BY LESLIE STERNLIEB
The school's international programs bring healing and hope to residents of distant regions, build powerful partnerships with caregivers and educators abroad, and transform the lives of participating students.
The school’s vigorous and rapidly expanding minimester programs are a vibrant reflection of its strong emphasis on cultural competency—an urgent priority in South Florida, whose diverse demographics are a bellwether for the nation’s future. “Miami is adynamic city that pulses with global energy,” says Dean Nilda Peragallo,DrPH, RN, FAAN. “Given the range and complexity of issues that our graduates will face throughout their careers, exposure to international experiences is a vital component of the education that we provide.
“These learning experiences enable students to challenge their assumptions and to develop skills that can be used successfully in work settings anywhere in the world.
”Peragallo, who is Chilean, launched the school’s first minimester program in 2005, using connections in her home country to fast-track a partnership between the nursing school and the Universidad Nacional Andres Bello in Santiago. Three years ago, the nursing school launched a Haiti minimester in coordination with the Miller School of Medicine and its highly regarded Haiti-based health initiative, Project Medishare. This summer, a group of nursing students traveled to Tampico, Mexico, in a new minimester made possible by the school’s relationship with the Universidad Autónoma de Tamaulipas.
During these journeys of discovery (which provide participants with three elective credits), students have the opportunity to hone classic nursing skills that were automated long ago in the U.S., such as checking blood pressure, counting IV drips, and triaging patients without diagnostic equipment or blood labs. Though the relative lack of resources can be frustrating, the exposure to different health systems and nursing styles inspires new levels of ingenuity, camaraderie, and compassion.
“Nursing is a caring profession,”says Johis Ortega, MSN ’06, BSN ’02, a PhD student and lecturer who directs the Latin American portion ofthe international program. “I want my students to feel more and care more for the patient.”
Before the groups leave Miami, Ortega familiarizes students with the cultural differences they will encounter in Latin America, such as the common use of indigenous therapies. Translators are teamed with groups of students to help overcome language barriers.
Satiago, ChileResource Disparities,
The three-week Chile minimester focuses on clinical observation and student-level participation in bedside nursing. Students practice at the private La Catolica and the public Sóterodel Rio hospitals and interact with Chilean nursing students.
They discover the dramatic disparity between the facilities available to the wealthy and the lack of resources in the region’s public hospitals. For example, Adreana Bedoya-Leal, BSN ’08, recalls seeing a nurse in the relatively poor public hospital draw blood from an HIV-positive patient—without gloving up. Blood draws are considered routine, and gloves are typically reserved for emergency use only.
Yet the students also find that Chilean health care is more holistic and prevention-oriented than that typically found in the U.S. Though Chilean nurses lack the supplies and technology U.S. nurses take for granted, “They know exactly what’sgoing on,” says Bedoya-Leal. “They know how to handle everything.”
This year’s Chile minimester included rotations at a hospital for children with chronic respiratory ailments. “We learned that there are different kinds of care we can provide beyond medical interventions—such as listening to and being there for the patient,” says Nadia Chung, BSN ’08.
In the same spirit of global exchange that inspired the Santiago minimester, Chilean nursing student shave visited UM for the past two summers to observe clinical practice at local hospitals and learn through hands-on simulations at the school.The experience of U.S. health care has fascinated them and even inspired one student, Natalia Villegas, to return to UM for her doctorate.
“I would like to improve nursing care in Chile through research, education, and prevention,” says Villegas, anurse midwife with a master’s degree in nursing administration. “The school’s research expertise in HIV/AIDS and sexually transmitted diseases is a perfect fit for my goals.”
Tampico, MexicoLessons in Life and Death
The international program extended its reach this summer, when a group of 14 students embarked for Tampico, a major seaport on the gulf coast of Mexico. The students provided screenings for young children, performed Pap smears, started IVs, checked blood sugar, and administered immunizations, many for the first time.
