Hayes’ helping hand

By Monica Grice

Overwhelmed. This is how Maria Hayes felt walking through the rain forest of Nicaragua.

It’s day three of the Texas State University nursing student’s trip, and they set out to complete census’ of a rural community located in the rain forest.

“Many of us went into this experience being very timid and unsure of what we have learned up to this point,” said nursing student Logan Smith. “However, once we got accustomed to conducting assessments and communicating with patients, the uncertainty melted away and confidence was built.”

Confidence is something Hayes exuberated without fault while abroad. Her adaptation to the Nicaraguan culture communicated her will to help people, and her love of nursing.

Next Stop Nicaragua

The Denison, Texas, native fell in love with healthcare when she was a student in high school.

Hayes spent 12 hours a day for a week shadowing doctors and nurses at her local hospital and experienced everything from surgeries to deliveries, which made her want to be a nurse midwife.

“The first delivery I saw, I cried; it was the most amazing thing I’ve ever seen,” said Hayes. “That’s the moment I knew I wanted to be a nurse.”

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Hayes on day two in Nicaragua. Photo by Monica Grice.

Hayes went to Nicaragua with her nursing school colleagues in January hoping to see what it was like to practice global health as a travel nurse, and to brush up on her Spanish.

Hayes originally enrolled at Texas State University in San Marcos as an engineering major.

“I wasn’t really connected to that; I knew I would get a job and went with it for that reason,” said Hayes.

After talking with her father, she ended her engineering major and pursued a nursing career.

Clinic Days

While in Nicaragua, the College of Health Professions students split into three groups and spent four days in three communities.

On the first day in the community, the teams were guided through the villages to interview community members and take a health census. The census would give them a better understanding of what illnesses were in the community, and how to prepare for them when clinic days arrived.

Hayes saw patients at a clinic located deep in the rainforest of Ticuantepe, Nicaragua.

“She just jumped right into whatever challenge was set before her,” said fellow nursing student Jessica Yehl. “She communicated well, assessed her patients with all the skill of an actual nurse, and was so prepared to help the team in whatever way she could.”

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Hayes during day two of clinics. Photo by Monica Grice.

Hayes remembered meeting a young woman in her 20’s on the day they collected census. The woman was emotional because she had a lump in her breast that she believed to be cancerous. Since the team didn’t have any medical supplies on them that day, Hayes urged the woman to come to the clinic. She came on the first day, but became nervous and left, leaving Hayes worried for her health.

Day five was frustrating for Hayes. The woman still hadn’t shown, and another patient’s blood pressure was dangerously high. Hayes and other healthcare students urged the woman to go to the hospital, but never found out if she did. It left Hayes feeling like she wanted to do more, but she couldn’t.

“I think her ability to be realistic sets her apart,” said Yehl. “A lot of nurses can be tempted to sugar coat hard situations, but she just gives it straight.”

On the third, and last day of clinics, Hayes felt rewarded.

“I feel really proud of the team and how much work we accomplished,” said Hayes.

The Woman From The Rainforest

After the last day of clinics, the Texas State group returned to one of the clinics for a day of giving back. Games, balloons, and a piñata were brought for the children and triage stations were set up outside of the church for any remaining community members who hadn’t been assessed.

Hayes’ clinic was chosen.

The woman from the rainforest was there. Hayes helped assess her and found out the lump was mastitis.

“I’ve been worried all week,” said Hayes.

Mastitis is an inflammation of the breast most common during the first six months of breastfeeding. Although painful, it’s not serious and can be remedied easily.

The emotion Hayes expressed was pure joy. She got the reassurance she had been waiting days for. Her worries were alleviated.

“That was really good, it was so relieving,” said Hayes. “I told her ‘I was ready to climb back up the mountain and find you,’ she thought that was really funny.”

She made a warm compress for the woman and explained how to continue treating the inflammation.

Hayes recalls this day as being the best part of the trip.

Returning Home

“I feel like I don’t need to be home,” said Hayes.

After the clinics, the team had a few recreational days and went to the nursing home in Masaya.

The nursing home was a unique experience for Hayes. As a career, she loves working with children. She seemed a bit hesitant, the whole team did. However, she molded quickly to the environment and left happy.

“She was able to adapt to the different culture and conditions of Nicaragua and perform confident and competent assessments on patients,” said Smith.

The day before the team’s departure, Hayes didn’t want to leave.

“It’s a bitter feeling to leave,” she said. “I wish we could have a few extra days.”

