Megan Duda R.N. reports on her trip to Ecuador

On Oct. 25, 2014 I led a team of 4 nurses and a pharmacist to Ecuador for a medical-outreach mission trip.  Our clinic was 4 days long we spent 2 days in San Josue, Ecuador and 2 days in Liberador Bolivar. We worked from 9am to 5-7pm. In those 4 days we saw over 700 villagers… absolutely amazing. The needs varied from villagers simply wanting vitamins to needing emergent care. Returning this year to Ecuador was a blessing especially to see the knowledge the villagers retained from last year’s teachings and care we provided.

I enjoyed watching my team grow individually and as a unit throughout the trip.  As a leader I was able to use my knowledge from last year to be there for my team. I enjoyed being able to experience the medical mission to the fullest by having the freedom to be a part of each assessment area for example the triage, in-depth assessment area, pharmacy area, teachings, and prayer area.  Overall, I think I enjoyed being able to pray more this year with the villagers than last year the most, because it created a bond between myself and the villagers that I will hold close to my heart forever.

The thing I enjoyed least was some of my team members being ill, myself included. Some of my team members were ill before we even left the states as was I, some became ill in Ecuador, and after we returned home. I was very worried about them. This was the most challenging aspect because as the leader I felt a little helpless not being able to know why they were ill or being able to relieve their illnesses.
The cultural difference that I observed was the male dominant society. One of the village nurses that helped us was not able to do anything like going with a patient to the hospital without getting permission from her husband first. She had mentioned having to ask at the right time, but in the end he still said no. Our translator was a newlywed who was in a more modern relationship; however she still needed to be home to make her husband supper before he came home from work.  Another example was one of our patient’s, Lida, she was a young woman that suffers from a dura tear with excessive cerebral spinal fluid nasal drainage for the past 6 months. She has been waking up in the morning to a soaked pillow in the morning, having frequent severe headaches, memory loss, and other complications. Her memory loss is so excessive she forgets she is cooking something and it burns… in turn domestic abuse is the result. I explained the complexity of her condition and informed her of the need for surgical intervention as soon as possible. She needed to have her husband come to talk with us to decide, for her, what she should do. When the husband arrived and talked with myself, the Pastor Luis, and the Pastor’s wife Karen, the result was unreal; as the Pastor talked with the husband there was no emotion from the husband; then the husband said, “ It is not my problem… it is her and her families problem.”  Tears poured down Lida’s face.  As we talked more with Lida is was clear that domestic abuse was the likely reason of the dura tear.  Although this is sad situation, I remind myself of is that Pastor Luis and his wife Karen are teaching the community how to appreciate your spouse and value equality within marriage as they demonstrate this on a daily basis.
The most difficult cultural difference is the ability to pay for healthcare versus the United States. In the United States we have government funding, foundations, special hospitals, or payment plans to assist with getting the treatment we need when we need it. In Ecuador, they need to pay for clinic visits and specialists. Some hospitals provide free care and procedures, but the patients need to buy the medications, anesthesia, and much more before anything will be done. If the procedure needs a specialist  for the surgery payment needs to be provided before the surgery. For example, Lida, a young women with the dura tear, needs emergent surgery, but is not able to afford to pay for the medications, transportation, or other aspects of care that she needs to have prior to the surgery, so she goes without. Her condition would be a neurological emergency in the United States.  Another example is an 8 year old little girl that has a narrowed airway passage and has seen a specialist that informed her family she needed surgery or could possibly die. The family has no money to pay for this $1000 surgical procedure. In the United States these things would be taken care of right away. I think people take this for granted in the United States. Yet, in Ecuador these people fear for their lives on a daily basis and pray that God provides a miracle.
Another cultural difference is the happiness and love the people of Ecuador radiate to each other as well as visitors.  As a sign of respect when you meet someone new, are greeting someone you have known forever, or when you say good-bye you give them a hug and a kiss on the cheek. This is actually one of the things I miss most when I return to the states from Ecuador.  Similar to the United States, the aspect that is hard to wrap your mind around is the abuse that occurs behind closed doors and the lack of love in some families; however there are organizations that are available for people to utilize to escape these circumstances in the U.S. and in Ecuador there is not.
The people of Ecuador are very kind and understanding. I needed to use my Spanish speaking skills much more this year which was a challenge. I am not a fluent Spanish speaker, but the Ecuadorian people did not criticize, did not laugh at me, and did not judge me as a stumbled with my words or required a little extra time to think of the right word I needed to use.  Instead, they would help me by suggesting words, help teach me proper pronunciation and vocabulary, and laughed with me when I made jokes or said something silly.

