Archive for Service Learning

¡Wepa!

Yesterday we drove from Caguas (near San Juan) to the south side of the island. We are in Ponce to work at a nursing home for our last service day, but first we had a delightfully warm welcome from the Ponce civic representatives, including the head of tourism. We explored the quaint and colorful town square and some of the city’s main sights, including a tree believed to be more than 500 years old.

At Parque de la Ceiba

The director of tourism passes out “Ponce Passports” for our tour of the city. Credit: David Zhao

Ponce town square. Credit: David Zhao

 

Today we served at Asociacion Benefica de Ponce, home to about 35 senior citizens. We helped with bathing and dressing, medication administration, and wound care. We also attended a lecture on palliative care by one of our leaders, Dr. Weihua Zhang. Members of the nursing home staff as well as nursing assistant students sat in on the lecture, which included an insightful comparison of end-of-life care in the continental U.S. versus Puerto Rico. As one might expect, many of of the emotions and rituals are the same, but we did learn that some people on the island practice Santeria, a Caribbean religion with its own spiritual traditions.

 

One of the most profound parts of our visit to the Asociacion was connecting with the clients one-on-one. One of our leaders, Gladys Jusino, took out her guitar and sang traditional Puerto Rican songs with the clients.

Gladys Jusino plays guitar for a nursing home client. Credit: David Zhao

A bed-ridden woman listens to music at the Asociacion. Credit: David Zhao

A client and nurse of the Asociacion clap along to music. Credit: David Zhao

 

We were reminded that a smile and a gentle squeeze of the hand are universal gestures that transcend language barriers.

Credit: David Zhao

Credit: David Zhao

Credit: David Zhao

 

We ended the day with a bird’s eye view of Ponce and sleepy car ride back to our headquarters near San Juan.

Credit: David Zhao

 

Our service learning trip has come to an end, and tomorrow we fly back to Atlanta. I think I can speak for everyone in our group when I say that we were humbled and honored to have been a part of this trip to Puerto Rico. We met incredibly gracious and intelligent people, we learned about the island’s vibrant culture and history, and we aimed to care for, in however small a way, some of its most vulnerable citizens. Thank you to our brilliant and fearless leaders, Gladys Jusino and Weihua Zhang, and their family members that accompanied us.

Wepa, a Puerto Rican word that implies joy and good cheer, was brought up a lot during this trip. Gracias, Puerto Rico, for welcoming us with open arms. We will be back! ¡Wepa!

Un Llamado Superior: Day 4 in PR

Today we spent the morning at the Colegio de Profesionales de la Enfermera, an organization for nurses in PR similar to the American Nursing Association, learning about nursing and the state of health care in Puerto Rico. In order to practice as an RN, nurses here must have a college degree in nursing as well as membership in this professional association. The director of the Colegio, Juan Carlos, told us that a recent Puerto Rican law decreased the number of sick and vacation days for all workers, and increased their probation time before becoming permanent employees. Juan Carlos also told us that in recent decades, Puerto Rico has seen a “brain drain” of its workforce to the continental U.S., including the departure of nurses. The Colegio is hard at work advocating for better pay and working conditions for its members.

Posing with Florence Nightingale at Colegio de Profesionales de la Enfermera. Credit: David Zhao

Juan Carlos ended his talk with a quote in Spanish from Florence Nightingale that referred to nursing as “un llamado superior,” a higher calling.

After another yummy Mofongo meal for lunch, we traveled to a local hospital where a very special organization – PITIRRE – is headquartered.

Mmmmofongo. Credit: David Zhao

 

I’ll let one of our team members, Tara Noorani, take it from here:

“My admiration for nurses was born from an exposure to street medicine. Their ability to address the entirety of the person was something displayed during each client interaction.

