R e t u r n   t o   t a b l e   o f   c o n t e n t s

Emory nursing students, pictured in the foreground, worked diligently to care for long lines of patients seeking health care at a clinic in Haiti.
 

 

The World Is Our Classroom
A new organization and graduate major prepare students who can lead the way in international nursing

By Valerie Gregg

   
One day we were in a ghetto in Cap-Haitien, and we were down to our last syringe. It was a big one too—an 18-gauge needle. We had to save it for the sickest person we could find. So for the rest of that afternoon, we used alternatives—oral medication and what have you. There were many people who needed it, but we finally used the syringe on a little kid with a temperature of 104. We had to make some hard choices. The hardest part of the experience was that every day we either ran out of time, drugs, or both. We could never see all the people who came. When we arrived in a town early in the morning, there would be a line of people out the door waiting to be seen. They waited for hours. Almost every day, we left with people still in line.—Eddie Gammill, 01N
 

Haiti is a place where desperation is palpable and need seems endless. Virtually everything is lacking except children, hunger, ill health, and misery. Relief workers and drug smugglers alike are pulling out.

It was here, on this tropical island of charred palm trees and ruined pastel-colored houses, that Emory nursing student Eddie Gammill came to understand the stark realities of life and health care in a developing country. The experience was jarring, eye-opening, and ultimately transforming.

Flying into the coastal city of Cap-Haitien, Gammill’s first glimpse of the “Paris of the Antilles” was a blackened and desolate landscape.

Eddie Gammill, 01N, was among the students who traveled to Haiti last spring. He is the founding president of the Emory International Student Nursing Association.

“The place looked like it had been bombed,” says Gammill, president of the class of 2001 and founding president of the Emory International Student Nursing Association (EISNA). “I later found out that people had burned the trees to make coal for fuel. You don’t see a lot of beauty in Haiti. You see a lot of filth and squalor. The people there have absolutely nothing. It’s an unbelievably sad place right now.”

For nine days last April, eight BSN and MSN students traveled from their base in Cap-Haitien to towns with melodious names like Lemonade and Milo. What they encountered was almost beyond comprehension. Babies with scabies. Women with six, seven, and eight malnourished, worm-riddled children in tow. People carrying elderly relatives with diabetes or congestive heart failure. Adults and children with malaria, tuberculosis, HIV.

“We would examine them and see what we had with us that could help them,” says Gammill. “We did a lot of hands-on work ourselves, although we were supervised by instructors, physicians, and graduate students. We gave patients head-to-toe assessments, and we quickly learned to take cultural factors into account. Haitian women would not talk about women’s issues if a male was translating. We had to be aware and work around these things so we could give the people the care they needed.”

Gammill quickly realized that the Haitian people need much more than the group of Emory nursing students could possibly give in nine days.

“I would look at these people living in this desolate, destroyed place, and think, ‘This is hopeless,’ ” he says. “In order to go on, I told myself at the end of each day, ‘I did some great work today. I couldn’t help everyone, but I did what I could.’

“Then I visited a Haitian nursing school that had only chalkboards and a few chairs, and I had a revelation. I thought of the old saying, ‘If you give
a man a fish you feed him for a day. But if you teach him how to fish, you feed him for a lifetime.’ I suddenly realized how egotistical it is to think you’re going to change the world in a day. People like Gandhi and Mother Teresa changed the world, but it took them a lifetime.”


The big picture
Lasting, sustainable improvements to health in developing countries is the objective of a new graduate major the School of Nursing will soon offer in coordination with the Rollins School of Public Health. The international master’s of science in nursing/public health degree aims to develop three types of nurse leaders—those from other countries who will return to their home countries and improve health care systems there, those looking to work internationally outside of their home countries, and those who will work with exploding immigrant populations within the United States. Current MSN/MPH programs focus on clinical specialties, such as family nurse practitioner or midwifery. This new MSN/MPH program offers students a “big-picture” perspective that focuses on changing health care systems and policies that could potentially impact entire nations of people.

