Have Nurse Practitioner Degree...Will Travel - Part 1
It is my last day in Japan, and I want to buy some souvenir magnets. The one in my hand depicts Mount Fuji and costs 320 yen, or about $4. As I rummage in my purse for money, I find 100 yen, some Ghanain cedis, a Hong Kong 50-cent piece, an Eastern Caribbean dollar coin, 20 Chinese yuan, and an American dime. Crumpled in the bottom of my purse are Indian rupees, Vietnamese dong, Brazilian reals, and South African rand. Forget about buying souvenirs! These coins, along with the many colorful new stamps in my passport, are a perfect reminder of my journey.
I am nearing the end of an epic trip around the world with the Semester at Sea program. On the beautiful and swift MV Explorer, the only floating college campus in the world, students take courses in global studies, art, geology, psychology, literature, economics, and more. As the shipboard nurse practitioner (NP) for the spring 2012 voyage, I am responsible for providing episodic and emergency health care to the approximately 450 college students, plus 200 faculty, staff, lifelong learners, and their families. Together with family physician Dr. Bill Yeaton, I cover morning and afternoon clinic hours while the ship is at sea and carry a pager for emergencies that occur at other times, including in the wee hours of the morning. While in port, we trade days on call and also operate an early morning clinic for those passengers going on excursions. Of course, on our days off, we go on plenty of excursions of our own!
Obtaining this position was a dream come true for me. Like George Bailey in “It’s a Wonderful Life,” I had long wanted to “shake the dust of this town off my feet and see the world.” However, I had not succeeded in finding a position that would allow me to travel abroad with my family and still be able to make my house payments. Volunteer positions sounded fascinating but were impractical since I have three school-aged kids. I fantasized about sailing around the world, but such a trip was far too costly, and some around-the-world cruises do not allow children. Then I remembered Semester at Sea. As a college student, my husband’s uncle had gone on a voyage that he described as life-changing. When I investigated the program online, it sounded very different from a traditional cruise, with much more emphasis on learning about countries and experiencing meaningful interactions with ordinary people in every port. Although the price was competitive, it was still beyond our budget. Then, fate led me to click on “Employment Opportunities,” where I learned that the Institute of Shipboard Education at the University of Virginia, which runs Semester at Sea, hires NPs for each voyage.
Although I seemed to meet their criteria, I did not get an interview for about 6 months. When I called the human resources department, they very kindly informed me that it usually takes years to get hired due to the many applicants. Also, they tend to hire NPs with some emergency room (ER) experience. As a family NP, I have worked in a variety of settings, but my time in the ER has been limited to doing sexual assault examinations for my local hospital. That nugget in my resume turned out to be in my favor; unfortunately, sexual assault is part of the picture in any collegiate setting. However, since it seemed unlikely that I would be hired, I sighed and packed my dreams away for a while.
Fortunately for me, the nurse who had been hired for Spring 2012 had to cancel, and on a Sunday night in December, Dr. Yeaton—who had recently been hired— called to ask if I was still available. In a split second, I decided that this was too amazing an opportunity to pass up, no matter what the consequences. I said yes before I even knew whether my husband and I could take off for the 4 months the journey would entail. Luckily, our jobs turned out to be safe. Once we explained what we would be doing, everyone was happy for us, including our children’s teachers, who saw the voyage as an incredible learning opportunity.
There was quite a bit of work to do during the 2 months we had to get ready for the voyage. I had to prepare my home practice for my absence, finding an NP to see my patients at least 1 day per week. Also, since I felt a little anxious about my rusty emergency care skills, I decided to take a trauma nursing core course, recertify in advanced cardiac life support, or ACLS, and spend a few shifts shadowing a nurse-doctor team in the ER. While I sincerely hoped none of these skills would be necessary, I thought I should be as ready as possible for anything. I learned that over the course of the 100+ previous voyages, medical staff had addressed all kinds of emergencies, including cardiac arrests, fractured femurs, head trauma, drug overdoses, alcohol poisoning, and even acute leukemia diagnosed on the ship.
There was also a daunting amount of paperwork. Our journey would take us to Brazil, Ghana, China, and India, all of which require visas for American travelers; each visa process is different and dictates a trip to the embassy for every traveler or a professional representative. Visas are expensive; the total cost was almost $4000 for five of us.
In addition to checkups certifying us to be healthy enough for the trip, we needed vaccines and medications. Vaccination against yellow fever was required to enter several countries. Meningococcal disease is common in Ghana, typhoid and polio boosters were highly recommended for India, and hepatitis A was a no-brainer for the developing world in general. My children and I had already been vaccinated for hepatitis B; my husband opted for the vaccination in case he needed care in a hospital where universal precautions are not routinely employed. Because bacterial diarrhea is common in travelers, we needed to bring ciprofl oxacin for the adults and azithromycin for the kids. Finally, we needed malaria prophylaxis. In Brazil, we would float up and down the Amazon; in Ghana, India, and certain areas in South Africa, we would potentially be exposed to mosquitoes while spending the night outside. My husband and our two boys, aged 10 and 11, could take good old cheap generic doxycycline. However, since doxycycline is contraindicated under the age of 7 and I am allergic to the drug, my 6-year-old daughter and I would need atovaquone/proguanil, commonly known as Malarone, at about $10 a tablet.