Wednesday (March 8th) began at PITIRRE de Iniciativa Comunitaria, an addiction treatment program offering healthcare, education and prevention services to homeless and HIV-positive clients. The pitirre is a bird found in Puerto Rico weighing nearly 1.5 ounces and personifying somewhat of a powerful underdog. El pitirre serves as a symbol of hope and resilience in the face of adversity. The staff at PITIRRE emphasized the bond between ourselves and our fellow human – the tie between providers and clients. They encouraged us to understand our intersection as brothers and sisters and the power in our collaboration with one another.

With this lesson in mind, we began our night by making sandwiches with members of Operacion Compasion de Iniciativa Comunitaria, a mobile clinic project rooted in Rio Piedras, Puerto Rico. We assembled hygiene kits, brewed gallons of coffee, and collected juice boxes, medications and wound care supplies into their mobile clinic truck. From 10pm to 3am, we combed the streets, in search of possible clients.

Led by two of the most humble leaders of Operacion Compasion, we treated a total of 38 clients and performed wound care on 6 of these people. We offered blood pressure screenings, glucose checks, coffee, juice and sandwiches. We witnessed the isolation a person endures in the street and how the label “homeless” overlooks their humanity. Inevitably this manifests into a marginalized community drowning in stereotypes and misconceptions.

When I reflect on this experience, I’m reminded of the importance of being present with those who suffer. The nature of homelessness obscures the client’s voice and visibility. By meeting these people where they are, we are choosing to resist the poverty and injustice of their circumstances. As student nurses, we have an obligation to uphold the individuality and autonomy of each client and oppose the forces impeding their access to care.

As Emory students, it is a privilege to serve the people of Puerto Rico, a pleasure to have been enriched by their culture and an honor to advocate for their health care needs.”

La Feria de Salud – PR Day 2

Today began the real reason we came to beautiful Puerto Rico: to be in service to the community. We started the morning with a yummy breakfast of eggs and sausage that the wonderful staff at the local Salvation Army (where we’re staying) made for us. We then got to work on our health fair (or, in Spanish, La Feria de Salud).

Local residents from public housing came to the Salvation Army chapel where we had several tables set up: blood pressure checks, glucose checks, self-breast exam information, and smoking cessation. We split up into teams of two or three and about 30 people came. We (along with our Puerto Rican-native professor and our nurse practitioner professor) counseled people on lowering blood pressure and managing diabetes. Some realized they needed to go back to the doctor to adjust their medications, and others got advice on lifestyle modifications. We felt strongly that we made a difference in these people’s lives, and they expressed their gratitude. It was a lovely morning of health education and outreach!

Checking blood sugar

Teaching a breast self-exam

During lunchtime, we were lucky enough to have a talk with Dr. Dana Thomas, a career epidemiology field officer with the CDC. She spoke with us about how Zika has affected Puerto Rico, and we were shocked to hear that an estimated 400,000 people have been infected with the virus. One important takeaway was that 75% of people infected with Zika are asymptomatic, so it can spread among people without their knowledge.

Universal Sim Man

In the afternoon, we visited National University College, a private university system on the island that has a robust nursing program. We received a warm welcome complete with gift bags and hats, and were able to see how nursing students here learn — turns out, it’s quite similar to us! They have simulation rooms and clinicals. We even recognized some of the sim mannequins as the same ones we have at Emory.

 

We then had a discussion with some of the nursing students about life as a student and nurse in PR. They were extremely knowledgeable and friendly. We learned that it’s more difficult here than in the continental U.S. to get a job as a new nurse. In fact, many of the students were hoping to come to the states to work once they graduated. We also realized that nursing is a universal language — we were all in the profession for the same reasons — to be an advocate for our patients and to promote and heal. Some of their students were fresh out of high school and some were older and had families, just like our programs. No matter our backgrounds, we all could commiserate about how tough nursing school is. 🙂

Swapping nursing student stories

Big thank you to the amazing staff and students at National University College in Caguas, Puerto Rico!

