1. Kennedy, Maureen Shawn MA, RN


Why nurses need to think beyond U.S. borders.


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AJN's December issue has often focused on global health topics, and this issue continues that tradition. But I sometimes wonder if such stories seem too foreign, too concerned with distant peoples dealing with complex issues, for American nurses to feel their relevance.

Figure. Shawn Kenned... - Click to enlarge in new windowFigure. Shawn Kennedy

We realize that, as the American Journal of Nursing, our main focus must be on presenting and discussing the issues faced by nurses here in the United States. But we also have many readers, especially online, who live and work outside U.S. borders. Many of these are American nurses serving in the military or working in international health care; and many are nurses in other countries who value AJN's evidence-based content.


And there's another reason we cover global health issues and events: considering the demographics of the U.S. population, we believe that such awareness is essential for nurses working in any setting in this country.


In 2010, over 13% of the U.S. population-40 million people-were foreign-born, with one-third having arrived in this country in 2000 or later. Many arrive with difficult histories. According to the United Nations High Commissioner for Refugees, the United Nations refugee agency, at the end of 2011 more than 42 million people worldwide were refugees, having been forcibly displaced from their homes as a result of "persistent and new conflicts." Forty-eight percent of these refugees are women and girls; 46% are children younger than 18 years.


This month's cover photograph shows young Syrian children who have fled the violence in their country and are embarking on life as refugees (see On the Cover for more on the Syrian refugee crisis). We also bring you a photo essay depicting conditions at the Dadaab refugee camp complex in Kenya, with photographs taken by Gerry Martone, a nurse and director of humanitarian affairs for the International Rescue Committee. The camp complex, which holds more than 450,000 people, mostly Somalians, is the largest refugee settlement in the world. It's also one of the oldest, with origins dating back to 1991, and many children have grown into adulthood there.


And as I write this, I'm wondering if Malala Yousafzai and her family will also become refugees. You might have heard about her-she's the 14-year-old Pakistani schoolgirl who spoke out in favor of education for girls and incurred the ire of the Taliban.


In October, Malala was riding in a school bus with her friends when a Taliban gunman sought her out and shot her. She survived the attack and is recovering at a London hospital; but the Taliban have vowed to continue trying to kill her.


Despite this, Malala vows to keep fighting for girls' rights to education. The attack-which came just days before the first International Day of the Girl Child on October 11, a day designated by the United Nations to recognize girls' rights and the inequities girls face simply for being born female-has inflamed sentiment against the Taliban worldwide. Perhaps this young girl will be the unifying catalyst for change.


So why highlight the issues and struggles of people whose lives seem far removed from our own? For one thing, they're really not so far removed. By the end of 2011, the United States was hosting an estimated 264,800 refugees. We can expect to see them in all practice settings, and we need to be mindful that they bring with them their unique health and illness patterns, travel and family histories, and cultural predilections for managing disease. If we're committed to providing holistic, patient-centered care, we must be cognizant of the situations that brought these refugees here.


It's equally important for all of us to remember that we are part of this global community. While you and I might sometimes feel there is little we can do as individuals to effect change, collectively we can raise our voices and support international organizations that are doing good work.


And here at AJN, we'll continue to look to our international advisory board of nurses, chaired by Judith A. Oulton, a former chief executive officer of the International Council of Nurses, for guidance in how this journal can best bring global nursing and health news to your attention.