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Alternative Winter Break – Nicaragua, Day 4

Alternative Winter Break in Nicaragua.

By Madysen Kovac and Sonia Ros
Photos by Alex Gumucio

Day 4: Teaching in El Tambo

Talks in El Tambo

We got to sleep in this morning… all the way until 08:00. No roosters seemed to stir this morning. After a quick breakfast, we caravanned out to the town of El Tambo to give seven different healthcare presentations to the community. The community hall where we were to give the presentations was beautiful. It was a building with red tiling on half of the floor and a stage up at the front. One end of the building was left open to air so the concrete and metal roofed building could breathe.

Madysen Kovac

When we arrived, Dr. Quintana walked around the village to round up a crowd of people to listen to the presentations. She impressively was able to find 14 people to come. The community was more than happy to come and learn; however, they needed a bit of time to prepare food before they came. It is harvesting season, you see, and the people of the community wake up around 03:00 just to harvest beans. We felt honored that they took time out of their busy season just to come and listen to us.

To kick off our presentations, Cierra and Anna spoke with the community about breast self-examination. They spoke in English, while our guide from Communidad Connect, Humberto, translated. It was kind of funny because they were very visual with their presentations and it was funny to have Humberto follow along with them. Next up was Grace and Claribel who presented, “Talk To Me Baby.” During the presentation, Grace demonstrated some of the concepts of the program by talking with one of the community member’s toddlers. Grace spoke in Spanish with the child and it was a cute interaction to observe.

Up next, Dan and Lauren gave their spiel about nutrition and used MyPlate as a visual representation. Following, Madysen and Sonia gave a talk about hypertension prevention and the possible risks of hypertension. The community was interested in having us take their blood pressures, as no one knew their blood pressure. The students jumped right in and began checking blood pressures. Once they did the reading, they explained the numbers and educated them further. Appropriately, the presentation on diabetes came next, taught by Gloria and Rebecca. Their teaching was important because although they don’t have a glucometer to check their blood sugar, the community was educated about the signs and symptoms of having a high or low blood sugar. They urged those in the community to seek help at a clinic if they experienced any of the signs or symptoms discussed, so the clinic could check their sugar.

Kathy and Yasmine spoke about a difficult and sensitive topic, domestic violence. They approached the topic with professionalism and tact. It is important to discuss this topic because those experiencing domestic violence sometimes feel that they are to blame. We clarified that the victim is never at fault. The women in the community understood the concept and even knew about the importance of speaking up if you are a victim. The women who said this was a brigadista and stated she had learned it from the television. Lastly, Alex spoke with the group about emergency preparedness, a topic which her and Dr. Quintana worked closely together on developing.

The community asked a lot of good questions about the topics as they related to themselves. These topics were not just randomly selected, but topics that the community asked for us to present on because they wanted to know more about them. They appreciate the time that we are taking with them to explain health concepts and answer questions. When they go to the doctor, they understand doctors may not have time to explain things in depth because they lead busy lives and they respect that. However, this can become a problem. For example, one of the community members has diabetes and her doctor told her to avoid rice and beans. However, she is afraid to eat any food because she is afraid it will make her blood sugar rise. Therefore, she is afraid to eat everything. We made sure to clarify this misconception before departing, by explaining that any food is okay to eat, in moderation. Also, we clarified that not eating anything is worse.

We ended the day a bit early to visit Dr. Quitana’s friend in El Tambo for a birthday celebration. There was dancing, food, cooking, music, desserts, and community! A fun time was had by all.

Alternative Winter Break – Jamaica, Day 2

First day of service in Jamaica during Alternative Winter Break.

By Lauren Noble

Photos by Jordan Waites 

Montego Bay, Jamaica – Day 2

Lauren Noble

The first day of service took place at Montego Bay New Testament Church of God. There we conducted a health screening which included blood pressure, blood glucose, body mass index, proper body mechanics teaching with demonstration, and nutrition teaching. We served up to seventy-five people. Overall, the population was healthy. There was the occasional high blood pressure and high blood glucose. Their good health is attributable to their fresh diet. The staple protein is fresh fish and chicken. Vegetables include callaloo, pak choi, and rice and peas. Fruits include bananas, pineapple, ackee, and grapes.

