I was so confused after my first few days of work. I waited for months and flew across the world but there was a big problem. I didn’t like it. I just wanted to  shout “just kidding!” and erase the past few months. Could I go back home, back to nursing in Rochester, and forget about all the adjusting I had done thus far? No, it’s not so simple?

My Nursing Identity

I am a nurse and that’s what I came to do. I know I’m good at it, and I feel passionate about it but those first shifts on the ward completely threw me. My entire identity as a nurse was tied to the way I learned to nurse in New York, the way my alma mater taught me to nurse and the way all my coworkers nurse. B Ward was not that way.

Let me tell you what it was like to nurse at Rochester General Hospital. I’ve cried over a patient because I couldn’t get him his pain medicine on time and I knew he really needed it. My tears literally fell in his hair as I stood behind him. I’ve felt accomplishment after a shift so crazy I never thought I’d make it out alive. I’ve proudly told new acquaintances that I’m a nurse and seen the way they admired my hard work. I’ve worked Christmas shifts with dying patients and shared gifts and cards together. I’ve felt the wheels in my brain smoking and I put critical pieces of information together and decide which nursing intervention needs to come first.

I missed that. I can picture busy, burned out nurses from across the country slapping me across the face for looking back and desiring what I had. We hated how busy we had to be in order to keep our heads over water. Our patients had a rainbow range of needs, and most of it wasn’t pretty. That pace left no time for a romanticized view of this vocation. And yet, I still loved it. It made me want to die and I cried the duration of my commute home more than once. But I was so proud of the work I got to do, the lives I got to touch and the compassion I still mustered up.

I missed communicating effortlessly with my patients. I missed the way I could assess their emotional needs and whether we would have a connection from our first interaction. I missed the way those annoying call bells reminded me I was needed.

On this ship, I work on B Ward, the home to plastic surgery, orthopedic surgery and Women’s Health. Compare this to my work in Rochester and it’s night and day.

Nursing on a Hospital Ship

Each patient has a mom or an auntie or a papa that must stay with them throughout their stay. These dedicated care givers do the majority of the child’s care. They comfort, they wipe and clean, they force feed nasty pain killers down throats.

Each ward has up to 4 crew members hired from Madagascar who help us translate (although not professional translators like I’m used to). They are also responsible for helping with linen changes, serving meals and convincing little mouths to open for Tylenol.

Then I show up. I’m a white-skinned girl from New York who can’t speak the language and has never worked with kids. Between the caregivers and the Malagasy day crew, what was there left for me to do? I felt useless. My workload had gone from 10 to 1 and this was not making me feel like a nurse. I felt like a highly trained giver of multi-vitamins. The spare time on the ward morphed from refreshing to imprisoning. There is no break room, no nursing station to escape to; no distractions from across the unit; no computers and no private rooms. You are in the ward with the patients the whole time with their faces staring up at you.

Evolving and Growing

I had to start the redefinition process of what nursing means to me to survive emotionally here. It starts as a perspective shift and evolves from there. I found that every aspect of nursing opposite from home had a silver lining. Those silver linings are what make nursing on the Africa Mercy so beautiful and enriching.

That extra time I hated? It’s a great time to play with the patients and be creative with new ways of overcoming language barriers. A few new words in their language will make a world of difference and they are ready and happy to be our teachers. The slower pace gives you the opportunity to give holistic care and compensate for the extra time it takes to actually understand what the problem going through a mama and a translator is. The lack of private rooms contributes to a beautiful village experience over the course of several weeks. You see patients with similar deformities notice they are not alone anymore. You see more experienced mamas explain to new admissions how different things work. It’s beautiful.

There were redeeming moments in those first few weeks that I held onto while I tried not to buy an early ticket home. It was a very gradual process, but my confusion settled. My calling to be a nurse and my motivation to do it well never changed. In fact, the ‘art of nursing’ was exactly the same on a ship in Madagascar as it was at home.

When I’m busy, but a patient has a complaint that makes no sense, I’m drawn to stop and listen, really listen, to figure out what they need.

When a patient is overwhelmed with emotion at a poor prognosis, I feel that squeeze on my heart that says, “This is not ok. This is not how it’s supposed to be.”

When a patient makes a comment revealing a misunderstanding, I don’t hesitate to give her knowledge that she deserves as the one living inside her own body.

That is the art of nursing, and it doesn’t matter where or who or how or when it’s done. Compassion and knowledge-sharing are deep within the DNA of nursing. I’m so grateful to carry that legacy anywhere I go.

Cross-cultural nursing can be surprising for any nurse. It takes a shift in perspective to truly enjoy.
Sandrins: A 9 year old I cared for. She asked me to paint her nails sky blue, same color as mine…

9 comments on “How I Experienced Cross-Cultural Nursing”

  1. Wow Ivanna! What amazing experiences that you have been blessed with! Praying for strength and peace 🙂 SO proud of you! Don't worry 2800 hasn't changed! Enjoy every moment. Every little thing you do, do for His glory 🙂

  2. I think it’s admirable what you’ve done. As a 2x young adult cancer survivor, it’s difficult to have nurses that don’t have compassion. You sound like someone who I would have loved to have as a nurse. Best of luck in your further adventures overseas.

    • That’s kind of you to say Cashea! A smile and a little patience go a long way. Thank you!

  3. I loved this. I run a non-profit that sources international volunteers to work in community based organizations in Uganda. We’ve hosted a number of health care professionals. Because nursing is so front line, nurses are often very overwhelmed at first – the lack of privacy, differences in hygiene, language barrier – but after a week or so, no problems. Nurses find their way. They build relationships. I guess that’s why they call it a vocation, eh?

    Keep up the great work!

    • Leslie, we probably have seen a lot of similar situations with the nurses we work with. The Africa Mercy is unique in that it’s a blend of Western standards and hospital environment with the local culture. It creates a third nursing culture to navigate! I’m still figuring it out after 2 years.

      You’re right about the vocation, though. Nursing has some strong common threads that don’t ever break, no matter which culture you’re in! Thanks for stopping by!

  4. Wow. I really like how down to earth you are. I think you’re an inspiring person with such an amazing story. We need more nurses like you. Faith in humanity: restoring.
    All the best on your future! Look forward to reading more.

  5. I’ve always wanted to work on a MercyShip – so thank you for sharing your experience! It’s good to hear from someone on the inside 🙂

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