Traveling Nurse: How to Do Medical “Missions” Right

The Journey To Becoming a Traveling Nurse

I didn’t always want to be a traveling nurse. I was a sweet, White, American college student who wanted to save the world. So I got my first degree in Peace Studies. Spoiler alert: It’s not that easy.

The summer after I graduated, I did the thing so many sweet, White, American college students do: I went to Africa to volunteer. I paid a hefty fee for a “voluntourism” company to set me up with a volunteer placement and a home stay in Nairobi, Kenya. I got a crash course in how little difference one American with zero specialized skills can make. Like so many other volunteers with great intentions but no idea of the impact of their actions, I probably got way more out of the experience than I gave back. In fact, I found my future in Kenya.

Traveling Nurse-Kenya
Kenya

During my last week in Nairobi, a European nonprofit showed up in the slum where I was volunteering and set up a free clinic for three days. Residents came out of the woodwork. I saw wounds bandaged, infections treated, and a whole lot of teeth pulled. After struggling for weeks to feel like I was making any discernible difference at all, here were nurses literally changing people’s lives in the space of a day.

All I knew at the time was that I wanted to be a part of it. The dentists quickly put me to work sterilizing equipment since they couldn’t keep their tools clean as fast as they were pulling teeth. I loved it. I loved getting my hands dirty instead of sitting behind a desk; I loved meeting and talking to each individual patient; I loved feeling like I was doing something that actually mattered to someone right there and then.

Traveling Nurse-Tropical Nursing course
Tropical nursing course

I went home and chose the quickest nursing program I could find. Exactly two years to the day after I started that job, I quit and moved to Tanzania. I’d been saving up during those two years working in the hospital, and I found an organization that would set me and my husband (a schoolteacher) up with volunteer work in Tanzania. We stayed as long as our money held out, had an absolutely life-changing experience, and came home thinking that we’d gotten travel “out of our system” and now we could “settle down”.

Traveling Nurse-Midwives for Haiti
Midwives for Haiti

Fortunately, that’s not how things played out. I got my dream job working in labor and delivery back home in Seattle, but it wasn’t long before the wanderlust returned. Over the next few years I went on medical missions to Belize, Sierra Leone and Nepal and took a month-long Tropical Nursing course at the University of Liverpool. I kept getting skeptical looks from acquaintances (“You’re traveling again?”) because the truth is that medical missions won’t make you rich. In fact, they’re usually going to cost you – I still pay for my travel expenses, and sometimes a reasonable volunteer fee, for most of my trips. So if I’m not making money on medical missions, how the hell am I paying for life?

Traveling Nurse-Zanzibar
Zanzibar

How The Traveling Nurse Profession Works

It turns out that nursing is a great career for travelers. Most hospital nurses work three twelve-hour shifts a week, plus get two weeks of paid time off. If I play it right, I can take eight days off without taking any vacation time. I can stretch seven vacation days into a 23-day vacation. Yeah, it’s awesome.

Traveling Nurse-Bahamas
Bahamas

Once I got my foot in the door doing disaster response­ (when I deployed to Sierra Leone to treat Ebola patients, and then to Nepal after the earthquake) I wanted even more freedom. It’s hard to leave for a disaster on a day’s notice when vacation time needs approval months in advance. So I took a leap and changed to a per diem position. Here’s how it works: I can pick up as many extra shifts as I want so long as the hospital needs staff, but I’m only required to work two days per month. I don’t get benefits (I’m fortunate to be on my husband’s health insurance), but I can still contribute to retirement. So if I have a big trip coming up, I work a bunch of shifts to save up as much money as I need. Then, as long as I cover my two shifts per month, I can take off any time – no approval needed!

And lest you think I’m some sort of saint, not all my trips are for medical missions – not by a long shot. This year I’ve been to Puerto Rico and Australia with my husband, and I’m treating myself to a week on the beach in Aruba once I get back from a month-long stint volunteering with refugees in Northern Uganda. I can’t even believe it myself as I’m typing this, but my job allows me to do all that, still own a home and save for retirement! (Full disclosure: I’m married so we live on two incomes, but my husband teaches public school so I make more than he does.) Working per diem, I bring home about $30 an hour. As long as I work enough to pay the bills, I can go wherever I want, whenever I want.