Later that day, we went back to the church to work with the youth. We opened with devotion. We presented the five pillars of health, which include: emotional, spiritual, mental, physical, and social. The youth group then examined each area and identified how the pillars fit within their lives and where they could make improvements. Afterwards, we tested their knowledge with a game of hangman. The kids really enjoyed the game and we had a lot of laughs.

Alternative Winter Break – Jamaica, Day 1

A rainbow forms in Jamaica during Alternative Winter Break.

By Lauren Noble

Lauren Noble

My alarm goes off at 6:30am on Thursday, December 14th, but I am already awake. In approximately 5 hours, I would be in Montego Bay, Jamaica! One Marta trip and 30 minutes of being lost on the Hartsfield-Jackson airport later, I am ready to board!

Upon arrival in Jamaica, it was a rainy day, but the sun was still shining. I was amazed at the scenery outside of the airport. There were so many people leaving and coming to the airport.

We quickly noticed that there were a lot of cars in which the steering wheel was on the left because they drive on the left side of the street as opposed to our right. As we waited, I just soaked in the environment around me.

Twenty minutes later, Willie and Miller, our drivers around the city drove us to the hotel. On the way there, I was amazed at how green everything was. There were a lot of fruit trees! It was just beautiful.

Once checked in at the hotel, we took off to explore. We strolled along the beach near the hotel. There was also a little island that you could walk across the water to that had coconut trees. The rain had cleared, and the ocean water was so blue and glistening. To end the day, a beautiful rainbow appeared, and it was time to prepare for the next day.

Alternative Winter Break – Nicaragua, Day 3

Crossing a body of water in Las Pilas.

By Madysen Kovac and Sonia Ros

Day 3:

Passing through Las Pilas

Cock-a-doodle-do! What is the best way to start your morning, you ask? What is better than a wake-up call from a rooster at five am! Roosters freely roam around the hotel we are staying at and they made sure we were up and ready for our trip to Las Pilas. In Las Pilas, we visited the local clinic where there are two nurses and a doctor to serve 2,500 people. Here they do general consults for pregnant women and other types of preventive care for the remainder of the population. Just as in the clinic at Tola, this clinic works with the community leaders on health prevention. One of the communities that this clinic services is called Guacalito. This community is incredibly isolated as it is surrounded by resorts and they have been forced into isolation because they refuse to sell their land to other companies seeking to build resorts. For this reason, they are hesitant to let people into their tiny 9-house community.

This clinic sees anywhere from 10 to 50 patients a day, and just

Madysen Kovac

like in Tola, this clinic has a quota of patients to see per month. Nurses must see 100 patients a month and doctors must see 410 patients a month. This can be stressful because the nurses are already stretched so thin seeing patients. On top of that, they are also responsible for completing administrative work. Additionally, it is difficult to get to work itself, as the nurse who was speaking with us takes a bus to Tola and then hitches a ride the rest of the way. The only time the bus comes is at 6am or 10am, so there is not much flexibility.

La escuela

Across the street from the clinic in Las Pilas is an elementary school. Here, we were able to use one of the classrooms to do a health presentation for the community. Two of our Emory students presented on the topic of nutrition and taught the children about the MyPlate initiative in the United States. The presentation was interactive with the children and the kiddos seemed to know their stuff. Two other students presented a language nutrition program from the United States called, “Talk to Me Baby.” This program encourages mothers to start talking to their babies in utero and continuing to use complete sentences and new vocabulary to speak with the baby. This has been proven to help their neurodevelopment and vocabulary acquisition.

La Casa of the Community leader

We were welcomed into the home of the community leader in Las Pilas with open arms, and when I say open arms, I literally mean, open arms. She hugged each and every one of us as we stepped over the threshold into her home. She made sure everyone was comfortable with a place to sit before she began telling us stories about her life as a former Midwife and current community leader.

