Going Global: PAs, NPs Practicing Internationally
In the end, this new program has been a learning experience for everyone—in more ways than one. It’s those kinds of exchanges with other cultures that make working overseas a joy and a challenge, Keim says: “I reflect back and think this has been a phenomenal career, because it has taken me down paths I never imagined.”
Honduras: Clean Water and Compassion
When Thad Wilson, PhD, RN, FNP-BC, graduated with a BSN from the University of Iowa nursing school, he happened to attend a career fair. One of the booths, way over in a corner, was advertising a primary care nursing position at a clinic in a rural area of Honduras. Wilson, who had been considering the Peace Corps anyway, jumped at the chance for an adventure. “I was going to be the only primary care provider for 5,000 people,” says Wilson (who was 22 and unmarried at the time).
During his first few weeks at La Buena Fe Clinic in a small village by Lake Yajoa, Wilson says he “got really good” at suturing. That’s because so many of his clients came in with machete wounds. One man even had a machete stuck in the back of his neck. Another patient still thanks Wilson every time he sees him, for sewing his thumb back on after he accidentally cut it off while working with a machete.
“This was a great clinic, in the middle of nowhere,” Wilson recalls. “I had no electricity and no running water. I delivered babies by candlelight and boiled water to sterilize my instruments.”
Just about every patient who came to La Buena Fe had gastrointestinal problems. The area was replete with tropical diseases. “I saw every kind of amoeba and worm you could think of,” Wilson says. “Those were my biggest nemesis.”
Upset by seeing toddlers dying of diarrhea, Wilson consulted with some local nonprofit agencies. Eventually, they built a well so the community could have clean water to drink. “Now, we don’t see the number of cases in that area with gastrointestinal problems,” he adds.
Without the fancy diagnostic tools most US nurses take for granted, Wilson says he honed his skills in taking histories and doing physical assessments. “The greatest technology we have is between our eyes and our ears,” he says. When he needed help, he turned on his ham radio and tapped into the expertise of several doctors thousands of miles away, back in the US. Talk about trial by fire… Wilson, who is now Associate Dean of the University of Missouri School of Nursing in Kansas City, recalls those days with fondness.
Thirty years later, Wilson (the Immediate Past President of the American College of Nurse Practitioners) still goes to Honduras on a regular basis. These days, he visits with 12 nursing and pharmacy students from the University of Missouri. He wants them to capture the magic and the intense hands-on experience that he had in his earlier years as a nurse.
The 15-day program gives students a chance to work in rural clinics as well as city hospitals. Part of the goal is to get students thinking about quality of care under different health care systems. For example, in Honduras, patients must make a down payment before they can have surgery in a hospital. “There are people who will die on that bed, waiting for $50,” Wilson says, “whereas in the US, we would do the surgery first and ask for money later.”
Compassion and cultural sensitivity are other byproducts of Wilson’s overseas class. For example, the students begin to understand the importance of family in Latin American culture. Back home, when an entire extended family crowds into their exam room for one family member’s appointment, they won’t mind so much.
Stoicism is another trait they learn about. “In Central America, they come from a culture where pain is just a way of life,” Wilson says. “They are able to improvise and do whatever it takes to survive.” So students realize patients from these areas may not complain much, and it might take a little coaxing to find out what’s wrong.
Wilson is grateful for his time in Honduras. It has offered a life-changing experience—both for him and for his students.
Australia: Digging in Down Under
Al Forde, PA-C, originally from Wyoming, admits he has always had a love affair with Australia. “I’ve always kept an ear to the ground as to how I could get there someday,” he says.
So he felt incredibly lucky to be hired at James Cook University in 2006, when the college decided to launch a pilot PA program. At the time, Forde was teaching in the PA program at the University of Utah in Salt Lake City. Luckily, his wife and 12-year-old daughter were up for the adventure of moving to Queensland.
