Headscarves and Hospitality

Since completing her registered nursing diploma in the small, northern Ontario mining center of Sudbury, Anita Fisher has held progressively senior positions in nursing in Canada, Saudi Arabia, Pakistan, and now, Japan. In March 2001, Fisher began her latest adventure abroad, working as a full professor at the Nagano College of Nursing in Nagano, Japan. Having worked overseas for five years, Fisher knows what she needs to do in new situations: "You adapt. It's a mind-set. I know I'm going into a new culture. I stand back. I watch. I listen. I don't push myself in," she smiles. "It's hard – I want to put my two cents in, but I hold back!"

In Pakistan, Fisher adapted by donning the local costume: a long, loose scarf called a dupatta, and a set of pants and long tunic known as shalwar kamiz. When she was in the North West Frontier Province, she covered her hair – not because the local people were bothered if she didn't, she says, but because she did not want to stand out in villages where the women wear veils all the time. Now, adjusting to life in the "Japanese Alps" has brought a new set of challenges: "It's a different culture. It's very affluent. It's very clean. It's less laissez-faire than in Pakistan."

An Expat Is Born

In 1995, Fisher was chief nursing officer and vice president of Ambulatory and Community Nursing Services at St. Michael's Hospital, a teaching hospital in downtown Toronto, Ontario, Ontario. She had been at "St. Mike's" for eleven years, and like many people in similar circumstances, she was looking for a change and a new challenge. She applied for a position in Saudi Arabia, and spent the next two years working as the director of nursing at the Security Forces Hospital, a 450-bed teaching facility in Riyadh, Saudi Arabia, the capital of Saudi Arabia.

Fisher quickly fell in love with the expatriate lifestyle, and when her Saudi contract was up, she accepted a position in Pakistan as co-executive director (with a Pakistani woman) of a large bilateral program funded by the Canadian International Development Agency (CIDA). With her bag of gold (one new piece bought with each monthly paycheck in Saudi Arabia), she set off for Karachi in December 1997.

Building Nursing's Appeal

Fisher's job in Karachi was with the Development of Women's Health Professionals Program (DWHP). Implemented by McMaster University in Hamilton, Ontario, and the Aga Khan University in Karachi, the primary goal of the DWHP is to upgrade the image of nursing in Pakistan. According to Fisher's research, in Canada, there are approximately 233,000 registered nurses for a population of 30 million; in Pakistan, there are a mere 21,000 registered nurses for a population of 141 million, with one nurse for every seven doctors. As a predominantly female profession, nursing in Pakistan does not have as high a status as medicine does. Inadequate educational facilities, ineffective career structure, and extremely difficult working environments also discourage potential candidates.

Fisher worked with the DWHP to upgrade the training programs for nurses who work in government hospitals and for the primary healthcare providers in villages, known as "lady health visitors" (LHVs). "If it weren't for the LHVs," Fisher says, "this country wouldn't have any healthcare in rural areas." What's more, she adds, some villagers will not let anyone but an LHV near them for their health concerns.

Fisher traversed the country, seeing nursing and LHV students in their communities, and visiting local hospitals, clinics, and outreach centers. Already a genuine, intuitive person, Fisher nonetheless learned a lot about how to approach people. Her adaptability and receptiveness to new ideas served her well. "Some (Westerners) didn't think they could learn from the Pakistanis, and came in with an attitude. 'Oh, I'm coming in to do so much good, to make changes.' You realize that it's not you that will make changes – they will. You open yourself up to them and they will make changes if they want." She explains, "The recipe for failure is to go in and implement change yourself. You need the nationals on board. There's a lot of PR involved. You lay out the options and say, 'Will any of these work?'"

Other Values

Fisher says that she never felt in any danger in Pakistan. She fondly remembers being welcomed into the homes of her driver and his eight siblings, her students and their families, and the villagers. "The children amuse themselves with so little," she observes. Although many people live in poverty, they always offer sweet, milky chai tea to their guests. "I've never met people as hospitable as the Pakistanis. When you come to their homes, you're the queen. They greet you, all the children line up – they do it for anyone who's a stranger."

When asked about the issue of women covering their hair or veiling, Fisher says firmly, "It is not an issue. The issue is more, 'I can't get a medication when I need it.'" When Fisher left Pakistan in December 2000, she felt the experience had been positive on a personal as well as a professional level. "Working abroad made me more critical of my own culture," she says. "I love Canada. I always will be Canadian."

"I've chosen things from my culture that I think are beautiful and want to maintain." But, she says, before her work with DWHP, "I was your upwardly mobile, money-making professional … Pakistan changed me. A lot of things I held dear are no longer dear to me. A good example occurred at Christmas in Canada. I went into the malls. I was there 20 minutes and I said to my sister, 'I have to get out of here. I can't stand it.' The commercialism, the money, and the spending. My son says, 'Mom, you've changed.' And he means for the better."

Teaching in Japan

At Nagano College of nursing, Fisher is the only non-Japanese faculty member. Some of the faculty and most of the graduate students speak English, but few of the undergraduate students do. Lecture notes for Fisher's course in symptom management are translated into Japanese, and a translator sits in on the class.

Fisher is also working hard to have her students provide feedback on her teaching. The students, she says, tend to put teachers on a pedestal and are reluctant to evaluate Sensei Anita (sensei is a Japanese term for teacher). So she taught a section on peer evaluation, stressing, "They learn from me; I learn from them."

In addition to teaching, Fisher is working on curriculum development, assisting with research on post-menopausal scoliosis in elderly women, and chairing a couple of Master's thesis committees. She is also involved with a student and faculty exchange program with the University of Western Samoa, funded through the Japanese International Co-operative Agency.

A Lifetime of Learning

In the midst of all of this, Fisher is working on her PhD through the University of Wales in Cardiff. (Her dissertation is on the nursing shortage in the province of Ontario.) She's no stranger to higher education. After finishing her nursing diploma in 1974, she worked for six years as a staff nurse – first in Canada, then in the United States – while simultaneously getting married, having a son, and earning a Bachelor's degree in psychology. She went on to obtain a Master of Health Science in healthcare practice from McMaster University.

Looking Ahead

Fisher's contract at Nagano runs until March 2003. After that, she says, she may sign on for one more year. Otherwise, she is unsure. She enjoys research and teaching, but she is also interested in health policy and in nursing ethics, as well as issues of globalization, privatization, and corporatization. One area of potential research interest involves the ethics involved in importing medical staff from poorer countries to work in wealthier countries.

"I love nursing," Fisher says. "I love it. I would do it all over again. It's been good to me. It's been there for me when I needed flexibility. It's given me two jobs when I needed it. It's given me the chance to go places I'd never go and meet people I'd never meet." She leans back, and with a satisfied smile concludes, "I am very, very happy with my life."

Discuss This Article

Have something you'd like to say? Tell us what you think! Read and post comments for this article.

Find a Job

Choose your career:

MedHunters is the world's biggest healthcare job board. Our job directory has 16,633 jobs with 2,439 hospitals and other direct employers.

We want you to find your next job on MedHunters. Need Help? Call us at 1-888-884-8242, email us at info@medhunters.com or sign up now.