Making a difference in the developing world: a nurse who registered a year ago, has found her nursing niche in voluntary work in developing countries devastated by natural disasters.

From as early as I can remember, I have wanted to be a nurse. I recall, aged seven, reading one of my aunt's nursing text books and longing for the day I could train and practise as a nurse. One of my aunts had travelled extensively in Africa, Asia and Europe after her training in the 2950s, and I grew up dreaming of working as a nurse in countries in the developing world and trying to make a difference in these impoverished people's Eves.

But life sent me in a different direction, and it was not until my mid 30s that I embarked on my nursing education at Southern Institute of Technology (SIT), graduating in 2005. During the course, tutors kept saying that an area of nursing would hit me and I would "just know" this was where I belonged. I enjoyed every area I worked in, but waited patiently for this "special" area to emerge, quietly envying the students who seemed to "know" where they fitted. At the end of my second year, a group of four nursing friends and I spent four weeks working under the guidance of New Zealand doctor, Derek Allan, "Dr Derek", in the outer islands of Vanuatu. (An article by nurses who worked with Derek Allan in Vanuatu was published in the September 2005 issue of Kai Tiaki Nursing New Zealand p18-20). On this trip we were constantly challenged emotionally, physically and professionally, and learnt so much about ourselves. The trip began as an adventure with friends but it became a life changing experience for me.

I returned to New Zealand in Christmas week 2004 and was enjoying reuniting with my family, when the Boxing Day tsunami struck. Like so many, I was shocked by the horrific toll of this tragedy. I still had the third year of my nursing degree to complete but knew I had to help in some way. I volunteered and travelled alone to Indonesia, joining the Electric Lamb Mission (now called Island-Aid), formed by two expatriate Australians, Rick Cameron and Jane Liddon who live and work in Sumatra. What had attracted me to the mission was its strong commitment to get aid to the areas missing out on mainstream aid efforts. During the first 10 days in Sumatra, I provided administrative support as Rick and Jane dealt with the massive logistical task associated with putting their plan into action. This plan involved using a ship and 20-foot motor boats, donated by Rolls Royce, to deliver aid and medical support to communities along the Aceh coast. With a diverse team of volunteers from around the globe and extraordinarily tong hours, their vision became a reality. It was an incredible privilege to have been part of this remarkable feat.

I then joined the ship delivering food, supplies, fishing equipment and medical care to thousands of homeless and traumatised people along the coastline of north Sumatra.

I made it home to Southland on a Sunday night in late January 2005 and started my third year of nursing studies the next morning.

My family thought I would have got disaster and developing world nursing out of my system, but no. As third-year elective placements loomed, I asked the nursing school about the possibility of doing mine in a developing country, although I didn't hold out much hope. Mine was a surprising request and the school set rigorous requirements but I completed them, and did the last four weeks of my training in Indonesia. I am very grateful to the SIT tutors who supported my request.

So in early October 2005 I returned to work with "Dr Derek", who had moved to Indonesia following the tsunami, and International Crisis Mission in Nias Island, which is go miles off the coast of Sumatra and had been devastated by an earthquake in March 2005. I was quietly settling into the work routine when the massive October 8 earthquake hit in Pakistan. Dr Derek and I volunteered and joined Crisis Relief Singapore (CRS), as part of its medical team in the worst affected area of Bagh in Kashmiri Pakistan. We lived in a tent in an army camp 4000 feet above sea level, daily carrying packs of medical supplies into the stunning mountains. We delivered desperately needed medical services and medications to people who either could not or would not trek down into the valleys where the non-governmental organisations (NGOs) such as Red Cross had their base camps and temporary field hospitals.

The wrath of nature

In Kashmir, I was again astounded by the wrath of nature and its devastating consequences. The earthquake had hit at 9 am, when many of the area's schools had just started, so a large number of the serious injuries and deaths were among school children. Ninety percent of homes in this area were either destroyed or uninhabitable. The earthquake struck as winter approached and, apart from the physical and emotional trauma, these people were being affected by many problems--gastrointestinal infections, scabies and lice--due to living in unsanitary conditions in steadily worsening weather. With winter fast approaching, it was healt wrenching to watch the surviving locals, many of whom had lost many family members, try to rebuild or salvage what was left of their posessions and set up for the cold months ahead. We found large families living in freshly-dug ditches, with only tarpaulins; over them to keep out the elements.

As the weather continued to deteriorate, I left Pakistan and returned to New Zealand to sit mock exams before nursing state finals. As I had extended my stay to work in Pakistan, I travelled home over three days on standby, arriving home on a Sunday night to sit exams on Monday morning. Despite such pressures, there was stilt no sign of this nursing in the developing world bug abating.

