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Fall Conference Welcome– Julie Anathan, RN, MPH: November 1, 2017

Good morning. My name is Julie Anathan, Associate Chief Nursing Officer at Seed Global Health. I’d like to start by welcoming our guest speakers, Catherine D’Ignazio, Rebecca Michelson, Anna Young and Rebecca Love. Thank you for joining us and providing us with the inspiration and expertise around the exploration of technology and innovation for global nurses across education and practice. I’d like to also extend a special note of gratitude to Dr. Thompson for hosting and joining us here today. As I understand it, UMass Boston provided the platform for the IDEAS UMass Boston, which brought diverse thought leaders together to build networks and create opportunity to foster innovation. Today represents an opportunity to keep that flame bright, here at UMASS, with this important focus on the intersection of technology, innovation and nurses across the globe. In light of that, I also want to extend gratitude to The global nursing caucus, Nancy Street, Monica Onyango and Amanda Hart for your vision and commitment in making today happen. My perspective for today’s conversation is grounded in nursing education. I’ve been incredibly lucky and honored to partner with nursing faculty across 21 nursing schools across 5 countries in SSA through Seed’s partnership with the Peace Corps and PEPFAR for the Global Health Service Partnership. Over the last 4 years, I’ve done my best to lend a keen ear and watchful eye to the critical needs and goals across many of these institution. As a result, the question that will reside in the back of my mind today is this: “how do we use innovation to close the theory – practice gap” in areas of the world where nursing students who graduate today are not ready for practice tomorrow.  The challenges that lead to this reality are complex, but suffice it to say, nursing students are graduating without the required skills and confidence to begin their careers at the bedside. I know for a fact that nursing innovation in nursing education is all around us. My friend and colleague Elisa Vandervort, here in the audience, is a midwife and was a Global Health Service Partnership Volunteer in 2015-6 in Tanzania. She didn’t have access to expensive simulation equipment to teach her midwifery students the correct hand maneuvers for a healthy delivery. Elisa found a big box and a pair of scissors, cut a hole in the bottom of the box and voila, a home sewn baby doll could be born. I’d like to also acknowledge Peter Cardellichio in the audience. Peter is the Associate Director of the Global Health Media Project, an organization that is headed by a midwife and an organization that has mastered the art of bringing audio/visual learning to limited resource settings through their beautifully crafted, well written and easily downloadable videos. While innovation resides in both the practice and educational settings, we may not know about it. As Jose Gomez – Marquez and Anna Young wrote in their important article called “A History of Nurse Making and Stealth Innovation”, The lack of recognition for maker nurses has a serious downside: All too often, nurse made solutions do not spread beyond their unit where they are created. As a result, care that could be improved isn’t, and the patients who could be helped aren’t. Everyone loses. By nurturing nurses’...

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Elizabeth Glaser, PhD, MS in Malawi: October 9, 2017

