This site is intended for health professionals only

Nursing abroad: at the Iraq front line

Eileen Munson
Age: 48
Home Town: Rhoose Point, Wales
Nurse placement: University of Glamorgan Senior Lecturer/HMS Cambria Royal Naval Reservist Nurse Practitioner Primary Care

Eileen Munson describes how life changed when she left her job as a university lecturer and was posted to Basrah, Iraq, to work as a nurse practitioner providing healthcare for British soldiers

What is your nursing background in the UK?
I started off in the intensive care unit, then did medical/surgical nursing and paediatrics, followed by midwifery. I began life in general practice in 1990 in Birmingham, which is where I did my BSc(Hons) in General Practice Nursing and gained a distinction. I then returned to Wales in 2000 to work as a practice nurse manager. In January 2002 I finally achieved my lifetime ambition of becoming a teacher and I started working as a senior lecturer. It is a job I feel privileged to do and am passionate about in relation to developing practice nursing. On 9 July 2006, the very day I graduated and collected my Nurse Practitioner Masters, I flew into Basrah, Iraq.

What made you decide to take up a placement in Iraq?
I was honoured to do my bit, as the role was all about providing care for our boys and girls, ensuring they remained fit to carry out their duties. My time was spent treating minor aliments such as urticaria, caused by extreme heat, or removing foreign bodies from eyes. Thrush was generally a major problem from the increased amount of body sweat, working long days in temperatures over 50 degrees. Having been in the Royal Naval Reserves (the part-time Navy) for the past 25 years it was what I had trained to do. I was the only female nurse and, at 42, was the same age as the Commanding Officer in charge.

At Camp Abu Naji in Al Amarah, where I was stationed with the batallion of 1,000 men, only 13 of us were women. I suppose I did adopt a maternal role as they were all so young, and several did need a bit of mothering sometimes. Of the women there, four were Combat Medical Technicians (CMTs) who rotated between providing primary care in the sick bay or worked on the ambulances going out to any incidences with the troops. Two worked directly with their Corp as Team Medic CMTs, one was a dental nurse, three were vehicle technicians and two were officers in charge of the men.

How did you find your first week in Iraq?
It was hot! Nursing in 50 degree heat is difficult at the best of times, but working in military uniform and body armour add to the challenge, too. Part of our training is in understanding cultural differences in relation to Western medicine as we also have to provide care for the local employed Iraq civilians. Naturally, we had interpreters if required, but most had some understanding of English so it was not too difficult. Culturally, there were many differences, with Iraqi civilians tending to believe that Western medicine will cure everything instantaneously, for example. You just had to cater the best you could with limited resources - there is no way we can reverse a long-term condition such as chronic obstructive pulmonary disease.

How would you describe a typical day?
Usually I would get to the medical centre and take over from whoever had been on night duty (we all did one 12 hour night shift in three on top of a full day). Then we would do the morning sick parade, which could be anything from dressing changes for Leishmaniasis (sand fly) bites or for cuts and abrasions, to prescribing and dishing out medication for various fungal infections of feet and groin to urticaria and sweat rashes.

If the guys had been out on a contact (where they had visited the local village and may have come under artillery fire) then it was also likely that we would be dealing with more traumatic injuries. This could happen any time of the day or night, and when we had an incoming casualty then it was all hands on deck.

Each day the equipment would all be checked and replenished in preparation for the next event. We also had a 10-bedded ward in Camp Abu Naji so that, too, would require manning if we had any inpatients - usually for anything from diarrhoea to ankle injuries to heat stroke. When the ward was open it really did put the pressure on staff in covering both areas 24/7.

What has been the most challenging thing you have experienced?
The most difficult thing I encountered was a flight out of Al Amarah back to Basrah. For the first time in my life I thought I was going to die as we were under air attack. The pilot had to undertake tactical manoeuvers to dodge the rockets and explosive devices that were coming our way. The lads on board and I emerged from the experience covered in vomit … but glad to be alive.

What are the advantages of working in Iraq as opposed to the UK?
I would say comradeship with your team - the austere conditions bind you together within the military and it is an environment where you make friends for life. There is a positive work ethic from everyone to do their best, as the life of each and every one of us depends upon the other.

Do you think that the experience has changed you as a person?
It has made me realise that there is a big world out there and that there is so much we, in the Western world, could be helping with, such as leprosy - which was evident at the colony in the north of Iraq. I think we certainly do our bit as a country, but there needs to be more partnership working and contribution of aid from their neighboring countries too.
What lessons can UK practice nurses take from your experiences in Iraq?

General practice nursing is the same the world over when it comes to direct patient care. One afternoon, a young soldier, aged 20, came in complaining of being hard of hearing. Initially, I thought it was due to him having been on a recent 'contact' and that it was the noise of the bullets that was affecting his hearing. But on examining his ears I could see a small white triangle segment in among the solid wax in his ear. I sent for an ear syringe machine for the front line and received it 10 days later. I syringed his ears, to find a small white tooth fall out! We were all amazed by this result. Our residential dentist then aged the tooth to be that of a four year old. It would appear that he must have popped it in his ear when he was a child and there it remained. I have the pictures of it … fascinating.

What advice would you give nurses thinking about going to work abroad?
Just go for it! In 1996-97 I was fortunate to work in Gibraltar for a year with the Royal Navy as the Senior Midwife at Royal Naval Hospital Gibraltar. That year changed my life as I had to learn to stand on my own two feet. My daughter was just two at the time, and I hired a wonderful nanny to care for her as my husband had just opened a business in Birmingham. This was in the days before women could stay in the military and have children. It took a reservist to show them that women can multi-task, working full time with a family.

More recently, I was invited by the New Zealand College of General Practice Nursing to lecture on leadership within the profession. This was a fantastic experience and a great honour to be asked. What I discovered is that, even though in New Zealand (as was the case in Australia where I also visited) practice nursing is 15 years behind us in the UK with regards to the autonomy that many of us have, the issues, constraints and professional frustrations with our medical colleagues and employers are exactly the same.

Your next deployment is in Afghanistan. What will be the major challenges you will face there?
When I went to Iraq initially I was told I was going to work in the primary healthcare centre of the Hospital in Shiabah. But on arrival I was then posted outside the wire to Al Amarah - the same place Johnson Beharry was stationed and injured. (Lance Corporal Beharry is a British Army soldier who was awarded the Victoria Cross, the highest military decoration for valour, for twice saving members of his unit from ambushes at Al Amarah).

If it is similar to my experience in Al Amarah then it is likely to be how well my stamina endures the long working hours with no days off. But that is why we have to maintain our fitness and get pushed to see how we react and endure the deprivation of long hours and little sleep during some of our pre-deployment training.

I think the other challenge for me is how I will feel about, and recover from, what I experience. Having started life as an ITU nurse at Cardiff Royal Infirmary I had to toughen up and deal with the drama that trauma patients present. Some 25 years later, even though we deal with this in pre-deployment training, it is not the same as the reality of seeing it first hand. l