1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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E-mail from Gerald Martone, MS, RN, is invariably fascinating. The director of emergency response at the International Rescue Committee (IRC), Martone is a contributing editor to AJN and a coordinator of the Correspondence from Abroad column. In July I received a series of e-mails from him, just after he'd returned from an IRC humanitarian mission to assess the crisis in West Africa. I eagerly approached the e-mails and the photographs attached to them.


The first one produced a visceral response in me: a wide-eyed, dark-skinned boy from Ivory Coast gazed up at me from my computer screen. Martone's photographs always tell stories, and these illustrated the devastating impact violence has had on the health of individuals, families, and communities in West Africa. The editorial staff and I discussed whether to publish the photographs in AJN. The journal's mission statement clearly spells out the goal of bringing a global perspective to American nurses. Still, I questioned whether readers would find the photographs as gripping and relevant to practice as I did. Here's why we've decided to publish them (see page 32).


First, recent global outbreaks of infectious diseases such as severe acute respiratory syndrome (SARS) have shown all Americans, and health care providers in particular, the importance of looking past our borders. For example, one of the profiles in this issue's Nurses Making a Difference column (page 118) is of one American nurse whose astute awareness of reports of SARS in China resulted in her identification of the first U.S. case-undoubtedly saving that patient's life and many others, too. And the 41 lives lost to SARS in Canada, two of them nurses, serve as poignant reminders of our common, human vulnerability to epidemics that easily cross national borders.


Second, when you look at the faces in Martone's photos, you realize that these could be people seen in your ED, confirming that violence is a public health problem that needs our highest attention. And the violence in our communities spills into our workplaces. According to the 2003 report Guidelines for Preventing Workplace Violence for Health-Care and Social-Service Workers, published by the Occupational Safety and Health Administration, the rate of nonfatal violent crime from 1993 to 1999 was 12.6 per 1,000 workers (averaging all professions) but 21.9 per 1,000 nurses. Individual nurses and nursing organizations are demanding that employers protect nurses from workplace violence. But how do we protect ourselves from violence that is endemic to our world? The photo essay of what violence has wreaked in West Africa connects us to our own vulnerability for becoming victims of violence, and illustrates that we must work with our communities to promote nonviolent approaches to resolving conflict.


For example, on July 26, the New York Times published an article, "A City's Police Turn to Buddhism to Fight Gangs," describing efforts by the Lowell, Massachusetts, police department to curb gang activity. It enlisted the help of a nearby Buddhist temple to instruct gang members, most of them Cambodian boys ages 12 to 16 who had previously run away, in meditation and to provide an alternative to street life. These gang members seem to be responding to this gift of sanctuary and structure-two things Martone claims are desperately needed for the psychological wellness of the children in West Africa. The approach could have particular importance for nurses who work in communities in which gang membership is high. Our claim that we focus on prevention should lead us to exploring ways to prevent the violence that consumes lives.


Senior editor James Stubenrauch worked with Martone in writing the text that accompanies the photographs, including statistics that show the effects of continuing violence, disease, and political injustice on the people of Liberia and Ivory Coast. But the photographs themselves speak most loudly. Let me know whether you think they're relevant to your work as a nurse.