To see the Texas State University respiratory care students in action at Georgetown Public Hospital, watch the video below:
To see the Texas State University respiratory care students in action at Georgetown Public Hospital, watch the video below:
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
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.
Let nursing student Danica Topham walk you through the clinic process from triage to pharmacy; something that could take an average of an hour, but summarized in a minute.
When the St. David’s School of Nursing students from Texas State University signed up for two weeks of volunteer service at a third world country, they knew it wouldn’t be the same as providing healthcare in the United States.
What was not completely expected was that the experience would require them to use skills from their first days of nursing school and provide an opportunity to immerse themselves in the culture through the Nicaraguan people.
Stepping out of the comfort zone
Elizabeth Biggan, clinical assistant professor at St. David’s School of Nursing, said she prepares the students by talking to them about the poverty that they’ll see. She also shows them videos from previous trips, but she can’t fully prepare them for the clinics.
“Every bit of school that they go through at home is in a hospital where all equipment is readily available. All medications are readily available,” Biggan said. “It’s hard on the students to have a patient who needs medication, but they don’t have it and they have no way to get it. They really have to learn to adapt to the situation, but they also learn to get creative with their solutions.”
Experiencing those situations is what makes students’ nursing skills grow. In the Nicaragua clinics, they can’t rely on machines for reassurance.
Students manually check vital signs like blood pressure and temperature, something most haven’t done for four semesters. Biggan said this is where students step out of their comfort zones and learn to trust themselves.
The language barrier
The nursing students ranged from feeling confident with Spanish, to remembering some words from Spanish class in high school, to not knowing any Spanish at all. Some prepared for the clinics by studying the anatomical terms in Spanish. Others had to learn on the spot or rely on the translators, but the difficulty was part of the volunteering experience.
“The first house visit was mostly people looking at me and at one point even laughing, like ‘what is this girl saying?,’” said nursing student Bridgette Young. “By the end they were really understanding me and actually answering back without the translator.”
Massiel Acetuno, assistant team leader, said it’s difficult for the students to have social conversations when they’re not able to fully express themselves in the foreign language.
The students used their broken Spanish, hand gestures, facial expressions and voice pitch as they tried to make connections with the people.
“Volunteers try to do signs or play with the kids to bond with them,” Acetuno said. “Sometimes I feel helpless when I see them struggling with language but I like to see that even though they’re not speaking the same language, it’s like their souls connect.”
When people of different cultures meet
Acetuno, who is constantly introducing new people to her culture, said she enjoys it because it’s her chance to tell people why she’s so proud of being Nicaraguan. Acetuno describes Nicaraguans as people who welcome visitors and who receive them as family members.
“I love the most when we go to house visits and clinic days and they’re able to see by themselves that I wasn’t lying, that everything I said was true,” Acetuno said. “People still welcome you even though their houses are really poor, they always say to you ‘come in’ without any fear, without any doubt.”
The house visits to the communities are the first opportunity that the nursing students get to interact with Nicaraguans.
“They’re going to give you all the chairs for you to sit down. These people are so nice, so selfless,” nursing student Jessica Ramirez said. “They don’t have a lot to offer but they still keep offering.”
International Service Learning, the organization that plans the volunteering trips, identifies rural areas where healthcare is not easily available. This means that the conditions will be some that the students may not have seen before.
There were latrines, houses with dirt floors and without doors, wood cribs and unpaved roads. Despite the conditions, Nicaraguans displayed something else to their visitors.
“Happiness. They only show how grateful they are for the things that they have,” Acetuno said. “You may not see in their faces pain or sadness. You may not see depression, but most of the people that we see in the communities have huge problems. Sometimes they don’t have anything to eat that day.”
On the final day at the communities, the students handed out rice and beans, played games with the children and broke a piñata. It was a day to forget about nursing work and interact with the community they had been helping.
“I think the most difficult thing was giving the families rice and beans,” Ramirez said. “When we handed the parents food, that was real. We were giving them a means to survive for a week.”
Acetuno said that at the end of the trip it’s not just about helping people but also about taking the time to understand their situation, understand their history and why they are the way they are.
For nursing student Rachel Nading, leaving Nicaragua was the most difficult thing.
“I feel like it’s not enough. I feel like I could do more,” Nading said. “More in medical care, in treating people, just more.”