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Global Health Nursing 2017

Image by David Torres Costales / @DavoTCDavid Torres Costales / @DavoTC (Wikimedia)

 

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2017 Recap: Riobamba, Ecuador

In January 2017, eleven students were accompanied by Dr. Norma Hannigan for a service learning experience in Riobamba, Ecuador, for the Global Health Nursing elective course offered in the winter session. The class arranged the 10-day trip with MEDLIFE (Medicine, Education and Development to Low Income Families Everywhere), an organization that partners student volunteers with local agencies to improve health.

The GHN course and field experiences focused on population health, cultural awareness, social justice, and health disparities. Students were matched with health improvement projects, working with MEDLIFE teams on initiatives such as mobile clinics, building of schools, latrines, environmental safety improvements or others. The MEDLIFE program incorporated education about local health and education systems, social determinants of health, culture, and reflection on the service aspect of the activities.

In addition to classroom and in-country lectures, discussion, and guest speakers, students worked with MEDLIFE groups each day from approximately 6:30 AM to 5:00 PM while in Ecuador. The typical Mobile Clinic week includes four days volunteering on-site at the Clinic, one day working with local community members on a development project (i.e., a stair or bathroom construction project), and two days of cultural tourism. Each day, students met with MEDLIFE staff to discuss community needs around health, education, and development.

 

Video Slideshow

Slideshow courtesy of Sara Haefner

 

Student Reflections and Photos

 

How did you feel as you left your home for Ecuador?

"When I left my house to go to Ecuador, I felt great anticipation! I knew that I would be volunteering my services (to an extent) to people from underprivileged communities. I still didn't fully know what to expect. I wondered about the different culture, could I communicate with the people knowing that there was going to be a language barrier? Would I get sick eating the food? Who would my roommate(s) be, would our personalities mesh or clash? What would my specific duties entail? Pre-trip preparations made me wonder "what did I get myself into?" Needless to say, all of my anxieties were alleviated." -Michelle


"As I was heading to the airport for my trip to Ecuador, I felt equal parts anxious and excited. I had been looking forward to this trip since the first time I saw the email about this opportunity. I couldn't believe that the day had finally come. I was especially nervous because I have never taken Spanish, and I wondered if I would feel stupid or worry so much about speaking that I wouldn't enjoy my time there.  However, I was so happy that I knew someone going on this trip, as I originally thought I wouldn't know anyone. In the past few years, I had seriously looked into a few different medical mission trips, but I never seemed to feel compelled to really pursue it. For some reason, this trip stood out, and I feel like it was the right thing at the exact right time, because something in me just HAD to do it. This is why it felt so surreal as I closed the door behind me to head to the airport. I had no idea what to expect, but I knew that my experiences could be eye opening and life changing. The very last thing I said to myself as I locked my door was, 'How lucky am I?'" -Sara

 

Mid-week reflection: What surprised you the most about MEDLIFE, Riobamba, and the people & environment of the community?

"This is the middle of our week in Riobamba; the things that have surprised me most are MEDLIFE's ability to coordinate multiple mobile clinics with the involvement of over 100 volunteers. It took much strategic planning to run multiple clinics concurrently. While things may not have been perfect, undoubtedly, their efforts to address the health care needs of those in the rural communities of Ecuador are greatly appreciated by the community members. The fact that some women prefer to have their pap smear testing done by MEDLIFE as opposed to the public clinic or hospital is because MEDLIFE gives them their test results. To me, this speaks volumes about the consistency of the services offered to the community members.

While the city of Riobamba continues to be a developing city, the rural areas house communities that lack significant development. How can people live without safe running water or safe sanitation? Why is the lack of safe running water the norm? These are basic necessities that many people from developed communities take for granted. I realized that although they may not possess these basic necessities, they seem to be content with their lives/lifestyles. The community members always greeted the staff and volunteers with a smile, a "buenos dias" greeting and a handshake, making the volunteers feel welcomed and appreciated.

I'm also appreciative of the fact that the doctors don't mind encouraging patients to incorporate the use of herbs for medicinal purposes. I heard a doctor instruct a patient to use a particular plant by boiling and drinking it as a tea to aid in her treatment regimen in conjunction with the medication prescribed for her. This practice is not common in the United States and is often discouraged due to potential drug interactions; however, the doctor, knowing the culture of the people that she was treating, thought it important to include home remedies into the patient's treatment plan." -Michelle


"...the thing that surprised me the most about MEDLIFE is their efforts to bring their clinics to people in the most remote places. While the community we visited on Monday was only 45 minutes away, on Tuesday I truly recognized why the people in the community of Alausi struggle to have access to this basic right. We were ultimately lost, asking locals for directions, taking the wrong road, and having to go all the way up a mountain until we got to the closest town to make a U-turn to go back down because the roads were too narrow. It took us over 2 hours to get to the community that day, and I can only imagine how difficult it must be for members of the community to get to the nearest hospital or health center.