In her role as a Midwife, it was evident that she had seen it all. In the past, midwives had no formal training, but trained generation to generation through the passing down of knowledge. This is no longer the case as midwives are required to have formal training. She still incorporates many of the things passed down from previous generations in her practices; however, she recognizes the importance of the formal training. For example, traditionally, a woman was only supposed to give birth on her knees and this was the only accepted birthing position. After MINSA trained her about the dangers of that, she was able understand why other positons should be used.

Another interesting story that came from her tales about being a midwife involved her role in the revolution in Nicaragua. During this revolution, she was both a soldier and midwife. She told a story, creating an impressive mental image in our heads, of how she had her ammunition strapped to her waist, her firearm on her back, and her boots on. But at the same time, she was delivering babies. Dr. Quitana, who has known her for many years, speaks highly of the bravery of this woman during the revolution.

As a community leader, she and other volunteers, called brigadistas, go out into the community and collect blood samples, give medicine, and spread knowledge about the importance of health prevention and immunizations. Being a community leader is not a paid position. However, there is much responsibility associated with it, and for that reason, it is a highly-respected role in the community. Those who become community leaders have a reputation that precedes them and are trusted implicitly.

Student Reflections and Funny Moments

The community leader in Las Pilas asked us what our favorite thing about Nicaragua had been. A fellow student was pleasantly surprised at the willingness of the nurses and the people in the community to come together and make such a concentrated effort towards health. The student was mostly surprised because she felt like that was not something that commonly happened in the United States. Another student spoke about the natural beauty of Nicaragua and how clean the country appears, compared to other experiences in developing countries.

While we were visiting with the community leader in Las Pilas, there were many animals roaming about freely. I spotted dogs, ducks, hens, roosters, pigs, turkeys, and even cows. As I looked out to admire the view, I saw 3 baby ducks with the mom duck being chased by a pig. In what was faster than a blink of an eye, there were only two baby ducks. The pig had eaten the baby. Many of the students who saw it were surprised and I certainly wasn’t expecting it and in the moment! I gasped! I suppose that’s just the circle of life. Speaking of animals, our instructor Gladys milked a cow. She almost got peed on by the cow, but emerged triumphantly with a few drops of cow’s milk.

Alternative Winter Break – Nicaragua, Days 1 and 2

In front of a town sign in Las Pilas.

By Madysen Kovac and Sonia Ros

Day 1: Next Stop, Nicaragua

Our adventure was set to start at 17:50, but of course, you know airports. Delays, gate changes, and long lines at security are commonplace. You name it, it happened to us. Hour waits at security, the gate was changed 3 times, and the departure time was pushed back almost three hours. Luckily, we were all just able to laugh it off and move on. At one of the first trip meetings we had, we were told that being flexible was important, as things often never went as planned during these trips.

As we finally boarded the plane around 20:30, familiar Emory faces were spread throughout the cabin. The plane ride was a bit bumpy, but we made it to Nicaragua and were cozy in our beds by midnight (side note: Nicaragua is one hour behind Atlanta).

I also wanted to give a quick introduction to some of the leaders involved in the trip with us 14 Emory nursing students. Our leaders from Emory are Gladys Jusino-Leon and Ursula Kelly. Upon arrival in Nicaragua, we meet the leader from Communidad Connect (the organization Emory has partnered with to make the trip possible) named Humberto. Also, we will have Dr. Quintana, who is a native of Nicaragua, to show us around and connect us with the community leaders as well as health clinics.

Day 2: Let the Learning Begin

Tola Teaching

After a quick breakfast, we piled into our 22-seater van and headed out to the town of Tola. No photo could do justice to some of the beautiful sights along the two-hour journey to Tola. We were incredibly excited to get to the clinic and learn about the healthcare system.

This clinic, the health center of Tola, serves 67 communities, of which only two are urban communities (the rest being rural). Local nurses from Tola put together a presentation to teach us about the healthcare system in Nicaragua. Throughout these 67 communities, there are 11 sectors that have health centers, which is an improvement on the previous 7 health centers.

