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Compassion, Fatigue Mission Report

Carina Cotaru

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Presentation given at the AMEN Australia 2018 annual conference held in Adelaide, Australia, www.amenaustralia.org.

Recorded

  • November 25, 2018
    10:00 AM
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I was meant to be talking about compassion fatigue but I've already presented about this topic a few years ago and I couldn't really find a new perspective but I was trying to think about the last time that I was that I underwent compassion fatigue. And it was actually about July of last year I had just come back to work after being away for 6 weeks I was on call and you think that being away for 6 weeks you would be refreshing and ready to face the demands of a challenging environment and that my compassion tank would be at its fullest but I hadn't actually just been on holidays for 6 weeks and actually spent 3 of those weeks in. Working at a mission hospital called a hospital and I'm going to tell you how I ended up there shortly but let me just tell you a bit about this incident that happened while I was on call. I had a very experienced by an accredited registrar working with me in the hospital and I was at home and she rang me to discuss a patient who wanted to discharge himself against medical advice that she was on happy with the fact that she was in a shared room she was a God patient and she actually had to share the room with a woman who had just had a baby so she was very unhappy about that she'd only had some minor surgery but she had a catheter and needed to stay in for a couple of days and that meant that she had to stay in hospital for a few days. And thankfully I was at home and not in front of the patient because I think at that point in time I had absolutely no compassion for her and these were the things that actually went through my head and I actually verbalized to my red star as well she had a clean bed which sheets to sleep on she only had to share her room with one other adult and a baby she had 5 meals provided for her for free she had nesting stuff to hear for a while in hospital and she didn't need to bring the relative with her to the cough to have. Their operation had been performed in a timely manner by a highly qualified CIJ and she didn't have any out of pocket costs and the cost of a travel from a remote community had also been paid for and I just couldn't understand how she could Dumon that she provided with a single room and I think the registrar was somewhat bemused and surprised at my intense reaction and so she very kindly to said OK fine also add it up so she offered to find her bed on another ward and the patient did stay in hospital when I put the I realize that my response was most likely out of proportion and that I was probably suffering from reverse culture shock something that I hadn't really thought about too much. And I needed to put into practice strategies to deal with this if I was going to become an effective clinician again back in my home environment. So given that we've already had a few talks about mission work I thought I'd share about my mission journey how I ended up at Galilee and some of the decision making process is that I went through and. You may find some of these tips useful so as has been mentioned before an obstetrician gynecologist based at road Darwin Hospital I've completed most of my training in Sydney and spent my last year of training in Edinburgh in Scotland and I'm telling you some of these things just a bit you I guess get an idea about the journey that God's taken me on to get to the point where I went to jail last year my family immigrated to stray when I was 12 from Romania and I've lived in small countries and travelled to well over 30 countries and I speak several languages my great grandfather was the 1st person in his village about 90 years ago to accept the gospel and then gave a plot of land away on which he went on to build a festive interest in his village and growing up in a Christian home I saw many examples of service and combined that with my positive experience of being welcomed into my doctor country I was always in visiting that tree my career I'd be serving in an area of need. And given that. I have cross cultural experiences and I love traveling I presume that I would be taking mission work overseas in some capacity at some point so my 1st taste of overseas mission work was a trip to Vanuatu with my school year 11 I can't actually remember why we were going but what we end actually ended up doing was hiking through several villages over awake we spent some time snorkeling and wishing with the local church on the weekend so I didn't feel like I actually was very useful but what it did do for me was that I opened my eyes to the conditions in which a large proportion of the world lives and it made me realize again how privileged I was and also strengthen my resolve that out of the abundance of the blessings that I had received I was compelled to help those less fortunate. My next encounter with Mission work was during medical school when I read about an MIT DR CATHERINE HAMLIN the famous a strange fistulas surgeon who together with her husband Ridge established that is out of the hospital in Ethiopia and this encouraged me to pursue my dream of becoming an obstetrician and gave me rather grandiose ideas about changing the world or at least that of women less fortunate than myself and then as a final wee medical student I spent 5 weeks a kid job a hospital in Kenya. Where I had a great time socializing with other medical students I did quite a lot of sightseeing but horrifyingly was also a lift in charge of the medical ward several nights a week which for my supervision by the physicians who are at home and I say her firing me because I think I realize now the extent of responsibility that was placed. On me and I do question the ethics. That because we would never allow that to happen in a straight. And it's something that actually still happens in hospitals and is that something that that's appropriate Yes you may be the most. Junior person maybe you do have more knowledge. And the local nurses but often often you diet. But this did have this little mission trip did. Sort of have a positive effect and I still want to do. To say that I visited in some capacity. The reality of daily laugh as a junior doctor than shit and it was followed by the pressures of applying for a training programme that picture flying face year is a ridge of straw and they all took their toll on me and the idea of serving overseas while Street still strong in my mind took a backseat. However at that time I decided to start a master's binge national