Year: 2023

Saying Goodbye to England

July 26, 2023 / Tamara

The last few months have been tough. The three of us have been juggling an array of emotions as we prepare our journey back home. The liberty of a leisure Sunday stroll into town has now been swapped with packing. We are slowly finding new homes for the items we have accumulated the last three years. Moving here had its own struggles, leaving is proving to be the same but for different reasons.

I am learning to take in the moments of happiness, even amid grief. I find myself in a peculiar situation in which I am joyfully immersed in our quaint English life, but it is stained with the knowledge it will soon be only memories. What was supposed to be a two-year jaunt to be able to travel more easily has evolved to a period in our lives that has changed how we see what is important in our everyday life.

Winchester Cathedral

The day I found myself embedded in English society was about two years after our arrival. I was sitting in Winchester Cathedral not visiting but attending the graduation of a good friend, an adoptive daughter of a sort, along with her parents. I realized then, that I was no longer viewing the culture from the outside but living within it. One of the keynote speakers shared the history of the huge west window. The vibrant stain glass window that welcomes you as you walk up to the cathedral. It lacks the traditional biblical scenes from the period and instead has a mosaic pattern that glows brightly on a sunny day.

In the 1600s during the English Civil War Winchester was the capital of England. The Cathedral represented King Charles I, and he believed he ruled by divine right, giving him the authority to raise taxes as he wished. Parliament protested and in 1642 they destroyed the majority of the cathedral including throwing rocks through the primary west glassed window. After the soldiers left the townspeople came around and picked up as much of the glass as they could and stored it in boxes under their beds in hope that when things improved the windows could be rebuilt.

A lifetime later in 1658 the Winchester community brought out their boxes of glass to see if they could put the West Window’s biblical scene back together. It proved an impossible task. Instead, they gathered all the bits of broken glass and made a mosaic, resulting in what exists now, a glorious window.

Community

For me the window represents the endurance of the community, and with it came together a beautiful window. The sense of community is something we have witnessed whilst living here, especially during the pandemic. Being part of this community has been a gift. We first felt it when we joined our street (the Honeysuckle’s) WhatsApp group. A group of people that make you welcome signs when you have been gone for more than a week or that bring in our rubbish (garbage) bins without a request. And then we saw another layer of community when we became assistance leaders of Alvin’s cub pack, the Scouting community. And of course, my work family, hard-working diligent carers from near and far. Now, when we walk into town, we always run into someone from our community. This only after three years of living here.

And now we find ourselves saying goodbye to this English community. I have never embraced a placed like I have England. Maybe that is why it is hard to leave. Always a nomad at heart, I’ve always felt most comfortable on the move yet here, within these communities, I found a home.

Life in England

As you walked into our home you could tell our life here was temporary, a mismatch of free furniture. We thought two years living overseas was going to be enough but when the two-year anniversary arrived, it felt like a blink. Therefore, we decided to let Alvin finish primary school here adding another two years to our original plan. But the universe had other plans.

Last Christmas we celebrated with friends who happen to be another expat family. Both of us without family around we joined together. But it highlighted our physical separation from our loved ones. The only comfort was knowing the following Christmas would be our last in England. It was going to be the start of many lasts, last Guy Fawkes celebration, last Hat Festival, last neighbourhood street party.

Spring

However, as spring arrived family was calling. First it was minor incidents, a bike accident with one of the older boys and personal frustration not being home to help heal his wounds. My mother and stepfather requiring additional medical needs and not being close enough to talk to the doctors in real time.

And then this April, the unexpected passing of my brother-in-law, one of the most gentle, kind souls I have known. He was young in my eyes, only a few years older than Gary. He had a heart attack, very unexpectedly, and was taken too soon from our family. Grief overtook us. The reality he would not have any more lasts. He had an appointment scheduled the week after he died to get his passport renewed. So he could visit us. His time with us over. That stark reality made us realize that our love for England is outweighed by our love for our family. We want our lasts to be around family.

We are still grieving; it comes in waves. Grief for my brother-in-law. Gary’s last surviving brother. Grief for leaving a country we have fallen in love with. We now will not have our planned lasts like we had imagined. But it is a reminder to cherish every moment, you never know when it will be your last.