Since July 2016, I have lived and worked in Malawi as part of the Global Health Service Partnership, a joint program of the Peace Corps, the President’s Emergency Plan for AIDS Relief (PEPFAR), and Seed Global Health. GHSP aims to improve clinical education, expand the base of physician and nursing educators, and build healthcare capacity in five countries, Malawi, Uganda, Tanzania, Swaziland, and Liberia, that face critical shortages of healthcare providers. I’m visiting faculty at Kamuzu College of Nursing, University of Malawi (KCN Blantyre Campus), where my brief is to expand research capacity. So what does it mean to “expand research capacity”? That means I supervise 32 masters’ degree candidates in their research dissertations, am an instructor for doctoral students, am working with faculty on their research, and am developing joint studies.  It also means working in collaboration with colleagues at the College of Medicine and other research institutions to promote and support the development of research that addresses the needs of the Malawi people. For example, many of the masters students are currently collecting data for their dissertation at district hospitals or other remote centres in the country. Data collection sounds so clean and easy, but it isn’t, interviews don’t always go as one hoped and records can be missing. In order to help students address challenges early in the collection process, I’ve been trying to review their data and find ways to mitigate issues that arise. The best way to do this, in my opinion, is to visit the student at his/her research site to understand the context and then troubleshoot together to find solutions.   Last week, my work brought me from Blantyre, the principle city of the Southern Region, to Mzuzu, the main city of the Northern Region, over 400 miles and a 10 hour drive away. The Northern region has less population density, lower HIV rates, and higher median years of education than the more populated Central and Southern regions (Malawi DHS 2015-2016). After hours and hours of driving through sere, dusty, crowded towns punctuated by hills denuded of trees, the land began to rise, and the temperature dropped. The burnt dry landscape yielded to tall green pines, granite domes, and the sparsely populated spaces of the North. At times, I had cognitive dissonance – am I driving to Yosemite or to Mzuzu – then turned a corner to see a troupe of monkeys sunning themselves on the shoulder of the road, reminding me that I was still in Africa.  Though I was staying in the city of Mzuzu in Mzimba district, I had to drive south for 1.5-2 hours to meet the graduate student at the main hospital in the southern part of Mzimba where she was gathering data on outcomes for women with severe primary post partum hemorrhage (PPH). This was a retrospective study where we are examining 4 years worth of labour and delivery records to determine the number of women with PPH and their outcomes based on various factors. Simply put, did women that experienced severe PPH live or die and what factors may have led to survivorship vs. death. She was still collecting records, but found issues with missing data on women that had been transferred to that main hospital from an outlying facility. Records hadn’t been sent with...

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UCSF Global Health Fellowship’s Emily Hall, MSN, MPH: September 8, 2017

Emily Hall, MSN, MPH is a family nurse practitioner, Global Health Science PhD candidate and clinical faculty at University of California at San Francisco. She started her work in global health as an RN, joining a group affiliated with her hospital doing work in Rwanda. She has also worked in Haiti, and focuses on providing clinical education in low resource settings. Her current role at UCSF is heading their Global Health Nursing Fellowship, a unique year long academic fellowship that aims to provide an opportunity for US educated nurses to have a training in global health. The fellowship, which is currently working on fundraising, includes a social medicine and curriculum with foundational global health education integrated with field experience in Haiti. The purpose of the program is to create collaboration and partnerships for nurses working in resource limited settings while providing support for US based nurses who desire to do that work. I also asked Emily about other ways that nurses not affiliated with academia could become involved in Global Health. “Nurses have so many of the skills which can lead to fruitful purposeful global health work. Being creative about your skill set can help you find opportunities. For example, an organization may not be hiring for a nurse position or may not have other nurses working for them, but their needs are program management, supply chain, training, monitoring and evaluation. These are all tasks which nurses are familiar with. It can be helpful to research a focused clinical area (just pediatrics for example) or defined geographic area and find organizations doing work in that space. Make connections to learn more about what they are doing and make yourself known to them because opportunities may arise later. Also I really recommend working in your local community. The principals of global health are similar for vulnerable populations wherever they reside and you may be able to make a larger impact...

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It’s “Colombia”, NOT “Columbia” –Paula Matarrese, FNP-BC: August 15, 2017

