Toughest place to be? Nursing on the frontline

Irish nurse Berna Breen saw the brutality of gang warfare in Honduras, writes Ellie O’Byrne, when she worked in an A&E department for RTÉ’s new series of ‘Toughest Place To Be’.

A terrified young man is brought in to accident and emergency. He has been abducted and taken to a derelict house, gagged, and beaten with rocks. He is black and blue, shaking, and whimpering, and so dirty that it’s difficult to see the extent of his wounds. Nurses set about cleaning him of blood and dirt.

In Irish hospitals, the aftermath of such severe violence will be encountered from time to time, and will leave their mark on the healthcare workers that treat them, but in Honduran capital Tegucigalpa, where there has been a murder rate of one person per hour every day since 2010, nurses at the city’s public hospital deal with traumas like these on a nightly basis.

For RTÉ’s new episode of Toughest Place To Be, the documentary series that sees Irish workers swap their nine-to-five for an equivalent post in a developing country, a film crew followed A&E nurse Berna Breen as she spent a week at Hospital Escuela Universitario, working alongside her Honduran counterparts at the coalface of the brutal gang wars that make the Central American state one of the most dangerous places on earth to live.

“I was 50 last year and I said I wanted to do something interesting, but I didn’t think it was going to be quite that interesting. I was going to go to Electric Picnic,” Berna laughs. Her week-long stint in Honduras was filmed last September, and she’s had time both to reflect on her experiences and get nervous about RTÉ’s airing of the show and the attention it has brought her.

Even the ads that RTÉ have been airing are bothering the camera-shy Wexford native, who works in University Hospital Waterford (UHW).

Berna’s choice to take part in the show was driven by her desire to challenge herself professionally rather than a thirst for her 15 minutes of fame.

She emerges as something of the reluctant hero in the hour-long show, as her competence, compassion, and professionalism are pitted against a language barrier and the brutal realities of working in a country where medical supplies are scarce in public healthcare.

The lack of pain management for patients with excruciating injuries was a shock for Berna. Not 10 minutes into her first shift alongside her counterpart, senior A&E nurse Felipa, a construction worker is brought in from a fall with a severe compound fracture, and Berna watches as the man is treated with no pain relief.

Visibly shaken, she quizzes Felipa, who says they don’t have an appropriate analgesic to administer.

“I found that the hardest of all,” says Berna. “Sometimes they would have to suture without even using a local anaesthetic, because they didn’t have enough. Pain management, even for quite significant fractures, was very minimal, probably the equivalent of paracetamol here.”

Berna was humbled by the warmth and kindness shown by Felipa, in whose home she stayed while filming, and also her accepting and forgiving nature; Felipa herself lost her eldest son to the gang-fuelled crime that is rife in Tegucigalpa, and yet, on a daily basis, she treats gang members, like those who killed her son, as well as their victims.

“The oath I took in nursing is to save lives, and so I work to do that, even if it is a criminal,” she tells Berna.

Berna Breen with some of the people she became close to while in Honduras.

To underline the point, Berna visits a young gang survivor who now lives in hiding. He openly describes his former life, using drugs and participating in the abduction and rape of women who would often later be executed, part of a sickening strategy of control through fear perpetrated against innocent bystanders as well as rival gangs.

Berna’s stay raised questions for her about the sources of inequality in Honduras. It was far more complex than she had anticipated.

“Because I had no clue what I was getting into, I felt I was going to come back and want to fundraise for charity, but it’s not that simple.

"It got me wondering if there were any ‘good guys’ at all; there was a huge police presence at the hospital all the time, even more so when the gangs came in, and sometimes you were grateful for that, but you would wonder how they can afford it, if they can’t afford the wherewithal to treat patients properly.”

Back in what she describes as “my lovely little life in Wexford”, Berna’s on-screen prediction that her life would be changed by her experience is true, but more in an emotional than practical sense. She has kept in touch with Felipa and her family.

“She’s amazing, just amazing,” says Berna. “She just sent me beautiful photos of her daughter’s 15th birthday, and I sent her a message saying that the programme was airing; she’s just as nervous as I am about it.”

The documentary concludes with scenes of Berna back at work in UHW, but the intention is not to gloss over the challenges faced by the Irish healthcare system, series producer Jamie D’Alton is keen to stress.

“Berna has worked in the Irish health system for a long time, so it’s natural for her to benchmark her experiences against her working conditions here, but that’s certainly not the point of the programme,” says D’Alton.

“It’s not about Ireland, but about an Irish person in an international context, which is actually one of the reasons I really love the format. I think it’s great that RTÉ are making programmes that are so outward looking.”

Toughest Place To Be is a format first aired on BBC and now popular in several countries. In the first Irish season, aired last year, Dublin street-sweeper Mark Crosbie travelled to Manila in the Philippines, while in the follow-up to Berna’s episode next week, Dublin bus driver Christy Carey will switch his regular route for a rather bumpier ride in the streets of Kathmandu in Nepal.

“It’s a great format, because you get to bring brilliant characters to brilliant locations,” says D’Alton. “What audiences really respond to is that it’s truly through the eyes of an ordinary Irish person; they’re not a celebrity or a politician, just an ordinary Irish worker. Berna is the star of the show.”

Would D’Alton describe her as a reluctant hero? “Absolutely,” he says. “Within five minutes of sitting down for coffee with Berna, I knew that she was the right fit.”

  • Toughest Place To Be… An A&E Nurse airs tonight on RTÉ One at 9.35pm.



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