February 28, 2003

Nurse without borders — World-traveling Carol Etherington serving global victims

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Carol Etherington has spent a lot of time traveling the globe, but loves spending time at home with her Irish setter, Belle and Lhasa apso, Wesley. (photo by Dana Johnson)

Nurse without borders — World-traveling Carol Etherington serving global victims

Etherington listens as her Community Health students describe working with local immigrants in Nashville.(photo by Dana Johnson)

Etherington listens as her Community Health students describe working with local immigrants in Nashville.(photo by Dana Johnson)

Etherington, assistant professor of Nursing, offers advice to students in one of her two Community Health classes in Frist Hall. (photo by Dana Johnson)

Etherington, assistant professor of Nursing, offers advice to students in one of her two Community Health classes in Frist Hall. (photo by Dana Johnson)

Her travels have taken her to places like Angola, where she cares for victims of war and natural disasters.

Her travels have taken her to places like Angola, where she cares for victims of war and natural disasters.

Carol poses with a goat she befriended in Bosnia. She has aspirations one day to become a goat farmer.

Carol poses with a goat she befriended in Bosnia. She has aspirations one day to become a goat farmer.

Carol Etherington is drawn to places — Bosnia, Cambodia, Angola, Kosovo, Sierra Leone, Tajikistan, sites of wars and natural disasters — that others are fleeing.

Nurses have always courageously stridden into sickrooms to care for the afflicted; what Etherington, an assistant professor of Nursing, does is apply that professional credo on a global scale.

This mission in life became clear to the Kentucky native very early on.

“As a child, I could never understand how or why the Holocaust occurred and I wanted to believe that, however small my effort, I would try to respond if such a horrendous event occurred in my lifetime,” says Etherington.

Her mission, however, was not always clear.

As a young adult Etherington found herself at the University of Kentucky majoring in political science and journalism, but not happy with the choice.

After taking a job working in the Medical Center at University of Kentucky, Etherington realized what she had been ignoring all along.

“I knew that I really wanted to have close proximity to people through my job, and there is certainly nothing that gives that more than being a nurse. So I started over again and spent four more years in college.”

Etherington graduated from Catherine Spalding College, now a university, in Louisville in 1971 with a B.S. degree in nursing.

“When I got out of school with my bachelor’s degree in Kentucky, I knew that I wanted to go to work with the underserved people. I knew that absolutely,” she said.

So three weeks after graduation Etherington packed up and headed out on the first of her life-spanning missions to aid underserved populations.

Etherington joined the Frontier Nursing Service in 1971. The rural, Eastern Kentucky organization was created by a midwife in 1927 because maternal mortality rates among the population in the Appalachia area at that time were reportedly higher than any place on the continent.

“I was completely overwhelmed with the intensity of needs, the lack of medical services, and the lack of health care providers. Nurses there were doing everything, as there was only one physician in the entire county. We were probably as skilled as any group in the country at that time — to the degree that the Army was always coming to our mountain to recruit us for the Vietnam War, because they recognized that these were nurses accustomed to working in an independent fashion,” Etherington says. “More physicians are there now, but really only physicians concerned with rural health or those required to be there.”

The Road to Nashville

After two years with the Frontier Nursing Service, Etherington knew without question she had chosen the right path for her profession, but was struck by the helpless and hopeless feelings of her patients.

Etherington wanted to further her education to address those concerns and came to Vanderbilt University School of Nursing, which at the time offered three specialties: nurse practitioner, psych-mental health, and acute care.

“I realized that the way I could have the most impact was to do the psych-mental health program. That decision sort of altered my life, without me knowing it.”

In the summer of 1975, her graduate year at VUSN, Etherington was given special permission to do a placement with the Nashville Metro Police Department and spent her summer responding to victims of personal crime.

“I spent a lot of time with rape victims, children who had been abused or sexually assaulted,” she says.

Etherington was appalled to find there were no resources to help victims of violence at that time. “The legal system that they had to rely on was not only insensitive, it was dismissive of the seriousness of the situation.”

That’s when Etherington made the decision not to return to the Frontier Nursing Service, but to stay and work to make a difference for the victims of violence in Nashville. In August of ‘75 she graduated from Vanderbilt with a master’s degree in psych-mental health and continued working with the police department, a place she would call home for 19 years.

Etherington’s pioneering work with the police helped create the Victim Intervention Program, one of the first police-based crisis counseling programs in the country. Now in its 28th year, the program continues to help victims of crime and to address needed changes in the health care and legal systems.

In Harm’s Way

In 1980, news of the tragedy in Cambodia and the genocide that had taken place under four years of rule by Pol Pot and the Khmer Rouge spread across the world and soon left haunting impressions in Etherington’s mind.

She was reluctant to leave behind her work with victims of crime in Nashville, but felt a compelling need to respond to the global crisis.

“So I wound up doing my first overseas mission — volunteering to work in a refugee camp on the Thailand-Cambodia border. It was life-altering,” she says.