public health to better prepare myself and while I let a lot of a lot during this time it also left me rather discouraged and with a lot more questions than actually and said And these are some of the questions that. I had and I don't know that I actually particularly have answers for them but I'm sure some of your big having the same sort of questions what and where is the best way to say how do I serve an ethical in an effective way useful way how long do I go for for me it was a matter of how much time could I take out of my training. Had a way how do I choose what organization to serve with when's the best time to go in terms of what time I could take off but also in terms of the skills that I could offer in terms of the impact that would have on my training and other commitments. So at that time I was in a training program in a hospital which didn't have a strong record for medical missions or where this was particularly encouraged so these questions would have continued to simmer at the back of my mind with not clear Ansell. Towards the end of my training. I went on another actually 2 short trips to the park with a small team of gynecologists and a system nesting stuff to perform Belviq floor surgery for 2 weeks for women who otherwise couldn't have afforded this life changing procedure we took along all our equipment performed surgery did a little bit of teaching on the way had a great time as attained did some sightseeing and then wrist turned to our respective lives in Australia. And while I acknowledge that we certainly improved the quality of life of many women this kind of short term volunteering left me feeling on easy again how useful was this project where we actually bring new skills to the country there were many train going to colleges who could perform the procedure we were undertaking but there were an overwhelmed by the need for obstetrics service. And the women needed to pay considerable sums of money so that made it out of reach for most of them where we reaching the women who are most in need and could war women have had surgery instead of sending such a large change from history if we just an Ace had the money we spent on travel and they could have had local surgeons performed. Another question I had was was it ethical for me to perform the surgeries as a trainee even with close supervision on unsuspecting patients who didn't know I was a trainee and then I had no way of following them up in the short or the long term. And what were we doing about actually preventing the causes of pelvic organ prolapse and the long term health of these patients I felt that I probably gained more from these trips than I had contributed and after 2 trips with these unresolved questions I decided that this was not a good fit for me and I continued to pray and keep an open mind for other opportunities. And then I'd expect a limb moved to Darwin and when I say unexpectedly was unexpected for me because as far as God was concerned he prepared this move for me how was however I was oblivious to the ways that he was leading and for the 1st time I found myself wishing in a department which was open to my pursuing volunteer work and I worked with other consultants who spent considerable parts of their careers with. Either independently or with Christian organizations or other N.G.O.s and so I was able to ask them what's of questions and was able to use them as resources when I eventually did work overseas. So how did I end up in Galilee over the previous 6 to 7 years I kept in touch with a friend who is a G.P. oxygenation and she ended up working as a missionary doctor in share in West Africa she's been there for 5 years now we've met up in various places around the world and she kept asking me to go and work with her and I kept promising that I would go when the right time came and that right time came when I actually went to Darwin where could grade to give me with leave without pay which would have been unheard of in Sydney and a few other opportunities lined up and that's how I ended up spending 3 weeks in the middle of last year with a county hospital which is run by civic mission in Sharon West Africa. Just a little bit about. This was this was one of the is that I come back to a lot and I think my mission journey illustrates this that God's now is the plans that he has for our lives and their plans that are good for us and good for those around us as well. So there is a landlocked country in West Africa not to be confused with with Nigeria. It's a Muslim country formally colonized by the French it's got a population roughly the same size of a stray are however when you look at their city sticks in obstetrics them a tenement hellery ratio is 650-651-0000 extension 0 in the charity So if 100000 women give birth 650 of those will die and you compare that with a stray is M.M.R. which is 6.8. Only 29 percent of women have a skilled birth attendant at delivery and they have a female literacy rate of 35 percent and this is what greeted me as I was landing. Looks very different to what more to stray looks like and. I still find it hard to articulate the experiences that I had it girl me there was a lot of heartbreak but there was a lot of resilience and joy both in the staff and the patients there are so many heartbreaking cases and many cases which were difficult to treat i need in the context of near babies and women who would have easily survived and thrived they lived in Australia and most of the diseases and poor outcomes I saw mainly due to the difficult living conditions. Almost every woman I saw had lost at least one baby either during childbirth were immediately after mostly due to lack of adequate care and. This patient had a profound impact on me and I still feel that I was probably the one that was more blessed by looking after her she had had 3. Term stillbirths or intraparty death so she'd had this was her 4th pregnancy and she had lost 3 babies we don't know exactly why so she came to our clinic on a Friday afternoon she had had internet OK with us was just a few days after her due date and for the obstetricians in the room. Volume was reduced and we were talking about whether we should induce her or not and in the end made the decision to deliver her vices here in sections I had for pregnancies and this was the 1st baby that actually survived I think she was just as stunned as I was. So. How did I prepare myself for going to what was some of the difficulties I encountered there felt like absolutely everything was new new language new culture and new clinical context and to a certain degree I felt like I'd landed on the moon but with extended X. sort of expected to function normally So these are some of the difficulties I expect and I guess in a way they go counter to