1. Risks, Realities and Responsibilities in the Field Carol Etherington, MSN, RN, FAAN Associate Director, Community Health Initiatives, Vanderbilt Institute for Global Health 2. Essential Questions Where are you going? Why are you going? With whom are you going? What is their history and what is their hx in this site? What will you do? How will you do it? How will you know the impact of what you did; what / who will follow 3. Before you go, be sure that .. you are clear on the organizations goals and objectives for the mission, and have received an orientation you have attended to medical requirements you have A LOT of information about the place/and the culture (your responsibility!) you have talked w/ family and friends so they have a reasonable understanding of where you will be and what you will be doing you know who will meet you upon arrival; have the address, phone number w/you in the local language. 4. Essential Issues Geography and Climate Housing and Work Sites Food, Diet, Drink, Meds & Paraphernalia Transportation Work Related Stressors Professionalism, Socialization and Judgment 5. http://www.environmentalgraffiti.com/news-stormy-weather-monsoon-season-around- world?image=9 GEOGRAPHY & CLIMATE Darfur Camps / Chad: CE 6. HOUSING & SITE LOCATIONS of WORK and for those caring for the people who reside there Living in tukuls, or under ox carts creates unique challenges for the people 7. FOOD, DIET, DRINK,MEDS & Paraphernalia http://www.bing.com/images/search?q=phtographs+of+unusual+food& view=detail&id=BF1AB1A7B4CCFE5A29109A60D29991A19DF8B0A 6&first=1 Dont be afraid to try new things, use common sense along with your curiosity. 8. Water is Precious 9. TRANSPORTATION Likely the most dangerous element of your trip Public transport to avoid when possible: matutus, put puts, rickshaws, chicken buses, Use great care in driving/riding in autos, bicycles, motorbikes, camels Use experienced, and preferably licensed drivers rather than drive yourself in questionable circumstances 10. WORK RELATED STRESSORS/RISK FACTORS Proximity to conflict or risk of conflict erupting Endemic tensions; local politics Expectations of patients Inadequate equipment Lack of procedural knowledge (local) Too little/wrong type of security Inappropriate mix of personal/social issues 11. WORK RELATED STRESSORS Internal tensions and conflict (project or team) Lack of self confidence/ too little training for the job Overly confident/eager to try new skills and assume roles Differences of opinion about how to achieve effective and efficient outcomes Witnessing disparities between ex pat/national staff 12. Witnessing extreme need e.g. illness or poverty Cultural/Social barriers Blurred professional/personal boundaries Lack of trust/confidence in project leadership Accountability without control or authority to make change Too few staff; too many ineffective use of resources 13. Considerations of National Staff in some settings Face more risks than expats Live with multiple stressors Likely impacted by the same traumas, medical or psycho-social issues as patients/consumers Understand social stigmas and issues particularly related to gender and religion, 14. Considerations related to the 3 Rs AWARENESS and ATTENTIVENESS COMMUNICATION VERBAL & NON-VERBAL CULTURAL COMMON SENSE PERSONAL RESPONSBILITY 15. Define it. Look it. Live it. PROFESSIONALISM in work & social setting/s http://www.bing.com/images/search?q=inappropriate+dress +in+work+place&view=detail&id=D75BE77EA8BC046AE90 96B4BF9B8FE502E9002CE 16. TYPES of VICTIMIZATION Physical Assault: kidnapping, aggravated, death threat, intimidation Property Crime: robber, armed robbery, burglary with & w/o person present, theft, vandalism Sexual Assault: Sexual Battery, Attempted Rape, Rape Death: Illness, accident, suicide, homicide 17. Mistakes to avoid . wearing and carrying expensive items; e.g. jewelry, cameras/electronic gadgets where they are clearly visible . wandering with a map &looking lost - go into the nearest shop/restaurant for assistance using suspect transport methods which can be dangerous for locals and tourists; use a metered taxi ...if using trains (try not to at night), sit in a car where there are other people; keep luggage in sight if possible . hiking into remote and rural areas without a clear plan and people who know where you are; use guided tours if available and go in daylight hours. 18. Additional Considerations look at locals to determine what is appropriate dress popular tourist destinations are often favored sites of pickpockets and in some places, terrorist activities if driving, know where there are gas stations/locations/distances between towns and villages . FIND OUT BEFORE YOU START where are the best places to stop have an understanding of police protocols/reputation 19. No relationship, no drink and no good time is worth the risk of losing your dignity, your position, your well-being or your life. Practice a prevention lifestyle & use good judgment .. 20. Kristoff BUT, dont be so cautious as to miss the magic! 21. http://www.globeimages.net/data/media/5/nashville_skyline_photo.jpg