My most “memorable moments” are caring for Lida the lady with the dura tear with excessive cerebral spinal fluid leaking from her nose and Rosa Rodriguez an 103 year old lady with extreme pain:
 Lindsay one of my team members was assessing Lida and called me over. Lindsay explained that Lida was having memory loss, headaches, dizziness, and burning with excessive nasal drainage that pours from her nose when she simply looks down. I ran to get a glucometer and asked Lida if she could give me a little sample of the drainage from her nose. She looked down and I couldn’t believe at how fast and how much drainage poured in the cup. I tested the nasal drainage for glucose which is an indicator of a cerebral spinal fluid leak if glucose is present. The test came back positive with a glucometer reading of 241.  Although, this was a very difficult diagnosis to explain to Lida, being able to diagnosis her or at least have a idea of the seriousness of her condition put into action a immediate interventions for Lida. All Lida needed to do was let us know she wanted help and if money wasn’t an issue be open to having surgery. After hours of praying with Lida, providing information of the seriousness of her condition, and informing her of complications she could experience if she did not have surgery, Lida informed us she wanted the surgery, so she could better take care of her kids. Lida doesn’t have support from her family or her spouse. She continues to have to live in an abusive relationship.  The bravery Lida showed at that moment was truly unbelievable.
At the end of our last clinic day we were closing the clinic when an elderly woman was pushing another elderly woman in a wheel chair down a dirt road. The lady in the wheel chair was crying and in excessive pain. The woman pushing the wheel chair reported that the lady in the wheel chair was her mother and is 103 years old. Her name is Rosa Rodriguez. The daughter explained that Rosa had broke her left hip a year ago and has had pain ever since.  Recently, she was having increased pain in both hips and her right lower leg. As a geriatric nurse this broke my heart. We immediately gave Rosa some Tylenol and I massaged her lower legs and hips with muscle rub. She continued to cry and as a nurse I have never felt so helpless and useless as I did not have the resources to relieve this woman’s suffering…at that moment I understood completely what these people experience every day.  I tried to comfort Rosa and I held her close as she wept. I could not hold back my tears.  Many people surrounded Rosa and we prayed a long time for her.  After we prayed, it was as if God reached down and placed is hand on Rosa…she finally had stopped crying and appeared settled. Although, she stopped crying Pastor Luis and I kept holding her hands and everyone that surrounded her was silent, but you could feel the empathy for Rosa in the air. We asked her daughter where she lived. She explained to one of the volunteers and we lifted Rosa into the truck and drove them home. Her daughter who was in her early 80’s had pushed her mother in a wheel chair about 2 miles to get her to our clinic. Pastor Luis and I wheeled Rosa into her house and her great grand-daughters helped her into bed. I taught her great grand-daughters how to administer the medications, properly lift her, properly lay her into bed, and provide adequate nutrition as well as fluids. I overheard Pastor Luis say to Rosa, “Do not worry. You are in your bed in your own home.” Rosa looked at peace. I knew we had to get back, but it took everything in me to leave her there… I wished I could stay with her and keep her comfortable. I kissed her on her forehead and hugged her family.  I asked Pastor Luis why he told her she was home. He told me because she thought her family was leaving her with us, which was another reason she was so scared. As we drove away I prayed that God would hold her close to Him and her suffering would be lifted. Rosa Rodriquez changed my life in ways I can’t even express… she has a special place in my heart that I will hold dear for the rest of my life.
The impact this medical outreach mission had on my nursing career is hard to put in to words. I will never be the same nurse or person as I was before this mission. The people I met and cared for changed me and reminded me why I became a nurse in the first place. In the United States, people sometimes take nurses for granted and the passion of nursing sometimes becomes dimmed by this. Sometimes nurses do forget why they became a nurse in the first place because after days, weeks, months, and years of staying late at work, not getting to use the bathroom for 8-12 hours, missing lunches, and being ordered to do things without a please or a thank you in return becomes tiring. However, after my mission last year and this year I have come back to the United States with such appreciation for the things other nurses have taught me, other things I learned on my own, and all the patients/resident’s I have cared for throughout my nursing career. God provided these rare opportunities to me and all I did was say, “yes” and he took care of the rest. Helping over 700 people in 4 days is definitely works of God because he gave all of my team, the volunteers, and me the strength, knowledge, and skills to help each and every one of His people.
I honestly wish every nurse could experience a medical outreach mission trip because I believe our society and health care systems including clinics, hospitals, skilled nursing facilities, hospice, home health care, school nurses, and every other nursing profession would be changed for the better as every nurse would have a renewed outlook and humbling experience to relate to when they are working with others.
I cannot thank One Nurse At A Time and their supporters for the scholarship I received this year.  Without them I would not have been able to experience and learn the things I did. 
Nursing is an extraordinary career and takes very unique individuals…Being a nurse we affect many people on a daily basis within our own communities… Being a nurse missionary we promote change in ourselves, our communities, and the world.
Thank you,

Megan Duda R.N.