Nineteen years ago, in a rural jungle village deep in Central America, I first felt the call to nursing. One year later, in a similar Honduran village, that calling was confirmed. So, at age 20, I decided to pursue nursing as a career. I knew that wherever life took me, whether to the suburbs of the United States or far away to a remote location, nurses would be needed.

Robyn Madsen Baran fulfilled her dream of practicing global nursing when she traveled with a medical team to rural villages in Thailand.

After finishing nursing school, I returned to Honduras to visit friends and the beautiful country that had first opened my eyes to the possibility of a nursing career. On the long bus ride to the village, I listened to music (on a Walkman, of course; MP3 players did not yet exist) and had hours to think about working in community health.

When I returned home, a surplus of nurses in the workforce made jobs hard to find. I accepted a part-time night shift position in pediatric hematology/oncology. I stayed in that specialty for three years and gained incredible clinical knowledge and experience. Those years of hospital-based nursing were challenging, exhausting and rewarding, and they changed my life. However, as much as I loved working with those amazing children and their families, I knew in my heart that community nursing was my true calling. That, combined with changes in my personal life—I married and began thinking of starting a family—led me to seek a new position in community health nursing.

Thirteen years of nursing experience, 10 years of marriage and two children later, I finally had the opportunity to fulfill my dream of practicing nursing in a global context. In 2009, I traveled to Thailand for 12 days with a medical team to serve two rural hill-tribe villages in the province of Nan.

Our faith-based team consisted of a U.S. contingent and a Thai contingent. The U.S. component included four physicians, two nurses, one dentist, a physician-assistant student, two interpreters and one support person. The Thai group included six interpreters and one physician. We partnered with the local public health department and Sustainable Development Research Foundation (SDRF), a local nongovernmental organization (NGO) dedicated to community development.

From the time we left Los Angeles International Airport, it took our team 48 hours to travel to Bo Klua, which would serve as our home base for the duration of our trip. Located in northern Thailand, Bo Klua is less than 10 miles from the border of Laos.

Thirteen years of nursing experience, 10 years of marriage and two children later, I finally had the opportunity to fulfill my dream.One day after our arrival, we headed out to our first village, Ban Naam Juun. The team spent two nights there, as the village is accessible only by four-wheel-drive vehicles. This gave us an opportunity to be available to as many residents as possible and to experience part of the everyday life of the villagers. We learned from the residents and the public health department that Ban Naam Juun has limited access to medical care, running water, food and other resources. Drinking water is typically from well or river water and usually is not boiled, which can cause many health problems, including parasitic infection. We did not see any school-age children in this village, as they were away at school. It’s a two-hour walk to the nearest school, where the students stay in dormitories with teachers during the week and then return home on weekends. The primary ethnic group in the village is a tribe known as the Lua.

My role in the clinic was to maintain the flow of the intake station. As part of a community assessment, the villagers first answered a questionnaire from the public health department. In addition to answering questions about their medical histories, respondents were asked about hours worked per week, access to medical care, use of village healers, whether or not they boiled water, their consumption of raw meat or fish and their use of transportation. I was surprised at how many questions were similar to those I ask of my clients in the United States, even though living circumstances are so dissimilar. After speaking with the public health department, the patients came to my area, the intake station, where we started a client form that asked about the patient’s primary complaint and took vitals. The patient then went to the physician, dentist or both, and finally ended at the pharmacy, where prescribed medications were distributed.

The most common complaint from patients was pain in their back, neck and knees from the strenuous work of harvesting rice. Another common diagnosis was dehydration from working in the hot fields with no access to drinking water.

The most common complaint was pain—neck pain, back pain, knee pain—caused from the rigorous work of harvesting rice. For most, the physicians prescribed a 30-day supply of either acetaminophen or ibuprofen. A common diagnosis was dehydration. Since days are long, hard and hot, and drinking water is not accessible, many people do not drink enough water, which causes tachycardia and fatigue. Physicians instructed patients to stay hydrated by drinking clean water. We did see some hypertension and diabetes in the older adults, as well as some urinary tract and upper respiratory infections but, overall, the villagers were very healthy.

After 2 1/2 days of working in Ban Naam Juun, we headed back down the steep dirt roads to our home base in Bo Klua. The next day, we had an easy 20-minute drive to the less remote village of Ban Sapan. We couldn’t believe how many people were already waiting for us when we arrived around 9 a.m. Many had walked as long as three hours to reach our site. We saw as many people that first day as we had seen during our entire time in Ban Naam Juun. Complaints were similar: pain, dehydration and common infections.

In Ban Sapan, schoolteachers brought children to see us. Most were quite healthy. The public health department is responsible for immunizing the community, so they were protected from certain diseases. Since parasitic infections are so prevalent, we did treat every child with one dose of mebendazole.  The teachers had questions about child development and behavior, which provided opportunity for education and assessment of this population. As a developing nation, Thailand has very limited resources and information about mental health and normal child development.

For me, the trip served as the assessment portion of an ongoing nursing process. I now have the challenge of researching and planning interventions for future trips. I look forward to returning to Thailand and collaborating with others to determine how health education and using community leaders to promote health can be achieved. Together, we can evaluate our intervention and complete the nursing process for the rural communities we serve.

My trip to Thailand was another life-changing experience. I am excited to explore new ways to pursue global nursing! RNL

Robyn Madsen Baran, RN, PHN, resides in Irvine, California.