Get to Know the 2018 MedicalMissions.org Physician Assistant of the Year
Nanette Laufik, MPH, PA-C
Physician Assistant in Family Medicine, Hillsboro, OR
To the winner of this year’s Advanced Practitioner of the Year Award, medical missions are about teaching communities sustainable skills. Nanette Laufik is a Family Medicine Physician Assistant from Oregon, who has been performing medical missions since 1999. With a life-long desire to help impoverished and marginalized patients, she now devotes her professional career to helping those in need here and abroad. Her greatest asset to the communities to which she travels is her passion for teaching. Nanette believes leaving skills behind is more important than equipment or emergency care.
What started Nanette’s interest in medical missions?
Nanette has always been drawn to observing other cultures. She grew up in a working class, immigrant neighborhood as a second-generation American. There she witnessed the grim reality of people struggling to survive. She noticed how her neighbors sacrificed for their children’s education so they could enjoy a better life, and how lifestyles and social class affected health outcomes. After childhood she became a hospital registered nurse, working primarily with disadvantaged residents of South Carolina. While she was finally in a place where she felt she could make a difference, she realized it still wasn’t enough for her.
This motivated her to extend her skills even farther to other areas of the globe, including some of the world’s poorest countries where there are no social programs in place. Her first medical mission was in 1999 in Shkoder, Albania during the Kosovar refugee crisis. Albania is one of the most impoverished nations in Europe, but they opened their borders to all displaced Kosovars. After this first international experience, Nanette was hooked on mission work. She has since served in Honduras, Afghanistan, Banda Aceh, Indonesia, coastal Indonesia on the USS Mercy, Lithuania, Latvia, Romania and Vietnam. In the U.S., she assisted in Gulfport, Mississippi after Hurricane Katrina and worked in Inupiaq villages in Alaska in the Arctic Circle.
Immersion in other cultures during crises, whether man-made or caused by nature, have been both enriching and humbling for Nanette. Translators and local physicians with whom she has worked during medical missions have often been young people in their 20s who simply want to improve their homelands. Their lives are obviously tough, but they still want to help others. These locals have been tremendous teachers, offering knowledge about the best ways to practice medicine within their cultures. Nanette has learned that people everywhere, no matter their location or circumstance, are striving for the same goals to serve those in need.
Why did Nanette decide to become a Physician Assistant?
Nanette loved bedside care as a R.N., and though she enjoyed problem solving as an assistant head nurse, she didn’t like moving away from patient contact. So, she decided to further her education and become a physician assistant (PA), allowing her to advance her skills and continue direct patient care. As a PA, she is an integral part of a coordinated team. Her background in primary care gave her the skills to work in many settings, which benefits her international missions.
Nanette is currently employed part-time at Virginia Garcia Memorial Clinic, a Federally Qualified Health Center, near Portland, Oregon. The clinic serves a low-income population, with special emphasis on migrant and seasonal farmworkers. In that setting she sometimes makes home visits with a social worker. She also teaches part-time at Pacific University’s Physician Assistant program, where she occasionally lectures about international relief work and mentors students with goals of working overseas.
How has her role evolved as a Physician Assistant performing medical missions?
To Nanette, medical missions are not about visiting an area in need, providing care, then going back home. “An ongoing project is more important than rushing in and leaving,” she says. After serving on a few missions only providing emergency care, she knew she could no longer leave patients behind without providing a solution for future care. This was most apparent in countries where doctors had few continuing education opportunities and were unable to get visas to further their knowledge in other countries.
In 2009, Nanette was selected to join a 12-month pilot program in Queensland, Australia. The goals of the program were to model the PA profession to adapt it for underserved areas in remote Australia, including Aboriginal communities, and to model the profession to Aboriginal health workers as an option for further education, to serve their communities at a higher skill level. At the conclusion of the program, Nanette accepted a position teaching clinical skills at James Cook University to medical students. During that time, she also worked part-time clinically in an Aboriginal Health Service in rural Queensland. She and Dr. David Baker formed the first doctor-PA team outside of a pilot project in Australia.
