Clinical laboratory Science in Nicaragua, an opportunity to educate for the future

When Clinical Assistant Professor and Clinical Coordinator, Joanna Ellis heard about the opportunity to take some of her clinical laboratory science (CLS) students to Nicaragua, she seized it as a chance to work in uncharted territory.

And when she presented the idea to her chair, Dr. Rodney E. Rohde, associate dean for research and a professor in the Texas State  CLS Program, he knew it could help students prepare for their future in healthcare.

After more than a year of preparation, the CLS program embarked on an unprecedented journey to Nicaragua in January where four seniors became the first clinical laboratory science students in the nation to work with patients and observe laboratory practices abroad.

The students – Ashley Wells, Jennifer Pemp, Idahlia Bland and Ashleigh Graham – spent 13 days with 19 nursing students, two respiratory care students and five mass communication students as part of the university’s first inter-professional service learning study abroad program in Nicaragua.

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The CLS students observe at the hospital in Masaya, Nicaragua

“Our students experienced what made this trip so important for their future in healthcare,” Rohde said. “They were immersed in a different culture where they learned and interacted. This trip really set the bar high for other universities not only in Texas but around the nation.”

Rohde said one of the program’s goals was to create an atmosphere where the health profession students interacted with each other and other healthcare professionals.

“As the first group to be granted access to clinical labs in Nicaragua we were given the unique opportunity to see how laboratory professionals in a developing country determine the critical tests to implement with little funding and how they maximize their resources,” Ellis said.

Ellis said she will attend different conferences and meetings to help spread the knowledge about how labs run in Nicaragua in comparison to the United States.

“The students had the opportunity to observe testing techniques, parasites, and specimen containers they would not see in their clinical rotations in the United States,” Ellis said.  “Baby jars for urine and matchboxes for stool, for example. It was an amazing experience that I look forward to sharing with colleagues at a conference this March.”

In Nicaragua, the public hospitals have limited resources as government funding in 2007 was $211 million by the Ministry of Health, according to the most recent statistics available.  Of the total budget, 79 percent came from public revenue, but 67 percent came from the treasury which means that the government is the primary source of health spending, not taxation of the people.

For the public hospitals, this lack of funding leaves the staff to reuse hospital equipment—a practice that would be seen as taboo in the United States.

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Walking through the hospital in Masaya, Nicaragua

“The difference in lab equipment is night and day compared to the United States,” Ellis said. “In the first hospital we visited, the staff was doing all their testing by hand. All the chemistry was done manually, predating lab methods in the United States by 40 years.”

Ellis said these manual methods leaves room for human error which can lead to results that are not 100 percent accurate. The lack of equipment and funding also left the staff to reuse microscope slides, tubes and even gloves.

“Here in the United States, when a slide touches the floor, you just throw it away and get a new one—when your gloves are dirty, you simply change them out, but here, they don’t have that luxury,” said Idahlia Bland, a clinical laboratory senior student. “It blew my mind that they were reusing equipment that way. In the States that would be absolutely unfathomable to healthcare professionals.”

When slides are reused, bacteria can contaminate the slide, giving results that may not be representative of what the patient actually has, Bland said. The clinical lab scientists in Nicaragua have learned from working in these conditions how to tell if a faulty reading is coming from a contaminated slide.

The trip provided a fast-paced learning experience. During the clinical days in the villages, the students helped local residents with urinalysis and glucose testing. They also spent a lot of time working in local hospitals and clinics.

“We walked around the hospital at first to get a feel for the atmosphere,” Bland said. “The hospital was very crowded, and in some rooms, there were up to two pregnant women per hospital bed. The conditions were not up to par with what we have back home, and hospital beds were out in hallways sometimes with patients because of the capacity.”

During the hospital visit in Masaya, clinical laboratory science student Jennifer Pemp had the opportunity to draw blood from three different patients. During her blood draws, she used methods that the doctors used in Nicaragua, not how she was taught back in the United States.

“They leave the tourniquet on the patient’s arm while they draw blood, and in the States we are taught not to do that because it can allow for false readings,” Pemp said.

Leaving the tourniquet on during blood draw does cause hemoconcentration that leads to an increase in some blood tests like potassium, glucose, and cholesterol, she said.

When Pemp was drawing blood from her first patient, the staff at the hospital stopped her and told her to proceed with the method that was used in Nicaragua instead of what she was taught to do in the United States.

“We’re not here to teach them how to do their job, especially since this is the first time lab has gotten the opportunity to do this, so I proceeded to draw blood the way they wanted me to,” Pemp said. “It felt unnatural for me, but I was humbled by the opportunity to work with them, and all these lessons I learned I will take back with me forever.”

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Pemp preparing to draw blood from a patient at the hospital

For the future, the CLS program will look into attending another program abroad. The success in Nicaragua will be the first of many for the program, Ellis said.

On March 31, Ellis will attend a conference in Allen, Texas hosted by the Texas Association for Clinical Laboratory Science where professionals across the state meet to discuss the future of CLS. A keynote speaker and past president of TACLS, Ellis will present on the logistics, impact and importance of the trip. The keynote will help other programs in the state who are looking to venture into CLS study abroad opportunities.

 

To see a visual comparison of how laboratory practice differentiates in Nicaragua and the United States, click the PDF file below.

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