Welcome to the Jungle – PR Day 1

What a day! The 11 Emory students in our group, plus two wonderful Emory professors, arrived in Puerto Rico yesterday evening and ate a traditional meal of mofongo, which is a mix of fried green plantains and, in our case, shrimp. We also sampled some conch meat — you know, the creature inside the shell you hold up to your ear and listen to the ocean with. What a treat!

Delicius mofongo

 

If you like (alcohol-free) Pina Coladas…

 

Today was our one “free day” of the week, and we packed in as many Puerto Rican activities as possible. We started in the Yunque National Forest, southeast of San Juan. We hiked through the jungle and splashed around in waterfalls. We drank homemade lemonade and got amazing views of the country from atop a fire lookout tower.

El Yunque National Park

 

We ended the day with a swim in the ocean, some snorkeling, and fried fish and ceviche. We practiced our Espanol and are resting up in our Salvation Army dorms for tomorrow’s activities — let the service learning begin!

Graduate Students Reflect on Immersion Experience during West Virginia Flooding

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School of Nursing graduate students participate every year in a two-week immersion program in West Virginia through the Lillian Carter Center for Global Health and Social Responsibility. Our students work in partnership with area federally-qualified community health centers to promote health and prevent disease throughout the region. Led by faculty Advisors Carolyn Clevenger and Debbie Gunter, students Andrea Brubaker, Phillip Dillard, Kimberly Eggleston, Hannah Ng, Jill Peters, Allysa Rueschenberg, and Abigail Wetzel, were providing essential health services through four community clinics located in cities to the north and south of Charleston. Two of our students, Phil Dillard and Abby Wetzel, were working in a clinic in Clendenin, a town 25 miles northeast of Charleston that was hit hard by the storms.

Phil Dillard discusses the experience in this WSB-TV Channel 2 interview. WSB Interview – West Virginia Flooding

Medicine and Compassion: A Journey through Italy

Every day, we learn to remind ourselves as healthcare providers how to be effective communicators and focus on patient-centered care. We learn about therapeutic communication and how to build an empathetic and compassionate relationship with our patients. However, 78% of providers think that they are providing compassionate care, and only 54% of patients think that they receive it. These numbers are not good numbers. This past summer, I received a scholarship to travel to Italy to study what it means to practice medicine with and without compassion. The program explores in-depth Italian literature, art, architecture, history, cultural and political development throughout the ages, from the early Etruscans, Phoenicians and Greeks to the Italy we experience today visiting towns from the northern alps to the southern shores of Sicily. We visited over 50 sites and museums, and over 47 towns and cities including visits to: Orvieto, Pisa, Assisi, Cinque Terre, Siena, Montalcino, San Gimignano, Pienza, Lucca, Florence, Ravenna, Padova, Vicenza, Venice, Verona, Naples, Pompeii, Sicily, Capri, Paestum, Sorrento, Matera, and many more. It is unique journey that integrates medical humanities with on-site cultural immersion. We worked to analyze visual art, cultural history and literature in the lens of what is compassion and what lessons can art communicate to healthcare?

Through each town, we investigated notions of compassion, mercy, and charity as civic and religious virtues illustrated through Italian history, art, literature social institutions, current events and daily life. With group discussions, individual research and lectures from faculty from the Center for Ethics and Schools of Medicine & Public Health, I was able to fully grasp the scope of Italian culture, history and identity. I learned that the arts and humanities help us demystify the notion of death, dying and suffering by providing countless examples of lives that have come before us. Our world is uncomfortable with conversations that speak about human fragility and finality, and it is increasingly hard to speak about the self completely in conversations because there is never an appropriate place or time to talk about such deep questions in the whirlwind pace of the environment that we all live in. Therefore, we all find ourselves by the bedside of those who are suffering and dying where the patient, health care professional, and visiting relatives struggle with how to be present to one another in their vulnerability.