Preparing to Leave

We have two weeks left in England and are cherishing the moments. Our bucket list of places to see was cut short but not due to time, but because we have enjoyed being home. Being in Winchester, taking long walks on the South Downs Way. Or day trips to obscure pubs. We are sneaking in weekend trips to the Jurassic Coast. But it is also the small treasures, the sunrise peeking in through the bathroom window. The difficulty distinguishing my chirping alarm from the birds outside. Our weekend walks along the clear water of the Itchen River. Or the pink sunsets on Whiteshute ridge.

A temporary move has left a permanent imprint. I did not know life could feel so safe and secure. No gun violence, no lockdown drills or fears as I go on jogs at 9pm. Giving Alvin the liberty to walk to the park on his own without concern. Even knowing that Gary’s medications are all covered on the NHS. I will not only miss the beauty of England but also the security it has provided. Minor stresses that have been relieved, I only hope to carry that calmness back to the US.

Lessons Learned/Learnt

I have learnt not only about a different health care system (a dedicated post coming soon) but also life as a foreigner. I have learnt to not ask “where are you from” but “tell me about your accent.” People often ask us where we are from. We understand what they want to know, but we are currently from Winchester. We now can empathize with the pain of arriving to a country with a solid job but still no credit history. And hence not being able to get a cell phone contract or a credit card.

I am also keenly aware of the privilege that comes with being an American citizen. My peers of international nurses cannot pick up and travel the manner our family has done. They must apply and wait to get a Schengen Visa which allows them to visit the European Union. Even UK citizens must apply for a visa to come to the USA, which requires sending in your passport. Yet here we are exploring as much of EU as time and money will allow without a worry whether we are allowed in the country. The liberty associated with being an American citizen is one I do not ever take for granted.

Saying Goodbye

We are leaving our beloved second home. We are exchanging walks in the moors for sitting at the edge of the Pudget Sound, taking in the saltwater breeze. Or afternoons in the pub with friends, for neighbours who whistle as they walk through our front door. We leave behind weekend trips to Malta but soon enough will have spontaneous family dinners, and the liberty to return when our hearts desire.

When we arrived the world was shattered, the peak of the pandemic. But as I looked up at the west window of the cathedral last fall, I realized no matter how shattered things seem, like the window, it can be put back together. We feel shattered as well but are healing with the little treasures England has taught us. The value of a good long walk. The therapeutic power of a cuppa (cup of tea). The value of living with less in a smaller house. The slower calmer way of life. We are taking all these little bits back home. Even as we say goodbye, with sadness, we are being put back together by community. The community of neighbours, of nurses, of Scouts, of expats all which have changed us. Thank you, England.

The Good, the Bad and the Ugly (of the NHS)

February 26, 2023 / Tamara

The Ugly

Band levels and Coloured Scrubs

Nurses in the National Health System (NHS) start as a band 5 nurse, the entry level for any newly qualified nurse. As you gain experience, you become a band 6 nurse which includes being in charge of the department. Also known as a junior sister. Followed by being the source of all knowledge, a band 7 nurse with managerial duties, a senior sister. On the other side of the spectrum a band 2 health care assistance, is an entry level position which provides direct patient care. And a band 4 which has duties similar to certified nurse’s assistances (CNAs) in the USA. Each band has a different scope of practice and different colour of scrubs.

The visual hierarchy is one of the sources of poor communication, in my personal opinion. The navy blue worn by the senior/junior sisters (nurses) is a status marker and the assumption is that you must know what is going on in any given situation. With my recent change in position, I felt the shift immediately. Previously in sky blue I had to speak up to be addressed. Now in navy I am the first to be addressed in the room, whether I know the patient. The saying goes ‘the paler your blue the least you are heard.’ In addition, the nurses tend to stay within their own tones. With the change in colour I am no longer one of them but part of the management group.

A poster from another Trust. I could not find one from my hospital, but it gives you an idea of the different uniforms

Long queues for ambulances

Two years ago, when I started, I appreciated the ambulances queuing to bring patients to the hospital. An abdominal pain that was stable might have to wait for 4 to 6 hours to get brought in. But recently I have come to see the fault in the system. An elder man who has fallen due to leg weakness (“off legs,” the colloquial term), and who is otherwise stable will have to wait. And what could have been a quick lift assist turns into a long lie, a patient on the floor for four plus hours, and now needs further medical evaluation. The long wait times for ambulances also creates a situation where we get very sick walk ins who realized it was faster to get a friend, family member or taxi to bring them in.

