Health care in conflict

The places many people are trying to flee are often where you'll find University of Cincinnati alumna Helen Perry.

The Fernandina Beach, Florida, resident travels across the world to provide medical care and population health-focused strategic planning in conflict zones and disaster-stricken regions. In the past few months, her efforts have centered on Ukraine and preventing violence against women there.

Perry's ability to land in the middle of these crises and hit the ground running comes in part from her military training. After she graduated with a bachelor's in nursing, she commissioned into the U.S. Army, where she learned to coordinate and provide care with few resources in places with poor health care infrastructure.

"I learned how to do everything with nothing," she says. "You have to think outside the box."

Perry continues to employ those skills as a global health nurse practitioner. She has worked on the ground in eight countries and remotely led projects in six others. Until April 2021, she served as executive director for a Florida-based nonprofit that provides emergency care to vulnerable populations displaced by wars or disasters, taking the organization from a deficit to $2.5 million in operations in three years.

Since April, Perry has worked as a global health advisor for VOICE Amplified, a nonprofit that supports women experiencing violence in conflict, crisis or disaster settings. She traveled to Poland to work with female Ukrainian refugees and learn their barriers to care. With this insight, she is helping women who experience sexual violence in the region receive treatment by creating at-home kits with emergency contraceptives, cleansers and other items.

"We're looking at what components they need to have at home in the event that they're sexually assaulted and can't get to medical care during this war," Perry says.

Perry felt compelled to do this kind of work long before she knew how. She remembers the Indian Ocean tsunami in 2004, one of the deadliest natural disasters on record, as a moment that stands out.

"I was a senior in high school or maybe a freshman in college when that happened and, even then, I felt like that's what I was called to do, to help people in these terrible situations," she says.

Perry started working toward a degree in education to become an early childhood teacher, but her medical curiosity, combined with insight from a friend, convinced her to switch to nursing. She finished her bachelor’s degree in her home state of Arkansas and commissioned into the Army. After five years, she entered the Army Reserves and went on to earn her master's in adult acute care nursing from Georgetown University. In 2017, she went on her first trip as a humanitarian to Mosul, Iraq, to aid in infection control at a local hospital.

Perry says Iraq was a meaningful trip, because it was the first time she saw war and conflict without the military lens. Each trip since has provided new insight about medicine, foreign health care systems, governments and cultures and taught her to expect the unexpected.

"You start out thinking you're going to be seeing patients on one trip and you end up dealing with a shelter's underwear shortage or something like that, because that's also a component of health, right?"

To those thinking about a career in global health, Perry says this: "Working in global health is partly about diving into the complex problems that affect health infrastructures to make a meaningful change in a population and partly about how comfortable you are getting diarrhea in a foreign country. I've had dysentery twice. I've had pertussis. I've had dengue fever. You get things like that when you’re doing this work."

Because she encounters many situations and patient populations, Perry chose to earn a Post-Master's Certificate to become a Family Nurse Practitioner (FNP). This gave her the formal education and experience in pediatrics and women's health needed to provide care more effectively. She chose UC's online program because it offered the most flexibility, accepted her previous master’s coursework credit hours and allowed her to apply her GI Bill benefits.

"My schedule is a bit crazy. I'm not the traditional student," says Perry, who graduated in Spring 2022. "UC's program was a really flexible, easy program to transition into, which is what a lot of us who are already practicing really need."

Richard Prior, DNP, FNP-BC, FAANP, associate professor and interim associate dean of graduate programs, who retired as a colonel from the Army after 25 years, says UC's online programs are structured in a way that caters to military members and others with busy or unpredictable schedules. In 2022, the college’s online master’s programs were ranked fourth in the nation for veterans by U.S. News & World Report.

The military offers a unique experience for nurses, Prior says, because it allows them to work independently and innovatively. Like Perry, Prior remembers learning to provide care within the limits of his environment.

"One of the things people don't really understand about nurses in the military is that those nurses work completely at the top of their scope, and they really push the envelope in ways that you don’t find in the civilian world," Prior says. During his second deployment in Kuwait, he worked as a nurse practitioner in a remote desert region. "The nearest hospital was two hours away and the nearest X-ray machine was half an hour away. I had to make real decisions about whether to put people in a situation where they would seek a higher level of care or diagnostic tests, because it was logistically difficult to do those things. You don’t have access to the full complement of resources that you do in the U.S."

Understandably, these intense environments take a toll on the people who choose to work in them. Perry says another lesson she learned from her time in the military was to "know your sphere of influence." In other words, recognize what you can and cannot change in a situation and focus on the former.

"You have to go into this work with a lot of realism. There is no shortage of conflict to drive the work that I do, and it gets really overwhelming," she says. For a short time, Perry stepped away from global health nursing. Now, she frequently talks to a therapist and purposefully sets boundaries for herself to avoid burnout.

Looking ahead, Perry plans to continue her work as a global health expert. She is also exploring establishing an educational and clinical program that teaches advanced practice providers some of the nuances of global health not covered in traditional post-secondary global health programs.

Featured image at top: University of Cincinnati Alumna Helen Perry examines a pediatric patient in Mexico in 2020. Her Post-Master's Certificate in Family Nursing expanded her scope of practice as a nurse practitioner. Photo/Submitted