Experiencing art may help to open one’s mind to a different way of thinking, to see the world or situation through another’s eyes. This helps to develop empathy, an essential element in a healthcare provider’s character. During my six weeks in Italy, I examined historical and recent writings from the medical humanities and explored the meaning of compassion and how it has affected the care and health of people over time. I explored multiple paths of communication with “others,” allowing an enhanced sense of global vision within me. I also looked at renditions of compassion in Italian art, attempting to understand what various artists sought to communicate about compassion, suffering and healing. This program has been the most challenging academic and personal journey I have ever had at Emory, but every moment has been invaluable and transformative. It is an experience that has changed my perspective on traveling to other countries, learning about other cultures, and ultimately, I have gained a deeper understanding about myself.

Alisha is a BSN student and sees that being a BUNDLE scholar is an opportunity to embark on a path that combines clinical practice and community engagement. From her past experiences of volunteering in Honduras or doing research in the cardiology department, she has discovered her passion to would in nursing, public health and research. Alisha’s goal is to work with underprivileged populations by providing compassionate patient care despite the limited resources and tragic levels of poverty and sickness.

You can contact me at abhima5@emory.edu


Information about the program used in this article has been referenced from the source below, along with using the insights and notions she learned from her professors, Cory Labrecque and Judith Moore.

http://www.italianvirtualclass.com/pdf/summer2016.pdf

My BUNDLE Experience

Kevin_CurrieAs a future nurse, I hope to develop a strong base of critical care expertise by working in an ICU before pursuing a doctorate in nurse anesthesia practice. As I develop professionally as a nurse through college and into my career, I strive to go beyond simply caring for patients and hope to make a meaningful impact in the field of nursing and beyond; that is to say that I strive to become more than a nurse; I want to become a nurse leader. And that is why I joined the BUNDLE Program.

The BUNDLE program has prompted me to visit a fascinating exhibit at the CDC about refugee crises, question what it means to be a leader, and practice my public speaking and networking, among other things. As a man who has wanted to be a nurse for at least six years now, the questioned abilities and masculinity, lack of male mentors, and numerous attempts of redirecting my career ambitions had set doubt in the back of my mind.

The BUNDLE program has offered me an immensely supporting community of beautiful human beings that has given me confidence to cast aside doubt in pursuit of my goals as well as offer constant support through trying times. I believe that a nurse’s holistic way of thinking, constant interactions with society’s marginalized individuals, and highly recognized and respected title help to more fully comprehend and address some of society’s shortcomings and public health needs, in particular.

I see nurse leaders not as leaders confined to the domain of nursing, but rather as unrestricted leaders with unique and valuable qualities; the word “nurse” is a badge of honor to be worn in front of the word “leader”. The BUNDLE program has helped me come to that realization. Thanks to the stimulating activities of the BUNDLE program, I am increasingly more drawn to develop and apply these unique nurse leadership traits in hopes of confronting and combatting some public health and societal issues through research, advocacy, and action.

Byline: I am currently a third year student from Nashville, Tennessee pursuing my BSN at Emory. In addition to my BUNDLE Program involvement, I am in the Honors Program, VANAP Program, and serve as secretary of Emory’s Men’s Water Polo team.

Montego Bay: Girl’s Home, Hospice Center, Women’s Centre, Children’s Home

Day 2 (continued):

After finishing our tour at Cornwall Regional, we arrived at the Melody Home for Girls at about 4:30 on Tuesday ready to enrich the lives of some young teenagers. This is an orphanage for young girls who have gone through some tough times in life, have no parental support, and need guidance. Heather Balenger (BSN ’16), Jessica Rutledge (BSN ’16), and Xueying Cao (BSN ’16) pioneered the way with health education presentations on the importance of exercise and STD and safe sex practices. The group drew the girls first with an icebreaker known as the human centipede followed by some stretching and group talk on the importance of exercise led by Jessica Rutledge. Heather and Xueying kept the girls attention with safe sex practices by involving them with the proper condom administration performed on bananas; and it was a hit!