One mosquito-borne illness we were likely to encounter and couldn’t be vaccinated against was dengue fever. The only way to prevent this nasty disease, which causes fever, severe myalgias, headache, and (rarely) hemorrhaging, is to prevent mosquito bites. To add to the difficulty, dengue mosquitoes bite during the day and are often found in tropical cities, both rich and poor.
Finally, we were as prepared as we could be. In the middle of January, we packed up our DEET-based insect repellant, water bottles with attached filters, sunscreen, clothes, Kindles, iPhones, laptops, kids’ textbooks, swimsuits, and a bulky first-aid kit, and flew to Florida. I shivered as the plane took off. Was the air conditioning set too low? I wrapped my shawl around my shoulders, but it really was no help. These shivers were of joyous anticipation!
On the morning of January 17, we boarded the MV Explorer with our new, temporary co-workers and neighbors. It was smaller than a typical cruise ship but very attractive and comfortable. For the first 24 hours, we were busy checking in, unpacking, and finding our way around our new living environment. We had paid $1000 for room and board for each child, and $2000 for my husband. For this fraction of the full price (about $40,000 per passenger), we received two small cabins across from one another, and could eat three buffet-style meals per day in the dining lounge. Our kids would share an inside cabin with three twin beds. The adults’ room featured a large window through which we could see the ocean and sky. While senior staff and faculty had enviable balconies, I was delighted with our view.
To my relief, Dr. Yeaton and I were given an extensive orientation to the medical center by retired orthopedist Milt Waldron, who founded the clinic decades ago and for whom it is named. He proved to be an incredible source of information and good-humored advice about students, parents, and staff. He warned us, “Parents will call you and tell you you’re not taking good care of little Susie. You just have to talk them down. If they get too ornery, let the dean deal with ‘em!”
At first it was difficult to keep straight the “who’s who” of the shipboard community.There were two top-level deans; literature professor Victor Luftig served as the academic dean and was in charge of the faculty, while Bob Vieira was the executive dean and supervised the staff. Bob and I had a few things in common, including our home state of Oregon and a connection with Oregon Health Sciences University. He and his wife Abby had first done Semester at Sea with their three children almost 2 decades ago and described it as a wonderful experience. I found that very encouraging! Faculty members came from all over the United States and offered a tempting array of classes: art, poetry, economics, geology, and more. The professors were a distinguished group that included Pulitzer Prize recipients and many renowned experts. In theory, I was welcome to audit any class, as long as the professor didn’t mind an extra participant, but I doubted I would have time.
As in a dormitory, resident directors would supervise students and keep things running smoothly. In a crisis, they would often be the first responders; I would soon learn how critical their presence would be. There were librarians, information technology staff, psychologists, tutors, and child-care providers. Work-study students assisted these folks and helped to run the campus store.
However, most of the heavy work around the ship was done by the crew, who hailed from all over the world. Housekeeping took care of the cabins and laundry; kitchen staff cooked, kept the buffets stocked, bussed tables, brought beverages, and helped children get their meals; security staff roamed continuously, looking for safety hazards, checking the many alarm systems, and preventing altercations; and, most importantly for my purposes, there was a crew medical team in the clinic.
Since there are more than 100 crew members, some of whom live on the ship for up to 10 months at a time, they have their own doctor and two nurses who share the clinic with Semester at Sea, helping out with students as needed. Dr. Yeaton, who had worked on one voyage, knew the basics, but for the crew medical team, including nurses Christina Tablizo and Christine Palomares, this was home turf. Like the majority of the crew, the medical team was Filipino. Although tiny, the medical center was immaculate and well organized, with labels on every drawer and cabinet. I soon learned to appreciate a small, impeccably organized space; the clinic defined the meaning of “shipshape.” There was one exam room with a table and good lighting; another room where lab tests and X-rays are done; an “intensive-care unit” with a bed, monitors, and crash cart; an “operating room” with a stretcher, suture, and surgical materials; and a room down the hall with two beds and its own bathroom, which was soon dubbed the “drunk tank.” Since I knew I wouldn’t be able to remember where everything was, I concentrated on the location of the crash cart and automated external defibrillator. Now, all I had to do was wait to set sail.
Stay tuned for Part 2 – the start of our epic journey around the world!
Jennifer Hanlon Wilde is a nurse practitioner and an English Instructor at CGCC who lives, works and writes in Mosier, Oregon with her family. She is an alumnus of American University and did her graduate work in nursing at the MGH Institute of Health Professions in Boston, and in English at Portland State University in Oregon. As a shipboard nurse practitioner, she had the opportunity to circumnavigate the globe with the Semester at Sea program in 2012, helping to care for students, faculty, staff and their families as they traveled and studied throughout South America, Africa and Asia. In addition to traveling, she enjoys reading, knitting, and making music with friends.