Click on the photo below to follow the 2017 inter-professional team through Nicaragua.
By: Allison Fluker
The first inter-professional study abroad team from the College of Health Professions traveled to Nicaragua in January to provide healthcare in rural villages.
The 34-member team consisted of students and faculty from the nursing, clinical lab science and respiratory care programs, along with the School of Journalism and Mass Communication’s Global News Team.
The health professions students, in partnership with International Service Learning, hosted three days of free medical clinics in local villages near Masaya, Nicaragua. An average of 45 patients were seen each day at the clinics; in addition, the students cared for elderly residents in a local nursing home.
Marylyn Kajs-Wyllie, a professor in the St. David’s School of Nursing, went to Nicaragua with the 2016 study abroad program which was joined by a group of mass communication students.
“Since there was a mass communication team tagging along with the nursing students, there was an idea to push for an inter-professional team,” said Kajs-Wyllie.
At the time, the College of Health Professions was pushing for collaboration between its programs. An inter-professional experience abroad would provide students with a community in a work environment.
But first, Kajs-Wyllie needed to find faculty members and their students who would agree to join her on the 2017 trip. She contacted Gregg Marshall, the chair of respiratory care at Texas State University, who put her in touch with other faculty, such as Sharon Armstead, a clinical assistant professor in the respiratory care department.
“Marylyn reached out to me via email to ask if I was interested in joining nursing on the trip,” said Armstead.
During a College of Health Professions graduation ceremony, Kajs-Wyllie asked Armstead to go on the trip and Armstead agreed.
“I thought it would be a great opportunity for the therapists to go,” said Armstead.
Meanwhile, a clinical assistant professor in the clinical lab science program contacted the chair of the nursing school to see if there were opportunities for her students to work with other professions.
“I serve on the inter-professional education committee and the study abroad committee,” said Joanna Ellis. “I wanted (the clinical lab science students) to have respect for the other roles. If we learn from each other and health care together, we will impact healthcare results in the future.”
With the addition of Ellis and Armstead and the mass communication students, Kajs-Wyllie assembled her 34-member team.
Expectations and Worries
The first inter-professional health professions study abroad team came with a lot of pressure and expectations.
“I wanted the nursing students to learn focused assessments, the culture, Spanish, to appreciate the differences in nursing and the differences between what we’re used to with what they have,” said Kajs-Wyllie.
Students from the nursing school practiced focused assessments during the medical clinics in rural villages.
“It gives you a lot of confidence,” said Desiree Davis, a senior in the nursing program. “Once you start asking questions, you learn what other questions you need to ask about the information for the problem the patient is having.”
Every faculty member on the team had their own expectations for the trip, as well as expectations for the entire group.
“I wanted (the clinical lab sciences students) to get a mutual respect,” said Ellis. “If we were able to go to the labs at the hospitals, we could talk about the labs in the group debriefings and show (the other departments) that we are taught a very different skill. We have a lot to offer and wanted to show them that.”
In Nicaragua, healthcare specialties such as clinical lab science or respiratory care, do not exist like they do in the United States.
“They don’t have us as a profession where we were going,” said Armstead.
Without resources for the level of education required to provide specialty care in Nicaragua, there are not many doctors who can provide the care that Armstead, Ellis and their students gave.
While some professors worried about limitations in their ability to apply their knowledge and skills, others worried about how their presence would effect the lives of the residents in the communities they visited.
“I was worried about our impact on the culture and the community here whether it would be positive or not,” said Ellis. “I was worried about the emotions that would ensue during the home visits and the nursing home.”
After seeing how well the 2017 team of students worked together, the faculty members recognized many benefits of having an inter-professional team.
Students utilized their acquired skills and applied them to caring for patients. That strengthened their ability to provide healthcare and perform focused assessments. By working with other health disciplines, the students understood what the other health professional’s job entails.
“They will communicate better and have an understanding of what the nursing students have gone through,” said Ellis. “They will have a reference for what the other professionals have gone through.”
Gaining an understanding of what other healthcare professionals go through in their daily routine is paramount to making a better workplace environment.
“I had that moment where I knew I was making a difference in someone’s life,” said Davis. “You’re able to sit down with the doctor and tell them what’s going on with the patient and give your own assessment. You start to see the same illnesses and know the right questions.”