Lack of Support

Newly qualified/graduated nurses have no residency program. After a two-week orientation to the emergency department they are expected to work independently. Six shifts, one day to learn to manage five patients. One day to observe and work in the resuscitation bay. Another day to work ambulatory chairs, sit to fit patients, with a nurse to patient ratio of 1:8. One day to learn to work in pediatrics before you are left to fend by yourself. And if you fail you just may have not been cut out for the job.

I should note that the NHS does have a Preceptorship Program for new nurses which gives them 7.5 hours a month of additional training, out of the department. And in the Emergency Department we try our hardest to support the new nurses.

The Bad

Reproving yourself as a nurse

In the USA you finish nursing school, you take your board exam (the NCLEX) and you are done! But here you graduate and you still have to prove yourself as a nurse. It does not matter if you did it at school you must prove once again you know how to administer medication, calculate drug dosages, draw blood, insert a cannula, do a male catheter, or place a nasogastric tube. And you cannot do any of those tasks until you have documentation that you have completed the training in the hospital.

As a new employee, I had to demonstrate all the competencies stated above when I started here. A standard across most hospitals in the UK. Therefore, as a clinical educator I spend a great of time having people demonstrate their skills to me. It does not matter if you have been a nurse for one month or 10 years.

It can wait.

Whether it be a colonoscopy, knee replacement, or even a wonky gallbladder. If it is not an emergency you will need to wait. Whilst I worked in anaesthetics it shocked me to see the number of weeks (50, 64, 72) next to the patient’s name stating the length of time they had waited for their operation.

The long wait list for treatment is not new. The combination of non-urgent services being suspended during the pandemic and staffing shortages has created a record high of almost 7.21 million people waiting for treatment as of October 2022 according to the British Medical Association.

Pay

I always said I would do this job no matter what the pay and now I stand behind my words. Nurses, along with other healthcare professionals, are not treated as professionals but more blue-collar workers and it is reflected in our wages.

As an experienced nurse, getting the highest level of a Band 5 nurse I get paid gross £16.84 an hour ($20.12). My take home after taxes being £11.75 an hour ($14.16). The funny thing is that cost of living is less here, so it has not affected our way of life too much.

Per the livingcost.org site: The average cost of living in the United Kingdom ($1818) is 18% less expensive than in the United States ($2213). The United Kingdom ranked 16th vs 5th for the United States in the list of the most expensive countries in the world.

The Zebra

“When you hear hoof beats, think horses, not zebras…. But don’t forget about the zebras”. Due to the NHS structure, there is minimal funding for the research, particularly if it is an obscure disease. As the UK government site states “although rare diseases may be individually rare, they are collectively common.”

In 2013, the UK government and the 3 devolved administrations published the first UK Strategy for Rare Diseases (the strategy). This may seem like a good advancement, but it is not. It was a start. It was not until 2013 (the 21^st century!) that the first strategy for rare diseases was developed in the UK. A fellow nurse recently got the diagnosis of hyperparathyroidism and all the research she found was from the USA. She is now looking at getting her parathyroid removed sometime next year. Since it is not emergent, for now they are just monitoring her calcium levels and giving her the appropriate treatment if needed.

The Good

The reasons we stay and tolerate the above

Free healthcare…

…Well sort of, we pay into the system via our taxes. But when you go see your primary care physician or the emergency department you do not have to worry about a co-payment. Every month, based on the amount you earn, you pay National Insurance Contributions (NIC). The tax is about 13.25% of your gross wages but if you are a low-income earner the tax is waved.

ALL medication prescriptions are £9.35 each and if you are under 18 years old or over 60 it is free.

But the biggest thing you get with socialized health care is an ease in society. People can choose their profession not for the health care coverage but if they like the job. An artist can be an artist. Small businesses do not have to calculate healthcare cost into their business expenses, giving them a better chance to thrive. Car insurance is MUCH less but not due to good driving but because medical expenses do not need to be calculated into the cost. You do not have to worry about getting sick and being able to afford the hospital bill, that societal worry is gone.