The soon-to-be midwife gained a deeper knowledge of the people and the country during the trip. Fellow nursing students, Smith and Yehl, admired how Hayes was able to jump into any situation and tackle it.

In the 11 days the Texas State team was in Nicaragua, Hayes explored what it’s like to be a travel nurse and practice global health: she thinks she can do it.

“I definitely loved it and I definitely think I could see myself doing it long term,” she said.

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Hayes with a village girl. Photo by Monica Grice.
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Women of Nicaragua: the unique burden

By Darcy Sprague

On Jan. 4th, a group of 29 health science and mass communication students journeyed into small communities in the Nicaraguan jungle where they met some of the locals and received some of the warmest welcomes of their lives.

The people who gave these welcomes were mostly women who were home with their children. Smoke billowed as they cooked or burned trash, and soapy water from washing dishes and clothes ran in the streets.

A 2015 report from the United States Agency for International Development states, “we know that women are vulnerable to extreme poverty because they face greater burdens of unpaid work… and are more likely to be forced into early marriage —all factors that reduce their ability to participate fully in the economy and to reap the benefits of growth.”

During the 2017 College of Health Sciences study abroad trip to Nicaragua, the team met many different women. Some were living in extreme poverty and some spoke candidly about their or their parent’s struggle for a better life.

The group that conducted house visits in Los Rio or Butter as it was referred to by the students, saw few men that first day. Many of the men were out working. Most of the men who were home were ill, leaving their wives to both earn money and do the house chores.

In Nicaragua, low income women are 12 percent less likely to work than men. Middle class women are 30 percent less likely, according to the World Bank Gender Portal.

Petronila Melendez, a 90-year-old woman who visited the Butter clinic, had 14 children and outlived nine of them. She still cooks, cleans and occasionally works in the fields to earn money.

She had three husbands in her lifetime. Two of them died and one left her. She lives with her son who does not currently work and does not help support her.

“I had a lot of children so I worked all the time,” Melendez said through a translator. “I wasn’t a very lucky lady.”

Melendez carried heavy baskets of fruit on her head from her village to the local market for 40 years.

She had her first child at the age of 14 after being raped. She married at 22.

“Your son will probably die before you do,” the doctor who saw her joked.  “Is your house older than you or are you older than the house?”

Melendez admitted she had little education. She lived her entire life in the same area.

In contrast, Massiel Acetune Vilchez, the 33-year-old International Learning Service team coordinator who assisted the group on the ground, lives in a four-bedroom house. She does not work in a labor intensive position. She has no children and is not yet married.

She said this is because she wanted to get her education and career in order before she settled down.

Vilchez’s mother grew up in a village similar to Melendez, but she had an “I deserve better” attitude, Vilchez said.

Her mother moved to the city and graduated from one of the free public universities. She met and married her husband, but continued to work. Her father lost his job so her mother moved to Miami to get a job. She sent money back so that Vilchez and her siblings could have a good life and education.

Vilchez said her parents always expected her to be in the top of her class. She received a scholarship and was able to attend a private university.

“My mom and dad raised me to be independent,” Vilchez said.

Vilchez said she has a different view of gender roles than many of the women who came through the clinic.

“I believe in 50/50,” she said. “I can cook, but so can a man.”

She added that her older brother cooks and cleans for himself.

 

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Vilchez (left) poses with Eddie, Alyssa Gonzales, Roland and Darcy Sprague

 

“It’s not about gender,” she said. “It’s about how you can be independent in every way. I want (my daughter) to be a powerful woman. I want them to fight for their dreams and for them to want to accomplish more.”

Olga Fonseca, 69, was another of the local women who came into the clinic and who had a life similar to Melendez’s.

Fonseca had 13 pregnancies and raised eight children. Now a widower, Fonseca lives with her 41-year-old son and supports herself by baking desserts in a wood hole in her house similar to a pizza oven.

Every morning she wakes up at 3 a.m. to make coffee and sweep the house. She prepares the desserts and cooks bean and rice for her and her son. She cooks until lunch, then begins cleaning again. She does not rest until after dinner when she reads her Bible. She goes to sleep at 11, resting for four hours before starting again.

Fonseca was never able to have an education. She has struggled for as long as she could remember just to make ends meet.

Fonseca lives off of 60 cordova a day, which is about $2 USD. Her son does not work or help with expenses.

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Olga Fonseca, 69, and Vilchez talk about the puppy Lucio

Struggling is not unique to the women of the village.

According to the World Bank, in 2008—the latest complete data available—roughly 42 percent of Nicaraguans live in poverty. Sixty-three percent of people living in rural areas are poor while only 27 percent of those living in urban areas fell below the poverty line.