They also learned the lessons of life and death that are part of nursing. CRNA student Anthony Roig was particularly moved by the case of a woman who was bitten by a coral snake while asleep. Her family traveled four hours from her pueblo to the hospital, where she received seven doses of antivenin. She lingered for a month—most snake bite victims die within afew days—before succumbing; Roig was at her bedside when she died. “The venom won in the end,” he says, “but she was a fighter.”
Gilda Pamphile, a native of Haiti, had never been in an ICU before Mexico. “One patient who had been in acar accident was bleeding from his mouth and nose,” she recalls. “The doctor said he needed an MRI, but it was too dangerous to move him to a hospital where he could get one. He died from a blood clot. I was shocked,but I managed to hold it together. And I was fascinated because the nurses and doctors were moving so fast, yet were so quiet and efficient. Their teamwork was awesome. I soaked up the experience like a sponge.”
The students were dismayed to discover that at one sparsely resourced hospital, medical equipment considered standard in U.S. hospitals was only available for rental, if at all—and at rates that were unaffordable for many patients. “Working in the community moved us to tears,” says Ivette Cardelli, who is planning her own charity drive to support the health care and daily needs of the area’s poorest families. Toward the end of their visit, the UM students made a special trip to a local Wal-Mart to purchase school supplies for local children. Cardelli and a group of Tampico alums are already planning to return to the area during spring break next year.
Hope Amid Profound Poverty
“I’ve seen poverty in different places,” says Laura Hlohinec, BSN ’08, who traveled to Haiti as a nursing student last January, “but this was shocking.” Haiti, a 90-minute flight from Miami and the poorest country in the Western hemisphere, has the highest child mortality rate in the hemisphere; its youngsters are plagued by chronic malnutrition and infectious diseases such as HIV and tuberculosis.
Yet, says Marie Chery, BSN, RN, director of the Haiti minimester and in-country director for Project Medishare, “Students are also inspired by the resilience, the optimism, and the resolve of the people who want to make tomorrow better.”
Created 14 years ago by Barth Green, MD, and Arthur Fournier, MD, of the Miller School of Medicine to provide quality medical care to poor and isolated families, Project Medishare serves some 80,000 people in Haiti’s Central Plateau. Nursing students joined the effort three years ago. Though living conditions in the Project Medishare compound are basic, warm camaraderie and a strong sense of mission overcome the lack of creature comforts. Working alongside staff, the students go door to door with community health agents to vaccinate children, staff rally posts (where people converge at a church or school for medical services), dispense prenatal vitamins, and provide for children’s nutritional needs at mobile clinics.
Valerie Mathurin, BSN ’08, a pediatric ICU nurse at Jackson Memorial Hospital who left her native Port-au-Prince for the U.S. when she was 10 years old, wanted to visit a part of her homeland she hadn’t seen before. She vividly recalls seeing the crush of patients at a remote mobile clinic—many of whom crossed rough terrain to obtain care and were grateful for any assistance: “It got me thinking:‘Wow, it’s the simple things that really matter.’”
A World of Possibilitites
The school’s partnerships with academic institutions and hospitals throughout the hemisphere continue to expand, providing students with a growing array of international learning opportunities. “Many have never been out of the country before,” says faculty member Johis Ortega. “They grow tremendously, both personally and professionally.” He notes that several students who would like to go cannot afford the travel expenses, which could be offset by philanthropic donations to fund scholarships.
Meanwhile, the students who have gone on a minimester abroad come back forever changed. Julie Megler, BSN ’08, whowent to Haiti last year, says that her experiences reinforced her growing interest in international public health. “What youdo with the experience is really important,” she reflects. “You can build on it.”
“I’ve become more optimistic about helping the world,” says Laura Hlohinec, who now plans to pursue a career in public health. Though she fell in love with the people and rich culture of Haiti, she says, “I would be willing to go anywhere.”
“The need can be overwhelming,” admits Ivette Cardelli. “But you make a dent. You provide education, a bit of extra time, you focus on the little things, and they grow and make a huge impact.”
Since her experience in Tampico, Cardelli—who first considered becoming a women’s health nurse practitioner—now hopes to open a community clinic and to also work indeveloping nations. In the journal she kept during her time in Mexico, she wrote: “My heart is finally where it belongs.”