Making a world of difference

Nursing student at clinic in Guatemala

Nursing students travel the globe to help patients in need

Faculty members Janis Rice (back row, second from left) and Dr. Frank Puga (far right) work with students to help patients during mission trips to Guatemala. Pictured with them are School of Nursing Class of 2015 graduates who, while they were students, participated in the mission trips. They are (back row, left to right) Adam Rick, Sean Brady, Amy Lynn Rose, (front row, left to right) Christine Johnson, and Ann Lee.
Faculty members Janis Rice (back row, second from left) and Dr. Frank Puga (far right) work with students to help patients during mission trips to Guatemala. Pictured with them are School of Nursing Class of 2015 graduates who, while they were students, participated in the mission trips. They are (back row, left to right) Adam Rick, Sean Brady, Amy Lynn Rose, (front row, left to right) Christine Johnson, and Ann Lee.

Every year since 2006, faculty, students and graduates from the School of Nursing leave their families, work and school to travel to remote villages in Guatemala to provide medical and surgical nursing care to the indigenous Guatemalan Mayans. All of these volunteers pay their own way.
While the distance between San Antonio and Guatemala is only about 1,500 miles, those participating in this international health care mission trip find themselves in a different world.
On this San Antonio Guatemalan Endeavor journey, nursing faculty, students and alumni work with an interprofessional health care team in very primitive environments. There are no state-of-the-art facilities here; the team has limited supplies, devices and medicine that are donated by local clinics, hospitals and practices. Janis Rice, M.S.N., RN, clinical associate professor of health restoration and care systems management, said the experience makes the nursing students “very aware of how rich our country is regarding medical care. They see how little health care is available in other countries.”  Rice, who attended her seventh mission trip last summer but has coordinated the trip since 2006, said the equipment and the clinic set ups are austere. During the last two years, the group has arranged the clinic in a vacant military hospital. “Because of the primitive facility, students get an opportunity to become proficient in so many skills. They also see the dynamics of coming together as a team. They learn how to deal with conflict.  “The students live in barracks with cots and sleeping bags. There are 40 to 50 people per barrack. The bathrooms are definitely not what they are used to. There is no privacy,” Rice explained. “We have communal dining that brings the team together. Those who come on these mission trips make friends forever.”

A week of hard work
The volunteers arrive at the medical site in Guatemala on a Sunday and immediately start setting up the hospital with supplies they have brought with them on the plane plus supplies provided by HELPS International, an organization created in 1981 during the country’s civil war. HELPS International was begun by a Dallas investment banker who brought aid to the war-torn country. The nursing school first participated in the HELPS International mission trip in 2006. Faculty and students became members of San Antonio’s local team, the San Antonio Guatemalan Endeavor.  HELPS International and the Guatemalan government decide each year the location of the temporary hospital. The nursing school volunteers work with health care providers from around the United States and Europe during their 12-day mission.  Surgeries begin on Monday and run through Friday. A HELPS International team will already have patients lined up. “We always have more patients than we can handle,” Rice said. “The local residents are always so excited that we are back for our annual trip. We are loved and respected by the Guatemalans.”

The School of Nursing volunteers learn the challenges of treating patients who do not speak English. The Guatemalan dialects are very different, she said. The health care providers rely on high school students from Guatemala who serve as translators. “These young Guatemalan students see a different part of their country. They learn a lot too.”

Nursing students provide direct patient care in triage, a preoperative/intra-operative setting, a post-anesthesia unit, and the post-operative arena. In addition to performing surgical procedures, the team also offers eye exams, eyeglasses and dental care. A mobile medical team travels to even more remote areas to see patients.  “We usually see around 200 people a day,” Rice said. “Our nursing students help in many ways. They spend one day with the mobile team in the very remote areas. They spend a day working in pre-op preparing patients for surgery, and they work a day in post-op caring for patients after surgery. Nursing students also spend half a day in the operating room and the other half in the post-anesthesia unit.  “It is hard work, but our students learn so much. They love it. The clinical exposure is huge for them,” Rice said. The students also spend one day installing cement floors, stoves and water purification systems in the homes of Guatemalan families.  The volunteers build what is called an ONIL stove, which was created by HELPS International in response to the amount of burns to children and smoke inhalation exposure from the floor fires traditionally used by residents. The mission volunteers build a clay-fired firebox in an insulated, durable stove that sits off the floor, which minimizes the risk of burns to young children. The stove also uses one-third of the wood compared to the traditional method.  Nursing students also install the ONIL Gravity Water Filter so families have safe drinking water. The water filter removes parasites such as guinea worm and giardia and pathogenic bacteria such as cholera, E.coli and shigella. The team of volunteers is helping prevent future health issues.

Undergrads volunteer
Rice said every year five undergraduate nursing students participate in this unique international mission trip. The trip has been part of an Accelerated B.S.N. Students Immersion Course for the past five years. The experience helps students meet The Essentials of Baccalaureate Education for Professional Nursing Practice competencies.  Last summer, five registered nurses, who are graduates of the School of Nursing, brought their years of experience to the team.  Christine Ledder, RN, said she attended the trip in 2012 as a student and decided to return as a registered nurse. She works in the neurotelemetry unit at Methodist Hospital.

