Global Health Volunteers: Educating for Change

Laura A. Stokowski, RN, MS

Disclosures

January 21, 2015

In This Article

Kelly Lippi, RN, NP: Uganda

Imagine that you are one of the clinical instructors for a group of 160 nursing students who are eager to learn what it is like to be a nurse and to put into practice what they have been reading, hearing, and studying. They look up to you because you are a real nurse—the ideal, what they hope to become.

This may be a likely scenario in many places, but it is not in a place like Uganda, where only two of Kelly Lippi's 160 students actually chose to study nursing. ''In the United States, nursing is a choice," Kelly explained. "In Uganda, students don't set out wanting to go to nursing school. Most apply to medical school, but it is extremely competitive, and spaces are limited. University-bound students take an entrance exam, and if their scores are high enough, they might be able to study medicine, veterinary medicine, dentistry, or pharmacology. Many of the students who did not get in to medical or pharmacy school end up in nursing." A lack of enthusiasm for nursing was one of the first big challenges that Kelly had to face when she found herself working as a clinical nursing instructor in southwestern Uganda.

Figure 2. Kelly Lippi, RN, NP, with a student in Uganda. Courtesy of Seed Global Health.

Although attempting to inspire pride in the profession may seem like an impossible hurdle, for Kelly it became the source of her greatest accomplishment in Uganda. It is important to understand, however, the reality of what nursing is like in the hospital where Kelly was teaching. When patients come to the hospital, those who can bring someone with them to act as an attendant, who does everything for the patient—bathing, changing linen, cooking, feeding, helping them to the bathroom, comforting and providing emotional support. Attendants give oral medications and tube feedings and even call the doctor if the patient takes a turn for the worse or dies. In short, attendants perform most of the tasks that we associate with "total patient care" performed by nurses in the United States.

A typical patient load is 50 patients per nurse. Nursing is a form of triage—identify the worst problem and focus on that. Students must learn to assess a patient in less than a minute. There is rarely time for taking vital signs—those are taken by the physician on daily rounds. Nurses do the most specialized tasks, such as inserting intravenous (IV) catheters and nasogastric tubes or administering IV medications. Little time remains for thorough patient assessments or teaching.

In such an environment, how was it possible for Kelly to convince her students that nursing was actually a very rewarding profession? How could Kelly even teach these students to be nurses? She did it by showing them what nursing could be.

Patients who had no family or friends and who came to the hospital without their own attendants were known as "destitutes." The destitutes might have beds, but they went for days without care. Some were paralyzed, and others were close to death from AIDS. They lay in soiled clothes, urine, and excrement, their skin breaking down, without food or drink, and entirely alone. Kelly's students took over the care of two such men—feeding them, bathing them, changing their linens, washing their clothes, and nursing them. Their lives could not be saved, but the students' care allowed these men to die with more comfort and dignity than they otherwise would have experienced.

Providing care to these patients turned out to be a profoundly important learning experience for Kelly's students. For the first time, they understood the meaning of caring, nurturing, and nursing. Even though they were exposed daily to the reality of nursing in Uganda, where severe understaffing has led to underutilization of nurses, Kelly's students learned first-hand what nursing could be.

"They gained confidence in their choice—forced or not—to become nurses. Every week, as I taught students in class or supervised them on the medical wards, I saw them slowly gaining pride in their profession and slowly appreciating all the traits that attracted me to nursing in the first place," recalled Kelly.

An important goal of the GHSP program is to help medical and nursing students gain the skills and confidence they need to be the future healthcare educators in their countries. "I tried to demonstrate what nurses are capable of doing for their patients, for healthcare, and for Uganda. I always showed them how much I respect them, motivating them to be proud of being nurses. I tried to inspire them to maintain their drive to change healthcare and nursing in Uganda by returning to the university to teach future nurses." All of Kelly's students passed their final exams and became experts in health assessment and physical examination. More than that, they found a love for nursing and became excited about changing nursing in their country.

"Nursing has not had a voice in Uganda. I tried to teach them to advocate for themselves. Doctors view the role of nurses as being task-oriented and following orders. They don't think of nurses as assessing patients and making judgments," explained Kelly. She told a story about how one of her students might have changed this status quo. "One of my students was in the emergency room performing a neurologic exam on a patient. A medical student asked her why she was using a penlight. She told him, 'I have a penlight, and I know how to use it.' She then proceeded to teach him how to perform a neuro exam."

Kelly's other role in Uganda was as a mentor for the existing nursing faculty. Kelly's presence at the university gave them the chance to do more than they had hitherto been able to do. With her support and that of the other volunteers, the faculty started a 2-year master's program in nursing. They wrote a curriculum and got it approved. The first 6 nurses were accepted into the program, one of which was a current faculty member at the university. Kelly also wrote and received a grant to fund a skills lab for the school, something they didn't have before. The faculty and volunteers worked together to find space and obtain the equipment for the lab so that students would be able practice and gain confidence in their clinical skills.

Kelly acknowledged that problems remain, but she highlighted how the GHSP program has a sustainable impact. She explained, "We don't just drop in and teach a few things and leave. One year is not enough. The faculty are excited and extremely capable, but the work needs to be reinforced. New volunteers will continue the work and keep the faculty stimulated to make changes."

How did Uganda change Kelly? "Before I left, I hadn't worked as a floor nurse for 7 years. I have been trying to 'prove myself' as a NP. My year in Uganda inspired me once again to be proud of being a nurse. I rediscovered my love of the nursing profession."

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