July 18, 2012. I’m sitting on a flight from Guangzhou, China to Vancouver, scribbling away in my journal, and suddenly, my pen comes to a pause. People who know me well know that rarely am I at a loss for words, yet for some reason, I just can’t decide what to write. Normally, my journal is just useless ramblings about my “fascinating” life and as my two full journals from the last three weeks can attest, I write about everything. At this moment, it’s not that I don’t have anything to write, but all I can think of is “how can I capture a month’s worth of memories into a sentence?” I want to wrap up my trip in a cute little package, before my journal progresses to consist of the usual happenings of my life in Edmonton, but I can’t figure out how to summarize the last three weeks. I am already dreading the moment when I return and everyone asks, “What was the best part of the trip?” and clearly, my brain is a step ahead of me, trying to create my answer. In all honesty, the best I can come up with is that I didn’t have a favorite moment. It truly is impossible to reduce my experiences into a “Cole’s Notes” version, but here’s what I came up with: Empathy, Hope, and #firstworldproblems.
Nepal, one of the world’s poorest countries, was where three of my friends and I decided to spend our summer holiday. As a nursing student, I’ve always had an interest in global health, and when paired with my jet-setting nature, it’s the perfect combination. Although I had promised myself that this summer was going to be dedicated solely to work, when a few friends mentioned nursing in Nepal, it didn’t take much convincing before I was booking my plane ticket. We planned our trip to be a healthy mix of tourism and volunteer nursing at a rural health outpost. I didn’t know which I was more excited for – seeing the beauty of Nepal by trekking around to UNESCO World Heritage sites, temples, and yoga classes; or getting to put my nursing skills to meaningful use helping people who really needed it.
Empathy: the ability to understand and share the feelings of another. From day one of my nursing education, I have had this term drilled into my skull. As a nurse, empathy is one of my best tools in my communication toolkit. While the Oxford English Dictionary gives a pretty vague meaning to this term, over three years of nursing studies, I have grown to appreciate and understand that being empathetic means being able to recognize that while one can’t possibly know what a person’s going through, an empathetic nurse will be able to validate and understand their patient’s feelings. As the old adage points out: before you make assumptions, you should walk a mile in someone else’s shoes. Well frankly, sometimes their shoes aren’t the right size, so even if you’re walking in them, you are not experiencing their life in the same way they do. However, trying to put yourself in someone else’s place can give an entirely new meaning to a situation. By throwing myself headfirst into the Nepali culture and healthcare system, I was able to view health and nursing from an entirely new perspective.
Having been challenged personally and professionally, I found myself constantly reflecting on the stark contrast between Nepal and Canada. At one point, I found myself standing in an Emergency room at the only local hospital in the town, staring at an empty room. Not a patient in sight. All I could think of was how back home, spending less than three hours in an ER waiting room would be a good day. While we complain about the flaws of Canadian healthcare (and I’m by no means claiming our system is perfect), it is not often that we stop to consider how fortunate we are to have a healthcare system. Although there is some government-funded healthcare in Nepal, in general, you have to pay to be treated. In a country where the average national salary is approximately $240, healthcare is not a luxury that everyone can afford. To go back to the ER, the quiet emptiness sent shivers down my spine. There are obviously sick people out there, are they not here because they can’t afford to come to the ER? Knowing what it’s like to be immersed in uncharted territory and seeing the disparities first hand has created a deep sense of empathy that has shaped my worldview. The most important part of this empathy is realizing how vital the context of a situation is, a perspective that will influence the way I approach each patient in clinical practice.
“First World Problems” has become a trending catchphrase recently. Essentially I see it as a way to humorously put into perspective some of the “issues” that plague developed or “First World” nations. One can joke about how the “worst day in the world” involved sitting in traffic for an hour, only to be made worse by the barista at Starbucks getting your order wrong. On one side of the coin, I think that the use of this phrase can be viewed in a positive light; people are reflecting on what they take for granted, and realizing their daily problems really are not as monumental as they appear in the moment. Maybe I’m being quick to judge, but I don’t think many people actually reflect on the contrary side of a “first world problem.” In other words, I think it’s the context of understanding the disparities and inequities between different parts of the world that actually creates that implicit knowledge about why our “first world problems” aren’t really problems at all.
Global health is about so much more than providing healthcare in developing countries. As much as I hate to admit it, I was naïve to think that I could go to the other side of the world, provide nursing care to people in need and through this, I was going to change the world. The reality of it is that while I may have touched a few lives while nursing in Nepal, I didn’t make a difference, not really. While this may seem like a pessimistic view, in fact it is one of hope. I realized that while lack of resources (including human resources) is a significant problem and it certainly is beneficial to volunteer your time and skills, the bigger issue is the systemic barriers that impede developing nations from achieving the same standards of health that we have come to accept as the norm. While I’m not claiming to have the answers to how to make this systemic change happen, I can say that the most motivating clinical moment for me was when a physician I was working with brought me along to a meeting one afternoon. This meeting was of a local community organization that is committed to improving health in their community by reducing poverty. Although the meeting was conducted in a language that was foreign to me, and I didn’t know the history of this committee, what was highly apparent was that this was a group of local individuals dedicated to improving the lives of the people in their community, through increasing access to education, providing food to those who can’t afford it, educating the community on healthy practices, and developing community programs for youth. These are the types of initiatives that our world needs in order to improve the health of developing nations. Who better to assess the needs, deficits and strengths of a community than members that live in, work in, and are active members in the community? While every moment of my volunteer time left me with a sense of understanding, enlightenment, confusion, or questioning, this gem of an afternoon left me brimming with a deep sense of hope.
So to backtrack to my airplane conundrum, how do I summarize the experience of nursing in Nepal into a few sentences? The empathy that I can bring to both my clinical practice and my daily life is something I could not have acquired without being thrust out of my comfort zone. I am filled with a deep sense of hope for the future of global health and the health of developing nations. And I finally understand the real meaning behind “First World Problems,” and will use this newfound knowledge to put my life into perspective when I feel like the world is ending. While I know I didn’t change the world on my trip, I do know that the world changed me.