The fascinating discoveries of a wartime nurse

Growing up, I did not believe I wanted to be a nurse, a teacher or in the service professions—the first several years in college, I majored in journalism with a minor in political science. That did not give me what I wanted, however, and after working a semester at a medical center in central Kentucky, I knew that I wanted a career that would allow me to interact with people in a very unique and special way.

Nursing absolutely fit that criteria, and after almost 40 years of experiencing it in every conceivable setting and situation, I can say that it has more than lived up to being THE profession that has allowed me to do most everything I have ever wanted. If I had seven lifetimes, at least six of them would be as a nurse.

I began my career in Appalachia, a place of great beauty and resilient people, a place possessed of extraordinary natural resources and environmental riches. It had taken less than a century for the land and the people to be exploited, manipulated and ravaged. Less than a century for the population to be left with staggering percentages of chronic illness, intense hopelessness, pervasive feelings of helplessness and a lot of corrupt and greedy people in power.

In the later stages of my career, as I became more and more involved in international health, I found so many of the same dynamics to be true. There are striking parallels whenever and wherever there are combinations of environmental riches, corruption and greed, which result in chaos and mayhem for populations who happen to be living in the wrong place at the wrong time in history.

I spent almost 20 years working in a metropolitan police department and, in those early years of my career, I saw a health system often negligent, ineffective and value laden in its response to victims of violence. I saw a legal system inefficient and ineffective, at times dismissive of the seriousness of violence—often until a tragedy of such magnitude occurred that it could not be ignored.

The response, or lack of it, seemed particularly true for victims of sexual assault or intra-family violence. While many countries have made major strides within their health and criminal justice systems these past decades, I am struck by the parallels of what is occurring to victims on a global level. Rape is used as a strategy of war; children of seven or eight are conscripted, brainwashed and empowered with a weapon that they can barely carry; an estimated two million women and children are sold or brokered into the bondage of sweat shops or brothels.

As I became more aware of the striking parallels from those early years and what I saw with individual victims, with what is happening to whole populations around the globe, I came to realize that, whether at home or abroad, health is inextricably linked to human rights. That is, the health and human rights of an individual, a family, a race, an ethnic group or a nation. While many people believe that they meld health and human rights in their everyday practice, there are far, far too few who are specifically, intentionally and loudly proclaiming attention to it at national and international levels.

Since those early years, I have worked in humanitarian crises in Cambodia, Bosnia, Poland, Kosovo, Honduras, Tajikistan, Sierra Leone, Angola, eastern Chad and the U.S., and in a noncrisis capacity in Kenya, Mozambique, China and Guatemala.

One of the most basic challenges of working in various countries has, for me, been trying to learn at least a modicum of words and phrases in each one. There is the added responsibility of not only assessing the current situation, but understanding the history and the infrastructure that existed before the catastrophic event—and in the case of war, repetitive events.

When war comes to a country, infrastructures collapse. The healthcare system, often already fragile, collapses along with the education system, the economy and the labor system. All the entities that keep the fabric of daily life running are gone. Communities that do not feel the direct impact of bombs are overrun by people fleeing the communities that do. There is a clash of cultures, creating tensions and resentment within, even though they might be aligned by religion or politics or simply their shared hatred of the oppressor.

Schools close and are inhabited by the displaced; workplaces close and, in cold climates, even in the midst of a hot summer, families will be seen selling their belongings to ensure there is heat for the winter. The elderly become a burden—and feel that way. They are often the ones who, by choice or necessity, are left when others flee.

As war continues, there is adaptation. The drudgery of seeking out food, clean water and shelter becomes a daily way of life and obtaining those things takes every ounce of energy. There is not much left over for nurturing and protecting children. With energy needed for sheer physical endurance, there is nothing left to cope with emotional wounds except “numbing,” which is an effective tool for emotional survival.

There are no global truths about how people experience war or respond to trauma. Today, more research than ever before is being done on the medical, psychological and social response to complex emergencies. Thankfully, nurses are involved in many of these efforts, though too infrequently are we at the table asking the tough questions and making people uncomfortable. We need to be much more active and visceral in our questioning.

In this age when so many nurses want to work in a global setting that is at least an ocean away from their daily life, it is important to remember that global health includes our own backyards. Eleanor Roosevelt once said that “human rights begin at home.” Vulnerable populations are everywhere and, whether you are working with malnourished in Appalachia or Angola, whether children are orphaned by AIDS in Harlem or Malawi, there is a need for awareness, and for nurses to be courageous, passionate and wise in acting and speaking out on behalf of their populations.

Carol Etherington, RN, MScN, from Nashville, Tenn., has designed and implemented community-based programs for people living in the aftermath of war and natural disaster in Bosnia, Poland, Honduras, Tajikistan, Kosovo, Sierra Leone and Angola. She has worked throughout the U.S. during times of natural and manmade disasters including earthquakes, hurricanes, school shootings and New York City post-9/11. She was awarded the International Achievement Award by the International Council of Nurses’ Florence Nightingale International Foundation (FNIF) in 2003. Etherington is an Associate Director of Vanderbilt’s Institute for Global Health and teaches medical, nursing and interdisciplinary groups of graduate students in community health, global health and caring for victims of violence. She is an outspoken advocate for underserved and vulnerable populations and strongly promotes the concept that health, mental health, human rights and human dignity are inextricably linked. Carol Etherington’s story has been excerpted from Nurse: Past/Present/Future: The Making of Modern Nursing.