Emily Way, RN, is no stranger to the intensity of trauma care and treating patients under difficult circumstances, having worked on a trauma unit and treated prisoners in Calgary. But practising in war-torn Iraq, she says, was a completely different level of trauma nursing than she had ever experienced before.
Trauma nursing with limited resources
Early in 2017, Emily travelled overseas with Samaritan’s Purse to work in a tent hospital outside the city of Mosul.
Stationed on a five-acre compound, the hospital comprises two operating rooms, an ICU, a women’s and children’s ward, an Iraqi Special Forces (ISF) ward and an enemy combatant ward – the latter being where members and supporters of the Islamic State of Iraq and Syria (ISIS) are treated.
On Sept. 28, 2017, Samaritan’s Purse announced that they handed over the hospital to the Iraqi Ministry of Health. Samaritan’s Purse continues to serve the displaced Iraqi citizens.
The hospital was made of tents – tent floors, tent walls, and the lighting was strung from the ceiling.
“We tried to work to the same standards of excellence with evidence-based practice there, but we were so limited,” says Emily.
Though hospital volunteer staff can perform some lab work, and they have an ultrasound and X-ray machine, they’re unable to treat complex internal injuries such as traumatic brain injuries. Discovering the cause of trauma is possible, but there is often little or nothing the nurses and doctors can do for that patient due to their limited resources. And even if they could operate, the resources required for post-operative care are often missing.
“There was a day we had three patients come in with frag (pieces of a fragmentation hand grenade) that had shattered their spinal cord, or was embedded in it,” says Emily. “We weren’t able to transport patients on a ventilator to another Iraq hospital. If they required any oxygen, they had to go on room air to go in the ambulance, but we didn’t know how long that ambulance ride would take.”
Culture shock as a barrier to care
Coming to a country devastated by war can be an extreme culture shock for many North Americans and Europeans. Despite rising to the challenge of nursing with limited resources in a war-ravaged country, Emily sometimes found herself questioning the ethics and morality around treating patients who were members of ISIS.
“You always have to remember that these are people who need my help, and it’s my responsibility to use my knowledge and skills to treat them like any other,” says Emily.
Another barrier to providing care is the Iraqi citizens’ perception of Samaritan’s Purse volunteers.
“We’re a white, Christian hospital in the middle of a country that is in a religious war,” says Emily. “ISIS had been spreading fear about us and about our hospital. People came in and they were really afraid; they thought we would hurt them and be mean to them. They were astounded at the kindness and the level of care, compassion and love that they were shown in the hospital. I’m thankful to have been a part of that.”
Coming home and lessons learned
After three weeks of working in the Mosul tent hospital, Emily returned home to Canada. Despite being over there for less than a month, she says the experience has affected her life profoundly.
Just as the quality and availability of health-care services differ around the world, so do health-care practices. In a first-world country where despite feeling strain due to financial pressures and a burned-out workforce, we tend to take for granted the seemingly unending supply of materials and medications at our disposal.
“It was almost more shocking coming back home than going over there,” says Emily. “My first couple shifts back were hard to get through because I was tired and also because it was like reverse culture shock, of coming home and thinking, oh, what I would have given just to have that supply over there.”
For many North Americans who visit or work in countries in the midst of war, the experience can be extremely traumatic. For Emily, however, she sees her experience as an opportunity to improve her nursing skills and bring more compassion to her nursing practice.
“I’m sure my bedside manner’s changed a little bit. These people go through so much, and they all deserve care and compassion,” she continues. “Especially now treating patients who are immigrants and come from other countries, I realize that this is especially traumatic for them because health-care systems in North America differ so greatly from developing worlds. I’m much better at being culturally sensitive while still caring for my clients.”
Ultimately, what this experience has taught Emily is that we have it very food at home. And it’s not something we should take for granted.
“I’ve become very thankful for what we have here.”