The ultimate nursing adventure

Student discovers a passion for transcultural nursing

By Andrea Pohlkotte

"Get out of classes for a week and get credit for it! Spend a sunny nine days in a five-star hotel with plush interior decorating and just minutes from the beach. Only $45 per night, all you can eat breakfast included, exotic animals, jungles and marvelous tourist attractions thousands of years old-all for discount prices." ***

***Warning: Do not drink the water, go in the water or eat anything prepared in water, do not walk by yourself on city streets; beware of killer mosquitoes; stay inside to prevent heat stroke, get all 50 recommended vaccinations before departing; and never take hand off of your wallet.

Would you go? Of course!

People always say take a risk ... do something exciting ... live a little! Get out of school? Where do I sign? The role of a typical nursing student in today's college setting is of an individual immersed in books filled with unrelenting information about everything from the common cold to Epidermalisis Bulosa, all of which students think they will undoubtedly know by the end of their career as a nursing student. The real picture is of tears wept over that last test grade, chewed fingernails from insurmountable stress and an undying urge to do nothing but get the heck out--a very personal portrait that I paint as I started my third quarter of nursing school when the opportunity arose to get away from it all in the sunny hospitals of Cambodia. Unbeknownst to me, the unexpected learning opportunity would serve as just the right dose of cultural immersion to open my eyes to transcultural nursing and boost my enthusiasm to meet the challenges of an unknown world.

The adventure begins

Now just beginning my senior year as a nursing student at Wright State University in Dayton, Ohio, I have always had a love and curiosity for strange places and new experiences. Born to parents with the same desires, I have been afforded numerous opportunities to travel abroad within the last ten years and share in the cultural diversity and beauty of the globe. Right before winter quarter started, amidst the papers, final exams and group projects, I came home and listened to the messages on my machine just like any other day. Nestled amongst messages to return calls were words from my sister that changed my life, "Hey, Andie. Do you want to go to Cambodia? Call me."

Not five minutes later I was planning an attack strategy to convince my professors for the impending quarter that this opportunity was a must. My fingers couldn't type fast enough to send e-mails to the assistant dean and upcoming professors to ask permission to take midterms early, make up clinicals, and turn in papers late. All attempts proved successful. However, in order to make any trip as rewarding and thought provoking as possible, one must get information and facts about the destination before leaving. First stop, the weather channel. "Ninety-five degrees and 100 percent humidity at 2:00 a.m. in February."

After continued research and information from my course coordinator, I learned of the real history behind Cambodia and the sadness that the empire had incurred in only the last 25 years and the devastating state that the countries health care system was now in. Once a prosperous and beautifully sculpted harvesting society, Cambodia is now barely able to survive after the fall of the empire to the Khmer Rouge in 1975. Cambodia as a whole has had to strive against impossible odds. Currently the life expectancy is only 53 years and the infant mortality rate sits at an astonishing 103 per 1,000 live births. Only 64 percent of the population has access to safe water and there is only one doctor per 9,523 people (Ministry of Health, 1998). These facts only made the drive for cultural competence inside of me that much greater and I felt the need to go out and conquer the world of cross-cultural nursing.

A student arrives in Cambodia

Only four weeks later, equipped with my brand new stethoscope and hundreds of antibodies from all the required immunizations, I was headed to Phnom Penh, Cambodia, to participate in the HOPE (Helping Other People Everywhere) Healthcorps conference run by the International Churches of Christ. After 26 hours of flying, my sister and I stepped onto the runway in 110° heat and 100 percent humidity. First thought: what have I gotten myself into?

Shuffled onto an air-conditioned bus (a rare luxury) filled with RNs, doctors, pharmacists, and administrators, I felt strangely overwhelmed and underqualified as a mere student who knew "nothing" other than the fact that there was a hospital just down the street from my house. I had never set foot into a hospital room, much less try to diagnose and heal someone who didn't even speak English. Unpacking, sightseeing and our first taste of Cambodian cuisine were to follow.

After a few days of lectures on international adoption, cross-cultural nursing and the worldwide IDS epidemic, the most rewarding, yet challenging, experiences of our adventure were upon us. All day we traveled over bumpy unpaved roads through poverty-stricken countryside as naked children stared curiously from the roadside. Final destination, two separate AIDS hospitals filled to maximum capacity with men, women, children and infants.

The first was run by a nun who devoted all waking hours to the care and comfort of some of Cambodia's most destitute AIDS victims. The second was run by an American doctor from California who moved "to change the world." Both clinics were unbearably hot, had minimal amenities, and were filled with love, compassion, and gratitude. Patients shyly embraced the towering giants from the States. Donated Beanie Babies were passed out to the children as their eyes sparkled with excitement and fascination. After exchanging smiles and awkward glimpses, we filed out as Cambodians bowed with hands together in thanks for our fellowship.

We boarded the cool bus and sped off in true American fashion. Behind my sunglasses were tears of guilt as we headed back to our five-star hotel placed in the heart of Phnom Penh. Early the next morning, 200 people strong and armed with bug repellent, stethoscopes, HOPE t-shirts and open hearts, we marched into Sihanouk Hospital Center of Hope. A unique blend of 20 international and 210 native staff, all care, treatments and prescriptions are free of charge for those that live in the abject poverty that exists amongst all city streets. As we passed through the Triage unit, browned faces stared at us in marvel as we moved cautiously toward the volunteers.

There to greet us were the smiling faces of doctors, nurses and administrators who had uprooted their lives and families to donate their hearts, minds and degrees to better the health of Cambodia in a hospital with only an 11-bed surgical ward, two operating rooms and an 11-bed medical ward that has treated over 250,000 people since it opened just five years ago. All were assigned to various units, myself to the outside clinic where those with non-emergent cases could be assessed and treated.

As a nursing student, I played more of an observational role but conferred with a British doctor in order to diagnose and prescribe medications. How did we communicate? The patient would share information with the Cambodian nurse, she would translate to me, and then my response would be translated back. Due to the language barrier and heat, a ten-minute assessment felt like hours.

After various patients afflicted with allergies and backaches, a young man sat in front of me complaining of chest pain. After 45 minutes of translation, I finally learned that the man had been given battery acid to take his pills with instead of water--two weeks ago! This was a population grossly unaware of critical health issues and their signs and symptoms; it was then that I realized the desperate need of expanded resources for Cambodia.

Seize the opportunity

However, sharing the stories, tragedies and sights that I encountered in Phnom Penh are not meant to dazzle, but to inspire. As a nursing student, sometimes I feel that it's hard to find a "niche." We cannot yet call ourselves nurses--yet we are more than just students. We are individuals who have set out to attain degrees in one of the most noble and demanding and diverse professions in today's society. As students, most of us are in the prime of our lives free from "real" jobs yet brave enough to uncover new worlds and fascinating cultures.

The purpose of this article is to share possibilities. The endless opportunities that are available as cultural awareness broadens our horizons are waiting to be discovered. So consider this article a nudge into the world of cross-cultural nursing as well as into the art of caring for those who we can communicate with in no other way than a smile. Although I have a particular interest in international nursing, a difference is waiting to be made in the culturally diverse streets of the very cities that we live in.

Disease lives within our own homes and to the most distant ocean. Cultural immersion from your front step to even the farthest and most mysterious places can do nothing less than create awareness of the diversity within each culture and light a flame of curiosity to help someone in need. A plane ticket is not needed--just a willing hand, an open heart and a passion for making a difference.

Andrea Pohlkotte is a student at Wright State University and will graduate in December 2002.

This article also provided to Monster.com's Health site.