Etherington served on the U.S. medical team with the International Red Cross, or ICRC, aiding refugees fleeing the Pol Pot regime. There, she and her colleagues treated more than 100,000 victims of war.

“People were dying all around us despite our efforts. The degree of starvation and disease was overwhelming,” she said. “Those who survived the genocide often did not survive the flight to freedom. During the monsoon season, people were so weak from hunger that, if they fell, they would drown in puddles because they didn’t have enough strength to lift their heads.”

Etherington says almost all international workers fell ill at some point, because they weren’t accustomed to the food or the climate, or because of sanitation problems. Etherington was one of the healthiest of her team, but still spent 12 days in a Bangkok Hospital with Dengue fever.

Her trip to Cambodia leaves lasting memories that help her never to take small pleasures of life in America for granted. “I still can’t believe it when I drink water out of my garden hose having watched so many die of cholera because there was no access to a safe water supply.”

Statistics show currently more than 1 billion people in the world lack access to a safe water supply.

New Challenges

After four months, she had mixed feelings about coming home and wanted to stay in Cambodia, but returned to her commitment with the police department in Nashville.

“When I came home, it took a long time to walk into a grocery store of stocked shelves and even longer to go out for a leisurely dinner,” she said. As time eased Etherington’s struggle to settle back into life in America, an old acquaintance popped into her life and set her on yet another path of discovery—marriage.

Etherington first met local businessman Stan Fossick in 1976, when she was new to the police department and asked for his help in a case she was working. They were reacquainted in the summer of 1982. The couple dated for a year and married in April of 1983.

“After 20 years, I must say that, while it is sometimes more difficult for him to stay than for me to go, his unwavering support has made it seem more like a team approach to doing this global work rather than my work as an individual,” says Etherington.

Fossick says he always knew that one day he might have to deal with his wife being called away on another mission in a dangerous environment. “For me to say I’m not concerned would be a lie,” he says. “But I knew before we got married that this was very important to her.”

In the meantime, Etherington spent time back home in Nashville expanding her focus to a new population in the criminal justice system.

By 1986 a number of community groups had formed to assist victims of violence in Nashville, so Etherington established Police Advocacy Support Services. It was designed to help police officers and their families deal with their own stresses.

It was 1993 before Etherington was contemplating another mission overseas, the first in a decade.

Etherington left for Bosnia that year, where rape was being used as a tactic of war. “With all of the sexual assault victims I had worked with, it seemed appropriate to take the experience and understanding I had gained about this crime and apply it there.”

She worked with a U.S.-based victim assistance organization to assess the needs of Bosnian refugees and to train local nurses and doctors on post-traumatic stress.

It was the first of four trips to Bosnia in a year and a half, during which time she transitioned to consultant status with the police department. “Being in Bosnia and adapting to the culture became a way of life. As much as I originally feared going there, leaving it was traumatic.” Etherington says she left a part of herself with the Bosnians she met and worked with during those times.

Return to Vanderbilt

Each time Etherington returned home to America was a time of transition. “Sometimes in the first weeks after returning home, there is an intense urge to embrace everything and everybody and to run around singing ‘God Bless America.’” But she adds that it’s also a lonely time, when she finds it hard to explain where she’s been and what she’s been doing.

She made the decision to leave the police department altogether, and came to inform Colleen Conway-Welch, dean of the Vanderbilt School of Nursing, that she could no longer take placement students at the police department as she had done over the years.

Conway-Welch seized the opportunity to offer Etherington a job teaching, another one of those professions Etherington had believed in her youth that she would never do. But a wiser Etherington now knew she could make a difference in the lives of other young would-be nurses, and in 1995 moved into her new job as assistant professor of Nursing at VUSN.

Joyce Laben, professor of Nursing Emerita, was teaching at VUSN when Etherington first came through as a graduate student. “What I remember about her at that time, she was very goal-oriented, motivated, and wanting to ‘do good’ and make a contribution.”

Laben says Etherington’s commitment to human rights has never wavered. “What has always amazed me is her selflessness in putting herself in harm’s way to help others. She has done this consistently over the years.”

Etherington’s husband adds, “That’s just Carol. She does that in normal life, not just on these missions overseas. She has taught me that material things are not the most important things. The most important thing in life is the well-being of others, and she exemplifies that.”

Etherington is now one of four Community Health instructors at VUSN. She teaches two classes of nursing students each week, in the spring and summer. She pairs students with immigrants and refugee families in Nashville to learn what problems they face in America and to identify their health needs. She also teaches classes to second-year medical students on domestic violence and on working with non-English speaking patients.

Etherington says 15 percent to 18 percent of Nashville’s population is foreign-born. “We have reportedly the largest Kurdish population in the United States, and refugees and immigrants from over 80 countries.”

Many of the countries are places Etherington has traveled. “At times, I’m able to give students a greater sense of the reality that their patients’ lives were like before they came here,” she said.

Current Community Health student Jilanne Rose appreciates Etherington’s teaching style. “She challenges us to think differently and outside the American box. It’s invaluable to have someone like her in your education.”

