In her mind's eye, Capt. Mary Lambert can still picture the children walking to school, just as children do in neighborhoods everywhere, talking in small groups as they amble along. Except in this scene, they are walking along streets lined with bombed-out buildings, and at least one child in every group is missing an arm or leg.
Lambert, an African-American nurse and commissioned officer in the U.S. Public Health Service, will never forget this and other surreal scenes captured in her mind from her time in Rwanda. The stark contrasts will stay with her forever: the lush flowers that grew higher than her head and the huge avocados dripping off the trees, versus the devastated cities and war-torn people, many of whom had lost nearly all of their relatives to roving bands of death squads.
"The people we worked with were so gracious and appreciative in the face of their losses," she says. "When I came back to the U.S., it was probably six months before I felt I could complain about anything."
But just as the experience made a lasting impression on Lambert, she ¬in turn left an equally indelible mark on Rwanda. In 1995, Lambert and other American health care professionals spent two months working in the civil war-ravaged African nation. Their assignment: to train 500 people to staff the country’s severely depleted clinics. The training was critical because Rwanda had lost an astounding 80% of its health care work force in the genocide the year before.
"It was one of the most humbling and rewarding experiences of my life," she says of her work there.
Serving in countries like Rwanda is just one of the many and varied opportunities available to nurses who work in the Commissioned Corps of the U.S. Public Health Service. Driven by their passion for public service, these nurses work on the front lines to deliver health care to the people who need it most, in locations ranging from Third World countries to America’s most underserved racial and ethnic minority communities.
Cmdr. Ana Marie Balingit-Wines, CCRN, chief of beneficiary medical programs, calls the U.S. Public Health Service “one of the federal government’s best-kept secrets" because so many nurses are still unaware of the career opportunities it provides. Under the direction of the U.S. Surgeon General, commissioned nurses wear uniforms and serve as officers. They work for local, state, federal or international health agencies in a wide variety of capacities. They help conduct research, design disease prevention programs, develop creative techniques in medical methodology, improve mental health care, expand health resources and much more.
"If you are somebody who wants to contribute to the overall health of the nation, and even the world, the opportunities are endless," says Rear Adm. Mary Pat Couig, RN, MPH, FAAN, an assistant Surgeon General and chief nurse officer.
Lambert feels the variety offered by the Commissioned Corps is one of this career’s greatest assets. "It's not easy work, but the opportunities are just incredible," she says. Her service in Rwanda is just one slice of her nine-year career in the Public Health Service. For three years, she helped provide care for some 4,000 seasonal farm workers in migrant camps in eastern Maryland and Virginia.
Later, she worked for the U.S. Food and Drug Administration as a consumer safety officer. There she managed the review process for FDA approval of nicotine substitute products, such as the patches that help people quit smoking. She also worked for the Centers for Disease Control and Prevention in Atlanta, where she helped create training programs and educational materials on immunization. Since November, she has been developing policies on military health issues as director of the Office of Military Liaison and Veterans Affairs.
In addition to their regular jobs working for government health agencies, nurses in the Commissioned Corps also can be mobilized in time of war or national and international emergencies. To become a commissioned officer, nurses must have earned at least a Bachelor's degree. Salaries are determined on the basis of rank, education and experience. The pay is competitive with the private sector, particularly after the first couple of years, and the benefits are generous. They include free health care, military commissary privileges and a fully funded retirement plan that doesn't require any matching contributions by the employee.
Unlike officers in the Army or other branches of the military, who are often forced to move from base to base, officers in the Public Health Service Commissioned Corps control their own careers. While they tend to be mobile, because promotions often require moving to another government agency, they have the freedom to choose where they want to go and what positions they want to take.
According to Cmdr. Marylouise Ganaway, RN, chief nurse recruiter, the need for nurses is greatest in the Division of Immigration Health Services and the Bureau of Prisons. Bilingual nurses especially are in demand to provide care for recent immigrants. Translators can always be found, but nurses who share the patients’ language and culture can establish a comfort level and provide care that much more quickly.
Although these are the only two areas that are currently experiencing a nursing shortage, there are still plenty of job openings throughout the Public Health Service. As Ganaway puts it, "We can always use more nurses."
Who is the ideal candidate for a nursing career in the Commissioned Corps? The answer is fairly simple.
"A qualified nurse who wants to make a difference in the nation's health care," Ganaway says.
"You have to be hard-working," adds Balingit-Wines, who entered the Public Health Service 14 years ago after serving as a nurse in the Air Force. "You have to make a lot of sacrifices. You have to want to do good."
In other words, this career is best suited for nurses who have a true passion to serve the neediest of underserved areas and are willing to boldly go to places where other nurses may be reluctant to work—from Micronesia to federal prisons to Mexican border towns.
Ever since she knew she wanted to be a nurse, Capt. Evangelina Montoya, RN, MSN, yearned to use her education and skills to help people with limited access to health care. Montoya grew up in a migrant farming family in Visalia, Calif., and knew first-hand the struggles of those without good medical resources. "I recall, as a child, the isolation and the financial burdens my parents endured," she says.
After graduating from nursing school, Montoya worked in a hospital on an Indian reservation in Arizona. Despite her nearly lifelong desire to serve, she admits that the adjustment was difficult at first. Having completed her nursing degree in Denver, Colo., she had grown accustomed to the comforts of living in a big city. She also had to learn how to speak the tribe’s language so she could communicate more effectively with her patients.