After registration, I was employed by Alliance Lorneville Meat Processing Plant as an occupational/practice nurse. There are 2500 employees and the medical centre runs 24 hours a day. My position is seasonal, so I also work at Gore Hospital as a casual RN.

In a newspaper article on my return from Pakistan, I said I felt I should complete one or two years of nursing before embarking on any more travel. But in July 2006 my seasonal position had finished for the year and, once again, I felt compelled to do some more work in the developing world. I travelled again to Indonesia to work in the Tello Islands, to work again with Dr Derek, this time under the aegis of his small NGO, Troppodoc.com.

One of our priorities was to try to encourage villagers to harvest water from rooves. Chronic and preventable diseases are rife, with many of the health problems directly linked to inadequate water intake. Many of the small kampongs (villages) have one home with a long-run roof. If we can get funding for spouting and a small tank for these houses, the water collected will provide clean safe water for all the villages' inhabitants. This has become one of our priorities, and we are working hard to raise money and get volunteers to help install these tanks. Such a small outlay in cost and work would save many, many lives.

Stroke and heart attacks often occur in people in their 20s and 30s. Temperatures of around 50 degrees require a water intake of four or more litres daily and often these people are only drinking three glasses. This is contributing to the large incidence of a multitude of easily preventable chronic health conditions, which affect women more than men. No toilet facilities mean the majority of elimination is done in back yards, so to decrease the need to go to the toilet, many women refuse to drink enough fluid. These young women are dying as a direct result of their insufficient water intake.

In Tello, we undertook four operations in my first five days. Dr Derek only undertakes lifesaving surgery. He operated, with my basic assistance, on a 51-year-old diabetic woman with gangrene in her foot; two young women with acute appendicitis; and we also removed an orange-sized tumor from a young man's lower back. There was no power and generators only worked at night, so operations could only be attempted during the night, unless they were performed in an individual's home in direct sunlight. Administering anaesthetics, minimal diagnostic equipment, and all our own postoperative care meant long hours, but it was very satisfying work.

At first, it seemed impossible to work due to the lack of basic medical equipment. But ultimately this lack increased the assessment skills we have all learnt but tend not to use fully, because of the machines we have in the developed world to back us up. This area desperately needs x-ray equipment, laboratory facilities, an echocardio-graph machine, pulse oximetry and blood glucose machines.

The days ran into each other, and with the surgical patients to care for, home visits to those who couldn't come to us, the remote village clinics, and an endless stream of patients at our boarding house door, we often worked 18-hour days. Our boarding house had no power, water was predominantly drawn from wells, we all shared a toilet and bathroom and there was no air conditioning, not even a ceiling fan. Being hardy is definitely an advantage. As there were no cooking facilities, we ate from street stalls, usually eating only once a day. In the 50-degree heat and almost 100 percent humidity, we often didn't feel hungry.

The work was incredibly fulfilling. Lives can be saved on a daily basis. But life is harsh. People expect to die. Seventy percent unemployment in this area adds to the huge number of stressors these people have to deal with.

Raising awareness of poverty and need

I have been asked to become a director of Troppodoc and want to raise awareness of the poverty and need in these countries and, more importantly, to encourage people to experience this work. We would love people from all walks of life to join us. Building, plumbing, agricultural, teaching, nursing and medical skills are all necessary, but enthusiasm and genuine caring about people are the only prerequisites. Dr Derek is able to put all skills to good use. New Zealanders' do-it-yourself practicality and energy have time and time again been all that is required, whether to help local communities grow produce they can sell, or to provide desperately needed medical services, or to build schools, orphanages or homes.

I have been home now since August and, as always, when I return home I struggle for a while with things such as flushing toilets with water that is drinkable, my teenagers running water while they brush their teeth and power at the flick of a switch.

I plan to continue this work with people I have grown to love. I can only afford to do this for one month every six, but who knows what may happen in the future? I would also love to involve my family. My teenagers would benefit greatly from experiencing this work and it would help make them more aware of how well off New Zealand teenagers are. I have been very fortunate that my husband, Gary, and children Alexandra, 16, and Matthew, 14 have supported me in this ongoing passion. Without their support, I could not continue, or spend time raising awareness and funds for the work and those who need help. I have made lifelong friends, bonded by our shared goal--to show our fellow human beings that there is hope, they do have a future, the world is aware of their plight, and we are there for them in their time of need.

And, for the record, I think I may just have found my "area" in nursing!

* If anyone would like to experience this type of work or contribute to urgent medical costs or ongoing care, please contact me at [e-mail] or look at our websites www.tropponurse.com and www.troppdoc.com.

Bronwyn McBain, RN, BN, when not doing volunteer work overseas, is an occupational/ practice nurse at Alliance Lorneville Meat Plant in Invercargill and a casual nurse at Gore Hospital.