KU School of Nursing partners with Woodland Charity in Guatemala
February 21, 2019
By Kristi Birch
In January, 18 University of Kansas School of Nursing students learned firsthand that you can improve health not only by treating individual patients in a clinic, but also by working with a community as a whole and helping people create healthier living environments.
These students, seniors in the bachelor of science in nursing (BSN) program, spent nearly two weeks completing a global health rotation in the rural village of Patanatic, Guatemala. In addition to working alongside local nurses to conduct health assessments and well-child checks in a clinic and at local schools, the students went into the community to assist with the area's clean water initiative and to help ensure that woodstove usage was not causing toxic air in people's homes. They also helped provide in-home checkups for elderly people unable to come to the clinic.
KU nursing students have been going to Patanatic since 2016, when the School of Nursing established a partnership with Woodland Public Charity, a nonprofit organization headquartered in Kansas City, Missouri, that helps provide people with access to safe drinking water, education, and health care in Central America and the United States.
In late 2018, the charity announced that the KU School of Nursing had won its Humanitarian Partner Organization of the Year award. "Woodland choose the KU School of Nursing because of their commitment to supporting access to the educational and health programs in Guatemala," said Jorge Coromac, executive director of Woodland Public Charity. "The partnership reassures local families that a professional team is working together with local nurses in Guatemala to help care for newborns, youth, adults and seniors in our community."
The partnership between the School of Nursing and Woodland Charity was developed largely by Vicki Hicks, RN, MS, APRN, then a clinical associate professor in the KU School of Nursing, and Kimberly Connelly, senior international officer and director of the Office of International Programs at KU Medical Center.
Hicks, who retired at the end of 2018, taught the population health practicum course that the students take their senior year, which enables students to apply the knowledge and skills learned in the didactic class. Hicks had also spearheaded many of the international opportunities that nursing students have, including facilitating their population health practicum internationally in addition to locally. Students wanting to experience a global practicum can also apply to go to India, New Zealand, Uganda, Zambia, Belgium or Scotland.
Meanwhile, Connelly had worked with Woodland Charity before she came to the KU Medical Center in 2013, when she learned that students in the KU School of Medicine worked with the charity in Guatemala. She approached Hicks about extending the opportunity to nursing students. The first group of seven KU nursing students headed to Patanatic in 2016. The village is located on the side of a mountain, and the nearest hospital is 30 minutes away. The clinic there is run by two LPN-trained nurses and serves roughly 1,500 people in the surrounding area.
Diversity of experience
"Woodland Charity provides our students with a good clinical experience in Guatemala as well as a cultural experience that makes them better equipped to deal with diversity," said Connelly. "They are more aware of themselves as cultural beings, and we hope it makes them better communicators so that they are better equipped as healthcare providers for the diversity in Kansas."
Blake Heying, a fourth-year nursing student from Overland Park, chose Guatemala because he wanted to improve his ability to communicate with Spanish-speaking patients. "I recognize how many Spanish-speaking patients we have in the hospital at KU, and in the United States as a whole," he said. "I thought going to Guatemala would give me the chance to practice those communication skills in a clinical setting."
Heying, who had taken Spanish in high school, said the interpreters at the clinic taught the students clinical terms. "By the end of the two weeks, we were able to tell patients we wanted to listen to their heart or look in their ears without having a translator present."
Gina Johnson, MSN, RN, clinical assistant professor and lead population health faculty in the KU School of Nursing, says that it's not just expanding their experience across cultures that helps train nurses, but also learning what influences the health of a community and how that impacts individuals in their everyday lives.
"Our overall goal is for students to look beyond the walls of the hospital and beyond the walls of the clinic," Johnson said. "It's where people live, learn, work, play, and worship that has the greatest impact on health outcomes."
Beyond the clinic
The fall semester before the population health rotation, the students are required to learn about the process of completing a community health assessment of the area. The assessment includes studying the morbidity and mortality rates, identifying the community's top five health issues, and determinants of health such as income level, educational level, physical environment, access to care, safety and transportation, and the social and community context. Then, once the students begin their rotation, they see how reality compares to what they studied in their classrooms in Kansas City.
In Patanatic, as in much of Guatemala, one major health issue is that many people do not have access to clean water. Much of the water supply is not treated, and the treatment that is typically used does not remove pathogens such as E. coli. Contaminated water causes diarrheal diseases, which can then rob the body of nutrients and lead to malnutrition. "They had told us about the tap water," said Heying. "Then we got there and saw that it was a very real situation."
Because many citizens cannot afford a water filtration system, Woodland Charity has been providing people with simple water filters that can last up to 10 years if they are taken care of. The students visited people's homes to make sure these filters were being maintained properly, and they also delivered and set up new filters in homes for families who needed them.
Indoor air pollution caused by woodstoves is another challenge in the region. "Many community members build fires in their house in order to [cook and] boil water to clean it, and that causes a lot of upper respiratory infections," said Jamie Franklin, a nursing student from Kansas City, Missouri. "So we built smokeless stoves for them out of cement block and equipment that Woodland sends. With these stoves, the smoke blows out of the house so people aren't breathing it."
In addition to practicing their clinical skills, such as listening to heartbeats and conducting ear and eye exams, the students also got a chance to learn from watching two very busy local nurses manage their caseload. "During the well-child checks, we ran into a situation where they were low on amoxicillin, so they had to decide, does this child really need an antibiotic?" said Heying. "We learned from them something about working with the resources you have."
The clinicians in Guatemala have learned from the KU Medical Center, too, through opportunities provided by the Office of International Programs. In 2017, with funding from the Redford Foundation, one of the two nurses at the clinic, Sonia Xiquin Calabay, traveled to the University of Kansas School of Nursing and sat in on classes, learned about community services and shadowed primary care clinics. A brother of one of the Guatemalan nurses who is studying to be a physician and who plans to practice in Patanatic, Carlos David Garcia Martin, came to the KU School of Medicine for training also.
For the nursing students at KU, the experience gave them a real-world chance to step back and see their profession through a population health lens. "When we left for Guatemala, I thought my biggest takeaway would be the technical skills I gained through the clinical experience," said Franklin. "But the most important thing I learned was how much of an impact community education can have on a whole population."