four licensed health visitors, and two nursing aides. Staff members rotate working in 24-hour shifts. The care unit includes a laboratory with a technician and a pharmacy with a pharmacist.

Patients pay 30 rupees to see the physicians, which is equivalent to $0.50 in US dollars. Most people do not have 30 rupees to spare, although children on the streets look well fed because there is plenty to eat. Everyone owns land and grows fruits and vegetables. The children asked me for pens or pencils for school, however. One of my friends had given me a lot of pens and pencils before I left, which I donated to the local school. In appreciation, the principal asked me to take a tour. I saw children sitting on mud floors in substandard conditions, but they were keen to learn. I decided that when I got back to the United States, I would work on collecting money to improve standards in the schools.

CULTURAL DIFFERENCES

I was assigned to work as an assistant to the physicians. The most common diseases I encountered were gastroenteritis, especially among the children; high blood pressure; peptic ulcers; and depression (Figure 2). Patient problems included high salt intake because the main food staples are excessive amounts of tea (ie, chai), to which northern Pakistanis add salt rather than sugar, and a local bread called phiti that they soak in the tea. Children start drinking tea and eating phiti from the age of one, and most are quite addicted to the tea. Most families are large, with up to 11 children, and in families with more girls than boys, parents often are depressed and under stress. The northern Pakistani culture dictates that families must have at least three boys, and boys always are preferred to girls because they support their parents when they are old. Having to feed and educate girls can result in stress for the parents and other family members.

Health Care Industry

Nursing abroad stirs the soul

AORN Journal, July, 2003 by Zarina Varma

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