The usual response I receive when I tell friends that I am going to Colombia, South America on a medical mission, is that of wide-eyed incomprehension followed by “are you safe there?” Granted, Colombia has a notorious past of violence and sophisticated drug trafficking organizations, some of which still plague areas of the country. The health care inequities are prolific among a confusing and changing health system. Nonetheless, Colombia has stolen my heart. As a Family Practice Nurse Practitioner, I volunteer both clinically and as a board member with the organization “Living Abundantly Using Guided Helping Hands” (LAUGHH). The LAUGHH foundation (laugh.org) is a grassroots, all volunteer organization, founded with a mission to serve the underserved through education and life skills. After one of the founding members, a native Colombian, expressed a desire to help her country, the LAUGHH medical mission to Colombia was born. From the beginning we were determined to make this more than a “feel good mission”. Our focus is on self-empowerment of patients through knowledge regarding their own health care needs. Preventive care and chronic disease self-management education is the core of our mission. In this way, we create sustainable health improvement techniques to improve lives. For the past 4 years, LAUGHH has established a relationship with the Colombian government to enhance primary and preventive care services for underserved areas. We travel as a group of some 80 U.S. and Colombian volunteers by bus into rural areas, evaluating patients throughout the life span in makeshift primary care clinics. Our group consists of doctors, nurses, physical therapists, nutritionists, and translators, as well as volunteers who just “help get stuff done”. Central to the evaluation, is the education of patients on self-management of chronic disease and health promotion. In Colombia, as in the U.S., diabetes and hypertension are prevalent. All patients receive diet and exercise education, as well as individualized learning on hypertension and diabetes. The focus on the educational aspect enhances the patient experience and bridges an education gap in what is often a very fragmented health care experience for rural patients. With low literacy rates, we work to educate on basic lifestyle changes and use graphic educational materials. We call ourselves the “mission within the mission” because although patients are evaluated by a physician and usually receive a small supply of medicine, our real goal is knowledge and self-management techniques of the things that patients have control over. Our acceptance by the Colombian government and the people of Colombia has been amazing. We now have native Colombian physicians accompanying us on our mission. We also have medical students assisting our doctors and providers, both as translators of the language and culture and in assisting in the medical history. The students also conduct education sessions and have learned the “teach-back” method of patient education. As young medical student put it – “In medical school we learn to diagnose and treat a patient. LAUGHH has shown us how to care for our patients”. What can be more affirming to an organization than that? LAUGHH is growing and expanding their imprint in rural Colombia. In the 4 years LAUGHH’s inception, governmental relationships and community trust has been strengthened, which has extended the reach of the organization. We have forged relationships with native Colombians in a way that was...

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Nursing in Nepal– Barbara Waldorf, BSN, MPH: July 9, 2017

Nepal had called me back again.  My last visit there was 20 years ago, so I was very curious about the changes that had occurred, especially after the 2015 earthquake. I spent time in the capital city of Kathmandu, the surrounding small towns as well as a mountaintop monastery. These are my reflections about some (planned and unplanned) nursing experiences; my acute awareness of public health wherever I go, and some thoughts about the experience of traveling alone.  Through the generous help of Sumitra Sharma, a nursing lecturer at Kathmandu Medical College, whom I met through the Global Nursing Caucus, I spent a day conducting a lecture for the second and third year BSN nursing students and meeting the nursing faculty at the college. But before getting to the college, so much happened. The morning started with someone at my guesthouse finding me and asking for help. A young boy had been bitten by a dog, while on his way to school. It was a nasty bite and while a few of us helped him by cleaning and dressing his arm, the folks at the local cafe gave him some toast and tea. His mother was called and she took him to the government hospital for treatment (stitches and rabies shots), as it is free for these types of problems. There are many dogs around, running in packs and are particularly dangerous for young children. This is just one of the challenges that some Kathmandu residents face in their daily lives. This event illustrated things that have and have not changed over the past 20 years. I have vivid memories from previous trips of the packs of dogs barking all night and having to be careful while walking in the lanes. Now there is a clinic close by, but the family could not afford their care, and so went to the government hospital. This boy was lucky to be going to school, as it is not a given for all children in Nepal. Despite a statistic of 96.2 % for boys attending primary school (https://www.unicef.org/infobycountry/nepal_nepal_statistics.html), I met children who were illiterate. After this rather unusual start to the morning, I was picked up by the driver from the college and we entered the chaos of Kathmandu traffic. What should have taken us 20 minutes, took an hour and a half. The traffic here is epic. The roads are being redone, due to laying water pipe (which is a good thing from a public health standpoint) and most are extremely dusty and have very large ruts and potholes. Everyone wears masks while on the streets. There has been a major increase in the population of the Kathmandu Valley over the past 15 years (from 644,000 in 2000 to 1.26 million in 2017). (http://worldpopulationreview.com/world-cities/kathmandu-population/) As well, there is a construction boom due to the population increase and rebuilding after the 2015 earthquake (https://www.britannica.com/topic/Nepal-earthquake-of-2015) which impacts so much of daily life. Another factor is that over the last years, there has been a significant increase in (many) people’s income, much of it from remittances (31.75% of Nepal’s GDP), and one result is there are many more vehicles on the roads.  We eventually arrived at the school. I gave a talk about global health and ethics. The students took a little while to...