One thing that surprises me about the people and environment of the community is their humility and appreciation for the small things we are doing to help. Although on Monday the waiting room/education station was hectic to say to least, the communities were always happy to have us. On Monday, I was honestly shocked that so many women were eager to have a pap smear. I later heard that their community health centers fail to send them their results and only perform the exams for government compensation, so when they heard we were coming the women decided to seize this opportunity to get real results.

On Tuesday, I thought it was beneficial to have the students from a nearby school come with their teacher to the mobile clinic as a 'field trip to the doctor’s office.' While there was a downside, such as having unaccompanied kids receiving medicine at the pharmacy, I tried to look on the bright side of things. For example, I witnessed the doctor perform stitches on one boy’s finger, a necessity that he likely would not have received had we not been there that day. Also on Tuesday, the environment of the tightknit community was evident because it seemed as if all the men in the village worked together to try to free our trip leader Kristine from the bathroom that morning. This one example of their unity and disposition to help truly resonated with me because although every community was different, its members manifested these same values, whether it be in this mini crisis or helping us set up the electricity for the mobile clinics." -Julie


"What surprised me the most about MEDLIFE is their commitment to the communities they serve beyond medical care. I knew we had the stair building project built into our week, but I didn’t realize until I saw the wall that MEDLIFE built in a small community at the bottom of the long road to Llin Llin de Santa Fe, that these projects were common. I also didn’t realize that MEDLIFE does follow-ups with the patients who prove to be at a greater risk by making house calls. I think what surprised me most about the people that MEDLIFE serves is their shear strength! From the little time we spent working with them on the stair project, I was just blown away by their balance while they practically ran up and down the steep hillside with no path in front of them, by their strength while they hauled sandbags filled with three or four times what we dragged for two feet, and by their attitude throughout the whole thing. They are a strong bunch." -Ellena


"...that Medlife is run by young people (group leaders) who are devoted to making a difference in people’s lives and future generations. For example, Sebastian (one of the project leaders) is from Riobamba. He is living and studying in Australia now. However, Sebastian volunteers for Medlife during his winter break to help the community. It is inspiring to see such young people who are not indifferent to their nation.

...[that] Riobamba is a developing city. At first I thought that it is a very large village. However, a closer look revealed that Riobamba is an urban city with universities, hospitals and night life.

...[that] the Quechua population is isolated from Riobamba. They do not own cars, and city buses run 2-3 times a day. As a result, indigenous people are cut off from the urban environment. Moreover, I was surprised at the lack of necessities of life in Quechua communities. For example, some families do not have housing, clean drinking water, or proper clothing. Despite these difficulties, people are positive, friendly and extremely hard working." -Lidia


"MEDLIFE: With so many volunteers, they were able to keep the mobile clinics well organized and had a consistent flow from station to station with minimal hiccups. I was impressed with how the local doctors and dentist would work through the day without any breaks or lunch. During one of the meetings, to my astonishment, Sarah mentioned that MEDLIFE is not funded by grants, but by donations. I couldn’t believe how much they are able to do without a grant. I was also pleasantly surprised when I discovered that MEDLIFE had a follow up care program. My favorite patient story was that of Rodrigo C. I loved that MEDLIFE not only funded Rodrigo’s surgeries but also built him and his family a house to live in.

Riobamba: I really did not expect Riobamba to be as beautiful as it was. The scenery near our mobile clinics in Guamote and Guano were just breathtaking, not forgetting the amazing view of Chimborazo. Furthermore, the culture is unlike any other culture I have seen. I am a dancer, so when I saw the different costumes and traditional dances at the parade, I was left intrigued by it all.

The people and environment of the community: The first thing I noticed was that many people from the communities would greet you with a handshake, irrespective of their age. It showed me how much they appreciated our presence. I also became fascinated with how the women would carry their babies on their backs--I had never seen this before. During my rotations through the hand hygiene and tooth brushing stations, I was impressed at how enthusiastic the children were to wash their hands and brush their teeth. From my own experience, I know that many children do not like to wash their hands or brush their teeth so it was refreshing to see this." -Sabrina

 

What have you seen or learned during this week that correspond to the readings from this course?