It doesn’t work for everyone, but for me it’s a dream come true. For those who are interested, travel nursing is another great option with tons of freedom – you sign short contracts, usually 13 weeks, to work at an under-staffed hospital in the US, and get paid a high hourly rate plus a housing stipend. I know travel nurses who work for six months and then take the next six months off.

Traveling Nurse-Puerto Rico waterfall
Puerto Rico

Are there bad days? Of course. All manner of bodily fluids are involved, though that’s never bothered me much. I have days that are so long and hard that after twelve hours on my feet (including four hours without a break, cheering on a woman to push her baby out, and then having to do a c-section anyway) that I literally cry from exhaustion when I get home. I’m very aware that my job is dependent upon my physical health and if I lose that, this dream is over. And no matter what nursing specialty you work in, you lose patients. In labor and delivery, that means either losing a baby or a mom – I don’t know how to rank tragedies, but that’s got to be pretty high up there. Finally, nurses around the world will agree when I say that we are highly skilled professionals working our tails off to literally keep people alive – but we’re often treated like waitresses or, if we’re working with men, prostitutes.

Regardless of all that, labor and delivery nursing is a magical job. For me, unlike most, it’s not about the babies (I don’t even want kids). It’s about the women. Every day that I go to work, I get to be a part of the moment in a woman’s life in which she realizes what a total badass warrior queen she is. I’ve looked into a woman’s eyes when she thinks she can’t go on anymore, and watched her find the inner strength to do what she has to do. Women are amazing, no matter what corner of the world I’m working in.

Traveling Nurse-Nepal
Nepal

A Word on Medical Missions

 Before I go any further, I want to say a quick word on medical “missions”. It’s the terminology widely used to talk about any humanitarian medical service abroad, so I use it – but the wording troubles me. I can’t pretend not to notice that the term “mission” is pretty close to “missionary”. Does that make me, a nurse volunteering in Africa, a medical missionary? Because to me that sounds like someone who offers medical care while simultaneously spreading the gospel. In fact, I’m often asked “Oh, what church are you going with?” when I tell someone I’m going on a medical mission.

I respect the fact that some people are motivated to do this work by their religion. In fact, I know some pretty inspiring people of all faiths who are doing amazing work all over the world. But I think it’s important to differentiate between an individual’s motivation and an organization’s goal. I’m happy to serve alongside people of all beliefs to provide medical services to those who need it desperately, but I don’t think it’s right to promote any religion as a part of that work. All kinds of problems crop up when a project becomes more “mission” than “medical” – for example, clinics in developing countries that are funded by Catholic charities and refuse to provide birth control or family planning education. This is especially precarious in nations where their progress is being held back because half the population is preordained to spend their whole lives endlessly pregnant and raising children. It is criminal. Medicine and religion are too frequently at odds, and I don’t want those conflicts to muddy the waters when I’m trying to care for my patients. So I want to be clear that that’s not what I do.

Rethinking the Ethics of Medical Missions

 Since I stumbled on that first medical mission in Kenya, this profession has taken me on more adventures than I could ever imagine. I’ve worn a hazmat suit to treat Ebola patients in Sierra Leone, delivered surprise twins in Haiti, climbed through the rubble of Kathmandu after the earthquake, and spent more days in makeshift clinics in remote villages than I can count. It has been a long journey measured not just in miles, but also in how I view my role in this work.

Over the years, I’ve become more critical of well-intentioned American volunteers coming to “save” developing countries. For example, that first medical mission I stumbled into in Kenya – I wonder how much we really accomplished. Did we help people during those three days? Absolutely, yes. But what happened after we left? Did we leave them with any long-term way of accessing healthcare? Did we help support the slum’s permanent clinic, which struggled with minimal supplies and had to charge its patients, but nonetheless, was all that was available after the foreign volunteers went home? Or did we throw a bandage on a gaping wound, pat ourselves on the back, and leave this place struggling just as badly as it was when we arrived?