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Nursing in MSF: June 9, 2017

Doctors without Borders/Medicin Sans Frontiers is a well known international organization started in 1971 by  French Doctors who wanted to provide medical care to “where the need is greatest, delivering emergency medical aid to people affected by conflict, epidemics, disasters, or exclusion from health care and provide medical aid where it is needed most.”  (http://www.doctorswithoutborders.org). Working in over 60 countries, their staff is made up of multidisciplinary professionals including nurses, nurse-midwives, nurse practitioners and nurse anesthetists. One of these nurses is Kristen Lubell, an experienced pediatric nurse, now family nurse practitioner student who most recently worked with MSF in the South Sudan. Kristen came to MSF with an extensive work history in neonatal and pediatric critical care, pediatric E.R. and flight nursing experience. In the Sudan she worked as pediatric nurse specialist whose responsibilities included being the only RN working with a team to operate a 55 bed NICU, a 13 bed PICU, and 203 bed pediatric ward, supporting Labor & Delivery, and running the Sexual Assault Nurse Examiner program. Her workload included rounding on anywhere from 50-100 patients a day, and providing support and community outreach for local programs. Kristen explains further that most international MSF nursing staff work to provide basic health care, rather than hands on medical care, except in emergency situations. Nurses often set up and run vaccination programs, health centers, or feeding centers. Much of MSFs work is done in collaboration with national health care providers and systems, although they also maintain their own independent projects as well. International nurses often provide supervision, training and managing programs, while national staff are involved in the staffing and direct patient care in these programs. MSF accepts open applications for registered nurses, nurse practitioners, and nurse-midwives. The minimum requirement is a degree and three years experience, and the ability to commit to at least nine months of work, as well as special training in several categories. To learn more about the role of nurses in MSF, see the link below....

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International Nurses Day Celebration: May 26, 2017

Deb Winters has been providing HIV clinical care since 1986.  She is the Senior Nurse Advisor for I-TECH providing teaching, clinical mentoring and curriculum development that began in Ethiopia in 2003.  Deb provided an overview of I-TECH’s Nursing and Midwifery Portfolio which started in 2002 and includes in-service training support, pre-service capacity building, leadership and management and regulatory strengthening and policy development in 18 I-TECH supported countries.   Deb presented information on her most recent work in Zimbabwe, South Africa and Malawi.  In Zimbabwe she has been developing case-based curriculum for I-TECHs eLearning training program focused on PMTCT, HIV Testing and Counseling for Children and Adolescents and Viral Load Monitoring.   The training approach includes blended learning, tablet-based self-study materials and distance learning.   In South Africa, the e-Learning curriculum contains interactive and practical learning exercises on how to effectively use health information and data centered around TB, HIV and diarrheal cases.   In Malawi, Deb and the I-TECH team developed a comprehensive HIV, TB and STI pre-service curriculum and she is currently providing faculty TOTs using the revised...

