Wherever they need her

RN and aid worker Ruth Jebb knew from an early age what she wanted to do. She talks to Dallas Bastian about travelling the world to lend a hand.

After exposure to the reality of human poverty at a young age, Ruth Jebb knew she wanted to dedicate her life to helping people.

“I told my grandfather at the age of 5 that I wanted to help sick children in Africa, Jebb says. “Since then, I have focused on working towards my goal of becoming a nurse and gaining enough experience to be effective and useful as a humanitarian aid worker.”

With her calling clear in her mind, Jebb applied for a number of aid organisations before she was successful with the Australian Red Cross. “I really haven’t looked back,” she says.

Jebb is now an RN and midwife with an international diploma of humanitarian assistance under her belt. She has had experiences in both hospital and pre-hospital care settings and now works as a clinical nurse consultant in Brisbane.

True to her aim, Jebb has indeed worked as a humanitarian aid worker for the better part of the last decade as well. Recently, she has also had opportunities to teaching and facilitate roles with the Red Cross and what was known as AusAID in Zimbabwe and Tanzania, training specialists in community health, psychosocial support and maternal, neonatal and child health.

Jebb has confronted physical and mental exhaustion and has even been held at gunpoint, yet she continues to travel the globe helping those most in need. She spoke to Nursing Review about her extensive work abroad, the challenges she has faced and what she has gained from caring for those affected by war and disaster.

NR: Can you tell me about your work abroad? What have you done recently?

RJ: As a humanitarian aid worker, I have been deployed to a number of both disaster (International Federation of Red Cross – IFRC) and conflict (International Committee of Red Cross – ICRC) settings, including sites in Kenya, Sudan, Cambodia, Haiti, Christchurch, New Zealand, Chad and the Philippines.

Kenya

In 2005, I was deployed to northern Kenya, to work as a nurse in an ICRC field hospital, primarily set up to manage the large numbers of wounded soldiers and civilians spilling over the border from the conflict in South Sudan. This hospital had been supporting the local community and wounded for more than 17 years. I remained in Lokichokio, Kenya, for six months, working in various areas of the hospital depending on the need. Compared with subsequent missions, I often look back at this one as an easy transition into the life of a humanitarian worker.

Sudan

In 2007, I was deployed with ICRC on a nine-month mission to Gereida, Darfur, in the western part of Sudan. Gereida was (and possibly still is) home to close to 145,000 internally displaced persons (IDP), as a result of the ongoing conflict in Sudan. Most had moved into camps to ensure they had access to basic necessities such as shelter, food, clean water and healthcare. My responsibility was to manage ICRC’s therapeutic feeding centre, including managing referrals, admissions, discharges, transfers, nutrition and the medical care of moderately and severely malnourished children and lactating and pregnant women.

It was a challenging mission, not only because of the direct impact of looking after so many unwell, undernourished and often dying children, but also because of the ongoing security risks that were a reality of our day-to-day life. On one occasion, my vehicle was hijacked at gunpoint whilst I was still in it and taken. Luckily, I was allowed to leave the car unhurt but that incident had an ongoing and significant impact on our ability to do what we were there to do.

Haiti

Since then, I have mostly been to areas affected by natural disasters. In 2010, I was deployed to assist with response and recovery efforts following the earthquake in Haiti. On the first occasion, I worked with a large international expatriate team to manage a tented field hospital, working in the intensive care unit of the hospital. Whilst the majority of our work was direct patient care, a large portion of our responsibility was to support and mentor the local staff. This is often the greatest reward from these experiences. On the second occasion, I returned to Haiti to work as a midwife, co-ordinating and managing the hospital’s maternity services. The workload was incredible, with deliveries peaking at 100 a week. We were seeing an additional 600-plus through the antenatal clinic each week. There were rumours that people were walking for days just to give birth in our free field hospital.

Chad

In 2011, following a cholera outbreak in Chad, I was deployed with the Canadian Red Cross as an emergency response unit community health delegate (team leader), primarily responsible for mobilising and training local volunteers in epidemic control, teaching skills in epidemic preparedness. I was also responsible for initiating mass community-based sensitisation campaigns focused on hygiene promotion and cholera prevention, with the goal of changing behaviours and hygiene practices in the affected communities. It was incredibly rewarding watching the impact that these trained volunteers had on their local communities.

Philippines

I have just recently returned from the Philippines, where I was deployed with ICRC to assist with the emergency response efforts following typhoon Yolanda. I was a member of an international rapid deployment emergency hospital team, assisting in setting up temporary supportive health services in Basey, Samar.

First deployments are unpredictable. My role as maternal and child health delegate changed due to other priorities that emerged on arrival in Basey. It was evident that the local doctor in charge of the health clinic required support in order to re-establish services to the population. Initially, this involved cleaning the double-storey facility, which was damaged by water and debris, and sorting through equipment for anything that was salvageable. The facility had lost all patient records and much of its equipment and pharmaceuticals during the typhoon. Within a day of our arrival, the clinic had been cleaned enough to commence consultations the following day. Whilst the hospital was being established, all patients were seen through this clinic.

My responsibility was to help re-establish and manage the health clinic services, together with the local doctor and existing clinic staff. This involved managing the patients presenting to the clinic, including establishing a triage system and re-establishing registration, treatment and referral systems. Triage and sorting of the patients was a new concept to the clinic team. Initially, I conducted the daily triaging of patients (up to 250 a day), but as more local staff were recruited and returned to work, I spent time supporting and training them in order to hand over this responsibility.

During this mission, I triaged 2000 people and, together with local staff, managed the registration, treatment, referral and ongoing care of these patients where required. This included acting as a resource for local staff. I was also primarily responsible for supporting the expatriate medical team members who were conducting the consultations, including providing advice on managing individual cases.