After hands-on experience and interacting with local physicians, the students were no longer timid about performing the healthcare skills needed to provide care.
“(Students) said that their confidence levels jumped,” said Armstead. “They feel comfortable approaching physicians. What we try to teach them, they already feel empowered to do it.”
Students were immersed into a new culture and learned differences in the healthcare between the United States and Nicaragua.
“It has prepared them for a multicultural world and encouraged them to give back or take part in a study abroad,” said Armstead. “Learning to learn Spanish will help better the care we can give them.”
Adjusting to a new environment didn’t keep the inter-professional students from accomplishing what their faculty wanted for them.
“I thought it was cute to see everyone working together,” said Armstead. “There was one time when a group of (clinical lab science) students sat together and I mentioned they weren’t mingling, but by the end of the week, you couldn’t tell who was in what department.”
By: Allison Fluker
Texas State University’s 34-member inter-professional team spent 12 days in Nicaragua. International Service Learning spent 60 preparing for them.
The team’s trip was divided into three days of medical clinics, two recreation days, one day of house visits, one day of sharing with the community, a service day in the nursing home, a service day in the orphanage, plus group dinners at six restaurants and two trips to the grocery store.
None of that happens without obsessive planning.
In order for ISL staff to decide where to take a medical team, they first have to connect with a community that doesn’t have easy access to healthcare. Some villages are hours away from the nearest health clinic.
“It takes a lot of hours and effort to check on partners from health centers and community leaders to set up or choose a community to work with,” said Pavel Guevara, the ISL country coordinator for Nicaragua.
ISL receives hundreds of requests for their assistance every day. The organization takes these requests and calculates the best fit for the incoming team to provide their services.
“I consider the level of poverty by conducting local visits, checking on the needs of the community, conducting interviews and checking risk factors that are present,” said Guevara.
Harold Mojica, an ISL assistant team leader, said the community leaders, who are typically doctors or pastors, send word to ISL that they’re interested in having a service team come to their town.
In Nicaragua, there are private and public healthcare outlets. If someone has a steady paying job, they more than likely qualify for private care.
“The company you work for covers 16.75 percent of your costs; 6.25 percent is taken out of your earnings from your salary and the government covers the rest of the costs,” said Mojica.
Basic care is covered, but if patients need an MRI or an X-ray they have to pay out of pocket. Often, rural residents cannot afford specialized health services. The GDP for 2015 in Nicaragua was $1,849 and a large number of residents cannot afford private healthcare. They receive only basic care, such as check ups, through public health services.
“Public care is for someone who doesn’t have a steady paycheck or can’t afford the costs of private health care,” said Mojica. “The people in the villages don’t pay for insurance. They live day by day on the earnings from their work that they bring home that day.”
Families who live in rural communities must choose between healthcare or buying food and supplies they may need. That’s where service organizations, like ISL, come in.
“We choose communities that don’t have health centers nearby,” said Massiel Vilchez, an ISL assistant team leader. “That shows that they don’t go to the hospital to check on their health often.”
To prepare for the service team’s arrival, ISL staff members visit the communities to meet with the leaders and to check if there are safety concerns. They also inspect the buildings where the clinics will be held.
“We go to the communities a couple of times to see the space (in the building) and to figure out the placement for distributions and where the teams will be going,” said Vilchez.
Mojica said churches or school buildings are typically used because people in the villages can easily identify them.
“We use the church because it creates a good atmosphere with good benefits for the communities,” said Vilchez.
Guevara consults with the Ministerio de Salud de Nicaragua representatives to obtain approval for ISL to host health clinics.
“We need to go to the ministry of health to get their permission since we’re doing clinics that are involving medicine,” said Guevara. “They give us permission in the area that they think would benefit the most.”
After getting approval from the government, ISL explains to the community leaders what the service team will be doing while in their town.
“We meet with the pastor and explain the dates the team will be there,” said Vilchez. “Then we explain the procedure and that we need guides for the clinic days. We also tell them the average number of people that would be seen.”
Planning after approval
Approval from the health ministry is one of the first steps in the process when placing teams within local communities. The planning process after obtaining approval is lengthy and thorough.