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A “First-in-a-Lifetime” Experience: April 16, 2017

A “First-in-a-Lifetime” Experience By: Nora Carr, BSN, RN For ten days this past March, I traveled to Grenada with a group of fellow nurse practitioner students and faculty members from Regis College.   Nurses and students tend to naturally be inquisitive and as a student NP and first-time visitor to the Caribbean country of Grenada, I was curious about many things.  What types of medical problems would be predominant?  How do Grenadians typically access healthcare?  What is life like on the island?  I had questions about everything from philosophical approaches to healthcare to logistical details like how to catch a bus.  One thing I knew from the beginning was that my Boston-centric view of healthcare (and the world) would be challenged, and for that I was grateful.  I have been fortunate enough to have traveled internationally on prior occasions, but this trip would be different.  Travelling in a professional nursing capacity was an once-in-a-lifetime opportunity not to be missed. Our trip was affiliated with the medical and nursing schools of St. George’s University, and we attended lectures and practical skills labs at the school.  We were paired up with physicians at the school’s health services to provide care for students, staff and their families.  Seeing patients in this setting felt similar to the way that patients are seen in clinics that I have seen in the Boston area, although there were many important differences.  One major difference is that many health services are free, although some diagnostics such as labs or imaging are paid for directly by the patient.  However these costs are much lower than they would be in the U.S.  This was also true at the local Planned Parenthood chapter, which provides women with birth control and reproductive health services.  For example, a pap smear costs around $15 USD.  Some Grenadians choose to have private health insurance, but it is not mandatory.  Therefore, there is a stark contrast in the amount of time spent filing paperwork, which in the U.S. is often a drain on the resources of clinics and private practices.  Another difference is that the technology on the island is limited.  There are no mammogram machines on the island, nor a cardiac catheterization lab, or a hyperbaric chamber.  There are only two hemodialysis machines on the island.  I take so many of these resources for granted in the U.S, and at first I couldn’t comprehend how people are able to get the care they need without these vital technologies.  I was told that people can travel to Trinidad for some of these treatments/tests.  However in other cases, diagnoses are made on the strength of the clinical assessments of the providers.  Many common health problems are treated empirically, without the confirmatory tests that we often order in the U.S.  It really made me question whether the so-called “million-dollar-workup” that we use in the U.S. could be done at a lower cost, or if it is always needed for commonly occurring conditions. As nurses, we are always concerned with the activities of daily living as well as the independence level of our patients.  I found that the social support network seems to be stronger for Grenadians, as families are usually the sole provider of caregiver services for their loved ones.  Skilled nursing facilities are rare, and when I...

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Sustainable Compassion Meditation: Barbara Waldorf: April 5, 2016

by Barbara Waldorf BSN, MPH Throughout my career as a nurse, I have been “burned out” at various times. Along with the impulse to find spiritual freedom, this journey of burnout and creating resilience has brought me to learning and teaching compassion meditation for nurses and other healthcare providers. There is a particular moment of burnout that can be identified as “hitting the wall”. These moments are the crux point, when things get to be too much and something has to change. My memory of these moments is graphic, even many years later. Handing the tiny silver bracelets of a baby who we had been unable to resuscitate to her grieving parents. Realizing that the patient I had been working with in a community mental health program was not going to stop undermining my every effort to help. That moment of knowing that I needed something more, to find the inner resources, education, time and space, to be able to cope with the work I wanted to do. These experiences led me to ask many questions. How can we retain the core motivation that inspired us to enter this field of caring? How can we restore ourselves? How can we tap into the resiliency that I knew existed, within the profession and within each of us? Some of the challenges faced by those working in mental health (and other fields) can be described as compassion fatigue, empathic distress or burnout. Compassion fatigue has been characterized as the “cost of caring” for those in emotional or physical pain (Figley 1982). Because we care, because we have empathy for the suffering we see on the job every day, we are susceptible. These effects are physical, emotional and can result in work related stress. The impact of compassion fatigue and burnout on both providers and patients has been well documented (Lombardo, Eyre 2011). There are many strategies suggested for nurses on how to reduce the tendency to burn out and the effects of secondary trauma. Lombardo and Eyre write; “Developing positive self-care strategies and healthy rituals are very important for a caregiver’s recovery from compassion fatigue. Healthy rituals are those activities that one participates in on a regular basis and that replenish personal energy levels and enhance feelings of well being.” Compassion can be defined in many ways – one is: loving, empathetic concern for someone who is suffering, and wishing him or her to be free and deeply well. Compassion is a core value of all healthcare professions (Baur-Wu, Fontaine 2015) Meditation is one of the ways that we can learn to evoke our natural compassion. Sustainable Compassion Meditation is such a practice, a means to cultivate the innate capacity to find our own inner resource for replenishment, to cultivate resiliency, and a sustainable source of compassionate presence to others. We are not seeking to find it outside of ourselves, in a better ‘strategy’, but rather to reveal to our self our innate capacity for care and compassion. The basic understanding of Sustainable Compassion Training is that we are all compassionate by nature. However, our habitual patterns of thinking and judging obscure the free flowing power of care. The purpose of Sustainable Compassion Training meditation is to interrupt these mental patterns with the loving energy available to us in moments of...

