A first hand glimpse of health care in developing world


Seven months ago, I almost died in Nicaragua. While swimming in waist-deep water at Poneloya beach in León, the country’s second largest city, a strong current pulled me away from shore. Floating on my back, I miraculously ended up close enough to the beach for a group of men to pull me from the violently breaking waves. They had responded to the desperate cries for help from my friend Nadine, who had been swimming with me.

The fact that I nearly drowned is part of what makes this experience powerful for me. But there is something else that is extraordinary. I was in Nicaragua to conduct focus groups with public and private sector nurses. These sessions were a crash course on the daily challenges of trying to deliver excellent care in the midst of severe resource shortages, both equipment and human. I was frequently astonished by examples of government and private sector employers’ devaluation of nurses’ contributions to health care, which is nowhere clearer than in their salaries. Earning $225(US) per month, these nurses are the lowest paid in Central America.

With help from my research assistants, I collected evidence of physical and emotional stress in these nurses’ work lives. But I also gained an increased understanding of what sustains them: a deep sense of meaning and satisfaction in delivering effective care, even without thanks.

After my rescue, I was taken to a public hospital in León. I received state-of-the art care. Finding acidosis from salt water intake, the doctors ordered the monitoring of my fluid output/intake, an IV drip, chest x-rays, and later a strong IV antibiotic. Nurses tested my blood gases, monitored my fluids and vital signs, administered the antibiotic, and bathed me on both mornings I was there.

I was lucky to have the constant presence of two friends. They brought me my toothbrush, toiletries, and even drinking water, a cup and my antibiotic. This reinforced what I had learned about the country’s public health-care system from our focus groups: patients need personal supports since the hospitals don’t provide basic supplies, much less expensive drugs.

What was amazing and humbling about this experience was the quality of care I received. While I was being transferred from a stretcher to a bed in the ICU, one of the nurses saw that I was shivering violently. She wrapped my feet in make-shift slippers of paper and tape, while the doctor wryly observed, “This is Third World medicine!” “But it’s very innovative,” I replied, recalling a word that many nurses used to describe how they coped with the inadequacies of their workplaces. This nurse also found a thick rubberized blanket that she added to the skimpy standard bedding. Her effort to warm me (which worked) was just one example of nurses stretching their limited resources to make a patient comfortable.

Since my 36-hour stay in the ICU, I’ve reflected on the Nicaraguan nurses’ use of the term “humanismo” in reference to what makes a good nurse. Not only did I experience this first-hand, I also felt a new appreciation for its importance to a patient’s overall well being. The doctors were wonderful, but the nature of their work is different; they don’t think about how you’ll go to the washroom with some dignity when you have a catheter, and one arm tethered to an IV bag.
The generosity of a health-care system in one of the poorest countries in the Western Hemisphere was also humbling. Shortly after I was admitted, I asked about payment through my drug plan and OHIP. A student doctor told me that public hospitals treat anyone who comes through the doors, no payment required. I think this fact would be surprising to most Canadians.

Of course, the joke among my friends and research assistants is that I am so dedicated to my study of nursing that I went to any length to get good data. I tell them I will stick with interviews as my main research method, and will not be doing participant-observation of hospital nurses again, if I can help it.

This article originally appeared in the September/October 2011 issue of Registered Nurse Journal.