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Sabrina Jahani (BSN ’16) followed their well received module with a very informative and interactive teaching on domestic violence equipped with a moving domestic abuse skit read by Erin Pollock (BSN ’16). The girls were very engaged in this subject and were most vocal on this matter. To round things off for the night, Chuncey Ward (BSN ’16) and Heather joined Sabrina for teaching on dating older men and the dangers associated with this matter. Everyone had a great time in fellowship with one another and smiles were everywhere at the end of the night. This was the first time for Emory SON at Melody Home for Girls, but I’m sure it won’t be the last.

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Day 3:

To get our third day in this beautiful city started, we visited a hospice center to provide companionship and laughter to the patients who lived there. We thoroughly enjoyed getting to know those patients and hear their life stories. Some students performed massages and others went room to room singing Christmas carols. The Christmas spirit was certainly in the air!

We arrived at the doors of the Montego Bay Women’s Centre at around 11:30 as the second stop on our Thursday leg of the trip. This is a place where young teenage girls who are pregnant can come and continue their schooling as being pregnant  is not allowed in the public schools. We found that the girls have the option to stay for 3 months post delivery if they choose and once they have given birth. Xueying Cao (BSN ’16) led the discussions by informing the girls on pregnancy prevention. Heather Balenger (BSN ’16) tag-teamed Xueying’s efforts with a presentation on HIV and STD awareness and safe sex practices equipped with her patented condom-on-the-banana race. Kate Yuhas (BSN ’16) finished everything up with a group interactive presentation on healthy food choices and nutrition pointers to keep in mind as young pregnant women.

Throughout the day the girls had several opportunities to win prizes that included baby bibs, board books, diaper rash cream, socks, nipples, bottles, diapers, and much more. At the end of our day we sat individually with groups of the girls and discussed similarities and differences between life in United States and Jamaica as well as their plans after pregnancy and high school. Gift bags including shampoo, soaps, toothbrushes, toothpaste, combs, lip balm, and candy canes were given to each of the girls on our way out. For our farewell, we sang Christmas carols for the group. Our holiday spirit carried us over to a daycare next door where preschoolers were enjoying popcorn and a bouncie house. We made lots of little friends there and also gave them a good helping of Rudolph the Red-nosed Reindeer and Jingle Bells…and they of course loved it!

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Our bus driver for our stay, Mr. Willie Smith (Not to be shortened as just “Will”) took us through down town Montego Bay for lunch to introduce us to what he described as “the best beef pattie spot on the island,” Juici Pattie. Everybody enjoyed the tastes of Jamaica indulging in patties with beef, curried chicken, curried shrimp, and beef and cheese.

After lunch, we continued on to the Blossom Garden’s Children home, an orphanage that took care of many children from infants to school-aged children. We performed health screening for all the workers in the facility including BMI, blood pressure, blood glucose, and counseling afterwards to discuss the results. Other students spent time with the children, feeding and interacting with them. Jessica Rutledge (BSN ’16), Nadege Pierre (BSN ’16), and Jaine Lee (ABSN ’16) provided education about physical activity and used the game “Simon Says” to show one way to perform exercise. Marcela Sanchez (BSN ’16) demonstrated how to correctly brush teeth and all children were provided a goodie bag that included a brand new toothbrush and bottle of toothpaste. Kate Yuhas (BSN ’16) provided education regarding healthy eating.

After a long day, the group returned to the our hotel and enjoyed a meal together along the water at one of the nearby restaurants.

Montego Bay: Comparing Jamaican and US hospital systems

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Day 1:

Our trip started off to a great start with our arrival to Montego Bay on Tuesday morning with 17 nursing students, our two faculty instructors Dr. Muirhead and Dr. Erin Ferranti, and four full suitcases of supplies for our work in Jamaica. Some of the medical supplies we brought include blood glucose monitors, lancets, gloves, first aid kits, hygiene kits, blood pressure cuffs, sharp containers, and stethoscopes. In addition, we collected other supplies and donations to give to the Jamaican community including bibs, pacifiers, lip balm, toothpaste, toothbrushes, candy canes, glasses, bar soap, socks, lotion, shampoo, razors, diapers, and combs.