"...Seeing the people in these communities get sick (and sometimes die) from diseases and infections like parasites, that are preventable, is unacceptable. The health inequities are caused by unequal distribution of power, income, goods, and services. I felt like this was clearly seen in the population that MEDLIFE treated. If a patient becomes sick, they have to travel for hours and hours to get to a hospital to be treated.  These people do not have appropriate access to health care. MEDLIFE can help these populations by educating the people about chronic diseases, infection prevention, and how to prevent parasitic infections by boiling the water. These steps are being done at the mobile clinics." -Erica


" 'No one sets out to ignore equity, but the way we frame issues of causality and response typically fails to give it due consideration.' This Paul Farmer quote made me enter and exit this experience in a different light; that I have to believe there were more good people than not. The injustice in the health equity is not primarily caused by cold-hearted individuals willingly ignoring the issues at hand, although sometimes it is easiest to come to that conclusion. Trips like these are to help the people, yes, but also to raise awareness of the true root of the problem and to keep the injustice from continuing. Every community is different, Paul Farmer reminds us to dive deep into a global community and really seek out what it is that they specifically need, beginning with medicine and education. The well should take care of the sick because access to health care should not be a luxury but must be considered a human right." -Jessica


"Political power can ultimately control the livelihood of people and what they have access to. As we previously read and discussed, political stakeholders can have the power to make changes that greatly impact health disparities. During my time in Riobamba, we discussed how political figures changed the history of Ecuador, specifically with the currency change from sucres to US dollars. This changed the economy of Ecuador, and ultimately changed how people were able to access money and necessities. While I was in Ecuador, I couldn't stop thinking about why leaders of a nation would put up with the health care issues plaguing its people. Why aren't leaders taking more initiative to place priority on clean drinking water and access to health care? Why is there a health care system in Ecuador that seemingly applies to all people, yet has so many barriers to prevent people from actually gaining access?  It makes me wonder what could be accomplished if these leaders fought to close the gap so that people could stop dying from preventable disease and start getting the care they deserve." -Sara

 

End of Trip: What is your greatest learning so far?

"This is the end of our week in Riobamba. My greatest learning so far has been that no matter what your circumstances are, you can find joy and peace in anything. The people that we have helped over the week have showed gratitude and have smiled almost every step of the way. Their outpour of gratitude has not only humbled me but it has touched my heart in a way that I can never forget them. At the inauguration when they continued to say may God bless you, I felt tears come to my eyes and this was something I was not expecting. I also learned that I can push my body farther than I originally thought. A little over a year ago, I tore several ligaments in my left ankle, and I had to go to physical therapy for almost six months to learn how to walk again with a steady gait, now I have climbed almost a mile up the Andes mountains, 12,000 ft. above sea level and worked until I was told to stop. I feel pride in that accomplishment and the good work we have done there." -Kristina


"My greatest learning so far has been knowing that we helped a total of 872 adults and 302 children during our week in the different mobile clinics. While I could acknowledge that we were busy all week, it was nice to finally put a number to it during our brief meeting during dinner on Friday. Also, knowing that 25 of those patients will receive follow-up care that most likely would have not occurred had they not come to the mobile clinic that day reassures me that our small actions did make a difference in people’s lives. I had the opportunity to witness the doctor perform an exam on one of these patients later deemed to receive follow-up care. The patient stated that she was losing sight in her left eye and then afterwards mentioned that she was has been losing sensation in her left side of the body for a while now. This is an important because the hemiparesis could be attributed to a stroke and needs further care and testing. Therefore, knowing that the nurses will be checking up on her is comforting. It also demonstrates that our actions have an impact on people in the community, whether it be on the individual level as with this woman, or on the community level such as the staircase we helped build atop the mountain." -Julie


"My greatest learning so far has been to not take things for granted. You do not realize the worth of something until its gone. For example, a staircase may seem insignificant but when it is not readily accessible to you, you begin to realize the value of it. On Friday, I was at the project site and it left a great impact on me. Climbing 12,000 feet once without a staircase was quite difficult and unsafe; I cannot imagine how the people of the Llin Llin community navigated through this steep hillside everyday. Witnessing women of all ages carrying sandbags from the top of the hill to the bottom and back became my strength during this developmental project. In the US, we usually have a choice between taking an escalator, an elevator, or stairs but these people do not have that choice. Stairs to this community is considered a luxury and because of this experience I now hold a higher value to stairs. Moreover, the inauguration ceremony was one of the most humbling experiences. I was brought to tears when the community leaders continuously expressed their gratitude and told us that we will be blessed in our lives." -Sabrina

 

Post-Trip: How has this service learning experience affected you?

