1. Stoltzfus, Alison BSN, RN


At a refugee camp, reaching out a hand, one life at a time.


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It is January of 2021. I bump over brick roads in the back of an ambulance. I am in the largest refugee camp in the world-the Rohingya refugee camp in Ukhiya, Bangladesh. I support a sick baby in one arm, careful to keep his airway open. With my other hand, I hold in place an adult nebulizer mask that I am using as an oxygen mask.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janet Hamlin.

I brace my knees against the stretcher beside me to support myself. The baby's mom, not even 24 hours postdelivery, groans as we jolt over the rough spots. A sheen of perspiration covers her upper lip. I let go of the mask long enough to reach across and pat her hand.


The baby, now 12 hours old, sucks in his tiny ribcage and grunts in a desperate search for air. Two hours he grunted like this while we waited at the clinic for the broken-down ambulance to be fixed. Now finally on our way, I clutch the baby in my arms, trying to protect him from the bumpy road.


Where elephants once migrated, the ambulance weaves through streets lined with commerce and a population commonly reported to be larger per square mile than that of Manhattan-a population without the resources, facilities, and staff to meet its extensive and varied medical needs.


It was these persecuted people from Myanmar that I came to serve when I volunteered as a nurse at one of the refugee camp clinics. It was my job to wade through 100 to 200 people a day and triage patients. Our care providers could see about 60 to 100 each day, which meant other patients, some with definite health needs, were sent away. When emergency cases came-chest pain in patients with a history of MI or respiratory distress in newborns-we lost valuable time waiting on the only ambulance in Camp 20, manned by an untrained Bangladeshi driver. We had no oxygen to administer. People with symptoms indicative of cancer had nowhere to go for treatments, because the one hospital in camp that offered general surgery refused to touch possible malignancies.


Some days the people would throng me in triage, pulling on my clothes and begging to be seen, desperation and longing in their eyes. A longing that at times I had to refuse.


Every day I would ask myself-"How can one care in a setting like this, and make a difference?" What good was it to make a difference to a few when there were so many lives I could not touch and so many problems we could not heal?


The baby I took to the hospital in an ambulance had aspirated meconium during delivery. All night, following his birth in a little bamboo shack, he had struggled to breathe. In the morning the midwife brought him to SALT clinic, where my life briefly bumped into his.


I still don't know what happened to that little Rohingya baby after I handed him off to the hospital staff. I know that that baby, kept at home, had very little hope for survival. But we increased that hope by whatever means we had-a patched-together ambulance, an adult nebulizer mask used as a neonatal oxygen mask, and an attitude of care for that family in distress. And I remember what touches lives. It isn't the effectiveness of treatment that makes people feel cared for and grants them dignity. It's our willingness to do what we can-to present the little we have with purpose and love.


That tiny baby in the back of the ambulance-did he keep breathing because kind arms supported him? Or was it those breaths of air loaded with oxygen from the nebulizer mask that tasted so sweet after his desperate struggle-so sweet that he finally opened his eyes and looked swimmily into my face? The baby's mom, groaning over the bumps in the road, loved her baby so intensely that she was willing to endure great pain to accept the little we offered.


I remember, and in my heart, I know-despite the struggles, despite the times when I felt a loss of hope and an inability to relieve suffering-that still those six months in Bangladesh were worth it. To that one family, and perhaps a few others, I made a small difference. As nurses, that is why we do what we do every day-whether in hospitals in America or rural clinics in Asia. We reach out a hand, one life at a time.


It is not to save the world we are called-it is to care.