At each of the 11 health centers, there are usually only 2 nurses and 1 doctor to care for an average of 4,000 patients. The nurses are regulated by the government to see a certain number of patients a month, and the same goes for the doctors. Furthermore, if a patient does not show up for an appointment, the nurses and doctors must go out into the community to follow up with the patient. Already, you can see a barrier to providing healthcare in Nicaragua, a lack of staff. To augment the staff and aid in attempts to reach more of the community, brigadistas are used. Brigadistas are volunteers who are trained by nurses to go into the community and assess their needs and make referrals to hospitals if needed. Furthermore, the brigadistas are equipped with acetaminophen and oral rehydration therapy to assist anyone in the community who is febrile or has diarrhea.

Madysen Kovac

Only recently, in 2009, has their healthcare system become more integrated and holistic, as before most services were fragmented. For example, if a woman came in for an appointment and brought her child, they would only treat the woman. Now, if a woman comes in with her child, they give preventive care to both mother and child. Also with this holistic care, the traditional healers are now included. Only recently has MINSA accepted traditional/natural medicine into practice. After some cultural sensitivity training with the nursing staff, they have come to accept and integrate traditional healers into their practice. Dr. Quintana explained that the doctors and nurses are more willing to accept the practices of natural medicine because it does no harm to the patient at the end of the day. Those who practice natural medicine can treat a variety of things such as stress, the curse of the evil eye, and bone pain with many different methods. Some methods include using plants and herbs, shiatzu, or even tai chi.

The referral system in the country is also quite interesting. First is the level 1 clinic. To get here, you may come as a walk-in or you can be referred to the clinic by a community leader. The more acute are then referred to a level 2 facility, which is generally a hospital, and the most acute are referred to a level 3 facility, which is a hospital in the capitol, Managua.

Another interesting thing about the healthcare system of Nicaragua is that all public services are free to the patients of the community, no matter what level of care they are receiving. Currently, MINSA in Tola is working on reorganizing the 11 sectors and ensuring they are fully staffed and educated. Additionally, they have several growing cities and they are expanding the sectors to accommodate for that. Lastly, they have constantly been collecting data about the health of the communities since 2009 to compile a database of information. To track these, they have created hand drawn maps of each community and marked, with colored tacks, the different ailments and situations they need to keep an eye on. For example, the green pin is for chronic illnesses and the red pin is for those who were pregnant.

Many women in the country are hesitant to go to the hospital to give birth, as they would rather do it more traditionally, as they always have, in their own homes. A few new projects have been implemented to encourage women to come to the hospital for their birth. When women agree to come to the hospital, they can bring any traditional meals they may have eaten at home, they can give birth in the position they feel most comfortable (which may not always be in a bed), and the hospitals allow the husbands to be in the birthing room as well. However, many pregnant women do not live close to a hospital, making hospital births more unrealistic. So, they created la casa materna (which basically just means maternal home; a home for pregnant women). This is a place where women can come just before they give birth to be closer to a hospital when labor begins.

The biggest problems in Nicaragua for pregnant women are preeclampsia and teen pregnancy. As confirmed by Dr. Quintana, most of the teen pregnancy issue is a cultural thing because in Nicaragua it is more acceptable for women to have kids and get married at a younger age. Overall, the biggest problems for health in Nicaragua, in order of most to least severe, are hypertension, diabetes, and kidney disease.

To speak specifically to the nursing aspect of healthcare in Tola, the nurses told us how the nursing shifts used to only be from 8am to 4pm, with no around the clock clinic care. Now, there is 24/7 care at the clinic with the shifts being from 8am to 4pm and 4 pm to 8am on the weekdays. The nurses work 24 hours shifts on the weekends. Whew!

The biggest barriers to nursing care in Nicaragua are related to a lack of understanding by the patients and a lack of medical staff. To attempt to make up for a lack of literacy and understanding, the doctors often draw pictures to explain complex concepts and ensure medications are taken at the proper times. The problem with the lack of medical staff stems from many places. One being that it is expensive to train nurses and doctors, as the government pays for all the training. For this reason, there are limited spaces. Also, there seems to be a cap on the number of doctors and nurses allowed at each healthcare clinic, as most of the clinics have 1-2 doctors and only 3-4 nurses. The newly graduated nurses come out with no job availability because there is no spot until the nurses retire and a job opens.