How does this work differ from your other roles throughout Australia?

This is a very difficult question to answer because the work I do overseas often feels like such a stark contrast to what I do back home.

If I were to look at the common threads, they would be that wherever I go and work there are always people in need, be it physical or emotional. There is always opportunity and a responsibility to support, mentor, teach and lead in both of my professional roles – as a clinical nurse consultant in a large tertiary hospital and as a humanitarian aid worker abroad.

The distinct differences would be access to resources, workloads and security, as well as the contextual differences. Back at home, I (and many of us, I think) often take it for granted that we work in a protected environment, where people are able to access quality healthcare safely and efficiently. We have all the resources we need to provide care to those who need it. Often, when working in developing contexts and post-disaster environments, it can be heartbreaking hearing the stories of people travelling for days to reach healthcare facilities, or of those who never make it, often with ailments that require simple life-saving and life-changing interventions. It can be confronting not being able to provide the same standard of care that we are so accustomed to back home.

What opportunities has this opened up for you from a clinical perspective?

I would say that both of my professional roles as a clinical nurse consultant and humanitarian aid worker have complemented each other, rather than one influencing the other. I think the experience I have gained in various roles as a humanitarian aid worker has enlarged my capacity as a senior nurse. However ultimately, I love caring for people no matter where I am.

I have had opportunities to be involved in disaster response with AusMAT (the Australian Medical Assessment Team), which I know has resulted from my extensive experience in the field as well as my experience as a senior level emergency nurse and midwife.

What have you gotten out of this work personally?

Way more than I feel I have given, that’s for sure. There is a level of deep satisfaction that is often difficult to describe, as it often comes with an awareness of not being able to do quite enough. It’s a difficult thing to express. The relationships and friendships that you develop with those that you are caring for as well as those you are working alongside, are the true highlights of this work. The difference you make is not always visible until you stop and look at the individuals you have helped. Helping one person at a time needs to be enough, otherwise it becomes too overwhelming.

Aside from that, this work is where my heart is. When you are doing something you love and something that fits, even through the challenges and often overwhelming nature of the situations you face, you tend to find a deep level of personal satisfaction.

What are the challenges of the work?

I’m not sure where to start answering this question. The challenges are always complex and often context/mission dependent. One common challenge I have experienced is security; in some situations our activities have been drastically limited and influenced by the insecurity of the context we’ve been working in. Although personal safety is a priority, it can be incredibly frustrating to be limited by security incidents that are occurring either directly or indirectly, especially when it involves life-and-death situations amidst the community you are there to assist.

Other challenges that I have experienced include handing over a site or developing an exit strategy early on. In my experience, this is often easier said than done. It can be difficult to merge the temporary supportive services that you have established into an existing system that often does not provide the same level of care.

Looking after critically ill patients, often with limited resources and poor existing referral structures, is always a challenge – particularly in developing countries. Working together with local staff, who are often victims themselves, many with limited to no qualifications, often requiring intense upskilling, mentoring and support can be the biggest but most rewarding challenge.

Apart from the obvious challenges of working in a disaster or humanitarian crisis situation, such as environmental and seasonal issues, the workloads associated with this kind of work are often overwhelming. During my last mission, I did not have a day off in four weeks, working from early in the morning until evening each day. The work is often both physically and emotionally exhausting. I try as much as possible to make sure coming home involves at least a few days off after a mission. It is important to make sure you have some sort of recovery/downtime when you come home.

Do you have any advice for others who are looking to work abroad?

Never give up. If you are passionate about working abroad there are a number or great organisations out there doing amazing work. Be persistent, and in the meantime, try to gain as much rural and remote experience as you can. There are also a number of organisations that provide training opportunities for those wishing to pursue a career in aid work, such as Red R and Australian Red Cross. There is normally a cost involved but it may just put you ahead of the game when it comes to applying for that position you want in the future.

Do you have any plans to continue this work in the near future?

Yes. I am not ready to stop just yet. However, I am always acutely aware that I need to balance commitment to my role as clinical nurse consultant in the emergency department with my desire to jump on the next plane out! If I were able to split myself in two, life would be perfect. At this stage, I will be heading back to Africa early next year to work again as course co-ordinator for a maternal, neonatal and child health short course. Other than that, I have no other firm mission plans at this stage. What I do know about this kind of work is that situations change and often with very little notice. I am generally always prepared and deployment ready!

Can you tell me of any memorable experiences you have had when working abroad?

I met a beautiful family whilst I was working in the Philippines recently. This family has had such a huge impact on me. I have two nieces the same age as the family’s two girls, which I think has contributed to how I felt when I met them. Sometimes I think when you can find a common thread, something that you can relate to on some level, it becomes a story you never forget.

From Ruth Jebb’s Philippines diary

“I met a beautiful little family yesterday – a father with his two young daughters, 3 and 8 years old – who were both sick with fevers and coughs. They had climbed onto the roof of their house to escape the floodwaters during the typhoon, and whilst the father was clinging to the 3-year-old, the mother was swept away along with the 8-year-old. He managed to jump into the water to save the 8-year-old but could not find his wife. The 8-year-old was drowned but he resuscitated her with mouth to mouth. Incredibly, she survived. After the typhoon, he then spent the next two weeks trying to find his wife and eventually found her deceased underneath a building. He told me he was just pleased he could give her a proper burial. They absolutely broke my heart. The 8-year-old was crying quietly as her father told me their story, clearly traumatised and missing her mother. The 3-year-old was just clinging to her dad. He usually works as a navy shipman, travelling the world but has now had to put that all on hold whilst he cares for the girls. The elder one has been in hospital after inhaling the floodwaters. So very tragic and I know this is just one of so many sad stories of lives lost and changed forever” – 11.25pm, Monday, December 2, 2013

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