Traveling Nurse-Ebola response Sierra Leone
Ebola response, Sierra Leone

There aren’t always black and white answers to these questions, but it’s important to keep asking them. The word “mission” sets us up to inherently feel like we are traveling on a selfless errand with divine backing to impart aid that will help everyone we touch. But in reality that’s not the case; I can mess up just like anybody else. And as a very privileged white woman working in developing countries in a setting of neocolonialism and misguided aid programs, I have a responsibility to think critically about how I can make a difference. I still am (and will always be) figuring out how to do this work best, but here are a few rules I try to follow:

How Not to Volunteer Like a Basic Nurse

  • Give as much you’re getting. 

    Real talk: Nurses who do medical missions get a LOT out of it for ourselves. People are constantly telling me how wonderful and inspiring I am; I get to put this on my resume and seem like a combination of Mother Teresa and Dr. Quinn, Medicine Woman (who doesn’t want to hire her?); I get to travel to new places and have amazing experiences that most people could only dream of. In return, I’d better do some research to make sure the program I’m volunteering with is making anywhere near that much of a positive impact on the community I’m serving.

    In many cases, that means medical volunteers should devote most of their time to training and mentoring local clinicians rather than providing hands-on care, so we can make a difference that lasts long after we’re gone.

 

  • Move the spotlight off me and onto the people I’m working alongside.

    The nurses I’ve worked with in developing countries do impossible jobs for offensive pay, and they’ve forgotten more than I’ll ever know about treating malaria or working with a corrupt Ministry of Health. They’re not helpless, and they’re not stupid. They’re just playing a game that is rigged against them. They also don’t get to go home to America at the end of their shift. In fact, when two of my coworkers caught Ebola in Sierra Leone, one of them got evacuated to America for intensive care at one of the world’s best hospitals, while the other stayed in West Africa and fought for his life in an old school building that had been converted into what could generously be called a clinic. The only difference between them? One was American, and one was Sierra Leonean.

    Local nurses are the real heroes.

    Traveling Nurse-Haitian midwife
    Haitian midwife
  • Be thoughtful about the stories you share.

    Yes, I’ve been to some of the most desperate places on earth – the largest slum in Africa, which houses 2.5 million people; an Ebola unit watching a child die on the ground; a Haitian hospital helping women deliver their babies in horrific conditions. But is that the only story I could tell about these places? No. And I think the world has that angle covered. I’d rather tell stories about smart, skillful Sierra Leonean nurses and funny, compassionate Haitian midwives.

    Stories that help people in the developed world see these places as more than just disaster and disease.

  • Ask, don’t tell.

    I try to start any mission by taking time to shadow, talk, and listen to the local nurses. They’re the experts. They know what their community needs. Busting in like a bull in a china shop to disrupt everything they’re doing and make them do it my way because it’s “better” is a waste of everyone’s time (it’s also rude). Instead of telling them to stop as I might have when I was a new nurse, I ask them WHY they’re doing something a certain way, and really listen when they answer. This is one more reason why I’m not a missionary: I’m not here to convince them that my way is right and they should switch to it.

    I’m here to ask them what they need and how I can help them get it.

    Traveling Nurse-Twins in Tanzania
    Twins in Tanzania
  • Don’t do things you wouldn’t do in America.

    I’ve watched non-medical volunteers hang out in a labor and delivery ward and ogle Haitian women in labor under the guise of “helping”. I’m sure they went home with some great stories to tell, but those mothers were no better off for them being there. A life-threatening medical situation does not become an exhibition just because the mother is poor and black. If that happened at my hospital in America, we’d call security. Are there situations in which something is better than nothing, and bending this rule is acceptable? I think so. I’ve delivered babies in Tanzania when there was no doctor available. I’ve given second-choice medications when that was all I had. However, this doesn’t give us an excuse to keep coming back and doing things we shouldn’t be doing. It gives us a reason to help rectify the situation and work ourselves out of a job.

WITH ALL THAT SAID, I became a nurse because I wanted to “save the world”. Instead, this job has given me the world. As is often the case, I feel like I’ve gotten so much more out of travel and volunteering than I’ll ever be able to fully repay. But I’m only just getting started.

 

For nurses interested in volunteering abroad and seeking scholarships: Check out One Nurse At A Time (www.onenurseatatime.org).

