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Susie Wood – Compañeros en Salud: Improving Healthcare in Chiapas: March 29, 2018

Written by: Susan Wood, PNP-BC, MPH, IBCLC “We go. We make house calls. We build health systems. We stay.” These simple principles are the mission statement of Partners In Health, an organization which has grown to include eleven sites around the globe. With its commitment to provide the best healthcare to the poorest communities in the world, PIH works on a multitude of levels: training community health workers (acompañantes) and healthcare providers (physicians and nurses), building hospitals and clinics, doing home visits, and removing barriers to good health (such as providing clean water and food, if needed.). Each PIH site reflects the unique needs of each country and community, and only serves at the invitation of local governments and health systems. Partners In Health (also known in Spanish as Compañeros en Salud or CES) began working in Chiapas in 2011. Chiapas is the poorest state in Mexico, and it has the country’s second highest infant and maternal mortality rates. In addition, chronic and infectious diseases, as well as mental illnesses, have historically gone untreated due to non-existent access to care. Working in partnership with the Ministry of Health, CES now staffs ten rural clinics in the Sierra Madre mountains with Mexican physicians (pasantes), who are required to do one year of social service following medical school. The pasantes work as a team with their community’s acompañantes to provide healthcare, health education, and social support to those in need. CES, in turn, supports both groups with living stipends and offers the pasantes a monthly Global Health course, taught by visiting medical and nursing faculty. I arrived in Jaltenango, a small and remote town in central Chiapas, in January. This is where the main office of CES is located, down a dusty road at the edge of town. Most of the staff are former pasantes who became committed to the goal of health equity during their year of service at CES, and have stayed on as supervisors for current pasantes.  Others are volunteers from the US, often recent college graduates on their way to medical school. All were warm and welcoming to me, and with each introduction came a big hug! Despite my rusty Spanish and comparatively advanced age (most of the CES staff are in their mid twenties to thirties), it wasn’t long before I felt integrated into the larger team. Indeed, over the course of the month I was there, I saw a variety of visiting faculty from the US come and go (many of whom were physician volunteers who came for varying lengths of time to teach), who also quickly became a welcome part of CES.   I was a Maternal Health Nurse Volunteer and my role was varied, reflecting the range of needs identified by CES. The first area of need was in early child development. CES was launching its first infant stimulation programs in several rural communities. Over the course of two weeks, I worked with the pasantes to train maternal health acompañantes in basic principles of early child development, and then helped support the implementation of these infant stimulation groups. Emblematic of the different challenges facing each community, one enthusiastically embraced their new infant group, whereas the other community – disproportionately impacted by social stressors such as alcoholism and unemployment – would need additional training...

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Barbara Waldorf – Bhutan: global health at home: February 25, 2018

Written by: Barbara Waldorf, BSN, MPH There are various threads of my life that weave together, influencing each other in different ways over time. Nursing is one of those threads, global health is another, and meditation is a third. I have spent a significant portion of my time and energy, training in each of these disciplines. And family is another thread that underpins it all. In thinking of writing about my experience in Bhutan last year, the tapestry of all those threads comes together.  There is always the question when traveling; “What does this mean for my life back home? What am I learning that is relevant to my day to day world?” My experience in Bhutan and Nepal last year had an impact, but I didn’t really see it clearly until I needed it. Push came to proverbial shove.  This is where global health and life back home intersect, which is a something that I (and many of my friends) have been contemplating for years. I went to Bhutan on pilgrimage, not to do nursing, but because of connections from BUSPH. I was lucky enough to meet with the former head of the their nursing school and talk about the status of nursing, the education and working lives of nurses in Bhutan. It was wonderful and very enlightening. She was very generous in describing the various challenges that nurses and public health providers face in this developing country. I appreciated being able to hear her perspective, and contrast it with my encounters with nurses in Nepal and India. The struggles of nurses to gain education, recognition and acknowledgement is not essentially different, although some of the issues of being in a developing country make this more difficult. It reminded me to be grateful for the opportunities I have had.  Something that really struck me about being in Bhutan was the emphasis on compassion and the support of practice. This is woven into the culture, like the extraordinary weavings that make up the cloth for traditional clothing that is still worn. It all felt very natural, being in this environment, so it wasn’t until I was back home that the connections began to be made. The intersections between the experiences in Bhutan and my studies in compassion meditation came to fruition in my response to caring for my stepfather when he became ill this fall.  I had been unsuccessfully trying to get my mother and stepfather (who are in their late 80’s) to move to senior living for a long time. During this time they have had various medical issues, started to become somewhat stressed and forgetful, and had an increasingly difficult time keeping their practical lives together. But they did not want to go, despite the logic of it and recommendations by friends. I was told, “We are not going to move until something really bad happens.” This fall, it happened. I sat across the kitchen table from my stepfather. Convinced he was dying, he asked for my help. In that moment, all my training; my 30 years of nursing, public health and Buddhist practice came together. Here was a human being who was suffering. It didn’t matter that we had spent the previous two years arguing and then not speaking to each other. It didn’t matter that...

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Debbie Wilson – Collaboration between expatriate & national nurses: January 24, 2018

Written by: Deborah Wilson, RN, MSN, MPH, CRNI Sometimes, you make a choice  that sets  you on a completely different life path than you ever imagined. In 2014 when Medecins Sans Frontieres (MSF) asked if I would go on mission to work as a nurse during the Ebola outbreak in Liberia, saying yes, set off chain reaction that changed my life forever. That mission and the timing of my return (two days before the first nurse came down with Ebola in Texas) catapulted me from a quiet comfortable life to one where I found myself speaking out publicly on the harm of political policies and actions of communities when fueled by the fear of Ebola rather than common public health sense and evidence based science. This led me to seek and complete a MSN/MPH at Johns Hopkins. Usually, after a mission, a hot shower a good meal and some wine lets you go back to your life – almost like nothing happened. But this  time so many things continued to haunt me. The intensity of working in a 120 bed Ebola Treatment Unit highlighted issues about working in the global humanitarian field that left me with more questions than answers. One was the perception that on missions national nurses did most of the work, but they were not always treated as colleagues. Expatriate nurses were always the supervisor and meetings that decided plans of action or care in the clinic/hospital or field usually excluded national staff. Of course, it is complicated, many factors are at play in the international humanitarian world,  but I could not help but wonder if there was a way that we could change this. The 78 Liberian nurses that I supervised when in Liberia, worked for the whole duration of the Ebola outbreak not just for a few weeks like us international ex-patriate nurses. They did not have the option of being flown to a country where they could receive state-of-the-art treatment if they contracted Ebola and they had to fight their Ministry of Health to get paid. In fact they were not paid for more than six months and never received the hazard bonus that they had been promised. In the face of such information my desire to see improved collaboration between national and expatriate nurses seems minor but it continued to haunt me.  I looked for articles about working in humanitarian emergencies and discovered that of 30 that I read only 2 had interviewed or surveyed national staff experience. The rest focused on expatriate experience and opinion. So I decided to do my own independent study as a student. I obtained IRB approval both from Hopkins and the Liberian Review Board and flew to Monrovia  to interview nurses that worked for various international NGOs. A Liberian nurse that I  had worked with during the Ebola outbreak completed the John Hopkins ethical and human subjects modules so that he could be an official co-researcher.   The quality improvement study we conducted asked the question “Can an increase in collaboration between expatriate and national nurses improve the clinical outcomes of patients?”.   We interviewed 20 registered nurses representing ten different international NGOs. The interview questions included asking what was positive about working with expats, what was negative and what ethical conflicts arose. The nurses provided numerous examples...

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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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