After the nurses spoke, Dr. Quitana spoke to the culture of Nicaragua, as she herself was born and raised here. She said that there is a strong family aspect in Nicaragua and the people of Nicaragua are strong in the things they believe. They believe they are stronger together. This strong sense of community is important to them and their culture and they see everyone as family. She referred to Nicaragua as a, “big, small town.”

La Playa

After a long day, we were all ready to shower and relax a bit before dinner. The hotel we were staying at for the night had a beach within 30 seconds of it. Gladys, a trip leaders, urged us to take a quick look. The sun was just starting to set in the cove of Playa Gigante. It was a beautiful and satisfying way to end the day.

Ann Rogers discusses study looking at shift work and sleep-deprived nurses

Ann Rogers

Ann E. Rogers PhD, RN, discusses a study out of Italy that looks into how shift work is linked to burnout in sleep-deprived nurses in that country. Professor Rogers is the Director of Graduate Studies at the Nell Hodgson Woodruff School of Nursing.

Read the full article here.

ABSN Student Leaders Reflect on Graduation and their Emory Nursing Experience

By Andy Goodell, Communications Manager
Nell Hodgson Woodruff School of Nursing

The BSN/ABSN Winter Awards Ceremony will feature two leading student voices, Cory Woodyatt and Stephanie Lee, as speakers during the event. This awards ceremony will take place at 2 p.m. on December 11th at Glenn Memorial Auditorium.

Cory Woodyatt

Woodyatt, originally of Georgetown, Canada near Toronto will earn his Bachelor of Science in Nursing (BSN) this month. He says that he was able to form meaningful relationships with the faculty at the School of Nursing that will last well beyond graduation, adding that many of them helped him “see the bigger picture” in the world of nursing. Assistant Clinical Professor Ginny Secor is just one of many faculty whom made an impression on Woodyatt.

“Dr. Secor’s attitude is contagious and her passion for pathophysiology is unprecedented,” says Woodyatt.

Woodyatt also credits Assistant Clinical Professor Ann Horigan with challenging him to think critically in complex and clinically-demanding scenarios, saying, “her experience is evident and her confidence (and comic relief)” put him at ease. He goes on to say that Assistant Clinical Professor Jeannie Weston also pushed him to think critically, adding that her dedication to student success is ever present in her pediatric clinical simulations. Additionally, Woodyatt credits Instructor Rebecca Wheeler with exemplifying nursing leadership and social responsibility to a point where she inspired him to join numerous nursing organizations.

Stephanie Lee

Lee, of Knoxville, Tenn., is also earning her BSN this month. She too credits numerous faculty members with bolstering her success as a student.

“My advisor, Dr. Kate Yeager, has encouraged me every step of the way, even for things not related to nursing school,” says Lee. “Our program chair, Dr. Carolyn Reilly, has done a fabulous job advocating for our class and making sure all of our concerns are addressed. Additionally, my clinical instructor, Takeya Shepherd, taught in my health assessment lab my very first semester and then acted as my role transition preceptor my last semester. It was so fun getting to know her and growing as a nurse under her instruction.”

Not only have faculty members impressed Woodyatt at the School of Nursing, the learning environments at the school have impressed him greatly, as well.

“Aside from access to renowned clinicians and researchers, I appreciated the well-known reputation and caliber of hospitals available to NHWSN students,” says Woodyatt. “The complexities and diversity of the patient populations available at these hospitals affords us incredibly enriched learning opportunities.”

Lee says that she values the true sense of community her cohort has developed.

“My fellow students are exceptional people who are dedicated to their education, their profession, and their patients,” says Lee. “Without the environment of support and encouragement that we have built, Emory would have been a very different place for me.”

As for the future, Woodyatt’s career aspirations are great.

“Whether it’s becoming a Nurse Manager or Chief Nursing Officer, I hope to one day serve as a leader who contributes to a shared vision and oversees strategic design and implementation of evidence-based patient care delivery,” he says. “Until then, I will remain a bedside nurse, most likely in the realm of emergency medicine nursing. Upon graduation, I will join the team at Emory Johns Creek Hospital in their emergency department (ED) as a new graduate nurse.”