Etherington says it’s important for her to instill a broad approach to patient care in students, and for them to grasp cultural differences and similarities. “We have such an influx of people from other countries, there really is a need for adaptation, not just on the part of the person moving here, but on the part of those of us who are going to be living and working with them.

“The bonus is, it has forced us to look at all of our U.S. cultures, and to better understand how Anglo-Saxons, African Americans, Hispanic Americans, for example, can mutually benefit from Native Americans or from those who live in Appalachia, the Ozarks or the Mississippi Delta. There is just so much richness to what we call the American culture, but within that there are so many subcultures that we’ve never paid attention to.

“I think now, with the new Americans coming, we are beginning to learn the importance of that. They are helping us learn who we are, who they are, but also redefining who the ‘we’ is.”

International Leader

In the fall, when she’s not teaching, Etherington works with Medicins Sans Frontieres (MSF), or Doctors Without Borders, an international medical relief organization that provides acute care to vulnerable populations in 84 countries, and that speaks out about tragedies of war, natural disasters and violence against humanity. In November 2002, she was elected President of the USA board of MSF, working to enact better policies and procedures for responding to victims in the field.

Etherington’s position on the U.S. board marks the first time a nurse has been elected to the prestigious post. She also volunteers on missions with MSF to assess and establish mental health programs as part of the medical response.

“One of the things you don’t want to do is put down a Western program in a non-Western environment, because it’s not going to work,” she says. “And if you have people starving, you’re not going to set up a mental health program, but you may set up a feeding center, and once children can thrive they may begin to be able to think back through the time and horror they lived through. And that may be a place to bring in mental health components.”

Her MSF work alone has taken her to Angola, Sierra Leone, Kosovo, Tajikistan, Honduras, Poland and Bosnia.

Etherington is often asked why she works so tirelessly in other countries, and not here at home. But few know she has also addressed and served mental health needs within U.S. borders, often with the local or national Red Cross.

She aided the victims of Sept.11 in New York City, assisted with the ValuJet Flight 592 plane crash in Florida, the Los Angeles earthquake of 1994, Hurricane Andrew in 1992, and countless tornadoes, fires, shootings, and explosions in Nashville.

“Nursing knows no borders or ethnicity and should be the model profession for care—locally, nationally, and internationally,” she says.

Etherington has been showered with countless national and international awards, including this year’s International Achievement Award from the Florence Nightingale International Foundation (FNIF).

She was first chosen among all others in the state of Tennessee, then the entire United States, and finally awarded the honor above all applicants internationally.

Louise Browning, executive director of the Tennessee Nurses Association, suggested to the TNA Board that they nominate Etherington, knowing all along she would win the award. “When I saw this call for nominations from the American Nurses Association, I immediately thought of Carol. I’m familiar with all of the things she has done around the world and I thought to myself, this is Carol’s award. It just seemed like it was made for her.”

Browning says anyone who has the pleasure to know and work with Etherington understands the praise awarded to her. “She just gives and gives again. We’re very impressed with her.”

Etherington will travel to Marrakech, Morocco in June to receive this year’s award from the FNIF.

Farm Girl at Heart

With such an immense span of service at home and abroad over the years, you can’t help but wonder what Etherington dreams about… but you’d never guess.

“What I really want to do is raise goats,” she says. “I don’t know why. Because I think at heart I’m much more of a farm girl, and I never really had the opportunity to raise anything. I really want to raise goats.”

Etherington never grew up on a farm, but spent time realizing her fondness for animals and being one with the land while working overseas and in the rural areas of her own country. “There is something that is just comforting about being in nature and doing timeless things. You know, people have been raising goats for thousands of years.”

She enjoys planting at her home, and mentions a desire to one day again teach ballet, adapting movements as an exercise that would be enjoyable and beneficial for older people.

Most days she enjoys a quiet existence with her husband and spending time with her close circle of friends whom she has known since graduate school at VUSN.

“I really like being at home, going for walks, doing boring things. I really like to do boring things,” she says with a laugh, but realizes how funny it sounds, given that her life’s work has been spent in countless life-threatening environments.

Perhaps Etherington’s father knew best, having told Etherington before he passed away to take pride in her accomplishments. “People would buy tickets to see what you do every day of your life,” he told her.

But Etherington, ever modest, says, “I don’t think of it in that kind of way. I just think that I’ve always wanted to be in the middle of something, or start something, particularly where people are oppressed or don’t have a voice. Sometimes it’s really important to create waves and to disturb, because things don’t change unless you do.

“But it’s also really important to make sure you’re disturbing the right things. And it’s important to know when to speak out and when to be quiet.” — all part of the lessons Etherington leaves behind to students at VUSN and students of life, evident in the English translation of an excerpt from a poem written for Etherington by Vejsil Dzanic, one of her bodyguards as she left Bosnia:

As a fairy with a magic stick,

You bring back smiles on children’s faces,

They are forgetting terrible crimes,

As you bring back love in children’s hearts.

One day those kids will become well-known people,

Because of your effort in offering a hope in future.