Many nurses are seeking ways to serve disadvantaged or imperiled populations around the world. Not long ago, we assumed someone else would step up to meet the needs of such populations. Today, most of us realize that “someone else” might well be us.

In both global and domestic crises, roles for nurses are increasingly diverse. From the earliest warning stage of a crisis through long-term recovery, the needs of vulnerable populations call for creative and culturally appropriate interventions along with clear-headed thinking and an organized approach to care delivery. Such interventions cost time and money and present political and logistic problems and, in some cases, danger. However, settings that pose extreme personal and professional challenges can be indescribably rewarding.

Planning your global experience
Planning when, where, and how to work in a global setting is essential. First, reflect on your reasons for seeking the experience. Then research the many available options. Thousands of secular and faith-based organizations and government programs respond to global crises. You can find most of them by searching “humanitarian resources” on an Internet search engine. Study the organizations’ mission statements. Find out what types of programs each organization administers and their site locations; trace their programmatic and financial histories. If you have questions that the website doesn’t answer, contact the organization directly.

Exceptions exist, but know that major world nongovernmental organizations (NGOs) don’t give you a choice about where you’ll go, or when. While the major NGOs usually require a commitment of at least 6 months, they cover all expenses. Other types of organizations, particularly church-based initiatives, will let you work on an international project for as little as 1 week but require that you pay all expenses.

Applying to an organization
After narrowing the field, apply to the organizations with positions that best match your skills and available time frame. Always provide honest information in your application. If you have medical problems or limitations, be honest about this upfront—not when you are in the field and may have to be treated and possibly airlifted out (which can cost more than the whole project’s budget).

Expect to wait at least several weeks to hear if you’ve been accepted, and even longer to receive a mission assignment. The larger medical relief agencies that recruit worldwide prefer to place people with international experience; being fluent in another language also can help. Exceptions exist during acute emergencies; for instance, surgical or ICU nurses may be accepted when an emergency operating theatre must be set up in the field. (See “Don’t just drop in” in pdf format by clicking the download now button.)

An important caveat: Even if you have the right skills and apply at the right time, you should accept a position only if you really want it and are qualified for it. If you wouldn’t take a similar job at home, don’t accept it from a humanitarian aid organization.

Tips for getting accepted
You may have a better chance of being recruited by an international relief organization if you:
•    have experience in international settings
•    have worked previously in disasters or emergencies
•    have a history of working independently, especially in rural or remote areas
•    can speak another language
•    have demonstrated skills in a particular area, such as emergency medicine, women’s health or midwifery, or public health or epidemiology
•    are in good health.

”I’ve been accepted! Now what?”
Once you have accepted an assignment and been given a departure date, you and your loved ones may have conflicting emotions about your leaving. Explain to them that while you’re away, you may not be able to have the close contact you or they might like. Although cell phones are everywhere these days, the power to charge them isn’t. E-mail can be unreliable, and you’re likely to be one of many people trying to stay connected. To dispel your family’s worries, tell them to assume no news from you is good news; if something goes wrong, your organization will call them.

What to expect when you get there
Organizations differ with their protocols, but ideally you will receive orientations at the organization’s stateside office or by phone before departure, when you arrive at the group’s headquarters in-country, and at the project site. Each orientation may differ somewhat. The information you receive at the group’s U.S. office is bound to be less up-to-date than what you’ll learn from the on-site coordinator at the destination. However, all orientations should have a reasonably consistent theme about your role and responsibilities.

Before leaving for your destination, ask who will meet you at the airport. Culture shock can be severe—especially during your first time at the airport of a developing country. You may feel overwhelmed by the crowds and taxi drivers hawking their services. Typically, a driver or a representative of the organization will be waiting for you with a sign bearing the organization name, or you’ll receive instructions on which taxi or car to take. Keep in mind that you can’t just go to a telephone and make a call without first getting local coins and knowing the language. Important: Make sure you know the name your organization goes by among the locals, as well as the address and local phone number of the place where you wish to go.
When you get to the site, you’ll probably feel extremely tired and confused. You may even question whether you were sane when you made the decision to go global! But with a little time, sleep, and a welcome from your team members, things will soon feel right.

In the field
Some nurses can become embedded in a project quickly, especially those with a specific job description and delineated responsibilities. Be aware that responsibilities may shift and flexibility is critical. For example, if you’re responsible for administering measles vaccine in a refugee camp, you may become expert in your job quickly. However, if a cholera outbreak occurs in the camp, you may be needed to help identify and test contaminated wells. While that task may fall outside your expectation, comfort zone, or expertise, it’s just as important as your usual responsibilities. “That’s not my job” is rarely heard in an effective, cohesive relief team.

Appreciate the national staff
The organization’s national staff is your best source of information on how to serve the population, as well as on daily life in the community. They can be your lifeline—especially those who serve as drivers and interpreters. Never underestimate their value to you, to the project overall, or to the future of the local population. Long after you’re gone, the national staff will remain.

Security concerns
How safe is humanitarian work? While the incidence of harm to humanitarian aid workers has been rising, rarely are these workers intentionally targeted for harm. In fact, traffic accidents remain the single greatest risk.

In cases of acute crisis, the United Nations is often in charge of overall security, but all organizations have their own rules, regulations, and codes of conduct. As a team member, you are expected to abide by them and usually sign in writing that you will do so. Ultimately, each person is responsible for making good judgments and decisions. To do otherwise may bring consequences or repercussions with far-reaching implications for the individual, the team, and the whole project.

Team tensions
On a global relief mission with team members of varied backgrounds, nationalities, and temperaments, tensions develop from time to time. Team dynamics are a common cause of stress, especially when team members share a house and work in difficult circumstances. Paradoxically, the tougher the mission and the more extreme the hardship, the fewer complaints arise—perhaps because team members have little time to worry about trivial things and a greater need to rely on one another.

Saying good-bye
Most international aid workers find leaving their missions a wrenching experience; the longer they’ve been there, the harder it is to leave. Love of the land, the people, and the way of life tends to become part of your life, and you know you’ll never be quite the same. (See Stop short of making promises in pdf format by clicking the download now button.)

Upon departure, your organization may debrief you. Debriefing is an opportunity for you to report the facts as you’ve observed them. It can be extremely cathartic. If you’ve experienced or witnessed atrocities, violence, or danger, the organization should provide a professional mental health debriefing protocol as well as follow-up contact.

Back at home
When you return home, expect to feel disoriented. You may have trouble describing your experience to family and friends. Even if they want to hear all about it, there’s a limit to what they actually want to know. After all, they have no visual images and only a limited context in which to wrap your stories. What they most want is for you to get back to being you and living your life as before. That may take time, however, and you may feel lonely with your thoughts and memories for a while.

During your transition to “normal” life, staying connected to people from the organization or finding others in your community who’ve had similar experiences can help. They’ll understand how hard it is to walk into a massively stocked supermarket still haunted by the faces of the hungry, malnourished people you left behind. Be assured, though, that just as you were able to adjust to a new place weeks or months before, you’ll readjust to life at home.
Going global has its risks and hardships, but they are usually outnumbered by rewards, wonders, and a profound sense of purpose. You have much to offer. Take the responsibilities of a global mission seriously and savor it as one of the most important ventures of your life—as a nurse and as a citizen of the world.

Carol Etherington is an Assistant Professor of Nursing and Director of Global Health Studies with the Institute for Global Health at Vanderbilt University in Nashville, Tennessee. She has worked in 13 countries, primarily in acute disaster and conflict settings with the international humanitarian medical relief agency Médecins Sans Frontières/Doctors Without Borders.