what I am where I have envisaged that I would I would be working in things that would make it easier and make my ministry more. Have a greater impact it is a long way from astray and it's difficult to get to Took me about 6 months to fill out all the forms I needed to be allowed to work to find and enjoy to go with and to attend medical as well as characterised phrase I had to travel to Paris to obtain my visas not embassy or consulate of Nigerian astray I didn't fancy parting with my passport for several weeks while I made the journey to the Nigerian embassy in the States and then back to Darwin. French is the official language in his air and while I do speak a little bit of French It wasn't it still made communication with the staff difficult during the day I did have an interpreter and at night I was basically left to my own devices and it would be something to the extent of I get a phone call to they doctor come and I would say coming always are you. And you know that if you've been on call those 5 minutes that it takes you to reach the hospital with 10 minutes to get to the hospital and someone tells you what the problem is is the time that you work out in your head what you should be joining for your patient I didn't have that privilege. Is a Muslim country and it's very conservative so I was expected to wear and collect skirts or dresses and a head covering while I was in the hospital and while I respected these cultural norms I did find it difficult to accept that I needed to behave and dressed in a certain way in order to be accepted while my male colleagues who went there were not inconvenienced by such cultural norms plus doing an instrumental delivery while your. You're trying to keep us from I putting up and become more revealing than scrum pets was wasn't the easiest the scope of clinical practice is very different even to what I encountered in Darwin and I had never seen a ruptured You troops and I only knew how to recognize the signs of impending rupture in theory so I recognize that there were. A lot of cases had more clinical more appropriate clinical skills and I needed to be guided by them. I was there any for a short time so while I observed practices which maybe could have been improved I was careful about the suggestions I made as I didn't understand the full context and limited Internet and therefore contact with my support network outside the Army made this made this difficult however it was an advantage because it actually led me to spend more time in prayer and relying on God rather than the advice of just friends and colleagues So despite all these difficulties why did I choose to go to me my friend who works there described an incredible need which I could help alleviate with my skills so Fishley because my friend was there and I had heard a lot about gal we felt somewhat familiar and I knew you would have a friendly I would have a friendly supportive place to help guide me through my time there and I also wanted to offer her the support. That she needed I knew that while serving with an organization like in this if is a trendy thing to do I felt that while long term missions is not something that I've been called to providing relief to a long term missionaries more sustainable and helps keep them in the field longer and thus actually building health system capacity rather than just providing short term assistance so what have I learned and what are some of the things I would ask you to think about if you're considering cross cultural missions and I have 3 questions. That I'm not going to spend too much time on because I didn't know how much more time I have with you but was the question that I asked myself is was my trip effective. And I believe it was I didn't just do it but I also shared my skill and I provided for away from my overworked friend was it ethical and was it culturally relevant I did try to form relationships with the locals and because my friend had been there for a long time I basically just went in to help relieve her and the hospital staff accepted me more readily. So on a personal level. What. Did this experience teach me it taught me to pray and to trust that God would lead me to the right place at the right time and also that he would give me the wisdom in those difficult clinical scenarios I learnt that it's important to have networks support networks in place and that may take all sorts of forms of go up to very close friends who live in different cities to me and we chat on Instagram We send each other messages and they were vital when I was there they knew I was there it was difficult to reach me but I knew that they were praying for me I had my home group in Darwin praying for me and I also had professional support so I had a couple of consultants who had worked overseas and I could just shoot them off a quick a mile or a message to ask them what do I do in this situation I have no idea what I'm meant to be doing. The other point that I have is. The most important it was prepared to be overwhelmed and know what you were limits are I actually took a week slave prior to arriving in a day to overcome jetlag and work tiredness and then I had 2 weeks holidays with friends in a family environment so I can decompress and prepare for coming back to work in Australia know that you will be under prepared and that you'll be challenge but the next time you go. Also I find joy in the small things was lovely to just walk to the hospital was a 5 minute walk if not shorter so I didn't have to wake up really early in the morning and it was beautiful to walk through the hospital grounds and say hello to all the other staff as well and as you come back I would say take time to reflect on your experiences when you returned home and to find someone he can deeply for if. So I guess in sharing my story I'd like to encourage you that if you are interested in have a space mission work it's definitely worth pursuing but the route it takes may be secure says and we need to be wise in choosing how and where we serve in order to be truly of benefit to guys I just want to leave you with 2 verses. Flippy has to do nothing out of selfish ambition or vain can see rather in humility value others above yourselves not looking to your own interests but each of you to the interests of the others. And the other best that brought me a lot of comfort while I was away from you don't want to be 31 to say the Lord himself goes before you and will be with you he will never leave you nor forsake you do not be afraid to do not be discouraged this media was brought to you by audio verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse or if you would like to listen to more sermons leave a Visit W W W audio verse or.

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