Think Globally

Young children hold stethoscopes up to nursing and pharmacy students

Duquesne Students Take to Costa Rica for a Week of On-The-Ground Lessons

The swift and sudden emergence of COVID-19 has changed a lot about these past 15 months, from graduation celebrations to nearly all of fall orientation. But on the edge of the lockdown that would ground planes and grind plans to a halt, one lucky group of students and faculty were able to slip in just one more trip – and it was one they will never forget.

Last March, students from Duquesne’s nursing and pharmacy schools set out for a weeklong spring breakaway trip to Costa Rica to expand their skills, do their part to help, and learn more about the culture, each other and themselves.

Bit of Turbulence

The world was already rapidly changing before the virus hit – in a way which called for a bit of quick thinking on behalf of professors Amber Kolesar and Dr. Yvonne Weideman of the nursing school and Drs. Jordan Covvey and Kevin Tidgewell of the pharmacy school.

The two schools had long taken separate spring breakaway trips, with pharmacy typically heading to Haiti and nursing to Nicaragua. Budding civil unrest in both areas led each group to question those plans in 2019, but faculty knew how foundational and important the experience could be, so they soldiered on to search out a safer location.

“We have had students go to Japan and Italy and all over the world on global health and education trips, but we wanted to offer a different experience,” Covvey says. “Japan and Italy are fantastic educational experiences, but we wanted our students to engage with a local health care system in a more meaningful way.”

With the help of some quick grant work and a partnership with International Volunteer HQ, the world’s largest volunteer abroad organization, and Maximo Nivel, a leading educational travel and study abroad organization, Covvey and Tidgewell identified Costa Rica as a unique location where students could learn about different health care approaches while working with underserved populations.

“Our team was able to see and learn a lot about health care and culture in Costa Rica,” shares Covvey.

In 2019, the School of Nursing was also seeking a new spring breakaway destination. “We wanted our students to experience nursing in another country and see firsthand the influences of culture on health systems,” says Weideman.

Weideman and Kolesar made the trip to evaluate the location and knew it would be a good fit. They quickly teamed up with Covvey and Tidgewell and combined the 2020 nursing and pharmacy trips.

“Combining our groups was a great opportunity for our students,” says Kolesar. “Interprofessional collaboration in health care is fundamental to delivering high-quality care. For students to witness how a different culture approaches health care as well as how a member of another health profession, such as a pharmacist, does is truly invaluable.”

group photo of nursing and pharmacy students in Costa Rica

The final group was composed of 16 students – eight from each school – giving participants not only the opportunity to learn from their experience in a foreign country, but to learn from fellow students and faculty who may have also been unfamiliar. This was exactly the type of experience many students had hoped for, including nursing student Julie Martin, BSN, RN, a 2020 graduate.

“I have always enjoyed helping others. It was why I wanted to become a nurse in the first place,” she says. “But I also wanted to experience another culture. I never had too much of that growing up, but in nursing, you encounter so many people from different cultures, speaking other languages. It is very important to be able to reach a level of understanding with those who are different from you.”

Touching Down

The group arrived with a full itinerary. During the weeklong stay, two days were reserved for providing basic health and wellness education to elementary school students, and another two days were dedicated to volunteering at community-based pop-up clinics.

While working with the children, students were asked to create fun lesson plans on subjects like dental hygiene and self-esteem, and they went all out on the task, making posters, writing songs and planning ahead of time how to say all the right words in Spanish. “It was fun work,” Kolesar says. “But they took it seriously.”

The clinic days were a bit more intensive – but no less educational. Nursing and pharmacy students were paired off to work in teams, conducting basic neurological, cardiovascular, respiratory, endocrine and musculoskeletal screenings or assessments for adults and children – all of whom lived in the neighborhood. Once they had evaluated a patient together, the students would then relay their assessment to a local physician, with all three collaborating on any appropriate interventions or future actions or recommendations.