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Zika Virus: The Outbreak, Response and Concerns Over Women’s Reproductive Rights, Or Lack Thereof: February 23, 2016

Sarah McAnaw, MPH(c), Siena Easley, MPH(c), Jackson Mesick, MPH(c), Paola Peynetti, MPH(c), Monica Adhiambo Onyango, RN, PhD **All the authors are affiliated with Boston University School of Public Health** Zika virus has arguably become the topic of discussion over the past few months and continues as a disease of concern to the public health community.  Although relatively unheard of by most of the general public until recently, Zika virus was first isolated in 1947 in the Zika Forest of Uganda. Zika was previously diagnosed across western, central, and eastern Africa as well as in South and Southeast Asia, where it remained until 2007 when it began spreading across the South Pacific. The current outbreak of the virus was first detected in mainland South America in Brazil in March of 2015.  The virus has since rapidly spread across 26 countries throughout South and Central America including Barbados, Bolivia, Brazil, Colombia, Costa Rica, Curacao, the Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haití, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Maarten, Suriname, the U.S. Virgin Islands, and Venezuela. Zika virus is spread by the Aedes mosquito, the same mosquito genus that carries dengue and chikungunya.  Although symptoms of Zika are similar to those of dengue, only 1 in 5 people infected with the virus become symptomatic and those who do typically experience a mild illness.  For this reason, it is not the illness itself that is causing widespread concern.  It is what we largely do not know about the virus and other potential consequences of infection that have raised global alarm. Beginning roughly around the same time as the Zika outbreak in Brazil, a significant increase in suspected cases of microcephaly were reported in Brazil.  Microcephaly is a birth defect characterized by newborns having an unusually small head circumference, and can cause or occur in conjunction with a variety of significant developmental delays.  Due to the timing of these two outbreaks, many government and health officials have drawn a possible correlation between mothers infected with Zika virus during pregnancy and microcephaly in their unborn children.  However, no evidence has yet been found to demonstrate a clear causal link between Zika and microcephaly.  In fact, a number of alternative explanations for such a sudden increase in suspected microcephaly cases have been circulating within the scientific and medical communities as of late, including one suggesting a link between a new larvicide targeting mosquitoes that was introduced into Brazil’s water supply late in 2014. Nonetheless, the World Health Organization (WHO) is calling the relationship between Zika virus and microcephaly “strongly suspicious” and “deeply alarming”, and declared the outbreak a global public health emergency on February 1, 2016. These concerns have subsequently led the governments of Colombia, El Salvador, Honduras, Ecuador, and Jamaica to recommend that women either delay or avoid getting pregnant at all for time periods ranging from six months to two years, or until 2018.  Not only are such recommendations impractical from a public health viewpoint, they raise important issues around reproductive rights for women living in these countries.  Women’s rights groups have begun to highlight that governmental policy in many of the affected countries – including those that have issued warnings against pregnancy thus far – often limit access to contraception as well as deny women...

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