Grace Anne Turner (center) and Monica Crolle, both 01N, assess a young Haitian boy’s condition.

“Nurses are the largest body of health care providers throughout the world,” says Joyce Murray, nursing professor and a member of the curriculum committee that planned the new two-year program. “This program will help nurses build capacity within their own countries, sustain health care there, and fight for the resources needed to deliver health care.”

Elizabeth Downes, academic program coordinator of the Lillian Carter Center for International Nursing (LCCIN), says this new program offers the potential to create lasting contributions to health care in developing countries. “I see training as the place where nurses can make the biggest difference. Whether it’s teaching hygiene to a group of mothers or CPR to nurses or developing curriculum at a nursing school, we hope to develop programs at the Lillian Carter Center with sustainable impact.”

The new MSN/MPH major aims to accomplish just that. Students from other countries will enrich and diversify the Emory student body. Training them and US students will offer lasting contributions to health care systems in developing countries, where nurses are often the only health care workers around. These nurses are dear to Downes’ heart.

“They are tireless, dedicated, caring, and hungry for education,” she says. “I have seen nurses who walk six miles to work, complete a full shift, go home—often on foot—and then cook dinner from scratch. We are talking firewood and pounded corn. It is hard not to be in complete and utter awe. It is also hard to turn your back on them.”


A gift of opportunity
The fledgling EISNA is a sure sign that students are taking a growing interest in international nursing issues. Gammill, the group’s first president and now an emergency room nurse at Emory University Hospital, was determined to make the Haiti trip more than just a spring break jaunt. He worked with Dean Marla Salmon and Helen O’Shea, baccalaureate program coordinator, to make sure
students who worked in Haiti earned academic community nursing credit for it.

EISNA’s founding members from the Class of 2001: (top row, L–R) Dallas Regan, Eddie Gammill, Sarah Pawlik, (bottom, L–R) Erin Brantley, Brittany Holley, and Deborah Osgood.

“We wanted the school to recognize the value of what we were doing,” says Gammill. “It’s a good thing Dean Salmon was behind us every step of the way, because we never intended to take no for an answer. In making international work part of the curriculum, we created an opportunity for future students.”

Community health nursing instructor Brenda Cobb says the Haiti trip met the academic goals for the course and beyond. “They learned firsthand about culturally appropriate ways to care for patients,” she says. “They also gained an appreciation for the importance of cultural influences and social, economic, and political factors on health. As a faculty member, it was gratifying to see them put together all the pieces of the nursing curriculum to use.”

Watching the students’ personal growth during the experience was equally meaningful. “As people, they recognized the realities of living in such a difficult, devastating environment,” Cobb says. “As nurses, they came to understand how that environment influenced the health and health-related lifestyle choices of the patients. Above all, they learned the importance of working together in cohesive teams. We all needed that support to work under the conditions we found in Haiti.”


When worlds collide
Nursing senior Anu Gopalan lives with one foot in the high-tech, fast-paced world of the United States and the other on a dusty road in rural India. EISNA president for 2001–2002, Gopalan brings an international perspective to the School of Nursing through her own life experience.

We have so much here, and the developing world has so little. We
are citizens of the world, and we have a responsibility as such.
—Anu Gopalan, EISNA president

Her childhood was split between India and the United States, and she returned to India when she was 15, after both parents were diagnosed with terminal cancer. They died soon after, within three months of each other. Gopalan remained in India to finish high school and attended college in the United States, earning a degree in biochemistry from Rutgers. She says it’s easier to accept her parents’ deaths as an Indian than as an American.

“Americans tend to think optimistically—that things will always go well for them,” she says. “But in places like India, life—even survival—is a day-to-day proposition. You have to live in the present in a place like that. After my parents died, every day on my way to school, I’d step over people sleeping in the streets. It occurred to me that many of them could have been dead. In a place like India, there’s a very thin line between death and life.”

