Starship Health paediatric nurse Vivien Welsh always knew she wanted to work with children. She entertained both teaching and nursing as career options. But time with a Christian missionary organisation based in Brisbane and travelling in India and other parts of Asia convinced her nursing was the right choice. “When I was travelling, I saw just how much need there was for health care.”

Her first paediatric placement as a student and her pre-registration placement on a neurology ward at Starship confirmed she had made the right career decision. She graduated from Auckland University of Technology in 2012 and began her nurse-entry-to-practice placement on the neurology ward where she had worked as a third-year student. Welch loves the work.

“I love working very closely with families. It is different to working with families of adult patients. When a child is in hospital, a family member is there all the time and every shift we discuss with that family member what we hope to achieve. It is a real partnership.”

She has stayed on the neurology ward – “there’s still so much to learn”. But her time there has been punctuated by two stints as a volunteer nurse with Africa Mercy, the world’s largest civilian floating hospital, which was in Madagascar. The Africa Mercy is run by the international non-government organisation Mercy Ships. The first time – from mid October 2014 to mid-January 2015 – she worked on the ship’s paediatric ward. She resigned from her job to do so, but on her return successfully applied for a position on her former ward. Welch knew she wanted to return to Africa Mercy. For her second assignment of 12 weeks with the hospital’s dedicated wound care team, which began in early January this year, the ward accommodated her unpaid leave.

She feels compelled to do this work. “I want to make a practical difference and Mercy Ships provides the structure and support to do that. I also feel a responsibility to do so. I’ve been born in this country but have done nothing to deserve that fate; I could just as easily have been born in a country with nothing. I feel I have a duty to give something back.”

Time with the dedicated wound care team was her way of doing so this year. “Working on the ‘dressings team’ was very different to any nursing I’d ever done before. Previously, I’d worked on the wards where I had a patient load. In the ship’s dressing team we definitely worked as a team, which was great. Five of us rotated, with four nurses on duty each day. We operated in pairs, alternating between performing dressing changes and distracting kids, while getting the instruments and dressings ready for the other nurses.”

There was always music playing, and dancing withher bandaged patients to Taylor Swift’s latest hit was a regular occurrence.

“Despite the seriousness of the conditions being treated, we created a fun environment to work in. There was always music playing. We sang and danced around with our patients – or solo – to entertain them! We always ended the day with our faces covered in stickers from the kids.”

A six-year-old boy, Manantiry, will always remain in Welch’s memory. He had pulled a pot of boiling water onto himself when he was two. His family lived in a remote village, had very little money and poor access to health care. She first met him during his initial dressing change one week after surgery on board. (See box on facing page.)

“He had  severe burn contractures and surgery released his scarring and he received multiple skin grafts. Dressings had to be changed on four different sites: his hand, axilla, elbow and the large donor site on his thigh.

“I had the job of distracting Manantiry and holding him still, while his surgeon did the first dressing change. It is something I will never forget. Manantiry screamed and screamed for most of the hour that it took.  I spent the entire time wrapping him in a hug and holding his arm or hand still for the surgeon. Manantiry stared directly up at me with his huge brown eyes. I spoke to him gently, reassured him, and sang to him. Through it all, I think Manantiry ended up trusting me more. For weeks afterwards, I was the only one he would allow to perform his dressing change. We formed a really strong bond. It was amazing to watch some of the movement in his hand restored soon after surgery.”

The basics of dressing changes

As her 12-week assignment was coming to an end, Welch was working in the ship’s dockside clinic doing outpatients’ dressing changes. Manantiry’s mother came to the clinic and told her they were going home, as a family member had died. The journey back to their small village took five or six days of difficult travelling. “She said they would return in a month because it would take that long to travel there and back. We quickly taught Mama the basics of changing the dressing and looking after her son’s wound. Before he left, he had 90 degrees of movement at his axilla.”

Welch later heard that Manantiry had returned to the Hospital Outpatient Extension Centre about three weeks after they were scheduled to arrive. His wounds had all healed but he had lost some range of movement because he hadn’t been doing his exercises. The rehabilitation team continued to work with him to regain that lost movement.

While Welch saw “crazy surgical presentations I’d never see in New Zealand”, the actual nursing practice on Mercy Africa was more akin to caring for elective surgery patients. “The nursing is not as acute as my nursing here – you’re not run off your feet so you can get to know the patients and their families really well. We could spend time hanging out with the kids, singing, playing, forming real relationships and seeing how much of a difference we can make. I loved that about it  and I certainly got more than I gave.”

Returning to New Zealand and re-entering a high-acuity environment, with acutely unwell children, takes a little adjusting to. But what she finds more of a challenge is some people’s attitudes. “All our patients have really nice single rooms but some people can still find things to complain about. They don’t realise how good we’ve got it here. We have access to free health care. In Madagascar, every intravenous line, bag of fluids, dressing pack etc must be paid for before you get any treatment. If you don’t have money, you don’t get help.”

Welch wants to continue making a practical difference. “I think perhaps it’s time to move on from the neurology ward and get some different experiences, keep challenging myself to learn new things and get new skills I can take overseas. I want to keep finding ways of working overseas, to keep learning and to keep becoming a better nurse.”

Published by Kai Tiaki, Nursing New Zealand December 2016. Posted with permission.