Capacity to help build a nation

Lance Jarvis returned to East Timor to help the young country he loves raise its standard of care. 

A love for Timor-Leste (East Timor), developed whilst serving time there with the Australian Army, inspired paediatric nurse specialist Lance Jarvis’s return to the country.

As part of St John of God Health Care’s Nursing Development Program, Jarvis works closely with nurses in Guido Valadares National Hospital to improve skills and nursing practices.

He has been there for 13 months so far, and says he is happy to stay for as long as he can. We spoke to him about his passion, job role and the challenges of working in the young nation.

NR: What originally prompted your interest in becoming a paediatric nurse specialist in East Timor?

LJ: In 2000, I served in East Timor with the Army 6th Battalion, Royal Australian Regiment in support of the United Nations Administration of East Timor. I was deeply affected by the experience and from that time had a desire to return [there] and do something similarly meaningful.

The year before I came out to Timor I worked in a Rheumatic heart disease program in the Goldfields of Western Australia, which involved a lot of patient and family education. I enjoyed the cross-cultural nature of the role and wanted to continue having that regular patient interaction.

When the paediatric nurse specialist position was advertised in East Timor, I felt I could pursue both my long-term interest of returning to assist the young nation and continue working cross-culturally with children and their families.

What are your main day-to-day responsibilities at St John of God Health Care – East Timor?

Our official role description is capacity building and our mission is to assist in the development and raising of professional standards of nursing in East Timor.

This involves seeking and working with local champions/leaders in clinical and management areas, and working alongside them [on]: nursing care; opportunities for learning and development for nurses; structurally supportive environments for improvements; and developing a consensus within departments on future quality improvement projects concerning organisational and clinical nursing care.

The key to all of our work is relationships with our Timorese nursing counterparts; hence learning the language and drawing on local cultural experts (St John of God has a language and culture team here) is essential – seeking first to understand before we can be understood. It is through relationships with our local counterparts that any changes or improvements happen and all of this takes time and patience. Work in the clinical settings happens as a part of this process yet we are not here as clinical service providers; our role is more closely aligned with a community development worker, yet in a clinical setting – for me in a 62-bed paediatric department.

As an example, recently we accompanied four nurses from [Guido Valadares National Hospital] to Perth to see how paediatric nursing works in Australia. This journey was an exercise in alternative realities, not just for the overwhelming amount of resources that Australian healthcare has but also because the nursing standards in Australia are very different. The nurses were deeply affected by the experience and have returned to Timor-Leste as champions for the ideas they encountered. I will be working alongside these guys as they present these ideas to their colleagues for implementation in Timor-Leste’s paediatric settings.

How would you say your role benefits/ improves patient outcomes?

Benefits from the program are evident. Several of the current nursing leaders have been developed directly by the influence of St John of God caregivers over the last few years. We hope they have increasing influence over the coming years as they continue to develop as professionals. Structural changes are evident from the time when St John of God started, with improved practices in medication safety and observation of patients. Physical environment improvements are evident from new initiatives such as the nursing assistant program, which has dramatically improved the cleanliness and organisation of the department.

What are the main differences you find in your role, as opposed to working in Australia?

The differences from working in Australia are huge. Firstly, in Australia I always worked as a service provider. Capacity building is completely different. The tension as trained service provider is to always ‘jump in and do’ but as a capacity builder, opportunities for learning need to be always in one’s consciousness. Hence jumping in and doing can be counter-productive. Often it is the slow and meaningful, encouraging steps, stepping forward together and working shoulder to shoulder on a project that fulfil the role of a capacity builder. To [perform this role] one must first know and be known by their counterpart. Trust must exist as a foundation otherwise there is no basis for a first step together. This is slow and deliberate, thought out work.

What skills are you able to develop due to this experience?

I have needed to focus on my cross-cultural competencies and communication skills. A lot of personal skills around resilience and reflective practice have required further development. Also I have had to further develop my organisation and project management skills, as many times there will be many small projects running concurrently.

What are some of your best memories of your role so far?

Some of my best memories are those moments of breakthrough in relationships with the Timorese nurses I work with: after many attempts to break the ice, and then to experience times of connection, sharing a smile and laugh. I also enjoyed the interaction with Timorese children, who are so curious about this large malae (foreigner).

What do you love about it?

I love living and working in Timor-Leste. I love the difference from Australia and how there is much to do but hope for the future. I feel my work is meaningful.

What are some of the biggest challenges?

It is an extremely resource-poor environment. There are serious challenges with many institutions, including logistics. Sometimes these challenges can be very confronting when you can see the direct impact on patient care.

What do you do to unwind and relax after a stressful shift?

I love to mountain bike. Timor is a beautiful country with dramatic climbs. I also spend time with my wife, Debs, and two sons. Diving and snorkelling is also amazing in Timor-Leste.

INFO:

Full Name: Lance Jarvis

Position: Specialist nurse, paediatrics

Works at: Guido Valadares National Hospital as a member of St John of God Health Care’s Social Outreach and Advocacy team in Timor-Leste (East Timor).

Other qualifications: Bachelor of nursing (ECU) 1998; master of public health (JCU) 2008; graduate certificate of health promotion (Curtin) 2008; certificate in disaster health management and refugee health (JCU) 2008; certificate IV in training and assessment (Durack Institute) 2011.

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