Last summer, Rodelia Busalpa, BSN, RN, a student in the Family Nurse Practitioner (FNP) program at Samuel Merritt University (formerly Samuel Merritt College) in Oakland, Calif., had a unique opportunity to not only learn about the health care needs of medically underserved populations in Southeast Asia but to actually help meet those needs. In August 2008, she and a dozen of her fellow FNP students went on a two-week medical mission to Laos, where they visited local hospitals, orphanages and villages in and around the capital city, Vientiane, and helped provide free health care for Hmong villagers.
"The villages were very primitive," says Busalpa, who attends classes at Samuel Merritt University (SMU) School of Nursing's Sacramento Regional Learning Center. "The traditional homes were made out of bamboo and soil, with no floor, no compartments; everyone slept in one room. There was no electricity, no running water, there were kids running around the village with no shoes. It's just a different way of living [compared to what we're familiar with in the United States]. Many of us were surprised to find that people still live like this."
Even though the poverty and lack of basic services took some adjusting to, Busalpa says the nursing school did a good job of preparing the students for what they were going to encounter in Southeast Asia.
"We took a course in Sacramento with [SMU assistant professor] Terry Deane [MSN, RN, FNP, MBA] about integrating cultural aspects into health care for the underserved, along with community health," she explains. "We read The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures [by Anne Fadiman]. At first I didn't understand the importance of it, but when I came [to Laos], it all clicked. Basically it was an understanding that we are not dealing with [just] one culture and we must recognize and respect what the villagers practice and believe in."
"Cultural understanding is part of our nurse practitioner curriculum. The FNP program at SMU has an emphasis on meeting the needs of multicultural and underserved populations," says associate professor Valerie Dzubur, EdD, FNP-C, who led the trip. "It's important to understand the different cultural contexts for people other than ourselves. It's a great way [for students] to see and respond to the challenges [of global health care]. It's a practical application, which is what nursing is all about."
The trip was part of Dr. Dzubur's new course, "Interpreting Health Care 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 understanding in international health care. Funding for the Laos trip was raised and provided by SMU students, faculty and friends of the University.
Once the group of FNP students became a part of the local Hmong community, they were able to gain a deeper understanding of the hardships the villagers face on a daily basis, Dr. Dzubur says. They also learned that the villagers' economic challenges create several health care concerns, such as vitamin A deficiency.
"Night blindness is one of the first signs of vitamin A deficiency," Dr. Dzubur notes. "Vitamin A deficiency also diminishes the body's ability to fight infections. It decreases growth rate and slows bone development. In countries where children are not immunized, infectious diseases like measles have relatively higher fatality rates."
Evelyn Shober, another FNP student who participated in the Laos mission, feels that despite the limited clinical care they were able to provide to the villagers, the group's presence helped in many ways. "We did mouth exams, listened to lungs," she says. "But I think that just by walking into a room with our stethoscopes 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 villages was 40 to 50 years," says Busalpa, who will graduate from the FNP program this April. "Half of the health problems you see here in the U.S., like heart disease and cancer, you don't see over there. Many of the villagers deal with tuberculosis, hepatitis and malaria, which are less common here."
In addition to her academic and research work, Dr. Dzubur is president of Windhorse Foundation, an all-volunteer, nonprofit organization founded in 2000 by educators, students and professionals in the San Francisco Bay Area. The foundation's mission is to partner with impoverished people in rural Southeast Asian communities to provide financial, technological and other forms of support, including health care services such as free medical checkups and supplies.
In the part of Laos the FNP students visited, assistance from Windhorse Foundation has already helped build a preschool, sponsor an orphanage and purchase land for farming projects. For the students' medical mission, money donated by Windhorse Foundation and Samuel Merritt University enabled the FNP group to buy a gurney and a microscope for a local public hospital. It took a 12-hour bus ride through windy mountain roads to deliver the new medical equipment.
"Buying the gurney made me so proud," says Shober, who is graduating in December 2009. "Dr. Dzubur has worked with this hospital before and they were so happy to receive it."
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," Shober reports. "They lie on a thin foam mat, I.V. poles are made out of wood, doctors take turns in the OR, and the operating 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," adds Busalpa. "Nurses in the U.S. are more educated and have more responsibility than they do [in Laos]."
The Laotian hospital's nurses weren't the only ones who were highly impressed by this group of future nurse practitioners. "The students were fabulous," says Dr. Dzubur. "In our culture they feel like novices, but in the 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 a sense of the gift of their own education."
Of course, the story doesn't end there. Since returning from their trip, the FNP students have raised additional funds to purchase an X-ray machine for the same hospital in Laos to which they donated the gurney. And while this was the first time Dr. Dzubur has taken students overseas since she began teaching her new course, it definitely won't be the last. Fundraising is already underway for the next trip, which will take students to the South Asian nation of Nepal in summer 2009.