“I make a budget and order which medicines we are going to be giving out for free to patients,” said Guevara. “We have to calculate how many patients per day will be our goal. I have to make sure there will be enough supplies and medicine to give out.”
At the Texas ISL headquarters, staff collects information about the incoming participants of the new service team. Once the team’s information is uploaded into a database, an itinerary can be formed for the trip, which is dependent upon the objective of the incoming team.
“Once the community is selected, we start sending the information (about the community) to the teams,” said Vilchez.
ISL wants to accommodate the team’s needs to ensure its members have the opportunities they want, for example, the Texas State health professions students visited local public hospitals to understand the differences between western medicine and Nicaragua’s.
“The hospital visits are special opportunities because it’s really hard to get the permission from the hospitals,” said Vilchez. “We need to select the staff for the teams. We tell them the specific details of the team’s itineraries and need them to talk to the doctors.”
Tables for 34, please
Part of the planning includes deciding where to take the team to eat.
The ISL staff in the destination country contacts restaurants in advance to receive their menus. ISL visits every restaurant they plan on dining at before the volunteers arrive to determine if they are sanitary and in good condition. They sometimes teach the wait staff keywords or phrases in English to help make the experience flow smoothly. If needed, they teach the staff how to seat and wait on a group of more than 30 people – and each paying their own ticket.
“We need to make sure we go to different types of restaurants with different types of food,” said Vilchez. “The hardest part is the budget. We have to find places that aren’t costly.”
When the volunteers were out working in the clinics, ISL provided lunches. The team members collected information on dietary restrictions from each volunteer before planning the week’s meals.
“We included vegetables and different things so it would have a good balance and try to change the protein every other day,” said Vilchez.
The ISL team plans recreation days for the volunteers to enjoy during their trip. The Texas State health professions team spent a couple of days exploring the Masaya Volcano, Granada City, and spending a morning at Miramar, a local zip-lining company.
Every detail of the team’s itinerary has to be approved by the ISL headquarters before the trip. Any changes made to the itinerary during the trip must be reported to the headquarters office in Texas. When the team decided to eat at the hotel instead of going to a restaurant, that had to be reported.
“We do a report after every day talking about what we did and what happened for the day,” said Vilchez. “If someone gets sick, we have to report it. If there are changes in the itinerary, we have to report it.”
A large amount of thought goes into the selection process of who will be on the team.
Most of the people who work with the ISL team, like doctors and bus drivers, have volunteered their time or their resources. Eight translators and three bus drivers were employed for their services while the Texas State University team was in Nicaragua.
“You always see translators and doctors and transportation providers because its people that have a great sense of service; it’s not a matter of business,” said Guevara. “I chose them because they love what they’re doing.”
Read more about some of the ISL staff members in Nicaragua.
By: Allison Fluker
Desiree Davis was sitting in the window seat of the 28th row on the plane headed for Managua, Nicaragua, that would take off Jan. 2. Her pink neck pillow hugged her neck as she quietly waited for the plane to take off.
Davis is from San Antonio, Texas. She is senior at the St. David’s School of Nursing at Texas State University.
At first glance, she looked calm.
When the plane lifted off from Austin, Texas, she let out a small scream as the air pressure popped her ears.
A team of 24 students from the Texas State University College of Health Professions was on its way to collaborate with the International Service Learning organization in Nicaragua to set up free medical clinics in small villages outside of Masaya.
When Davis found out about the trip last year, she didn’t hesitate to apply.
“We’re so used to being in America, it’s forcing us to have to embrace a new culture we’re not used to,” said Davis after spending a day seeing patients in La Borgoña. “It is important to connect with people who are not like me.”
Davis’ determination to get outside her comfort zone caught the attention of her friends and colleagues.
“She’ll take the opportunity that’s most challenging,” said Madeline Longtin, a senior in the nursing program. “Even if she’s scared, she likes to push her boundaries to see where her limits are.”
Davis does not speak Spanish, but was called on to communicate with patients in their native language. Her nervousness was evident, but she overcame that obstacle and looked people in the eye and nodded her head in understanding.
A Life-Long Dream
Healthcare has always been important to Davis.
During her senior year of high school, she participated in a certified nursing internship at local hospitals and in nursing homes. Her dream job is to be a pediatrician.