Indeed, people die every day from preventable diseases in developing countries like India. Leprosy, tuberculosis, malnutrition, and diarrhea are rampant. Life is often cut short by illnesses that these days rarely kill anyone in the United States. Gopalan believes EISNA will encourage her classmates’ interest in life outside US borders.

“Nurses are the answer,” she says. “We have so much here, and the developing world has so little. We are citizens of the world, and we have a responsibility as such.”

EISNA hopes to organize student trips to Cuba, Mexico, and Haiti during 2001–2002. “Our goal is to get at least 10 students to another country,” Gopalan says. “An understanding of developing countries is not something that can be taught in a classroom. It comes from experience. Going to another place and being immersed in a different culture opens the mind.”

After graduation next spring, Gopalan plans to earn an MSN/MPH and become a pediatric nurse practitioner. She then hopes to return to India, where she would like to run an orphanage or clinic in a rural area.

Her single-minded resolve to pursue a career in international nursing stems from a moment of clarity back in India.

“I was riding a bus one day when I was about 18, and I sat down next to a woman with severe leprosy who was breast-feeding a baby. She had lost her eyesight, and her hands were a mess. It struck me that she couldn’t even see her baby or really even feel what it was like to hold her—all because of a preventable, treatable disease. At that moment, I decided I would become a nurse and come back to India. This is the work I was meant to do.”

Valerie Gregg is assistant director of Health Sciences Publications at Emory University.

 


Janet Irizarry (center) helps other Emory students tear down an old clinic building in a small village in Bolivia. Irizarry ventured there this summer as part of Emory University’s “Year of Reconciliation” delegation.

 

Janet Irizarry found it hard to resist the charms of these Bolivian girls. Irizarry will soon complete her MSN to become a nurse midwife and work to reduce maternal deaths associated with childbirth in the developing world.

On the frontline in nursing midwifery

Midwives love nothing better than a good birth story, and midwifery student Janet Irizarry has heard plenty. The women she cares for tell of laboring alone while caring for several small children. They tell of delivering babies on the bathroom floor or in the woods, with only a sister or mother to help. A Venezuelan woman she knows birthed her baby in a hospital while rats scurried around the room. A Bolivian woman was carried by relatives for three hours on foot to the nearest hospital—after three days of labor failed to bring the baby.

Roses, ice chips, and epidurals were not part of the picture for these women. Childbirth in the developing world is often a harrowing and risky business. The World Health Organization reports that about 98% of all maternal deaths associated with childbirth worldwide occur in developing countries. Only 53% of deliveries in developing countries are attended by a health professional, and only 40% take place in a hospital or clinic. The global gulf between rich and poor is astounding.

Irizarry, who officially becomes a midwife when she graduates with an MSN this December, hopes to build a career around improving these sobering statistics. She is bilingual, an American of Puerto Rican descent, and she hopes to work for a birthing center in a Spanish-speaking country or for the Department of Global Outreach of the American College of Nurse Midwives.

“Educating birth attendants in developing countries is the answer,” she says. “Maternal mortality there is often due to infection or hemorrhaging. No one who is properly trained to care for a hemorrhage is available. Unsanitary conditions can also put the woman and her infant at risk for infection. Both can lead to death.”

As a student, Irizarry has already made a difference in the lives of many women from poor countries. She has traveled twice to Haiti with a health care aide group and once to Bolivia as part of an Emory “Year of Reconciliation” delegation.

To fulfill her clinical MSN requirements, she has given prenatal care to women at “La Clinica de la Mama” in Norcross, Georgia, and delivered more than 50 of their babies during the past year. Most of her patients are undocumented immigrants from Mexico and Central America. They followed their husbands north, searching for work and a better life. Many are the wives of day laborers and have no health insurance. Because they are undocumented, their prenatal care is not covered by Medicaid.

Irizarry is continually amazed by the women who are her patients, both in the United States and abroad. “They are amazingly strong and appreciative women, and they don’t complain,” she says. “Their main issues are poverty and no access to health care. Because we have so much more than we need, we should do what we can to break down those barriers.”—Valerie Gregg

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