Why pursuing this type of work is still an option despite the pandemic
By Nancy Edwards
July 4, 2022
The opportunity to work in rural Sierra Leone, West Africa, as a community health nurse and educator changed my life and career. I initially went for two years, but I stayed for five. The village and classroom work was challenging, captivating, and exciting. I was inspired by locals — mothers, chiefs, traditional birth attendants, and village health committee members — who advocated for health improvements. They taught me the foundations of primary health care: trust, authentic dialogue, collective action, the power of ancestors, village leadership, and the roles of cultural insiders and outsiders. I have repeatedly returned to what I learned in Sierra Leone during my career in global health.
Many Canadian nurses have forged careers working in developing countries. I am one of those who practised nursing in a lower-income country with an international development organization — in my case, Cuso International (formerly CUSO). World University Service of Canada, Crossroads International and the Canadian Red Cross are other organizations that have placed nurses overseas. Regrettably, the COVID-19 pandemic has drastically changed programming and opportunities for field placements with such organizations. Options for overseas postings in nursing have diminished in the near term and seem uncertain in the longer term. Nurses interested in pursuing this type of work must be asking if this career option has closed. I don’t think so, and here’s why.
Barriers to working abroad
There have always been barriers to working overseas, including cost, finding a suitable country and work placement, and professional registration. When I graduated with my BScN from the University of Windsor in 1974, I was ready to sign up as a volunteer with CUSO but disappointed to learn that at least two years of clinical experience were required. By 1978, I had got the essential work experience and was posted to Sierra Leone, where my career in global health was shaped, cemented, and launched.
Many Canadian nurses have forged careers working in developing countries.
The 1970s was a different era for working in developing countries. Many African countries were grappling with their relatively new status as sovereign nations. The trickle-down approach to global development was firmly ensconced. There were growing concerns about an unsustainable population explosion and much controversy over enforced family planning programs. We were near the end of a 40-year period when the world’s population almost doubled from 2.3 to 4.4 billion. The limits of growth were under discussion, but there was no United Nations (UN) agenda for sustainable development and no history of climate change summits. The UN Convention on the Rights of the Child would not be signed until 1989, and Canada would not officially endorse the UN Declaration on the Rights of Indigenous Peoples until 2016. HIV/AIDS had not yet dealt its deadly blows. The UN’s Millennium Development Goals (2000–2015) and Sustainable Development Agenda (2016–2030), which described paths and commitments to reduce health inequities, were still to be formulated.
5 things you can do
Each decade seems to bring new global health challenges while revealing persistent problems. COVID-19 has brought renewed attention to long-standing health inequities within and among nations. These inequities are the sine qua non that leaves some nurses feeling compelled to offer international assistance in a lower-income country. Although opportunities to serve abroad have at least temporarily diminished, there are other ways to engage with global health issues and provide assistance in this pandemic era.
Work actively with the diaspora
Nurses from many parts of the world live in our communities. Over and over, we’ve heard their pleas for more secure, manageable and safe routes to get registered as nurses in Canada. Learn more about their difficulties. Reach out to these nurses. Consider opportunities to provide mentorship. Sit, meet, and dialogue with them and allow your biases and preconceptions about nursing preparation and nursing practice in other countries to be challenged and changed. Invite them to share their work experiences in other health systems with your colleagues in Canada. Provide informal opportunities for immigrant and refugee health workers to practise using nursing and medical terms in one of Canada’s official languages. Encourage them as they navigate registration hurdles. Consider how you can advocate for more streamlined processes for nursing registration with your provincial/territorial regulatory association and/or college.
Provide opportunities for mutual learning
Explore options that allow nursing students in lower- and higher-income countries to join virtual learning circles via the internet and encourage them to sign up for a mentorship program. Provide opportunities for mutual learning about successes and failures in practice and how health-care systems can support or deflate nurses’ efforts to improve health in different parts of the globe. Find the common touch points.
Examine practice innovations
Resource-constrained settings have long been a hotbed of practice innovation. For example, oral rehydration solution, envisioned as an alternative to the intravenous administration of water and electrolytes for cholera victims, was developed in Bangladesh and has saved countless lives in lower- and higher-income countries. The origins of kangaroo care come from Colombia, where a nurse sought an alternative to neonatal incubators when none were available. Rapid community assessment approaches were developed in response to local health crises in Southeast Asia. The use of drama for health education came from African and Caribbean countries and can be a game-changer for audiences at all educational levels. First-generation cellphones were adapted as viable household data collection tools by community health workers in rural villages. Not surprisingly, COVID-19 has also driven innovation. We can boost mutual learning about how nurses are supporting the mental, physical, and social health of patients and communities in a time of crisis and scarcity.
Learn about decolonizing health
Nurses and nurse educators can embark on a period of self-study or bring together an interest or discussion group or congress (like this example) to learn about decolonizing health care, health inequities, intergenerational trauma and Canada’s Black history. Our colonizing past with Indigenous Peoples is also something we can all better understand, and reading articles on this topic is a good place to start. For those with a keen interest in working outside of Canada, there are lessons to be learned about the experiences of colonization and its impact on policies, structures, and self-determination. During their years of formal education in Canada, most nurses learned little or nothing about residential schools and their intergenerational impact or about the system failures that continue to drive injustices among Indigenous Peoples. Consider, for example, ongoing boil water advisories on some of Canada’s First Nations reservations.
Reach out to others
Nurses and nurse educators can join with others for dialogue about global health approaches, whether they’ve changed, how they need to change, and how to advocate for improvements at home or abroad. The time is ripe for a deep look into how we practise nursing the way we do and how we think about Canada’s diverse peoples. Be prepared to have your preconceptions and patterns of thinking challenged. We can all come out better informed and reinvigorated on the other side of the pandemic.
Let’s use this international development travel disruption as an opportunity to seek new approaches to global engagement. All nurses, of all ages, in all types of work settings, are well positioned to more fully embrace what it means to be global citizens. Perhaps more than ever, reciprocal learning opportunities in other countries are within reach, providing a fresh look at what is meant by a career working abroad for nurses.
Read what the federal government says about how to get involved in international development.