Running head: NURSING IN A DEVELOPING COUNTRY 1

A Reflection on Providing Western Nursing Care in a Developing Country

Riley Murphy

March 19 2018

NURS 2020
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A Reflection on Providing Western Nursing Care in a Developing Country

Look Back

In February of 2018, I had the opportunity to travel to Honduras with Trent University on

a nursing brigade to complete my NURS 2020 clinical placement. While in country, I learned a

plethora of new information via first-hand experience. I took this knowledge home with me, and

I will apply it to my career as a future Canadian nurse.

Elaborate

Being that Honduras is a developing country, the lack of resources is a prominent issue

that my team often faced. Resources that we would expect to find almost anywhere in Canada,

such as the soap needed for my hand-washing project, or toilet paper, are limited, especially in

the rural settings in which we were often working. Running water is considered a luxury in

Honduras. The main water source for many residents is a river. Some residents have a pila in

their homes, which is a concrete cavity in which water from the river is held, connected to the

river through underground hosing. It is not uncommon to see livestock roaming in and around

the homes, in close proximity to their drinking water, and creating a problem for infection

control. Honduras has a different culture than Canada, with its own set of beliefs and values.

Education in Honduras is funded by the government up until grade six. The families of children

who do not have the funding to pay for schooling past grade six do not receive any further

education. While presenting my handwashing project, I realized that some of the children I was

presenting to were genuinely unaware of the importance of handwashing. Throughout my time

on this nursing brigade, multiple realizations such as this were made, which led me to think

about the disparity and lack of education this country faces.

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Analyze

One key issue that was prominent during my time in country was the lack of resources. A

rural nurse in the community of El Siriano in Yoro faces this challenge daily. His medication

supply is often empty, as the government does not provide the much needed medication on the

dates that they are supposed to be delivered. When my partner and I went to present our

handwashing station at a rural school in Yoro, we did not think to bring soap. In Canada, almost

every public facility with a bathroom has an abundant supply of soap, including in schools. Upon

arrival, we realized that this school did not have a supply of soap. Thankfully, we were able to

find a bar of soap in one of our donation bags, but this scenario only highlights the issue of the

lack of resources. An article posted in the Journal of Hospital Infection indicates that “Infection

control in developing countries differs substantially from that in the developed world. Limited

resources represent the main challenge for governments in developing countries” (Raka, 2009, p.

293). The limited resources made it difficult to present our handwashing project when we were

made aware that soap was not a supply that was in abundance.

A second challenge that my team and I faced while on this nursing brigade was trying to

perform nursing care in a different culture. It is important to note that just because an

intervention works well in a developed country, does not always mean that it will be just as

effective in a developing country. Santmyire (2009) states that “Even if a plan of care or

treatment is based on EBP [evidence based practice], the NP [nurse practitioner] must consider

the cultural and social consequences of following it” (p. 311). Relating this to my experience in

Honduras, the implementation of menstrual cups as a form of feminine hygiene does not work

for all women in Honduras. They hold the belief that inserting anything into the vagina means

that they lose their virginity. Although this is not a social construct in Canada, it is very relevant
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to women in Honduras. Even though menstrual cups may be a solution to many of the issues the

women face in Honduras when menstruating, the social backlash they might receive causes them

to be reluctant to use the cups. An article written by Santmyire (2013) tells a story about how

mothers with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome

(AIDS) in Burkina Faso were given infant formula and were told of exclusively formula feed

instead of breast feed for the first six months of their infant’s life, as per the standards of the

World Health Organization. After it was found that the mothers were not formula feeding, it was

discovered from one mother that “The only people who formula fed their children were the very

rich and those with HIV. Understandably, she was not rich and was not ready to announce to

everyone that she had HIV and face the social and cultural consequences” (p. 310). This is just

another example that although evidence based practice interventions may be successful in

developed countries, they may not always be successfully implemented into developing

countries.

In addition to the challenge of a different culture, a third challenge that we experienced

was a lower standard of education. In Honduras, education is funded by the government until

grade six. Bajkiewicz (2009) expresses the importance of preparation and research before

departing for a medical/nursing brigade. This preparation includes researching the education

level, predominant health issues in the region, and using education materials that are geared

towards the literacy and cognition processes of the audience. This was something that my partner

and I did do while creating our presentation. We created our presentation at a grade six education

level, and used many images and analogies to help better explain bacteria and the importance of

handwashing. Bajkiewicz (2009) also indicates that leaving behind resources such as

posters and visual aids can be an effective long-term strategy for the retaining of
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knowledge after the presentation is over. This is a strategy my partner and I also used.

We created posters on how to and when to hand wash, and had them hung on a wall near

our handwashing stations. Our knowledge of the education level in Honduras prior to

departing for the brigade allowed us to create a presentation that would be most effective

and helpful to the audiences we presented to.

Revise

Based on my analysis, preparation and research on the country before entering was a

good strategy that should be continued to be implemented for future brigades. Preparation made

for less of a shock and an easier transition into the culture upon arrival. Additionally, the

bringing of medical supplies and donations such as clothes and toys is a helpful intervention,

since Trent revisits Honduras twice a year. On each brigade, they are able to replenish supplies,

creating a sustainable donation system. If this nursing brigade were to be a medical/surgical

nursing brigade rather than community health and health promotion, I believe that more

extensive knowledge regarding the stigma and beliefs around certain implementations and

procedures would need to be analyzed thoroughly prior to the brigade. This would allow for only

the interventions that work best for the people in the country of study to be implemented,

allowing for the biggest beneficial impact.

New Perspective

This nursing brigade has taught me a lot. I learned how to implement a health promotion

strategy, and learned that upstream approaches are just as, if not more important, than the

treatment itself. This brigade has taught me to be more culturally competent, and incredibly more

aware of how impactful the social determinants of health are on someone’s physical health. I will

now ask questions before making assumptions, as you cannot fully understand a person’s
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situation just by their physical appearance. I learned that everything that I learn in Canada

regarding “the best way” to nurse does not and cannot always be applied in a developing

country. I will apply the experience and the knowledge that I have gained from this brigade to

my practice as a future Canadian nurse.

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References

Bajkiewicz, C. (2009). Evaluating Short-Term Missions. Journal of Christian Nursing,26(2),

110-114. doi:10.1097/01.cnj.0000348272.27924.24

Raka, L. (2009). Lowbury Lecture 2008: Infection control and limited resources – searching for

the best solutions. Journal of Hospital Infection,72(4), 292-298.

doi:10.1016/j.jhin.2009.03.017

Santmyire, A. (2013). Challenges of Implementing Evidence-Based Practice in the Developing

World. The Journal for Nurse Practitioners,9(5), 306-311.

doi:10.1016/j.nurpra.2013.04.001