Work Benefits

When I first started working at the NHS I was so busy learning how to maneuver the system that I did not consider time off. Three or so months after I started I got pulled aside and told I needed to take a week or two off. Otherwise, my annual leave would accumulate and it would be difficult to use. Management requested I take at least one week off a quarter. I get seven weeks of paid time off, which is one of the reason we can travel with such ease.

Annual leave is not part of sick leave. You do not have to accumulate your sick leave base on hours worked like in the USA. I do not know if there is a designated number of hours for sick leave. But base on a research you get one month off full pay and the following months at half pay.

Sick leave here also includes mental health, including stress. I do not recall seeing someone take sick leave for mental health concerns back in the USA. You of course need a valid doctor’s note, but there is no limit of the time you can take off. We also have free counselling service through work. In addition to a Staff Wellbeing hub that provides stress management resources such as free online yoga, fitness classes, menopause educational sessions, and holds wellness campaigns.

Yes, I complained about the scrub colors earlier but at the start of your employment you are given your own set of scrubs. I no longer need to purchase them. If your position changes you get a new set. Additionally, if you have wear and tear, they are replaced at no cost to you.

Camaraderie

Being part of the NHS, I am part of a bigger community. People will say “I work in the NHS,” you are not working for them, you are in it, you are part of it. You understand the struggles and the rewards being part of the national health system.

And they support you back.

The cost of living is going up all around us and the NHS is very aware how it affects their employees. My hospital does not shy away from that reality and recently sent an email stating:

“We know such concerns can impact overall wellbeing and happiness, and whilst it’s beyond our control to ‘fix’ the wider cost of living problems, we feel strongly that we should aim to provide the widest range of support possible to our people through this period.”

With the email came a list of reward programs to support us during this time. Including an increase for mileage rates reimbursement for those that drive for work. And the creation of a Hardship Fund for cases of unforeseen financial needs. In addition to discounts specific to NHS employees.

And it is a group you want to be part of. I felt the inclusivity soon after I started working here. The executive team sent email addressing race head on. Below is an excerpt of the email

The week before Christmas we were in a state of critical incident due to high patient volume with a lack of beds. There was physically nowhere to put incoming patients. The seams of the hospital were bursting. All educational and non-urgent meetings were cancelled. Nurses from other wards came to the ED to help with patient care. And the Executive team were walking around with the tea trolley handing out a cuppa (a cup of tea) to patient’s, family members, and staff. Everyone in the hospital came together to help, we were a team.

So even though the NHS has some ugly bits, or bad areas, for me the good outweighs it all.

All the big wigs passing out tea, thank you!

Life is Never a Straight Line

January 20, 2023 / Tamara

Like walking down an unsteady path and having to curl your toes to steady yourself, the last six months have been a bit turbulent. Some may call it a midlife crisis, but I kind of went through that when I packaged up my family and moved to England. This period has been more of a career reevaluation. A turbulent one, but one in which I think I have come out ahead. Time will only tell. As any emergency room nurse in recent times will tell you, we are overworked and our light has been dimmed. Many of us have left the field. I did too, going into the field of anesthetics, then doing another a bit of a U turn.

But first,

Before I share that tale with you, I would like to share a conversation I had with a trusted friend years ago that is still fresh on my mind. I was talking with her on my commute home. Catching up after a tough day in the emergency department (ED), venting to her about not getting my break until 8 hours into my shift. It had been an especially grueling day. And now I had a scratchy throat and felt like I was getting ill. She said to me point blank, “Well maybe you love your job, but it doesn’t love you back.”

She was referring to the fact my job was not conducive to self-care. Regularly, I went six-plus hours without a meal and held my pee for ages, always putting my patients needs ahead of my own. By the end of most shifts, I was hangry, on the verge of a urinary tract infection, and exhausted. Talking to her, I got defensive. Didn’t she understand that I put my needs aside to care for others? To be there for them at the most vulnerable point. Didn’t she know how altruistic I was? Didn’t she get what it was to have a career, not a job, one that you’re passionate about, that you put your entire soul into. Why didn’t she see it?

Maybe, I couldn’t see how much of myself, both physically and emotionally, I was giving, and how it was breaking me. And she did see it.

During COVID being an ED nurse also ment having marks on your face from the FFP3 masks

Fast forward, ten years later

I am living in England, working in a smaller community hospital and thanks to better management, I do get my breaks. The work is still hard. I am on my feet for hours. My system is still on high alert waiting for the next emergency. And as research has shown, persistent surges of adrenaline is damaging on blood vessels and puts you at an elevated risk of heart attacks or stroke. Not to mention the toll of the night rotation every other week that is hard on this old mother hen. Even though it is rewarding being an emergency room nurse it comes at a cost, the cost of my own health.

I decided that I was ready for a new challenge, a career change, and it led me to anaesthetic nursing. It is a different field here than back home in the USA. In England, you are the assistant to the anesthesiologist, his helping hands, versus an independent practitioner like in the USA. (My next post will be about the lessons learned whilst an anesthetic nurse.)

A new way of life

The change in field also altered my hours and my way of working. I could be home for dinner most nights and on weekends. I not only had my lunch breaks, but additional tea breaks as well. It was easier on my body, and no more adrenaline surges. Then, as I settled into this new area of nursing, walking the sterile halls of theatres (operating rooms), I learned that the clinical educator in the emergency department was leaving.

Before leaving the emergency department, having been so recently in their shoes, I had taken on teaching and giving guidance to junior nurses and recently-arrived international nurses. I found myself falling asleep at night thinking about how to describe a second-degree heart block to one of the newbies. The language of medicine lives with in me.I realized I get a thrill being able to share that language with others. Thus, the U-turn: I took a chance and applied for the position.

A Chance

I was short listed and granted an interview, my first ever management interview. That is the moment I started leading a double life. By day I worked as a new anesthetic nurse, and by night, I prepared for the interview. It consisted of creating and giving a presentation on the topic of “linking clinical education to recruitment and retention.” Two weeks later, days before the interview. I found myself walking the English coastline, practicing my presentation, titled: “Empowerment Through Knowledge: A Culture of Education”.

the coastline I walked as I recited my presentation

The day arrived, my heart was racing, my breathing exercises did little to relieve the dripping sweat from my armpits, but I felt I did well. The interviewing team, unable to decide that day, requested a day to think about it, uncommon in England. Over the following twenty-four hours, I realize the immensity of what I had just signed up for. If I got it, it was going to be a challenging position, and a difficult one to leave behind at work, as any schoolteacher well knows. Was I again choosing a job that I loved too much?

The Quandary

In the middle of the night following the interview, sitting in an empty staff breakroom waiting for an emergency worthy of an operation. I put down the book A Promised Land by Barack Obama and let my mind wander. Thinking about a possible future as the clinical educator for the department I heard the echo of Obamas words: the importance of inspiring others, is a worthy cause. Was it my fortune to guide other nurses on their journey. Or was I about to take a position that would consume me? I live and breathe the nuances of being a nurse, but can I leave it at work? Will this impede the precious moments I have left in son’s childhood?

As I crawled into morning, I was still unsure of which future I wanted. Truth be told, at this point in time, it was out my hands. But those 24 hours gave me the opportunity to reflect on the decision I was making, and the life I was choosing. Was it time I choose something for my whole self, not just for part of me.

The day before this, my wise husband asked, “will you ever be happy?” It made me chuckle and think, when will I be satisfied? Back in the States, I had strived to be a critical care transport nurse, then a pediatric emergency nurse, then the move to England, and into the operating theatre, and now clinical educator. What am I looking for? What is it I was striving for? I needed to remind myself to stop, and soak in the moment after a goal has been reached, instead of looking for the next goal.

I did not get the job.

A sense of relief laced with disappointment seeped in. I heard the universe telling me to focus on life in England, on home, my family, so I jumped fully into anesthetic nursing, no longer having to lead a double life.

The role expanded my perspective as a nurse, but it removed some of my best skills, IV starts (cannulation) for example, or thinking on my feet during an unexpected critical situation. But I had the space to let my mind wander, and the time and energy to learn new things. I found myself being thrilled during the first hours of an operations, but then I would just get on my phone and let time slip through my fingers. I became very good at Wordle and discovered Quordle.

With spring in full bloom, we headed on holiday. While soaking in the sun on the Costa del Sol, I got a call from Mobile Medics International, an NGO, to go to Romania and help with the refugee crisis stemming from the war in Ukraine. Still in training for anesthetics, I easily slipped out for a week and went to help.

On one of the days there, walking the streets of Galați, looking up at the tall cement buildings and the blue sky, my phone buzz. I had an email. It was from a fellow ED nurse at Winchester, letting me know the clinical educator assistant job (a part time, fifteen hours a week) had been posted. There I was in another country, helping to treat minor ailments, but using my skills. And teaching the local volunteers first aid as they prepared to go into Ukraine. Was the universe giving me a nudge? I put aside my fears of rejection and as soon as I got back, applied. And I got the job.

Facing the Fear

So, after five months of anesthetics training me, with only weeks to go until I was practicing on my own as an anesthetic nurse, that I put in my notice. The conversation with my manager was one that caused a tight knot in the pit of my stomach. I knew I was jumping back into the madness of the emergency department, working there part of the time, and the rest as the clinical educator. Was it the right choice?

That day, as I cycled away from the hospital, there was a group of monks chanting, a calming hum overtaking the traffic noise. It felt right. I was taking a risk in the right direction.

Learning to care for myself amidst chaos

So, I was back in the craziness of the emergency department. I felt a flutter in my chest but one of joy. A comfort to be back in a familiar environment. A feeling that any ED nurse knows after they have left the ED only to be drawn back. My first day back in the ED I was thrown right into the trenches working in one the busiest areas. The pressures could have easily overwhelmed me, but I kept telling myself to breath. And my focus for the day was to keep everyone alive. I might not complete the hourly observations/vital signs right on time, but I would provide level of care that goes beyond the numbers.

These two positions gave me balance. The two twelve-hour shifts as a staff nurse giving me an accurate pulse of the department. Then the two eight-hour shifts as the assistant to the clinical educator where I could I provide hands-on teaching and create education material for the department.

The Unexpected

Then the day came when the clinical educator and emergency department matron (director) pulled me into their office. The matron was going on maternity leave for a year, (the standard in the UK) and her position was being filled by the clinical educator which left a vacancy. One they asked if I would fill.

My current balance suited me, even though I rushed around to provide the education I wanted in the 15-hour weekly limit. I was not sure how I would handle teaching full time. Should I take another chance?? My mind replayed all the chances I had already taken, from going to the visa department when the country was shut down to moving to England. The hard part was done.This was another chance that had to be taken. The new goal was not to lose myself in the chaos of my work.

I applied, I interviewed, and I got the job.

How do we learn to give it our all without losing ourselves?

There are a couple components to the question. First, to remember to care for yourself, otherwise you will not have the energy to care for other. Second, learning to be uncomfortable. Whether it be caring for patients or working with colleagues, we need to empathize and be uncomfortable with them, without losing ourselves. As Brene Brown famously states: to be able to connect with other we first must be brave enough to get in touch with our emotion. I also like to remember that a moment of uneasiness for us, it just that a moment. A moment for us to connect, but for the other person it is a permanent mark. So, by learning about ourselves, our emotions, we can hold on tighter and not lose ourselves.

A fellow nurse once told me a story of an elder woman whose husband had just passed. She was a young nurse then, and it had hit her hard. She was crying. The woman told her “Darling it was my husband, it is my loss. You have your job to do. It is not your grief to carry.”

Back to the beginning.

I started the year looking for a change in my career, something that brought more balance to my life, and in a roundabout way, it found me.

I am breaking in this new position, learning to be uncomfortable with unfamiliar tasks and duties. Advocating for staff to be given time off to attend courses in a department that has no funding. And in my spare time I am learning about male catheterization the English way so I can teach it to the department.

All with an effort to leave it behind at work and not bring it home. I have been pulled into nursing again, and pulled away from writing.

I am about to turn forty-two, and a goal in life, a purpose, it is to leave something behind beyond myself. To cause a ripple that surpasses my existence. Education fulfills that purpose. I am still figuring out the nuances of my teaching style but now it is a full-time job versus two shifts a week. I am learning as much as I am teaching, growing humbling.

Straight lines in life do not allow you to see things from different angles. I do not know what this year will bring, but I am learning to care for myself a bit better, challenging myself in a new role, and learning to let go of work on my ride home each evening.

My time in Romania

January 20, 2023 / Tamara

On Thursday February 24th 2022 Russia invaded Ukraine escalating the Russo-Ukrainian War which began in 2014. The invasion has resulted in Europe’s largest refugee crisis since World War II. According to United Nations, as of May 13^th 12 million are believed to have fled their home in Ukraine. Eight hundred thousand going south to Romania, with 300 still residing at a refugee center created by Galați University. This is where I headed to on April 24^th with the non profit Mobile Medics International.

A drop in the ocean of the people in need.

The COVID crisis was just starting to ease and the university students were returning to in person learning when the invasion took place. “Dunarea de Jos” University of Galați made the decision to continue online learning and use the student dormitories to house the incoming refugees. Each dormitory building is able to house over 300 refugees. The refugees were originally scattered among three dorm buildings. By the time I had arrived they had been consolidated to one building, building C.

The dorm building in Dunarea de Jos” University of Galati

Arriving

The air was muggy and thick the morning I arrived. Kelly, an old friend and humanitarian, welcomed me into the teacher dormitory where I would be living for the next 10 days. Our reunion was brief as she was heading to Ukraine later that morning. Her team was composed of 20 Urban Search and Rescue Romanian volunteers. The plan was to staff ambulances near Odessa and transport the critically ill to the hospitals or a safe area. After their departure and a quick power nap, I joined my team consisting of a mental health nurse from Ohio, a pediatrician from Missouri and an EMT from Alaska.

Kelly and I on my arrival, had to capture the moment.

The Galati Urban Volunteer Search and Rescue UVSAR office was on the bottom floor for dorm building C. A hidden room located halfway down the hallway. It served both as the UVSAR office and as the refugee clinic. As you entered the room you saw the UVSAR volunteers and two twin beds that straddled the room, covered with translucent sheets. At the end of the room, you could see the tools required for the clinic. A mismatch of bandages, a heart monitor, protective personal equipment such as gloves, stethoscopes, and blood pressure cuffs.

The previous medical team had identified patients that required follow up but other than that we started from ground zero. Our first task was to assess the 300 refugees who had been there about a month. New waves of refugees were expected any day. Due to a language barrier we had to create to a health assessment to identify the needs of the refugees. We translated it from English to Russian and with the help of the translators delivered them to the refugees by the end of the first day. We discovered that because Russian is understood by Ukrainians it was the best choice for translation.

Assessing and Translating

The following day we gathered the assessments forms and using Google translator identified the patients that required immediate treatment. We divided ourselves into two teams and started working. We had rooms that stated they required medical help. Each team had a Russian translator and young Romanian USVAR volunteers eager to learn anything medical. The Russian translator would translate to Romanian, the Romanian volunteer would then translate to English. And then we would backtrack the steps to communicate back to the patient.

Patient Care

My first family of the day was a single mother with her two children. A typical presentation. We only had two males of the 300 refugees. The men stayed behind to fight.

Two families were sharing a room and it held a total of four children and two women. One child with a history of asthma and no inhaler resulting in an anxious mother, the second with a viral cold. We had interrupted their school as we walked in. The school age children were gathered around a tablet. Propped up on the sole table of the room. We learned that the Ukrainian teachers were holding online lesson for the children while displaced. I took the ten-month-old out of her cot, with the mother’s permission, wiped her running nose and played with her. It sunk in that her cot is her only haven in this new home. We treated the two children with colds with assurance and made sure they had clear lung sounds. We also arranged for a pharmacy to fill the prescription for the inhaler and headed to the next patient.

A patient that required follow up based on the previous team was a quiet man with chronic leg ulcers. He needed bi-weekly wound care and dressing change. As I started to remove the old dressing, he jumped a little as my hand grazed his leg. I realized he probably had not been touched in some time. The goal was not only to provide wound care but to teach the UVSAR team how and why to do the dressing change. We wanted the treatment to continue after our team was gone. After that first day, I made sure to always embraced his hand, providing as much human touch as possible. By the time I left our hands locked together, reaching towards our wrists. I thanked him for welcoming me into his space and he thank us for helping Ukrainians.

Room 207: unexpected treasures

As we were walking to the top floor, we were pulled into our second room to see our next patient. He was sitting on the bench in the foyer, limp and vacant, waiting for time to pass. His wife was bustling around him and grabbed us. Communicating with hand gestures we knew she wanted our help. We nodded and followed her as she dragged him like a lifeless cape, his arms wrapped around her neck, the end of his tall body sliding on the floor, to their home now, Room 207. It was a flare up of Parkinson’s. Previously very capable man, the founder and chair of an NGO in Ukraine for people with disabilities, now unable to carry his own weight.

Treasures in a room…

As we opened the door to their room, we were overtaken by a their son practicing his violin. A talented musician, I requested he continued, but his preadolescent shyness kicked in. His mother’s scowl told him he should continue. I selfishly wanted to hear the beautiful melody during this dreadful time. As I listened to him play I was take back home to hearing younger sister practice.

Their entire life was encapsulated in that room. The one table scattered with boxed food, schoolbooks, and a brush. Depending on the hour of day it served as desk or vanity. And above the bed an oil painting which they carried by hand, a gift from the mayor for all the work they had done in the community. Everything they had built, a home, a career, a retirement, all taken away in matter of weeks.

The oil painting, hanging above thier bed

The woman had pulled us aside because her husband’s Parkinsons was getting worse, and she was trying to get a medicine that had worked in Ukraine. I took note of the symptoms, completed a full assessment & history, and I took the name of the medication. I then jumped into the rabbit hole of looking for the medication in Romania. Thanks to Google translate and the help of the resident pharmacist at the dormitory I made his needs known.

The days went on

The following days we welcomed thunderstorms, which cleared the air but washed away the chalk art the children had previously done. During down time I found myself playing with them outside. They would make structures of carboarded boxes left over from donated items or mountains of snails. As I picked up a piece of chalk and drew a daisy near one of the rainbows, another girl wrote thank you in Ukrainian. We spoke through play.

The team gathered momentum with the health assessment to guide use. We would go from family to family.

The assessment form showed many of the refugees were having sleepless nights. How do help those in need in a span of 10 days I kept wondering what long term impact will our team would have?

Most of the refuges were and are in a standstill waiting for the war to be over. They do not want to leave the dormitory till they can go back home. But what does home consist of now? One expectant mother was planning on naming her daughter Liberty. She believed by summers end, her daughters due date, Ukraine would be liberated. The faith of the people lifted me.

Teaching

In between providing care we would head back to the UVSAR office and talk through the possible diagnosis with the young volunteer. The volunteers had dedicated their weekends to training and almost every evening to this cause. It was amazing to see the commitment of these young people to becoming humanitarians.

practicing nasopharyngeal airway NPA placement

By day five we had seen most, if not all, the refuges that required an evaluation. And the next wave of refugees had yet to arrive. We asked our young helpers what they wanted to learn, and their requests spilled over. As a team we decided to hold a full day teaching session followed by a full day of simulations.

The UVSAR volunteers were not only providing aid to the arriving refugees but a good number of them were also heading into Ukraine to help. The photos do more justice than words.

Simulation in an abandoned building
Assessment of a collapsed patient
Basic Life Support training
Learning to check a blood pressure
The UVSAR Team

In the End

I did not provide any life saying medical treatment, but we did make sure minor illness and injuries were handled on site. Our goal was to alleviate the impact of the refugees on the local infrastructure. We did open the communication between the department of health and the onsite UVSAR clinic. And make sure chronic issues were not overlooked. I did not get to see the beautiful sites of Romania, the mountains in Transylvania or the parliament in Bucharest. But I did get to see its heart: the people. The welcoming hosts, not just for our team but also towards the refugees.

The last day as I was getting ready to leave, I rushed back into the clinic to grab my water bottle. I walked in on a UVSAR volunteer teaching a newer volunteer good chest compression, arm straights, hands overlapped, at a rate of 120. That was it. The moment, I realized a drop in the ocean would continue to have a ripple effect beyond my little splash.