First Aid for Nurses on the Mission Field

by Jean Dyer

Missionary nurse expresses frustrations she feels on the field.

The hot, tropical night air presses in on the closed wooden shutters of the tin-roofed maternity building. Droplets of perspiration on the face of the exhausted young mother glisten in the lantern light as she strains to give birth to her first baby. The missionary nurse, called from her bed to examine the mother, notes with consternation that the presenting part of the baby is not the hoped-for head, or even an acceptable foot, but rather a dreaded hand.

Family members who carried the mother in from the village admit that she has already been in labor for two days. The nurse knows that this means the mother must immediately be transported to the hospital for surgery. As the family reluctantly prepares for the trip, the nurse worries: Will the ancient Land Rover that serves as an ambulance start? Will the soldiers enforcing the dusk-to-dawn curfew permit a midnight trip to the hospital? Can family members be persuaded to donate blood? Will the mother survive the three-hour journey over the badly rutted roads?

In another village, a missionary nurse turns restlessly on the slatted, wooden bed provided for her by the village leaders and wonders if she’ll get any sleep this night at all. Some living thing is definitely crawling along the wall of the sleeping hut, and the goat that normally stays in the hut at night is noisily protesting being tied to a nearby tree.

The lump of manioc paste and the hunks of goat meat fried in palm oil that she’d successfully swallowed for the evening meal now feel heavy and uncomfortable in her stomach. As she tries to ignore the persistent buzzing of the thirsty mosquitoes gathered outside her mosquito net, she thinks about the village meeting scheduled for the next day.

She wonders: Will the villagers’ welcome turn to angry rejection when they learn that funds aren’t available to establish a dispensary in their area? Will they be willing to choose, instead, one of their own people to be trained as their village health worker? Will they make a decision quickly so that it will be possible to get back to the base station before the rains start and the roads become impassable?

At the end of a hectic week, another missionary nurse sits quietly on a backless bench in a crowded village church and lets the sounds of the morning service (the clapping and singing of the people, the beating of the drums, the crying of the babies) flow around her. She feels weighed down with fatigue, worry, and sadness.

She had been called out in the night (the third time this week) to see a cholera patient. Yesterday her two oldest children had flown 500 miles north in the little MAF plane to begin another long three-month term at the boarding school for missionary kids, and this morning her husband had headed out in the Land Rover for a two-week safari. Naturally, no sooner was he out of sight than the generator stopped dead and her youngest son began to cry with a headache-a sure sign of another malaria attack.

She shifts on the bench and wonders if she should slip away to the mission house to check on her son. She decides: I’ll go when the third translator begins his rehash of the morning message. In the meantime I’m going to sit here and think about what in the world I’m doing here anyway.

WHAT IN THE WORLD AM I DOING HERE?
"Oh, God," she prays, "It’s all your fault. If you had left me alone I’d still be working in that clean, orderly little hospital in southern Kentucky and I wouldn’t be sitting here trying to figure out how to help 100,000 Africans come up with some kind of health care system.

"I wouldn’t have to deal with sick people who try every home remedy in the book before they come to the dispensary for treatment. And, God, there’s the staff you have foisted off on me. I hope you have noticed they are irresponsible, dishonest, and always late. I’d also like to know how you expect me to run a medical work with so few medicines and such lousy equipment. I would think that the least you could do would be to make things easier at the border so that the hospital supplies could come across more quickly.

"And while I’m on the subject of problems, God, I’d appreciate it if you could do something about the mission field director. Besides being totally obnoxious, he won’t listen to any of my suggestions and even had the nerve to take the nationals’ part in the last salary dispute.

"Oh, God, I know you get tired of hearing me gripe, but there is so much work to do and I can’t seem to get around to doing any long-term planning because of always having to deal with emergencies. And you know something? If it weren’t for these Sunday morning services (which I can’t understand because I’ve only had two months of language study), I wouldn’t get a chance to talk to you at all!"

As she stood up and squeezed her way toward the door, she remembered that in the rush of getting her husband off on his trip, she hadn’t had time to read the mail that had arrived on the plane that had taken her children to school. As she hurried into the mission house, she picked up a letter from the stack on the table and opened it as she walked down the hall to her son’s room.

The letter was from the mission personnel director. It said: "Dear Jean, I detected undertones of frustration and even anger in your last letter. Could you please let me know how we here in the home office could be more helpful to you?"

She let the letter slide to the floor as she sat down slowly in the chair next to her son’s bed. She wondered: Now how do I truthfully answer that? What would be helpful to me?

After checking on her sleeping son, she picked up some airmail paper from a nearby table and began to write. She started:

"DEAR PERSONNEL DIRECTOR
"Dear Personnel Director, It’s true that I have felt discouraged lately. It seems there is so much to do and so few of us to do it. And some days I feel more like a Land Rover mechanic, a kerosene refrigerator repairman, or a referee than a professional nurse. Also, some of the conflicts within the mission are beginning to wear me down.

"Since you asked me how you can help, I’ll volunteer a few suggestions:

"It would have helped me if I could have had a more realistic job description. No one mentioned that I would end up acting as midwife, general practitioner, bone-setter, pharmacist, lab technician, teacher, administrator, bookkeeper, guest-house hostess, community developer and blood bank supervisor, and that it would be handy if I could also administer anesthesia and do minor surgery!

"It would be nice if decisions in the mission could be made more democratically instead of being handed down from on high. We like to feel that we are part of the planning team.

"All of us could use more language training (away from the station). Many of our problems with the nationals seem to arise from communication misunderstandings.

"We missionary nurses would appreciate being able to attend some continuing education seminars. We need to learn from each other and from outside consultants.

"We need to have someone to turn to for counseling when we have difficulties, so that we can deal with small problems before they become big problems. Have you thought of having a pastor for the missionaries who could organize spiritual retreats, conduct conflict management seminars, and provide confidential counseling?

"We need more time away from the station and away from each other. As I heard a missionary nurse say to her house-mate: I need a vacation from you, not a vacation with you!

"I wonder if you are considering some ways of making better use of our scarce resources (people, finances, time)? Another mission in this country has implemented a community-based primary health care program and their missionary nurses are training village health workers to care for their own people in their own villages. The missionary nurses say that the people like this system because it makes health care available to them close to where they live. The nurses like it because it stresses prevention, people development, and local planning.

"Thank you for asking for my suggestions. I feel better already just for getting a chance to ‘speak my piece.’"

She put the letter aside and placed her hand on her son’s forehead. Ah, it felt cooler already and he had stopped moving about so restlessly. The medicine must be starting to do its work. Gratefully she prayed: "Thank you, God, for listening and caring, and for helping me to cope."

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