Raquel Ramirez worked as a translator for the group, but most days she is a doctor. Currently pregnant, she is having a hard time finding work.

In her profession she was working from 8 a.m. to 10 p.m. six to seven days a week.

“We make due,” she said. “I like what I do, but sometimes I need family time.”

Ramirez earned $450-$500 a month as a doctor. The poverty line in 2005 was $413.53, according to the World Bank. Ramirez, a doctor, one of the highest paid professions in the United States, barely earns enough money to be above the poverty line.

Women are making some headway in the country, however. Women are eight percent more likely to attend secondary school than men, and female children are four percent more literate than males.

“It’s not about opportunity, it’s about education,” Vilchez said. “Some f these families don’t know about thing else besides their village, they do not try to move on.”

Meet the respiratory therapy students that became the educators

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By: Taeler Kallmerten

Bubbly, free-spirited and stubborn are three words to describe the women of the respiratory therapy team from Texas State University.

Two respiratory therapy students, accompanied by their faculty, were a part of Texas State University’s first inter-professional study abroad program in Nicaragua.

Initially, the respiratory therapy team was not going, but clinical assistant professor Sharon Armstead and her two senior students Veronica Richardson and Amber Hazelett readily accepted the invitation from the trip’s lead faculty member, Marylyn Kajs-Wyllie. 

There are few countries that have a specialized role for respiratory care and Nicaragua is not one of them. Like the majority of the world, Nicaragua’s respiratory care is practiced by standard physicians and nurses.

This was a challenge for Armstead, Richardson and Hazelett. Instead of spending most of their time in the community clinics, Armstead and her team focused on giving seminars about respiratory care in local public hospitals.

As Armstead set up her MacBook to give a seminar, 12 nurses wearing white uniforms sat watching intently. The seminar took place in the cafeteria of the hospital and many employees passing by joined the lecture as they ate their breakfast. Richardson and Hazelett passed out brochures amongst the nurses, so they could follow along in the demonstration.

“I love to educate as I go,” said Armstead. “Not only do we learn from the community, but they learn from what we offer in education.” 

Through one seminar Armstead said she completely changed the way one hospital gave a nebulizer treatment.

“They were giving the nebulizer treatment without a mask or a mouth piece and the neb was just going out into the air,” said Armstead. “Until we showed them the proper way to use a nebulizer, they did not know.”

After educating healthcare providers in the hospital for two days, Armstead said it is important to recognize the hospitals are not wrong in their methods of respiratory care, but they are just different. 

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Infographic of respiratory issues in Nicaragua. Graphic by Monica Grice.  

The work is personal

The irony of the respiratory therapy team is that all three women have asthma themselves.

Hazelett, a respiratory therapy major, said her asthma gives her the ability to empathize with her patients because she knows their pain firsthand.

“Growing up sometimes people would tell me, ‘there’s not actually something wrong with you,’ or ‘no, you can breathe just relax,’” said Hazelett. “I know that these people really cannot breathe.”

Hazelett said she understands that those who do not have asthma sometimes think asthmatics are making up their medical condition.

“Just because it can’t be seen on the outside doesn’t mean it’s not going on on the inside,” she said.

The first day outside of the hotel in Nicaragua required long hikes to get from home to home and Richardson constantly checked on Armstead’s breathing and reminded her to use her inhaler.

The family dynamic of taking care of each other was the anchor that held the respiratory therapy team together.

Richardson said having Armstead as a professor has made her more confident in her abilities as a respiratory therapist.

Richardson said she had an intense discussion with a doctor in Nicaragua about whether a patient’s lung problems were asthma related.

“I did a full chest assessment and I was right that there was something wrong with the patient’s lungs,” said Richardson. “In my mind, there was that split moment where I thought what if I’m wrong; then my confidence came back and I was like I know I’m right.”

As Richardson explained how Armstead’s teaching has impacted her, Armstead, who was sitting next to her, began crying, but with a smile on her face.

“I wanted them to see that in these countries, they don’t have RT, but what we can do is to promote our profession and to educate,” said Armstead.

Richardson and Hazelett will graduate in May. While Richardson has just finished her internship in the neonatal intensive care unit at St. David’s North, Hazelett has begun her night shifts at her internship. Richardson plans to eventually practice respiratory therapy abroad and Hazelett plans to get her masters degree and eventually teach at her alma mater, Texas State University. 

An immersive study abroad program in the School of Journalism & Mass Communication