“I grew a lot as a nurse on that first trip. I learned so much. I was absorbing knowledge the entire time,” she said. “I decided to come back as an RN because I felt like I could contribute much more now.”  During her initial trip, she said she learned from the professionals about team work, safety and flexibility. “During my second trip, it was challenging, and I still learned a lot. I really appreciate how people who don’t know other each other can come together as a team.
“When I returned to work after my second trip, I came back with a huge appreciation of the support staff, such as the phlebotomist who takes blood and the housekeeper who cleans the rooms. We did it all on the mission trip. There was no support staff. I really appreciate them much more.”  Ledder said her experience in Guatemala as a student inspired her to return later. “I’m so happy that I chose a profession where I can give back to the global community.”

Graduate students provide care
In the summer of 2015, Kathryn Parke, D.N.P., M.S.N., RN, CPNP, clinical assistant professor of family and community health systems, went on the trip with two family nurse practitioner students.  Dr. Parke, a pediatric nurse practitioner, said the graduate students rode out with the mobile medical units with military escorts to remote villages. They set up a health clinic in a village named Todos Santos, which the organization had never been to before.  “We set up in an empty building and saw adult and pediatric patients for two days. We saw a lot of women with ob-gyn health issues. We saw children with asthma, diarrhea and dental caries. Everyone was treated for parasites,” Dr. Parke said.  She said they referred some of the residents who needed surgery to the hospital. The two family nurse practitioner students worked with adult care providers who were very pleased with the level of care they administered.  “The physicians said our two family nurse practitioner students allowed them to provide a volume of care higher than ever before. That was really great to hear,” Dr. Parke said. “While our students provided health care, they received a lot in return. This experience gave our students, who have only seen health care in the United States, an entirely new perspective.  “Our students had to use their clinical skills and judgment. They didn’t have all the resources they have here,” she said. “They worked with and respected the different cultures. This is so important because global health is one of the missions at our nursing school.”  Rice said after providing a week of health care, the students, faculty and graduates spend Saturday packing and conducting inventory of all supplies. On Sunday, the team headed to Antigua for much deserved rest and recreation. Each person pays $2,125 for the trip.  “I have been fortunate to take this trip for seven years. I truly enjoy seeing how the trip changes the students,” she said. “I am always impressed by their commitment to their profession. It is wonderful to see how they grow during the 12 days.”

Interprofessional teamwork
In addition to providing health care, stoves and water purification systems to local residents, the School of Nursing is also performing research on teamwork and cultural competency during the San Antonio Guatemalan Endeavor mission trip. A few years ago, one of these annual mission trips raised the issue of how to improve team performance with a group of strangers.  Frank Puga, Ph.D., assistant research professor in the School of Nursing, said in this unique environment, challenges exist to achieving successful team work.  “The challenges include limited resources, language barriers and working with individuals who they usually don’t work with,” he said. “These challenges can impact how well the team communicates, the clarity of team member roles, and ultimately the safety of patient and team members. To promote a culture of safety, we looked at adopting evidence-based strategies to facilitate effective teamwork.”
As part of the research, they introduced concepts and strategies to the approximately 100 individuals who went to Guatemala.  “We trained the individuals on strategies to improve teamwork. They practiced teamwork scenarios of difficult situations they might encounter during the trip. This was first done the night they arrived in Guatemala before they saw any patients,” he said. “In preparation for the week, we evaluated their perceptions and attitudes toward teamwork. We also identified and discussed barriers to teamwork they might experience,” Dr. Puga said.  With this information, the research team was able to anticipate and respond effectively as a team to difficult situations. “During the training, we learned a lot about the situations the team was most concerned about and how effective teamwork can result in better outcomes. During the week they were delivering care, we performed observations and video recordings to get a sense of how the team was functioning in real time.

“What we found was the training really seemed to help facilitate teamwork. Specifically, we identified opportunities for improvements such as defining roles before going to Guatemala,” he said. “We think this research is important and contributes to the larger body of knowledge related to global health. Delivering care in an international setting has its unique challenges and approaches that can benefit from effective teamwork strategies.”
The researchers also had the opportunity to assess the student experience. “They get a unique experience to learn about teamwork in an environment that is very different than what they have learned in clinical at the nursing school.

“We assess the students’ perceptions and attitudes toward teamwork before and after the trip. We are finding the students are leaving the experience with a stronger sense of what teamwork looks like and the skills they can transfer to their career as a nurse,” Dr. Puga added.  Based on the research performed in Guatemala, Dr. Puga and Rice were asked to co-present their findings at the International Council of Nurses Annual Conference in Seoul, South Korea, last summer.

“This project spoke to the themes of global health, international learning experiences for students, and teamwork across international boundaries,” he said. “Presenting at an international conference in Korea gave us the opportunity to learn about other countries’ and universities’ ways of approaching the issues of teamwork. This experience helped shape our understanding of the importance of teamwork for global health. It highlighted the value and importance of our School of Nursing’s research and education activities.”

Article by Catherine Duncan

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