“My family left after the volcanic eruption,” Sister said to me with a heavy heart. “But I asked myself, who will take care of my fellow Montserratians who stayed behind?”

These poignant words reflect the resilience and dedication of the nurses I encountered during my recent medical mission to Montserrat. During my time on the island, I collaborated with cardiologist Icilma Fergus Rowe of Mount Sinai Medical Center in New York City, who returns each year to provide much-needed cardiac care. The team serves over 100 patients in just five days, providing essential cardiac consultations, follow-up visits, and diagnostic echocardiograms, as well as referrals for further treatment or testing in Antigua or sometimes the United Kingdom (UK).

Local nurses under strain.

While many patients waited all year for consultation with our team and our presence was met with gratitude, local nurses who facilitated this care also revealed to me that our visit placed additional strain on the already overwhelmed nursing staff. Now, as I reflect on the benefits brought by medical missions like ours, I remain aware of the poignant reality that when you leave, you leave behind hurting colleagues whose pain stays with you.

The lasting effects of a devastating volcano eruption.

This small island in the Caribbean 25 miles southwest of Antigua, once a thriving community, has faced numerous challenges, from the devastating volcanic eruptions in the 1990s that led to the departure of half of the island’s population to the ongoing aftereffects of the COVID-19 pandemic. Today, those who remain on the island live primarily in the northern region, relying on the Glendon Hospital—once a school—for primary and urgent care. Many specialized services like cardiac care and assessment require patients to travel to neighboring islands in the Caribbean, or even the UK, making access to health care a significant challenge.

Emotionally overwhelmed health care workers—and their patients.

In the midst of a persistent sense of health care scarcity and crisis, there’s significant strain on the mental health of the nurses who form the backbone of the health care system. During my presentations to and discussions with the nursing staff, it became painfully clear that their own mental health struggles were being overshadowed by their commitment to care for others.

Many of them also felt that the equally overwhelmed patients they treated behaved “as if they had given up” and were noncompliant with diet and medications. In addition, many nurses had themselves experienced profound personal losses due to the eruptions and the resulting migration of loved ones. They shared their feelings of isolation, the trauma of losing homes, and the exhaustion of working with limited staffing and resources.

The COVID-19 pandemic has also left lingering effects that continue to impact the health care system in Montserrat. Nurses are grappling with burnout and the psychological toll of constant crises. The mental health impacts are not just personal—they resonate throughout the community, as the loss of even one nurse can have a devastating effect on an already strained health care system.

The strain on nurses globally.

Of course, every nurse knows that this situation is not unique to Montserrat. Around the globe, nurses face a mental health crisis, with staffing shortages and burnout leading many to leave the profession altogether, even here in the United States. The American Nurses Foundation found that 56% of health care providers feel a stigma associated with seeking mental health care. This stigma is often most clearly manifested in intimate communities like Montserrat, where there is only one psychiatrist and one psychologist to serve the health care staff.

As health care professionals, we are often trained to prioritize the needs of our patients above our own. However, this mindset can lead to a dangerous neglect of our well-being. As I left Montserrat from this most recent medical mission, I carried with me a deep admiration for the nurses who have given so much to their community, but I also felt a profound urgency. The stories I heard during my mission serve as a powerful reminder of the resilience of nurses everywhere. It’s a call to action: to ensure that we support not just the health of our patients but also the well-being of those who care for them. The healing of nurses is vital for the healing of communities, and it is time we prioritize their mental health just as fiercely as they prioritize the health of others.

Caroline Austin-Mattison, DNP, RN, APRN-BC, FNYAM, is a director of advanced practice nursing at Mount Sinai Hospital. With a commitment to preventative medicine and health promotion, Caroline focuses on reducing the burden of cardiovascular disease. Her passion for improving health equity locally and globally is reflected in her advocacy, clinical work, and educational initiatives aimed at promoting wellness and preventing disease.