Last week, I had the pleasure of speaking with Susan Fletcher, EdD, MSN, Professor at Chamberlain College of Nursing. I had heard about the International Nursing Service Projects that she developed and was anxious to learn more about the experiences of the students who accompanied her to countries such as Brazil, Kenya, Bolivia, and Uganda.

Dr. Fletcher, whose background includes community health, emergency room, and school nursing, has been taking students on mission trips for over 12 years. I was in awe after hearing about the patients they cared for and how innovative the students were in their planning and interventions. They had to think “outside the box” and come up with clever ideas to improve the quality of life of the people. For example:

• In the slums of Fortaleza, the students saw a quadriplegic man who was regaining some use of his arms. His house was a brick area the size of a closet and he spent his life in bed. Family members would bring him food sporadically. The students noticed pinpoint red marks on his toes. After seeing him for 3 days in a row, they realized these marks were rat bites. The students thought to all take off their socks and put them on his feet to make it harder for the rats to get to his skin.
• Another patient, an elderly woman, was bed-bound with heel decubiti. There was nothing to use to elevate her feet and reduce the pressure. Students filled rubber gloves with water and placed them under her ankles.
• In Bolivia, students met a woman with a severely prolapsed rectum. They gave her pads and a belt to use for support.
• In Africa, where the prevalence of HIV infection remains high, there are many orphans. Students saw families of children taking care of children. In one case, an 11-year old girl was responsible for 3 younger brothers and sisters. She’d cook over an open fire dug into the ground. Students cared for burns, infections, and injuries in various stages of healing.
• Another patient, a man with TB and AIDS, was dying. Students would help the family clean him up. There was one student whom he consistently followed with his eyes. This student learned that “sometimes all you can do is ‘be there.’”

Dr. Fletcher discussed the transformative nature of these experiences. The students developed amazing clinical skills and enhanced their critical thinking ability. They learned to understand the differences in cultures and the problems related to the lack of healthcare facilities, caregivers, and medical supplies. Students became more comfortable using local resources and learned to “create from nothing.”

To be eligible to go on a mission trip, students must maintain a certain grade point average, complete an interview form, provide a letter of recommendation from clinical faculty, and have a one-on-one interview. Dr. Fletcher described the living conditions as “often sleeping on the floor, sometimes eating rice three times per day.” In Kenya, students woke at 6 am, walked 3 miles to the village and then spent all day in the clinic. On that trip, the students saw about 2,500 people in 2 weeks.

Difficulty of leaving… “touch and let go”
In Kenya, as the group was preparing to leave, a 2-year old orphan was squatting outside the clinic, crying. The students “couldn’t stand it; they wanted to take her home.” Dr. Fletcher reassured them  that someone had taken the time to dress this child and would be back for her. She told students, “These are the life circumstances here and we can’t rescue all the orphans.” Another important message, conveyed by one of the team members with the group, was “although you are upset, remember that because you were here, you’ve saved lives.”