"I had never lived on a reservation," she explains. "Once I got there, I was in culture shock." Although she believed her nursing education had prepared her to be culturally competent, she soon realized she had a lot to learn about working within a culture different than her own—for example, how to collaborate with the tribe's medicine man in the treatment of patients.
Another tough challenge in Public Health Service nursing, says Francess Page, RN, BSN, MPH, is "recognizing that you can't reach [every person in need] all the time, even though you'd like to." Page, who is African American, entered the public health arena after working as a nurse in hospitals and seeing patients suffering from conditions that could have been prevented.
Driven by a passion to educate people so they can live healthier lives, she has played a major role in national AIDS prevention programs. Today, as director of policy and program development for the Department of Health & Human Services’ Office of Women's Health, she continues to work on the AIDS awareness front, along with coordinating prevention and education efforts on such issues as lupus, domestic violence and minority women's health.
Despite the hard work and the steep challenges, a career in the Public Health Service Commissioned Corps can offer profound rewards—whether they're achieved directly, by treating patients, or indirectly, by shaping health policy. Page, for example, was instrumental in the effort that led to the creation of a national domestic violence hotline. She also helped establish a national nurses’ summit on violence against women and recently helped put together a national working group on lupus that is providing education about that disease to federal employees and the public.
Montoya, who is now a public health analyst for the Division of Community and Migrant Health, helps develop health care policies for migrant farm workers. She also works in a number of local clinics, to keep informed about what's happening on the front lines of her field. "I feel I am giving back to the community," she says.
In addition to her five years of working on Indian reservations in Arizona and New Mexico, Montoya has also served as an occupational health consultant and traveled internationally. In 1995, she went to Mexico as part of a World Health Organization delegation to help that country create a national health care plan. Three years later, she traveled to Chile as part of a delegation on nursing practice models.
Balingit-Wines says her work at the Alaskan Native Medical Center in Anchorage was one of her most rewarding nursing experiences. Many of her patients lived in such remote areas that their only access to health care facilities was by plane. Yet despite the isolation, the population faced growing problems of coronary heart disease and diabetes due to increasingly Westernized diets. Balingit-Wines, who is Filipino, says the fact that she physically resembled her Alaskan Native patients helped establish an immediate comfort level. "Just to hold a hand and see a familiar face meant so much to them,” she recalls.
Capt. Ernestine Murray, RN, BSN, MAS, has worked in a wide variety of positions during her 20 years as a commissioned officer. Murray, who became a nurse after a career in business at Lockheed Martin, worked as a critical care nurse at the Public Health Service Indian Hospital in Tuba City, Ariz., caring for members of the Navajo and Hopi tribes. As a nurse consultant and scientific reviewer for the FDA, she helped develop educational programs aimed at reducing complications associated with the use of medical devices. She also worked as a cardiovascular and surgical intensive care nurse at the National Heart, Lung & Blood Institute.
Currently, she is a senior health policy analyst for the Agency for Health Care Research and Quality. She is involved in the agency’s Center for Practice and Technology Assessment, where she develops and implements clinical practice guidelines and evidence-based reports on health care.
"With each job, I gained valuable experiences and wonderful memories," Murray emphasizes. As an African American who grew up in Maryland during the time when schools were being desegregated, she thought she had been well exposed to disparities in equal access to basic human services. And yet, she says, the work she did on Indian reservations gave her a new appreciation for the stark needs that still exist.
"America’s health care system cannot be considered effective until those who have the least have the same access as those who have the most," she maintains. “But through working in the Public Health Service, you feel your input helps chip away at that lack of access."
Nursing students can earn money and get valuable experience through two programs offered by the U.S. Public Health Service Commissioned Corps, as well as a related federal program called the National Health Service Corps.
In the Public Health Service’s Junior Commissioned Officer Student Training and Extern Program (Junior COSTEP), students are commissioned as junior assistant health service officers. Nursing students can earn about $2,300 a month working for public health agencies on assignments ranging from 31 to 120 days. Students are not obligated to go on to a career in the Commissioned Corps after they graduate, but if they do, they receive credit for their time in the program for pay and retirement purposes.
For students in their final year of undergraduate or graduate school, the Senior COSTEP offers a competitive financial aid program in exchange for an agreement to work for the Public Health Service after graduation. As an active-duty officer during their senior year, students are paid about $2,300 a month and receive uniformed services benefits. When they graduate, participants are promoted according to their degree and professional experience. A nurse with a Master’s degree, for instance, would be promoted to a junior lieutenant with a $2,700 monthly salary, plus benefits.
To learn more about these opportunities, go to the student page on the Commissioned Corps Web site. Applications for both programs are available online, or by calling (800) 279-1605; if you are located in Maryland, call (301) 594-3453.
Meanwhile, nurses in certain specialties can apply for scholarships and educational loan repayment assistance through the National Health Service Corps, a program sponsored by the U.S. Health Resources and Services Administration (HRSA), Bureau of Primary Health Care. The program works together with local communities to place health care professionals in rural areas and inner city neighborhoods where the need for health services is greatest. Unlike the Commissioned Corps of the U.S. Public Health Service, however, members of the National Health Service Corps work for the community agencies, rather than the federal government. They are not part of the government's uniformed services.
The scholarship and loan repayment programs are highly competitive. In exchange for the financial assistance, winners agree to work in two-year residencies in underserved areas.
The scholarship program is open to students studying to become nurse practitioners or nurse-midwives; the loan program is open to primary care certified nurse practitioners, certified nurse-midwives and psychiatric nursing specialists. For more information, see the NHSC Web site, or call (800) 221-9393.