Many nurse practitioners (NPs) participate in short-term mission trips to provide healthcare to people around the world. Healthcare personnel engage in health assessments and often treat patients-with medications they brought with them. In some instances, they even provide surgical care.
Short-term trips, however, may raise ethical issues. They may be viewed as self-serving, raising unmet expectations, ineffective, or a burden on local health facilities, and may not offer continuity, equity, and sustainability.1
While short-term mission trips may overcome these problems, their contributions are difficult to sustain. In contrast, the Global Health Service Partnership (GHSP) was established as a sustainable program to improve clinical education for nurses and physicians. It also increases the number of educators to build capacity in countries experiencing critical healthcare provider shortages. GHSP is a public-private partnership between the U.S. Peace Corps, the U.S. President's Emergency Plan for AIDS Relief, and Seed Global Health.2
In 2013, 30 volunteer physicians and nurses were placed at 11 academic institutions in Malawi, Tanzania, and Uganda for 1 year of service. Volunteers provided classroom education, clinical teaching, mentoring, and support for the educational and clinical mission of the academic program.3 Over the course of 32,000 work hours, they taught more than 2,800 trainees using 85 courses and activities. Recognizing that financial obligations such as medical and nursing school loans are often barriers to service, Seed offers debt repayment stipends of up to $30,000 to GHSP volunteers. Last year, Seed provided close to $700,000 in stipend support for 27 out of the 30 volunteers.
Linda Jacobsen, MPH, ARNP, FNP-BC, CNM, was a member of the inaugural group of GHSP volunteers and now serves as a Deputy CNO of Seed Global Health. She spent 1 year as a member of the faculty of Bugando Medical Centre in Mwanza, Tanzania where she taught midwifery, which is part of basic nursing education.
Below are excerpts from an interview I held with Linda to learn more about her experience and the program.
What drew you to Seed Global Health?
Linda served in Lesotho between 1979 to 1981 as a Peace Corps Volunteer. This provided her with a glimpse into healthcare in limited resource settings. Her rich career in nursing helped her cultivate a skill set she believed could make a longer-term contribution to improve healthcare. GHSP would also allow her to integrate into a community and be part of it. She knew it would be a huge shift from what she had been doing as an NP in the United States; however, she viewed the chance to share skills and knowledge in a sustainable way as paramount and was congruent with what she wanted at that point in her career.
What did you expect?
Linda went into this experience with the expectation she would learn about the current status of nursing education in Tanzania and tried to keep an open mind about what was needed to support the schools. She knew there would be limited resources and that she would need to make a concerted effort to gain the trust of her new colleagues and students.
What did you actually experience?
Linda described her experiences in regards to the healthcare delivery system and the education system. The healthcare needs are staggering and were more startling than she expected in a 900-bed hospital. Many patients in the main ward would have been in an ICU in the United States. At least once a week, a woman had full eclampsia and seizures. Culturally, the idea of woman-centered care is still emerging in Tanzania, and she introduced those concepts in the classroom and clinical settings.
Nurses are frontline care providers where trained professionals are available. There are too few nurses to meet the needs, which has prompted increased enrollment in schools of nursing, often with few faculty members. Linda's role was to teach midwifery to diploma and bachelor-level students in both the classroom and clinical areas. The challenges included educating nurse midwives to provide care to women who often had diseases such as malaria, tuberculosis, and HIV in resource-limited settings. These situations are often in stark contrast to the pregnant women midwives typically care for in the United States. Furthermore, midwives in Tanzania perform about 80% of the deliveries for women who deliver with a trained healthcare provider. They perform breech deliveries, manage eclampsia, severe anemia, and many other complications of pregnancy and childbirth.
Linda's faculty colleagues were quite gracious. She cotaught with some, and trust was easier to build because it was a long-term commitment. There was a wide age range of students who had diverse educational backgrounds. Classes were taught mostly in English in which students had to be fluent to excel academically. In Tanzania, students begin English language education in secondary school rather than primary. This unfortunately can make lectures taught in English more challenging for some nursing students to understand.
Linda promoted the use of case studies and more group activities in her classes to help students organize their thoughts regarding a case in terms of how to assess, analyze, apply facts, and plan care. Books were limited, and Linda wanted to stress the importance of critical thinking skills. In the clinical setting, Linda found it challenging to manage students who faced almost impossible situations to care for patients and create meaningful learning opportunities. The students, however, were brave and stepped up to demands to provide care. Linda could not be in a ward with five groups with a total of 40 students at one time-a typical faculty-student ratio. She had to make a plan for what students needed to learn, and then students had to provide a verbal presentation about their experience-similar to a grand rounds.
Overall, Linda had a positive teaching experience in both the classroom and clinical settings despite the challenge of working within another culture with students of diverse backgrounds. Some of the frustrations GHSP volunteers experienced included ever-changing schedules and working within systems that have limited resources for students or faculty, and oftentimes, fewer faculty members than needed to teach in all the subject areas.
What are the characteristics of GHSP volunteers?
Linda explained that the second-year volunteers of GHSP were as varied as the sites where they were placed. The third cohort of volunteers recently arrived in their host countries. The ability to be flexible on a daily basis is essential. Needs change, systems are fragile, and it takes a long time to make change. The settings also may be vastly different than the ones volunteers are familiar with, which requires these individuals to adapt quickly to work effectively in their new environments. Prior global health experience in limited resource settings helps volunteers-especially with setting realistic expectations. Lastly, volunteers must have prior teaching experience.
What are your last thoughts for NPs who may want to volunteer?
NPs are used to being independent in the United States, yet in some places, the role of the nurse is not viewed in the same way. In Tanzania, for example, diploma nurses can decide something is abnormal but are typically not the ones who make the assessment. At the same time, however, they deliver advanced practice nursing care, such as breech births. For Linda, navigating these cultural norms while working in a new clinical/educational setting made her GHSP experience fascinating, challenging, and ultimately worthwhile.
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