THE BILLIONS of health care dollars entering the developing world through various spigots - the Global Fund, PEPFAR, the Gates Foundation, the Clinton Health Access Initiative, and other largely US-funded charities - are tangible, irrefutable expressions of the good will of the people of the United States. The ambassadors who deliver the services are thousands of American doctors and other aid workers who fan out across Africa, Asia, and the Caribbean to bring care to the most impoverished corners of the world.
Many of these efforts have their genesis in Boston, a world capital of nongovernmental organizations and home to the nation’s leading health care providers. Through Partners in Health, the outreach program founded by Harvard-based Dr. Paul Farmer, Boston physicians serve overseas while remaining under the aegis of the city’s leading hospitals. These institutions - Brigham and Women’s, Mass. General, Children’s, and many more - deserve credit for saving lives and furthering the ambitions of a generation of globally focused physicians. Now, those hospitals should make the same opportunities available to nurses.
In cutting-edge settings like the three Partners in Health-staffed hospitals in Rwanda, visited recently by a delegation of journalists from the International Reporting Project, Boston doctors save lives on a daily basis. In a district of 340,000 people that six years ago had only a single physician, a 150-bed teaching hospital now treats patients and trains local doctors and surgeons. But the number of local physicians can still be counted on two hands; by contrast, nurse educators from the United States could train hundreds of local health providers to work in numerous capacities. Most pressing is the need for nurses to care for hospital patients. But there is also a lack of nurses to administer tests and prescribe medicine in villages without any health providers.
While Boston hospitals have sent nurses to attention-grabbing emergencies such as the Haitian earthquake, there hasn’t been a corresponding effort to improve nursing care in chronically underserved countries. The same reasoning that prompts hospitals to send top doctors into the Third World applies to nurses, as well. Emerging nations offer a scope and variety of challenges to hone the skills of even the most nimble clinicians; doctors and nurses come home better prepared to serve their patients in Boston. Moreover, hospitals that allow their employees to tackle the most challenging problems in the world will attract the most dedicated professionals. With a shortage of highly skilled nurses, hospitals can use the prospect of overseas service as a recruiting tool.
Nurses’ careers follow different paths than doctors’. Most nurses work under union contracts, with benefits accruing through seniority. Unions should do their part to ensure that their members are able to undertake overseas missions without losing seniority.
The work of the American government, foundations, hospitals, and churches in emerging nations has saved millions of lives, and won the admiration of hundreds of millions of people. Significant attention has been devoted to actions, such as the Iraq war, that diminish American prestige abroad; Boston hospitals are part of the undertold story of how America is regaining prestige through the skills and humanity of its medical professionals.