Her time in Australia motivated Nanette to pursue a Master of Public Health degree, with a focus on improved access to healthcare for impoverished populations. The degree has reinforced her belief in the benefit of ongoing projects and education over short-term assistance. Like her mentors, she is committed to improving skills of health workers in resource-poor nations and to reduce reliance on medical aid from other countries.
Her primary goal for medical missions is to help create sustainable healthcare environments with local residents, so they can continue to maintain effective health systems autonomously.
Because of this passion, her most recent medical missions were, of course, medical education projects. She was the group coordinator in Vietnam in 2015 and 2016 for American doctors and nurses who taught techniques to local physicians and midwives to improve neonatal outcomes. The organization she represented funded and coordinated similar projects in Central and Eastern Europe in the mid-2000s.
Her favorite medical mission organization is International Relief Teams (IRT) in San Diego, CA. IRT mobilizes highly-trained, unpaid volunteers like herself, and engages local citizens in other countries wherever possible. The organization has evolved from emergency response to educational and sustainable projects. To Nanette, this is a better model where there are often long-term non-governmental organizations (NGOs) in a country who can assist in managing emergencies more efficiently. Leaving skills behind, instead of just equipment, serves communities and countries with a longer-lasting impact.
She believes she has become more flexible as a PA after her experiences. One learns to do more with less. “My work partner in Albania was an ER nurse from Seattle. She complained of noise while trying to listen to heart sounds. She asked if anyone knew how to get the cow in the window of our makeshift clinic to stop mooing! We all do our best in less than optimal settings.”
How have medical missions impacted Nanette on a personal level?
For all the improvements she has made within the communities she’s visited, she remembers more the stories of those she couldn’t help, and that’s what fuels her commitment to keep driving change to healthcare across the globe.
“A difficult scenario I’ve seen in various countries is children presenting with undiagnosed hydrocephaly (excess water on the brain). Their parents never knew why they didn’t walk and otherwise develop normally. It’s such an easy problem to correct in developed nations, but impossible in the highlands of Honduras and many other places.” Nanette hopes providing medical training for underserved communities will help reduce similar easy-to-solve pediatric issues in the future.
“I also recall a lovely, elderly Afghan woman, carried into our mud hut clinic on a blanket by three of her daughters. Her congestive heart failure was too severe for her to walk. After I examined her, I regretfully explained that I did not have the medications needed for her heart. She thanked me, kissed me on the cheek, and said she would pray for me. I still feel like crying when I think of her.
My involvement in medical missions is a way to show thanks for what I’ve been granted in life and to let people in other countries know the world hasn’t forgotten them, even if what we can do is so limited. On my return home, I always reflect on what I’ve done. I’m always overwhelmed and humbled by what I couldn’t do; sometimes I feel guilty returning to my safe, stable home in a land of plenty.”
What advice does Nanette offer healthcare practitioners considering medical missions work?
“Never just show up unprepared for a disaster. You become an encumbrance, instead of help. Only go with an invited, reputable organization. (I witnessed this after the 2004 Tsunami in Indonesia. Many articles were written about this issue in Haiti.)
Disasters and poorly-resourced communities constantly change. The actual situation is always different from pre-departure briefings, no matter how reliable they may be. Be prepared for less-than perfect intelligence and situational summaries.
Think twice about volunteering to “work,” if the mission is comprised of one day of seeing patients and 10 days of touring and sightseeing. This may be more properly termed “poverty or disaster tourism.”
Be sure to research the organization with whom you’re considering working or volunteering. A great place to look is Charity Navigator. IRT, the organization with whom I have worked, consistently receives their highest 4-star rating. You want to be sure a very high percentage of expenses is actually spent on programs and services, not on overhead; also, that the organization receives a top rating for transparency. (In 2017 IRT received ratings of 98.8% and 100%, respectively.) If the organization is not rated at all, you may have a lot of homework to do to learn more about them.
Most importantly, thank your partner, family and friends who support you a thousand times. Their financial and emotional support before, during and after a mission cannot be understated.”