A Bond Abroad
Growing as nursing professionals—and colleagues—far from home
Writer: Matthew Merchant
After a seven-hour flight to Antigua, Guatemala, and a rough truck ride into the mountainous region, a small group of Frances Payne Bolton School of Nursing students—and one faculty member—arrived last summer at a colorfully painted clinic in San Raymundo, where patients were waiting outside, eagerly seeking care.
Kristin Kelly, a second-year adult- gerontology primary care nurse practitioner student, was among those who came armed with suitcases full of donated medical supplies for a weeklong study abroad mission organized by the School of Nursing in partnership with Refuge International. Through the program, students volunteer their expertise to receive clinical hours toward graduation and, more importantly, gain invaluable experience working directly with patients.
“The thing with mission trips is that everyone talks about helping people, how they change you forever,” Kelly said, “but I didn’t realize just how much the people of Guatemala would teach me—and how I would change as a provider.”
Though modest in size, the clinic boasts a three-bay operating room, dental clinic, waiting areas, recovery zones and living quarters. Primary and chronic care are the core offerings, though services change based on the diversity of volunteers on the team, including nurses, cardiologists, anesthetists, dentists and others from across the U.S.
“The students have an amazing opportunity to work independently and learn from others from different professions,” said Assistant Professor Marie Grosh, DNP, RN (NUR ’15, ’21), who led the experience last summer.
Grosh and the students found a sharp contrast between the complex network patients typically see in the U.S. and the fast-paced, self-sufficient system at the clinic.
In Guatemala, patients often express health issues stemming from poor diets and a lack of basic healthcare, students and faculty said. But due to the language barrier and lack of healthcare knowledge, it’s common for patients to describe symptoms simply as “burning,” which makes it challenging for nurses to prescribe treatments.
“The students must rely on their physical-assessment skills and quickly identify what they can do to help. It’s much different than the technology- focused methods we use here in the U.S.,” said Grosh. “It’s an incubator for critical-thinking skills.”
Learning lessons
Rachel Kirschling, a second-year family nurse practitioner student, said the study-abroad group quickly transitioned from a hierarchical U.S. approach to a more collaborative decision-making process. Instead of having to wait for approvals from higher-ranked nurses or doctors, for example, the students acted quickly and efficiently on their own.
“Your confidence grows quickly when you suggest a course of action and the doctor or cardiologist says, ‘Sounds good, let’s do it,’” said Kirschling.
Most patients arrived at the clinic before sunrise, she said, seeking services as simple as taking vitamins or dewormer medication. Others presented with multiple serious health conditions beyond what the clinic was capable of serving.
“The patients there are grateful for your advice, to be seen, to have something over the counter even,” said Kirschling. “However, sometimes we had to take each patient and say, ‘What’s the most important issue I can address today?’”
Local guides acted as interpreters, helping students bridge the language barrier with patients. With little to no access to regular medical services, patients typically bring a sheet of paper with handwritten health notes from previous clinics—a far stretch from the digital records available to nurses in the U.S.
“You have limited resources in this remote town, so you’re forced to come together and just care for people with what you have,” Kelly explained, even if that means going well beyond the care the students expected to provide.
Kirschling, for example, found herself assisting in the dental clinic with extractions and fillings. Students also helped diagnose sexually transmitted infections, took shifts in the Post-Anesthesia Care Unit and even gained familiarity with more obscure illnesses rarely seen in the U.S.
Making connections
The seven nursing students were only part of the mission’s group—they were joined by other volunteer doctors, students and medical staff from across the U.S.
“It was good to have the clinical leadership from Marie [Grosh] coming from CWRU,” said Kirschling. “But then you have the other volunteers from across the country who are actually familiar with CWRU and our nursing program. There was an immediate respect and trust for each other as professionals, regardless of us being students, because of the quality of our program.”
Before leaving Antigua, the group of seven students took in the sight of distant mountains one last time, reflecting on their week of service at the clinic in San Raymundo. As graduate students in different specialty programs at the nursing school, they don’t often have opportunities to interact with one another. But this trip changed that for them, the students recalled. Coming together to serve others in a foreign land forged a bond between them.
Now back in Cleveland, the students acknowledge all they learned about patients and their profession. But they also agree that they shared an experience that transcends program boundaries, leaving an invaluable impact on their nursing journeys.
Summer 2023 study abroad students’ impact, by the numbers
Total surgeries: 46
Clinic consultations: 370+
Dental patients: 86
Surgical consultations: 59