Lee sees a similar wide open road of possibilities for her nursing career. After graduation, she will work at Emory’s Winship Cancer Institute in the Ambulatory Infusion Center.

“I hope to earn a terminal degree in nursing, whether that be a PhD or DNP, and make a difference in the field of nursing and in the fight against cancer,” says Lee. “My foundation at Emory has provided an incomparable springboard for my future.”

MSN/DNP Winter Awards student speakers look back on Emory Nursing Experience

By Andy Goodell, Communications Manager
Nell Hodgson Woodruff School of Nursing

At the MSN/DNP Winter Awards, attendees will get to hear from two dynamic student leaders from these programs, Haley Reid and Shanita Webb. The Nell Hodgson Woodruff School of Nursing’s MSN/DNP Winter Awards Ceremony will take place at 4 p.m. Monday, Dec. 11, at Glenn Memorial Auditorium.

Haley Reid

Reid, of Loganville, GA, is earning her Master of Science in Nursing, Family Nurse Practitioner this month. She’s also currently working toward a Doctor of Nursing Practice in Health Systems Leadership, which she is set to complete in 2019.

Reid credits Assistant Professor Clint Shedd with making her FNP class time extremely valuable because of his engaging lecture style. Shedd, who serves as FNP coordinator at the School of Nursing, provided Reid with plenty of support for her chosen path of learning, she says.

As a School of Nursing student, Reid says she admires the flexibility afforded to her, especially as a nurse practitioner in training. She says the learning environments at the School of Nursing help her balance class, clinical rotations, class work, family, friends, and personal time.

“The faculty here at the School of Nursing are dedicated to improving the student experience,” says Reid. “As a student, I appreciate their willingness to address my needs and make changes as appropriate. Whether it was posting an additional lecture to clarify a confusing concept in class or giving us an extension on a project, as a student I always felt cared for and supported.”

Webb, of Atlanta, will earn her Doctor of Nursing Practice with a concentration in Health Systems Leadership this month.

Shanita Webb

Like Reid, Webb also found endless support at the School of Nursing. She credits Assistant Clinical Professors Lisa Muirhead, Corrine Abraham, and Associate Professor Ursula Kelly with making a lasting impact on her life. She says their expertise and support was critical in the formation of her DNP project.

“I really enjoyed the collaborative academic environment the DNP faculty and staff created,” says Webb. “It really fostered opportunities to learn from our colleagues, faculty and guest speakers.”

Webb is an Air Force Nurse Practitioner and hopes to enter into a leadership position at the operational or strategic level within the Air Force Medical Services. She even aspires to be the chief nurse of the United States Air Force someday.

Upon graduating with her FNP, Reid says she plans to practice as a family nurse practitioner in rural or underserved areas to fulfill her HRSA Nurse Corps Scholarship agreement. As for her career after earning her DNP, Reid says she will continue to address healthcare disparities and qualities inconsistencies in rural and underserved areas.

“I have always loved working with vulnerable populations, and with the health professional shortage seen in the state of Georgia, I found myself drawn to primary care,” Reid says. “I enjoy seeing patients of all ages- from infants to the elderly- and I love the privilege of being able to create long term relationships with my patients.”

DNP student details important volunteer experience

Brandon Spratt, Doctor of Nursing Practice Candidate at the Nell Hodgson Woodruff School of Nursing, recalls the incredible volunteering experience he had in Nicaragua. Read the full article on Comunidad Connect.

Help Women and Families in Crisis

Nurse-Midwives are urgently needed beginning August 23rd to assist the Syrian American Medical Society (SAMS) with medical relief efforts in Northern Greece for Syrian, Iraq, Kurdish, and Congolese refugees.

Volunteers are needed for:

  • Breastfeeding
  • Family planning
  • Health education
  • IYCF support
  • Pregnancy care

*A two-week minimum commitment is requested*

To find out more information or to sign up to volunteer, visit: or email Nikiforos Papachristos, Volunteer Coordinator for SAMS Global Response-Greece, at


To read about Emory MSN Alumna Barbara Lockart’s own experience providing care for families in crisis in Greece visit: