Barbara Grogg, Humanitarian
Nurse Practitioner Barbara Grogg, APRN, C-FP, has been doing humanitarian work of one kind or another for over 20 years. Along with her husband, a pediatrician, her early efforts focused on local charities in their home base of Tulsa, Oklahoma, where they own and operate a clinic, International Travel Medicine.
As a life-long lover of travel who has visited over 150 countries (the couple owned a travel agency prior to founding their clinic), it was only a matter of time before Barbara became involved in international humanitarian work.
“We always liked to travel close to the ground,” she says. “We like to interact with locals, regardless of what country we visited. In poorer countries, we saw an incredible need and knew that healthcare skills could be utilized in all kinds of ways.”
A Cultural Education
Barbara’s first organized global medical outreach trip was to Guatemala with Do Care, the outreach arm of the American Osteopathic Association about 10 years ago. The trip included medical students, and both Barbara and her husband immensely enjoyed the opportunity to teach them in the field.
“Since then, that’s where our thrust has been,” she says, “Taking medical students to study and partner with colleagues in the countries we visit.”
The trip teams are made up of healthcare providers of all stripes: osteopathic and allopathic physicians, NPs, PAs, and the recent addition of a dentist. Medical and nursing students are welcomed and encouraged to join the teams.
Barbara tells the story of one pre-med student who was deeply affected by a vision mission, providing glasses to an underserved population.
“He knew immediately that was what he wanted to do,” says Barbara. “Seeing providers and students being turned on to their potential, and realizing how important it is to both learn their skills and cultural sensitivities, is very rewarding.”
Continuity of Care
In addition to engaging and educating students, Barbara’s work focuses on continuity of care.
“We want to avoid the “bandaid” approach,” she says. “If we find a serious problem, we want to be able to funnel patients into proper channels for the help they need. Just identifying a problem is not good if you can’t follow through.”
For this reason, she says, her groups tend to go back to the same communities over and over. In Guatemala, for example, her organization partners with True North, which has built up a network of local partnerships over the years.
Another of Barbara’s long-term areas of care is in Chacra Seca, Nicaragua. There, she works with Just Hope, an organization that she calls a “boots-on-the-ground” partner.
For the past two years, Barbara has helped coordinate the clinic there, but it only has one physician for 8,000 patients in a large and rural area. She has helped the Nicaraguan doctor by bringing in support from additional medical teams, working to coordinate financial aid and education, and providing moral support.
In bringing students to the area, Barbara emphasizes not just the healthcare education but also the cultural education around the community.
“This is not about the organization’s priorities,” Barbara says. “We work with community leaders to determine their priorities, to respond to community requests. We are an integral part of the community, but they tell us which areas have the greatest needs.”
Because Barbara and her teams return to the community, year after year, they are able to see trends and to provide basic education, as opposed to only dealing with the most immediate crises.
“When our teams arrive, the local people don’t flock to the clinic and overwhelm the program now,” says Barbara. “They know that the providers will be back. We are walking hand in hand with the community.”
The NP Difference
Nurse practitioners play a key role within a global healthcare outreach team.
“NPs come to the table with a whole different set of skills from medical students and physicians,” says Barbara. “We can take care of virtually anything in the field that any mission team can take care of, but we also bring the educational piece – part of our makeup is educating patients. That particular skill is missed a lot of times, so that is a big, important piece of the puzzle.”
Out in the field, there is another important difference: the nurse and nurse practitioner approach to patients.
“There is a difference to the training,” Barbara says, “It’s not the medical model, and that shows up very obviously in the field. Patients are often not used to providers touching them and listening to them – there is a warmth that nurses and NPs have that connects with people.”
It’s A Jungle Out There
by Lorna Schumann, PhD, NP-C, ACNP-BC, ACNS-BC, FAANP
An anthropologist approached me requesting a medical team to fly into the Amazon Basin of Ecuador. She had been there many times with her husband and students working with the indigenous tribes. Several nurse practitioners and NP students were interested in going. Translators consisted of U.S. embassy staff and one Spanish-speaking anthropology student.
In May of 2006, we flew to Quito, then drove to Shell, Ecuador, over-nighted, and then flew by small passenger plane to Conambo, a remote village that became base camp. The plane had to make five trips to get the team and baggage into the jungle. Each team member was weighed with their luggage (embarrassing for some).
We set up our bedroom in one school room and the medical clinic in the another school room.
The first two days of the trip were spent in base camp seeing patients, then some providers went by dugout canoes and others by airplane to surrounding small villages. Two providers and translators remained in camp to handle emergencies. There was no running water, no electricity, only food we packed in and one out house.
The anthropologist and I flew to a village with three families. The oldest living tribal member at 87 years old lived in this village. Monkeys came out of the trees and tried to get our lunch (roasted peccary). It tasted pretty good until a baby peccary (so cute) rubbed against my leg, then I lost my appetite.
On a day that most of the team had gone to other villages, we were busy seeing patients when we heard an airplane coming in for a landing. The pilot brought in an 8-year-old bitten by a poisonous black snake and a 6-month-old with croup and wheezing. As we crossed the airfield we heard another plane and watched as a small commercial plane with Shell oil administrators overshot the runway and landed upside down. The villagers ran to help them and we started working on the two children. Five vials of antitoxin ($890 per vial) had been donated for the medical mission. Typically an adult patient requires 10 vials. Although the directions were in Spanish and none of us had ever given antitoxin, the process went very well. Without electricity, a nebulizer could not be used, so we put a toilet paper tube on an inhaler and provided puffs of albuterol to the 6-month-old.
The results: the plane was uprighted and was flown back to Shell, where they could beevaluated at the hospital. The executives were scared and bruised, but no major injuries. We were able to stabilize both children, before our pilot came back with a provider and a student who bundled them up and headed for the hospital in Shell, also.
Although stressful at the time, the team worked well to provide quality care.
Lorna Schumann has taught in the Family Nurse Practitioner Program at Washington State University since 1996. In addition to teaching, she has worked as a staff nurse in ICU/CCU at Valley Hospital and Medical Center, Spokane, Washington until December 2008, and has practiced Urgent Care, Internal Medicine and Family Practice. She completed two post-Doctorate fellowships, one at the University of Rochester in Rochester, NY and another at the University of South Carolina in Columbia, SC.
She is Chair of the American Academy of Nurse Practitioner Certification Commission and represents the commission on the LACE committee, Corporate Council of AANP, IOM, BCEN, Citizens Advocacy Committee, National Council of State Boards of Nursing, Institute of Credentialing Excellence, American Board of Nursing Specialties and Alliance Committee. She is editor of the Continuing Education section for the Journal of American Association of Nurse Practitioners. She is Co-chair for the International Council of Nurses, Advanced Practice Network, Research committee.
Lorna is an avid wake boarder and water skier, enjoys travel including international medical missions, and thoroughly enjoys her eight grandchildren.