Twelve steps to prepare for global health nursing

reprinted from something I wrote for one of the publications of the American Nurses Association.


Your nursing skills are your gift to the world. Take these steps to prepare to use them in a foreign culture.

More American nurses are venturing out into the world to offer their skills, even if only for a short period of time. Maybe it’s earthquake or cholera relief in Haiti; maybe rural community health in Latin America; military duty overseas; or a short term Christian mission trip to Africa. No matter where you go, you need to prepare. These simple steps will guide you to make the most of your experience.

We all exist in an invisible “bubble” – an insulating set of comforts and expectations to make daily life easier and predictable.  The “bubble” consists of familiar routines and objects that make our daily life easy. It’s also a set of cultural assumptions, most of which are taken for granted. For example, whether the cars drive on the left side of the road or the right; the way a toilet operates; table manners; or the proper greeting when you meet a stranger.

To use your nursing skills in a foreign location is a challenge unlike any other. What is your travel style? Maybe you have taken a cruise, or stayed at a foreign resort. Maybe you have visited Europe or other states in the US or Canada. Clever tourism promoters go out of their way to present a predictable packaged experience – “the bubble” – to insulate the traveler from the sometimes-unpleasant reality of life in other parts of the world. A trip to a Low Income Country is off-the-beaten-path, and qualifies as “adventure travel” with unpredictable elements. When you combine travel and nursing practice, you are going behind the scenes, to the places the usual tourist does not go, and meeting people in their turf, in settings not in the guidebooks. You will need to learn a whole new set of travel skills and it takes courage. Less than four percent of all travelers engage in adventure travel. Here is a short list of things to consider.

Choose an NGO. NGO stands for “Non-Governmental Organization.”  The most well-known are Doctors Without Borders or the Red Cross, but there are literally thousands of groups working all over the world. An NGO will pave the way for you to use your skills to the maximum. Often, they will plug you into an existing program that will fit your needs, and also help you with in-country travel and such things as food shopping.

Learn the language.  Take language lessons. This is the single most important long-range skill required for most global health experiences. Nursing depends on making a person-to-person connection and dealing with the patients face-to-face. In a clinical setting you can not always count on having an interpreter. Being able to say hello, navigate the local bus system, and to order at a restaurant will ease your transition.

(New as of July 2018) Learn to “Code-Switch if the country speaks a form of English. I only learned the formal name of this recently (2018) though I have done it all my life. Go to my 2018 blog to learn more.

Meet somebody who is from there. In the largest American cities nowadays, you can find small pockets of people from nearly every society on earth – this is an amazing resource. Use the internet or go to your local college and you can find somebody who is from the country you will be visiting. They can become a source of valuable information in all sorts of ways.  Before I left for my first trip to Nepal I found a Nepali language tutor by posting a small flyer on the wall of the only South Asian grocery store in Honolulu. She taught me about language and customs such as table manners and greetings.  Befriending a person from a different culture is a two-way street and has many advantages.  It is something we can all do even if we have no intention of leaving home.

Go camping.  Learn how to get by with fewer creature comforts than the typical American. If you have never prepared food using primitive equipment over a woodfire, or used a privy, this skill will open your eyes to the daily challenges faced by rural people all over the world. Start to walk or hike regularly – if the transportation system is poor, you may find yourself walking a lot more than usual. In some cultures, coffee is not a daily menu item; If you simply must have coffee every day, learn how to make it using a wire mesh filter.

Eat the food. This starts with going to an ethnic restaurant if there is one nearby; but in many countries where cooking is the role of women, you can experience the role of women by familiarizing yourself with food preparation and the time it takes.

Read the literature of the country. Start with a Lonely Planet tourist guidebook; these usually include the elementary rules of etiquette. You can learn about religion, politics, gender roles, customs such as those surrounding funerals, and body language.

Plan for culture shock and re-entry shock. Culture Shock arises from the inevitable comparison to your home. Re-entry shock is something that sneaks up on you – it happens when you return, expecting to take up your life where it left off, but realize that you have changed in unexpected ways. It is not unusual after a global health experience to feel disconnected from your home culture.  Every nurse needs to be aware of this phenomenon.

Minimize your baggage. I have friend who has led ten trips to rural Nicaragua. She blushingly confessed to me that she brought a blowdryer with her the first time. On each subsequent trip she learned what she did not need. Nowadays, she travels very lightly, with only as much as she can fit in a daypack, for a three week trip.

Plan to share from the beginning. We owe it to our fellow Americans to educate them about global health, and a firsthand account is powerful. Get a camera and practice with it before you go. No matter how much you tell people, they will never understand what it was like unless you have photos when you return. If you buy souvenirs or artifacts, choose ones which tell a story about the daily life of the people. Keep a journal.

Learn about hospital and clinic standards. Many of the health problems are directly traceable to lack of public health infrastructure. There will likely be more problems with infectious diseases; and you may need to learn how the local providers deliver care even though disposable supplies may be limited or they may not have new equipment.

Practice “water discipline” and food sanitation. Clean water is something we take for granted. Food- and water-borne illnesses are the single biggest problem encountered in foreign adventure travel. In many countries the water from the tap is unreliable. It is helpful to practice safe ways to use water which will become firmly engrained habits prior to the trip. Visit a travel clinic and start getting immunizations in advance.

Even if the primary purpose of foreign travel is vacation and you are not planning to use your nursing skills, there are some things you can do. For example, if you go to the Caribbean, you can get “out of the bubble” by spending a half-day touring a local hospital. Often, somebody will gladly show you around even if you give limited notice. In Low Income Countries, up-to-date nursing textbooks are beyond the reach of local health care workers. Pack one with your luggage as a gift for the hospital library and you will contribute to local health care even if it in is a small way.   This sort of person-to-person experience does not need to be planned in advance.

In summary, an experience in global nursing can be very rewarding, but to have the best success will require intensive preparation, and the time to start is now. We can benefit from adopting a global attitude, even if we never leave home.

Update May 2015: and if it’s Nepal you are thinking of visiting, read my two books about Nepal health care, the most recent is The Sacrament of the Goddess and you can get it on Amazon. Send me an email.  I will give you some personalized advice.


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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7 Responses to Twelve steps to prepare for global health nursing

  1. Great article, Joe! I especially think the idea of ‘go camping’ before you go is a good one. It’s a quick way to remember that you wno’t always have the comforts of home while you are on your medical mission.

    I have found that global experiences ARE rewarding and each time I go I come home realizing that the life that has been changed is my own.

    Good luck in Nepal this summer!


  2. Pingback: Jan 7th update for summer 2013 plans – | CCNEPal 2013

  3. Nita says:

    It is your great movement to make the global health nursing . Lots of best wishes from our side . Keep it up .

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  6. Pingback: How a doctor or nurse can prepare for a medical volunteer trip to Nepal since the April 2015 earthquake. | CCNEPal 2015

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