“It was really cool to see the students coming together, despite not really knowing each other,” Covvey says. “We may all be trained in health care, but we are all trained in slightly different models – and that’s a good thing. When you have a whole team working together – a nurse, a pharmacist and a physician – you can really create cohesive care for the patient. When we come together, it makes us all stronger.”

It was a precious lesson every member of a medical team needed to learn, but it came with a twist: The whole process took place in Spanish, allowing even more room for the team members’ personal growth.

young boy listens through stethoscope

“It was really nerve-wracking speaking Spanish in front of Spanish-speaking people,” Martin says. “But sometimes you just have to dive in, even if you make a mistake. Because of course at some point, you are going to say the wrong thing, but you learn from that.”

Translators were also working with the group to ensure any potential miscommunications – especially regarding medical information – were smoothed over. But by and large, the experience of facing a language barrier was all part of the plan, Kolesar says.

“It just adds an additional layer to their humility and their ability to interact with people,” she explains.

“We are all limited by our personal experiences, but when a student is challenged to communicate with someone who speaks a different language, it is an expansive experience. It helps to make them better communicators as health care providers.”

Taking Off

A large part of the trip was dedicated to helping the students become well-rounded individuals. Days were roughly divided in half, with mornings dedicated to serving in the community and afternoons and evenings reserved for soaking in the Costa Rican culture.

Students were given a tour of the University of Costa Rica’s nursing, chemistry and pharmacy buildings one afternoon. On another, they practiced Spanish while perusing a local market. And yet other days saw them enjoying many aspects of the country’s diverse natural beauty. “We really wanted to create a fully integrated cultural experience,” Weideman says. “We wanted them to have a good understanding of the culture and to see what people’s day-to-day lives were like. We also wanted them to have a solid look at the country outside the barrios.”

Yet perhaps the most important time of the day, according to the faculty, were those unplanned spaces at the edges of the itinerary, which allowed students to truly process the experience.

As members of two separate schools who may not have otherwise met, that time also let the students bond over shared experiences.

“I did not have any classes with pharmacy students,” Martin says. “You always see them in the library, but you do not really have a reason to talk to them. But on this trip, I got to make so many new friends.”

Fostering those kinds of cross-departmental connections does not just enhance a student’s future professional life but the health care profession as a whole. “That reflection time gave them a chance to feel more comfortable and to get to know one another, which translates to a better experience when they are in a practice setting,” Weideman says. “If you are going to work in a collaborative environment, you have to trust those with whom you work. This helps build that trust, especially when you are working side-by-side in an unfamiliar environment.”

Flying High

  • large group poses for photo in gymnasium
  • community clinic site in Costa Rica
  • nurses listening to a patient
  • young girl holds stethoscope up to chest of woman nursing student
  • group of nursing and pharmacy student pose with small children at health clinic in Costa Rica
  • Photo of nursing and pharmacy faculty

Still, along the way, students were called to rely on more than one another. The entire experience was designed to place them outside their comfort zone, where they would have to learn to listen to – and trust themselves.

“We could see them beginning to be comfortable with being uncomfortable,” Tidgewell says. “Working with children really helps. They start to learn that it is OK to say the wrong word and to not understand, but to communicate with hand signals and other gestures. By the end of the week, you see them waving the interpreters aside and saying, ‘OK, I have got this.’”

Indeed, for many students, that empowerment extended beyond the clinical setting.

“Toward the end of the week, I felt like I could read a menu or comfortably use certain key words in conversation,” Martin says. “People were very kind. Nobody was offended or angry if you made a mistake, so it made it easy to keep trying.”

According to Martin, that is the exact set of skills she hopes to bring to a hospital setting. “Being in a hospital orientation, you just have to go out and get your feet wet,” she says. “The only way to learn and grow as a student or as a health care professional is to just dive in and do it – that is the only way you are going to ever become a better person, to learn more about yourself and to grow.” 

This article has been reprinted from Nursing Magazine, Vol. 6.

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