1. McCrory-Churchill, Shannon DHEd, RN, CPNP-PC, CNE


A case for persistence in the face of adversity in medical mission work.


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I was unsure if I'd continue into year 11 of mission work. I'd led teams of students in multiple developing countries in varying states of upheaval, largely at my own expense. After a decade, I want to tell you it gets easier, that I'm a selfless person who never judges and always does the right thing. I'm instead choosing honesty. This is hard work. This can be thankless work if you let it, and sometimes, you let it.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Eric Collins /

The student who complained all week, didn't like the food, was too cold, too hot, too everything. The medicine impounded at the airport, the flat tire, the cliff-edge bus ride in the rain, the Campylobacter. This is all so fresh in the mind at the end of a trip. Does this work matter? Have I made any difference at all? Why do I keep doing this to myself?


Because I'm optimistic. The negative always fades away with time. The first-time traveler gets over her fear of leaving the United States. New roommates save each other from "enormous" geckos. A team that was built from strangers comes together to care for others and grows.


Because I want students to experience their value in nontraditional environments. In a pavilion recently filled with horses, your options are limited. You rely heavily on history and assessment skills. There is no X-ray, no central supply, no electricity. You make it work. Students often comment that it's what they "imagine nursing used to be." They learn to rely on their clinical knowledge rather than on a system of electronic prompts. It builds their confidence.


Because I want to expose others to true health disparities, and what happens in the absence of care. Certainly, had the gentleman with the diabetic ulcer had care, it would not have overtaken his foot. The young man with the motorbike burn could have avoided sepsis, the emaciated child with the congenital heart defect could have lived past seven. The horrific things that can never be unseen could have been avoided with access and education. We all come back changed.


Because I'm selfish. I'm against voluntourism, against dumping medicine on a population that doesn't need it, against "playing doctor." I support education and sustainable processes. I visit the same villages yearly. Places where they live on less than $1 a day, but where we have partnerships with community leaders, and can find a way to get them a surgeon or refill their medication. These are not easy things. If this was easy, I would not be there.


Because I get my heart broken, in all the best ways. I'm a large white lady in scrubs, in villages that have none. As such, people remember me. Because I see them every year, I remember them. Students need to see that, and the joy and sorrow that accompanies it. Seeing the 100-year-old man in great health one year and seeing his widow the next. Sitting with a scared woman who waited until everyone else in the village had been seen to talk about a sonogram nobody would read for her. Telling her she could have children, hugging her while she sobbed softly in relief. Holding her healthy, chubby baby the next year.


Because she had a door. We made a house call to a homebound woman. Her home was a pieced-together metal shack-as they are, with a curtain door, some plastic chairs, and a mattress on the floor. She looked pained, unkempt, and wanted nothing to do with us, but we persuaded her to let us help. The very short version is, she fell, got hurt, refused to get out of her chair, became weak, her knees hurt, and she couldn't get up. She didn't see very well up close, so she couldn't do anything while she sat there creating a perfect storm for depression. We saw an opportunity. Reading glasses, ibuprofen, and modified physical therapy.


Fast-forward a year. A woman walked slowly into my clinic and asked me to come home with her. This happens, so I thought little of it. She was kind, vibrant, and told my translator she wanted to show me something. I immediately recognized the home, and feared the worst, when it hit me. This was the woman. She looked nothing like the frail, sad woman of last year. Her gait was stiff, but she was able to get around. What was the important thing she needed to show me? She had a door. She remembered my patience while the curtain repeatedly fell on me as I worked and wanted to share her good fortune. The glasses allowed her to sew again, so she found purpose. The physical therapy allowed her to do things on her own again, allowing her daughter to work, increasing the household income.


So why, in reflecting on a decade of mission work, tragedies, frustrations, and financial woes will I sign on for year 11? Because I saw a family turn education, reading glasses, and a dollar's worth of ibuprofen into a door.