FNP Helps Southeast Asia's Underserved

FNP Students Rodelia Busalpa, BSN, RN and Family Nurse Practitioner (FNP) student from the Sacramento Regional Learning Center, credits Samuel Merritt College (SMC) for preparing her for the class trip to Southeast Asia. She and a dozen of her fellow FNP students went on a two-week mission to local hospitals, orphanages, and villages in and around Vientiane, the capitol of Laos. The students helped provide free health care for Hmong villagers.

"The villages were very primitive. The traditional homes were made out of bamboo and soil, with no floor, no compartments; everyone slept in one room," said Busalpa. "No electricity, no running water, kids running around the village with no shoes; it's just a different way of living. Many of us were surprised to find people still live like this."

Despite the poor conditions, Busalpa feels the College prepared her and several of the students for what they were going to encounter.

"We took a course in Sacramento with Terry Deane, (RN, MSN, MBA, FNP and SMC Assistant Professor) about integrating cultural aspects into health care for the underserved, along with community health," said Busalpa. "We read 'The Spirit Catches You and You Fall Down : A Hmong Child, Her American Doctors, and the Collision of Two Cultures.' At first I didn't understand the importance of it, but when I came here, it all clicked. Basically it's an understanding that we are not dealing with one culture and we must recognize and respect what villagers practice and believe in."

"Cultural understanding is in the nurse practitioner curriculum," said Associate Professor Valerie Dzubur, EdD, FNP-C. "It's important to understand the differences between cultural context for other people then ourselves, it's a great way to see and respond to the challenges. It's practical application, which is what nursing is all about."

Dr. Dzubur said once the group became a part of the community they were able to gain a deeper understanding of the hardships the villagers face on a daily basis. She adds that the villager's economic challenges create several healthcare concerns, such as Vitamin A deficiently.

"Night blindness is one of the first signs of vitamin A deficiency," said Dr. Dzubur. "Vitamin A deficiency also diminishes the ability to fight infections, decreases growth rate, and slows bone development. In countries where children are not immunized, infectious diseases like measles have relatively higher fatality rates."

Dr. Valerie Dzubur and student examines a local villager

Evelyn Shober, FNP student, says despite the limited clinical care they were able to provide the villagers, she feels the groups presence helped in many ways.

"We did mouth exams, listened to lungs," said Shober, "but I think just by walking in a room with our stethoscope and putting our hands on someone, it gave some people a sense of comfort knowing that we wanted to help."

"The average age in the village was 40 to 50 years of age," said Busalpa. "Half of the health problems you see here in the U.S. you don't see there. Many of the villagers deal with tuberculosis, hepatitis, and malaria, those things are not common here. For us in the U.S. it's heart disease and cancer."

Along with providing free medical checkups and supplies, the program also supports the local community. Assistance from the Windhorse Foundation has helped build a preschool, sponsor an orphanage and purchase land for farming projects. Money donated by the Windhorse Foundation and Samuel Merritt College provided the FNP group the resource to buy a gurney and a microscope for the local public hospital in Laos. It took a 12-hour bus ride through windy mountain roads to deliver the new medical equipment.

"To buy the gurney made me so proud," said Shober. "Dr. Dzubur has worked with this hospital before and they were so happy to receive it. I felt in awe to be taught by a professor who was recognized all over the world for her humanitarian work."

FNP donates gurney to local public hospital

The hospital itself was an eye-opening experience for many of the students.

"You see 20 to 30 patients sleeping in one room with no privacy," said Shober. "They lay on a thin foam mat, IV poles are made out of wood, doctors take turns in the operating room and the table is held up by wooden planks. We take so much for granted here in the U.S."

"The nurses at the hospital held us in high regard," said Busalpa. Nurses in the U.S. have more education and responsibility then they have there."

"The students were fabulous," said Dr. Dzubur. "In our culture they feel like novices, but in developing world they are already experts. To experience their competence, to use their education, especially at this stage, is really important to build confidence and give them the sense the gift of their own education."

The trip is part of Dr. Dzubur's new course, "Interpreting Healthcare in a Global World." The one-unit elective is an opportunity for FNP students to travel to places like Laos and Thailand to develop cultural understandings in international healthcare. The FNP program has an emphasis on meeting the needs of multicultural and underserved populations.

"That is why I chose SMC, because of this commitment to serve the underserved," said Shober. "Schools like UCSF are great medical campuses and a university, but SMC's commitment to the underserved and the fact that faculty go out there and start clinics and work in underserved communities, its right up my alley. I look forward to next year's trip."

The funding for the FNP trip was raised and provided by SMC students, faculty, and friends of the College. Family nurse practitioners are licensed and fully qualified to diagnose minor illness and injury, perform health assessments, and order necessary tests. In addition, they can prescribe prescriptions and monitor chronic disease conditions.

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