"This service learning experience has changed me in the following ways: to bring me back to why I became a healthcare professional. The fundamental reason for being a nurse is to be available for people who are in need of your helping hand and just be there for them. Also, as collective efforts, things can be changed for the better. On a personal level, I was once again reminded of how fortunate I am in where I live and work. There are so many things I take for granted and this trip was such a great reminder that I should be more thankful every day. I had a great time with everyone in the group that was a definite bonus of this trip." -Dorothy


"I think it’s going to be tough going back to work tomorrow. This experience is something I will carry with me for a while. It makes me realize that I can do more and should do more, on both a “global” scale and more locally. A lot of the problems that affect the indigenous population of Ecuador are strikingly similar to problems that our own poor or marginalized society faces here in the US. Even if we don’t have time to take trips like our MEDLIFE trip, we can still do our part by being more active in politics. Nurses are a giant force and it is widely known that as professionals we are considered to be trustworthy, and for that reason, people should listen to us! The work of Nurses United is a great example of this. I think it is very important that we leave the bubble of our hospitals and classrooms and see the bigger picture and get involved in any way possible." -Ellena


"...I have learned the beauty of nursing care in a holistic perspective so that when I care for my patients, I will be mindful of their religious beliefs, medical wishes, social and environmental conditions that are influencing the progression of a medical condition, rather than just providing repetitive, routine care. By advocating and being involved in nursing politics such as health care reform, international and local nursing groups, one can support or create regulations that would benefit the designated populations. Likewise, as a nurse, I need to continue to be involved in direct community health outreach programs as well as support and act on global health injustices to promote equity and equivalent medical coverage for all. The mobile clinic helps one develop intellectually, and the various tasks at each station enhanced my nursing skills. From the service, I learned the significance of being flexible, tailoring care to the population’s needs, and most importantly, in order to have advancement in communities, the inhabitants’ social determinants must be improved. When global problems arise such as malaria, its reduction of the community’s morbidity and mortality requires cooperation from all nations. Learning about global health nursing in Ecuador has been an eye opening experience. Being part of MEDLIFE’s movement by helping at the mobile clinics to working on the staircase...it was fulfilling to see how MEDLIFE’s efforts are establishing effective educational workshops, renovating unstable infrastructures, and helping all have access to medicine. I defiantly look forward to participating in other global project, as it is a meaningful experience." -Jessica

 

View more photos on MEDLIFE's Facebook page

Kids waiting for toothbrushing lessons in La Moya, Ecuador
Kids waiting for toothbrushing lessons in La Moya, Ecuador
Ellena Crotty, AGNP student, teaches toothbrushing at a community center in La Moya, Ecuador
Ellena Crotty, AGNP student, teaches toothbrushing at a community center in La Moya, Ecuador
A boy receives toothbrushing lessons in La Moya, Ecuador
A boy receives toothbrushing lessons in La Moya, Ecuador
Students working at a community mobile clinic
Students working at a community mobile clinic
An outing to Guano
An outing to Guano Bottom to top: Jessica Tovar, Erica Thomas, Julie Moreno, Jessica Uyaguari, Kristina Way
A day at the community center mobile clinic, Manuel Lasso, in Chimborazo, Ecuador
A day at the community center mobile clinic, Manuel Lasso, in Chimborazo, Ecuador Back row L to R: Michelle Maxwell, Erica Thomas, Lidia Tskhay, Kristina Way, Ellena Crotty, Sabrina Raghunand. Front: Dr. Hannigan, Jessica Uyaguari, Sara Haefner, Julie Moreno. Missing: Dorothy Park and Jessica Tovar--they were building a staircase in another town!
A sign for directing visitors at the community mobile health clinic
A sign for directing visitors at the community mobile health clinic
Students working at a community mobile clinic
Students working at a community mobile clinic
A student prepares a glucometer at the mobile health clinic
A student prepares a glucometer at the mobile health clinic
A student takes a blood pressure reading at the mobile clinic
A student takes a blood pressure reading at the mobile clinic
A student assesses a patient at the mobile clinic
A student assesses a patient at the mobile clinic
Students working in health education
Students working in health education
A student observes a dentist at the mobile health clinic
A student observes a dentist at the mobile health clinic
A student poses with children from the local community
A student poses with children from the local community
A student assesses a child at the mobile clinic
A student assesses a child at the mobile clinic
Students working at the pharmacy within the mobile health clinic
Students working at the pharmacy within the mobile health clinic
Finally, the whole group together!
Finally, the whole group together! Back row L to R: Kristina Way, Michelle Maxwell, Sara Haefner, Sabrina Raghunandan, Lidia Tskhay, Dr. Hannigan, Ellena Crotty. Front: Julie Moreno, Erica Thomas, Dorothy Park, Jessica Tovar, Jessica Uyaguari
Students and Dr. Hannigan enjoy some down time
Students and Dr. Hannigan enjoy some down time
Students enjoy some down time
Students enjoy some down time
HBSON students in the field with other MEDLIFE volunteers
HBSON students in the field with other MEDLIFE volunteers
A stair construction project
A stair construction project
HBSON student with members of the local community
HBSON student with members of the local community
Students working on-site at a stair building project
Students working on-site at a stair building project
Students working on-site at a stair building project
Students working on-site at a stair building project
A section of stairs near completion
A section of stairs near completion
The group stands on both sides of the world at the Equator
The group stands on both sides of the world at the Equator