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After checking in to our hotel, the group headed to The Church of God to speak with the men’s group about healthcare problems specifically associated with  Jamaican men.

Erin Pollock (BSN ’16) led our discussions with an education module about smoking cessation and the problems associated with both firsthand and secondhand smoking. The men were very engaged in learning about how nicotine affects the body and ways to quit smoking and/or share with friends and family. Afterwards, each participant received a handout to help develop an action plan to ditch the habit and a pack of gum to show one way to support smoking cessation.

Chuncey Ward (BSN ’16) continued with an educational module about the risks and symptoms associated with benign prostatic hyperplasia and prostate cancer, which is a very prevalent issue in the country of Jamaica. The men received handouts with relevant information to bring back home with them in hopes that they will educate their peers and community.

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After both presentations, we performed blood pressure and body mass index (BMI) screening. For those whose BMI was elevated, our nursing students provided one on one patient education regarding exercise, diet, and lifestyle modifications.  The men were receptive to our advice and felt very motivated to maintain healthier lifestyles.  Afterwards, every participant received a gift bag which included anti- fungal cream, condoms, and razors.

After debriefing upon return to the hotel, the group got a good night’s sleep in preparation for our day at Cornwall Regional Hospital.

Day 2:

At 7:30 am, the group left the hotel and headed to Cornwall Regional Hospital, a ten-floor facility of the West Regional Health Area that served the Montego Bay population in a variety of specialties including psych, pediatrics, and oncology. We met the director of nursing services as well as other nursing personnel who helped explain the structure of the nursing profession in Jamaica. We then divided into two groups and toured all units of the hospital. We were able to engage with the nurses and ask questions, comparing practices between Jamaica and the United States.

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Some examples of the differences we found include:

  • No epidurals are performed, only spinal analgesia
  • Hospital facility was open to air in center of hospital and in almost every patient floor
  • No IV pumps, gravity based drip factor calculation
  • Medications are not locked, no Omni cell
  • Nurse to patient ratio is 1:15, can be up to 1:25
  • Average wait time in the ER is close to 24 hours
  • No heparin is used in the facility
  • They use water jugs for traction
  • There were wards instead of units; individual wards are separated by gender
  • No electronic files, all handwritten notes
  • Med cards are written on index cards instead of an electronic MAR
  • Nurses here work 8 hour shifts instead of 12 hour shifts
  • Very formal dress wear including a headdress
  • 1 male registered nurse in the whole facility
  • Nursing school onsight, 5 year bonding
  • Pale comparison in pay: $641/month, $7700/yr, 32% taxes
  • Security guards at front door of hospital
  • Full healthcare coverage for everyone

Later in the day, we were able to break up into different wards and observe the nursing role in the hospital directly.

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Montego Bay – Day 4

Today was clinic day!  Our group ran a health clinic at the New Testament Church of God in Montego Bay; we were able to screen 118 members of the community for BMI, blood pressure, blood glucose, and vision.  After each participant was screened, they received individual counselling on their results.

Many of our participants were anxious to have themselves tested. They were worried about their health and concerned about what their results would mean.  Many of them had elevated BMI’s, blood sugars, and blood pressures, and therefore, had cause for concern.  Counselling provided these patients a chance to strategize about how they could change their patterns in order to improve their health.  Many were receptive, but some were not.

Something that struck me today was that, as nurses, there is only so much we can do for our patients.  We can give them all the information we have, we can help them plan changes in their health behaviors, we can encourage them to make those changes, but they have to actually make the adjustments for themselves.  It was difficult to watch patients leave knowing they probably wouldn’t make any modifications and their health would continue to suffer.  On the other hand, it was extremely rewarding to teach patients health strategies, knowing they likely would make those adjustments and benefit their overall health in the long-term.