Why Pakistan? by Rachel Lien

People often ask why I traveled to Pakistan to volunteer as an nurse practitioner, and my response is always “Why not?”  With the drastic disparities in the world, the question should not be “Should I go?” but rather to consider many factors and ask “Is now the right time to go?” and “Is this the right organization to serve with?”  I finally was able to answer yes to both of those questions and booked a ticket to Pakistan.

My job was to help support the Pakistani staff of a women’s hospital while an American medical physician was on leave.  As aIMG_6226 family nurse practitioner with years of pediatric nursing experience, my focus was on the newborn nursery, inpatient pediatrics, and the family staff clinic. Prior to my trip, I studied the hospital protocols, took a neonatal resuscitation program (NRP) course, and packed my bags full of donation equipment that they had requested.

I never want to take a job that a local native person can do, so at the beginning I observed in order to see how I could best contribute.  I rounded on patients with a native midwife, gave feedback as we bounced ideas off each other, and supported her as the primary decision maker.  Some of my feedback was encouragement to invite parents to be involved in conversations earlier about a premature baby’s status and options for treatment.  Too often, treatment was delayed as we waited for a parent to be present or waited for transport.  If the baby is full-term, the change of survival is high, but premature babies were almost guaranteed to struggle significantly and may need costly interventions and transfers to the children’s hospital.  My duty was to humbly give a perspective from an American practice and then discuss with the native workers if and how they wanted to incorporate that into their practice considering cultural and logistical factors.

IMG_6680 2Each day after seeing patients, I would pour over research papers from resource-saturated settings and resource-limited settings to learn more about quality care.  With this information, I gave a presentation to the Pakistani staff on recognizing and managing respiratory distress.  My main goal was actually not to change their current practices, but to expose them to the idea of conducting literature reviews and thinking about what they think is best to improve their practice.  IMG_6734

In addition to reading research, I helped the hospital collect their own clinical data.  The most reliable determinate of newborn outcomes is gestational age, so there was a large focus on prenatal care.  I worked alongside staff calculating statistics for accuracy of fetal growth scans, and taught them new functions of excel to help make their work more efficient.

The highlight of my trip was helping care for the staff and midwifery students.  From seeing them in staff clinic to teaching a diabetes class for the diabetic housekeepers, I enjoyed promoting health and wellness.  I was surprised that many of the problems I see in the US are the same problems in Pakistan.  They had hypertension, diabetes, headaches, and back pain just like us.  Since diet was difficult to coach on without understanding the South Asian cooking methods, I focused on IMG_6753 2exercise leading classes for the students and staff. Although they could only afford to wear sandals, that didn’t stop the young women from running, playing soccer, skipping rope, and surely not dancing.

One of the hardest parts of my trip was the restrictions of not being allowed off the gated hospital compound without a security guard and permission from the administrator. Despite the disappointment not being able to see a lot of the beautiful country, I was amazed at the beauty of the Pakistani people.  They so warmly welcomed me, honored me, and shared their lives with me.  They taught me how to dance, how to make chapati bread, and how to cook extremely spicy food.  They welcomed me to their parties, to hand washing clothes together, IMG_8644and to their worship and prayer nights.

When the time finally came to say goodbye, I was in tears.  The midwifery students warmly sent me off with a henna party with so many hugs and handmade cards.  I returned home with cherished memories, and plans to continue improving my ability to help them serve their own people.  They are the leaders and I was grateful that they welcomed me into their journey.

I learned that the most effective volunteers are highly experienced, creative, and most of all have a desire to live as the local people do with great love and admiration for new friends.  Back at home I am continuing to gain work experience broadening my experience from just pediatrics to family practice.  I’m also returning to school for my DNP in order to learn more how to translate research into clinical settings and to how to teach effectively.  As I grow more at home, my heart is still with the people of Pakistan and I look forward to the next time I can say a double yes and again buy my next ticket to serve.

I am very appreciative to One Nurse At A Time for supporting me in this work.