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.”
The Texas State University students embraced the people and scenery that Nicaragua had to offer. This video compiles a single second from every day of the two weeks abroad.
Jan. 4 – The Momotombo volcano greets the Texas State professors and students as they arrive in Managua, Nicaragua.
Jan. 5 – The team has dinner by Lago Xolotlan (Lake Managua) at night.
Jan. 6 – Nursing student Jasmine Casey plays with a baby boy during the house visits at the San Joaquin community.
Jan. 7 – The first group of nursing students visit the Dr. Humberto Alvarado Vasquez hospital in Masaya.
Jan. 8 – Three girls from the San Joaquin community, Liz, Ashley and Nicole sing one of their favorite songs.
Jan. 9 – Nursing student Jasmine Casey gives piggyback rides to the kids of the San Joaquin community on her free time.
Jan. 10 – The nursing students paint the walls at the orphanage Hermanas Siervas del Divino Rostro.
Jan. 11 – TxState Global News Team member Amanda Gibson waves as she zip lines through a coffee plantation.
Jan. 12 – Nursing student Emily Estes takes the census at a home from the Campuzano community.
Jan. 13 – Dr. Melina Quezada offers advice to nursing student Lucy Vitek while at the clinic.
Jan. 14 – Nursing student Anastasia Houze takes the vitals of a baby while at the clinic.
Jan. 15 – Nursing student Bridgette Young carries a boy around the circle while playing Duck, Duck, Goose.
Jan. 16 – “We just got in trouble,” nursing student Michelle Juarez said. She had been walking a woman who had turned 110 years old the previous day. The woman wasn’t allowed near the door because she liked to run away.
Jan. 17 – The team spends their last day in Nicaragua at Pochomil Beach.
Jan. 18 – After two weeks out of the country, the team completes the final element of the trip: landing back in Texas.
Michelle Juarez arrived at Hogar San Antonio – a nursing home in Nicaragua – with her fellow classmates of the St. David’s School of Nursing at Texas State University on Jan. 16.
Like the rest, she walked into the infirmary and soon noticed the single patient who lay in a bed. Her name was Petrona and she had been at the nursing home since 2007.
In the two weeks prior to the team’s visit, Petrona’s kidneys had started to fail her. Juarez had been taught that once the kidneys go, everything goes.
Petrona was now in sepsis and had anasarca all over her body. She was in hospice care, but her family didn’t want her to receive any other type of care. The only thing she was getting was normal saline to keep her hydrated. She couldn’t drink anything because of the risk of aspiration pneumonia.
Knowing that Petrona’s mouth was probably dry, Juarez went for a gauze, moistened it with water and swabbed Petrona’s mouth. Another student gave Petrona drops of water.
Petrona’s sounds from her struggle to breathe filled the room. Petrona needed oxygen. She didn’t have it. She needed pain relief. She didn’t have it. She needed someone to hold her hand and comfort her. Petrona would probably pass away in her sleep, so Juarez prayed for her and loved her in every way that she could.
As a senior in her last semester of nursing school, Juarez will soon be in many more situations similar to Petrona’s because she wants to be a critical care nurse. She said that being Petrona’s nurse that morning helped confirm her decision.
“When you’re a student you have no clue as to how you’re going to be as a nurse, you need that confidence, so caring for her honestly made me feel great that I know what I’m doing and that I can handle this,” Juarez said. “My desire to help critical patients is stronger than my desire to go cry in a corner. I don’t do that until later.”
The fast pace of the emergency room and intensive care units give Juarez an adrenaline rush.
“It’s just something about having to learn every day,” Juarez said. “You don’t know what’s going to happen but you’re ready to be there.”
One of Juarez’s reasons for pursuing a nursing career is because her little brother has Down syndrome so she was exposed to the medical environment at a young age.
Juarez will be the first person in her family with a four-year degree and now that she’s about to graduate, her parents, little brother and patients give her the drive she needs to continue.
“Every single patient that I have encountered, I remember their stories. I remember their family. I remember their faces,” Juarez said. “And it’s not easy. It is the hardest thing I have done in my entire life, but it’s definitely worth it. If you ask any of us, we all have patients that have stuck with us already and we’re not even nurses yet.”
At 21 years of age, Juarez is one of the youngest in her nursing class, but that doesn’t stop her from being a leader.
Shawn Boyd, clinical associate professor at Texas State University, said that Juarez has the three skills that professors look for in nursing students: critical reasoning, dexterity and caring. Although the third skill, being caring, can be tough to teach, Boyd said that’s what makes Juarez stand out.
“She looks patients in the eye. She uses touch. She does all those things that might be somewhat uncomfortable for some people. She is an exemplary student,” Boyd said.
Juarez often chooses the most difficult cases to challenge herself. She takes the sickest patients. She takes initiative. She is confident. She doesn’t doubt her nursing abilities. Yet, Juarez is humble and loving toward everyone.
While in Nicaragua, Juarez helped her peers improve their Spanish and even cooked dinner for more than 30 people. She bought snow cones for kids at the San Joaquin community and gave her backpack to an elder at the nursing home after he asked if she could bring him one the next time she visited.
“I don’t have anything to lose by giving someone something that I don’t need,” Juarez said. “The man then said ‘Que Dios te bendiga’ (God bless you). The happiness that I gave him is unmeasurable.”
For Juarez, the best part of her day is talking to her patients.
Boyd saw that eagerness in Juarez and describes her as a patient advocate. Boyd sees Juarez as continuing to do work with people who do not speak English either in Latin America or on the Texas border, contributing for those who are underserved.
Alexandra Orzech, nursing student and fellow classmate, said it’s important to Juarez to protect a patient’s dignity.Juarez is respectful: she explains what she’s going to do before starting. And she is a good listener to her patients.
“I think she’s going to be an awesome nurse. She’s book smart but she’s also personable. When she’s with patients you can tell there’s more than a textbook behind her knowledge,” Orzech said. “She’s very at home at the hospital. You can tell that’s where she’s supposed to be.”
An immersive study abroad program in the School of Journalism & Mass Communication