About The Author

Emily and her husband write a blog called Two Dusty Travelers about ethical and off-the-beaten-path adventures. They even wrote a post on how to find an ethical volunteer abroad program. Check out their blog or follow their social media by clicking the buttons below:

25 thoughts on “Traveling Nurse: How to Do Medical “Missions” Right

  1. What an interesting and fulfilling way to spend one’s life! You’ve nailed it by choosing a career that keeps giving back for both you and those with whom you interact. Very inspirational!

  2. Great read, and love your tips, Emily! I think a lot of them are applicable to travelling more broadly as well (ask don’t tell, be thoughtful about the stories you share, etc).

    On a side-note, pretty disturbing how some of the volunteers were ogling women in labour — wtaf people.

    1. Absolutely, lots of this is applicable to all travelers! We just need to stop rolling into developing countries like we own the place!

      And yeah, those “volunteers” had me in a total rage. They were just having the time of their lives while a patient was literally having a medical emergency. Definitely reported them to the org I was working with, and they had words with their leadership.

  3. Love love everything about this post. Thank you for shedding a light on a subject more than often taken advantage of.

  4. This is, hands down, one of my favorite articles posted on this site. I admire what you’re doing, as well as your awareness of your position as a privileged white woman helping provide medical assistance to people in poorer areas of different developing nations. As the daughter of a nurse and someone who used to work at a professional organization for L&D nurses, I have a sincere amount of respect for the profession. You all are rockstars, forreal. Thank you so much for sharing this part of your life’s story!

    1. Thank you so much, honestly that means so much to me!! I feel really fortunate to have the opportunity to share this here, in the awesome community Kiona has built! You’re a rockstar too, girl!

  5. This is an excellent post with some wonderful insights. You are so right, volunteering is about helping them and doing what is best for THEM, not what we can get out of it and convincing them our way is right. I’m definitely keeping this in my pocket for anyone who wants to volunteer abroad. Also, your job sounds amazing and I respect you so much for making real differences in people’s lives.

    1. Thanks so much for the kind words! I’m crazy lucky to get to do something I love and get paid for it. And if I get to use that skill to help folks, then I want to make damn sure it’s actually helping! And yes share away with anyone who needs to be set straight 😉

  6. I literally love this. You are a hero not because of the work you are doing but because of the intelligent and reasoned way you are thinking about that wok. I honestly think it’s just as important to volunteer with the right mindset as it is to find the right volunteering programs or options. You go girl!

    1. Thank you!! I’m so touched by the positive response to this. And you’re absolutely right, a volunteer with a backwards mindset can make a mess out of any program. Hoping that mindset is changing as more people become aware of the damage they can do!

  7. What a beautifully written and touching post! It was very interesting to learn more about what being a traveling nurse involves. At the end, you did a wonderful job emphasizing the the importance of those in the medical profession in non-Western countries that lack the advantages of Western development. Anyone in the medical field deserves to be recognized for their efforts, especially in places where it’s more difficult to serve their patients.

    1. Thank you so much! Absolutely, the local nurses and docs don’t get enough credit. Foreign volunteers roll in for a week or two and get called heroes, but the local clinicians do the work every single day, and with far fewer resources than we have in the States. I really wish more volunteers would go into these trips with the mindset that both sides have a lot to learn from each other, not just us “fixing” them.

  8. Loved reading this honest portrayal of volunteering, and the balanced way it can be used to enrich one’s life. While volunteering can be intensely rewarding, it doesn’t preclude one from wanting an actual vacation or a retirement fund, and it was great to have my own feelings mirrored in this regard. So often, volunteers are portrayed as martyrs, which really only serves to make the work they do seem like an unattainable lifestyle choice for the general population. This piece really highlights the practical ways in which someone longing to help can make a tangible difference. An amazing piece by an inspirational author.

    1. Wow, THANK YOU for such kind words! And you’re absolutely right, we shouldn’t treat volunteers like martyrs. I’d be lying if I said I didn’t enjoy this work, so it’s definitely not a sacrifice for me. When you get to that point of recognizing how much you actually get out of it for yourself, it becomes that much more important to really make certain that you’re making a difference in the host community (and not just doing it for you!).

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