“I love working at the bedside with patients,” Davis said. “I love to be there for people and to take care of them.”
Davis has a strong will for taking care of people. When she graduates college, she wants to work at Brackenridge, a level-one trauma center, in Austin, Texas. She ultimately wants to work in an intensive care unit.
“Level one is when you get the most critical patients, like from air support,” Davis explained.
Davis’ love and compassion for patient care have not gone unnoticed from her peers.
“She has so much joy,” said Longtin. “She cares so much, beyond words.”
Davis’ joyful attitude and pleasant demeanor makes her patients feel comfortable and at ease.
“She’ll help you out before she takes care of herself,” said Rebecca Duffy, a senior in the nursing program.
How the Clinics Worked
On Jan. 4, the health professions team was split into three groups and named themselves: Group Peanut, Group Butter and Group Jelly. Each group followed a community leader into the villages to visit residents in their homes and take a medical census. They used this opportunity to invite community members to the clinics, which were held in local churches.
Davis’ group – Jelly – went to La Borgoña, a community near Masaya that received three free clinic days.
“There was a reason why we were there,” said Davis. “We were there to show them love.”
The local residents attended the clinics to receive care for illnesses ranging from diabetes to allergies.
During the operation of the clinic, the health professions students split into groups of two and, with a translator next to them, conducted focused assessments on the patients who had lined up outside the church to be seen.
Davis exuded confidence expected from a seasoned professional. A curious fire raged in her eyes when she consulted with patients.
“You start to see the same illnesses and know the right questions,” said Davis. “It gives you a lot of confidence.”
By the third day of the medical clinics, the previously nervous students grew confident and eager. Their confidence was built, in part, by consulting with the Nicaraguan physicians who pushed the students to utilize the knowledge and skills they learned in nursing school.
“You’re able to sit down with the doctor, tell them what is going on with the patient and you’re able to give your own assessment,” said Davis.
Some students began to assess patients without one of their colleagues by the third day of clinics.
“I was by myself the rest of the day,” said Davis. “I began to ask questions like ‘Has anything changed in the last 6 months?’ A lot of education went into finding out what happened to some patients.”
One patient stood out to Davis. The woman they were performing an assessment on who already knew what was going on with her health.
“We had a 47-year-old woman that was diabetic who was diagnosed 13 years ago,” explained Davis. “When we took her blood sugar, it was 448. In that moment, she automatically knew it was high when we showed her. She started to tell us how stressed she was. Her son had just gone to jail. While my partner, Mady, was taking her blood pressure, we started hugging her and holding her. You could tell she was just so stressed out. We asked Harold, our translator and ISL assistant team leader, to take her to the hospital with one of the buses.”
After the three days of clinics ended, the health professions team returned to the village, Chocoyera, to give back to their community. Everyone in the team went to the store earlier in the week and bought things for the children to play with.
“There were tons of kids,” said Davis. “Everyone was so comfortable with each other. Some of us started blowing up balloons inside (the church) and others set up the health fair outside when we arrived.”
Some students played with children from the community while other health profession students set up a couple of tables outside the front of the church. These students would continue to take blood pressures for local residents and give smaller focused assessments.
“I played with a little girl named Carmen,” said Davis. “She was teaching me little words (in Spanish) the whole time. I asked her what she wanted to be when she gets older and she said ‘doctor.’ I had brought a doctor play set with me and I decided to give her the doctor set. The smile on her face was so breathtaking.”
Davis special moment with the little girl, Carmen, is a small reflection of the experiences many of the other students had that day.
The study abroad to Nicaragua was brief. The health professions team flew out of Austin, Texas, on Jan. 2 only to return on Jan 13. In that time, the students traveled to small villages outside Masaya, a nursing home and to a children’s home. Throughout their time abroad, they performed hundreds of focused assessments and impacted many lives.
“We’re walking into a place where people didn’t choose that lifestyle,” said Davis. “It’s important to count your blessings because you don’t know what that person is going through.”
Davis went on the trip not knowing what was going to happen but she returned home with a bigger understanding of the world, healthcare and the knowledge that she made an impact in so many people’s lives.
“It is impressive to see the locals have so much joy in them even though their situation might not be the best,” said Davis.