THE JOURNAL OF EDUCATION, COMMUNITY, AND VALUES
By Tiffany Boggis, MBA, OTR/L
Associate Professor, School of Occupational Therapy, Pacific University
The site created by Professor Boggis as part of this project is found at: http://www.pacificu.edu/chp/international/nicaragua/
New opportunities for collaboration abound with the inception of the newly formed Pacific University College of Health Professions campus in Hillsboro Oregon. Prior to 2005, the health professional Schools of Physical Therapy, Occupational Therapy, Professional Psychology and Physician Assistant Studies were located in separate areas on campus and operated as autonomous entities within the University system. Since then, these Schools have moved to one central location and now include the recent addition of the Schools of Dental Health Science and Pharmacy. Unification of these six health profession programs under one roof lays the supporting foundation to enhance inter-professional educational collaboration among faculty, students, and those who benefit from our services. The Health Promotion of Elders in Nicaragua project evolved from the College of Health Professions' (CHP) goal to "foster inter-professional planning, instruction, and clinical experiences for schools within the College".
The Promotion of Health of Elders in Nicaragua project is the first inter-professional international educational endeavor for the College of Health Sciences. The goals of the project are (1) to provide health-related service-learning opportunities in Nicaragua using a community-based rehabilitation approach to build capacity and long-term interventions, within the means of the local economy, for Nicaraguans to help themselves and (2) to enhance inter-professional understanding and service delivery among health disciplines for students and faculty.
Nicaragua is the second poorest country in the Western hemisphere. Over 50% of Nicaraguans over the age of 60 are unemployed. Elders receive no government pension, frequently leaving them without secure financial support.[1] Their families, who must leave the country to find work, are frequently forced to abandon the elders. Elder family members who can no longer work and have no family to care for them live in elder centers that rely on foreign aid and limited municipal assistance for funding. These elders experience the long-term effects of aging, poverty and a lifetime of poor health care. Diabetes, chronic pain, poor mobility, gum disease, and lack of productive and leisure opportunity are common concerns.
During Christmas break 2007-08, the College sponsored a team of six students and three faculty members from the Schools of Occupational Therapy, Dental Health Science, and Physical Therapy to travel to Nicaragua to assess the health needs of elders. The initial trip laid the foundation for on-going collaboration, and educational experiences among health profession students and faculty in coordination with Dr. Milton Lopez, one of only four gerontologists practicing in Nicaragua, and the Jesse F. Richardson Foundation that has been sponsoring development projects in Nicaragua for the past six years.
Because the College had no formally agreed upon policy, procedure, nor coordinated infrastructure to plan and organize a venture of this nature, formalization of the process to meet the unique needs of the College of Health Professions to support sustainable methods to facilitate on-going interdisciplinary international education became an urgent need. Additionally, it is the ethical responsibility of the educational institution to follow accepted guidelines and practices to adequately prepare faculty and student participants to undertake an experience abroad and to re-enter their own culture. [2]
Because schools within the College operate on different schedules, it is a challenge to gather all participants in one physical location at a specified time to coordinate efforts to prepare students and faculty for participation. The few meeting times participants managed to agree upon provided insufficient time to process the vast amount of information needed for full participation in another culture.
Thanks to the Berglund Center for Internet Studies at Pacific University, a Fellowship and Berglund expertise were offered to develop a virtual solution. The Fellowship enabled the author to establish procedures and develop Web resource pages for the Pacific University Web site containing information specific for preparation and travel to Nicaragua. Web pages include: information about the project; resources to learn about Nicaraguan health, government, culture, history and geography; resources to learn the Spanish language; pre-departure planning tips; information on health and safety; fund-raising and donation gathering tips; and slide shows and testimonials from participants who travelled on prior trips. College required documentation forms are also available online. [3] Project participants continue to meet in person through fund-raising events and educational sessions, critical to form bonding relationships and learn details of the project not found on-line; however, the Web pages provide a virtual format to facilitate detailed preparation outside of meeting times.
This past year, 2009, nine students - including five occupational therapy students, three dental health science students, and one physical therapy student - along with practitioners in each field and one pharmacy faculty member traveled to Granada for ten days to continue to work with elder residents of La Providencia, one of twenty elder homes in Nicaragua.
While in Nicaragua, occupational therapy (OT) students presented dementia training to caregivers using a video they developed in advance of the trip, assessed the functional capacity of elders, and facilitated their ability in a variety of tasks including feeding, dressing and leisure participation.
Dental Health Science (DHS) students collaborated with the Ministry of Health to open a community dental clinic at the La Providencia. They provided exams, cleanings, and extractions of abscessed teeth for thirty residents. Students also provided oral health education to community members. In addition students conducted an interactive training with caregivers on proper dental hygiene and the benefits to health.
The physical therapy (PT) student collaborated with OT students to develop an exercise module that was used with the elderly. A written copy of this module was presented to local physical therapists for future use with the residents.
The pharmacy faculty member assessed pharmaceutical needs of elders in preparation to engage pharmacy students this coming year.
Because the goal of the project is to create sustainable in-country services, it is critical to offer interventions that can be implemented by Nicaraguans. Community-based rehabilitation (CBR) promotes collaboration among community leaders, people with disabilities, their families, and other concerned citizens to provide equal opportunities for all people with disabilities in the community. Disability is not viewed as merely the result of physical impairment but includes environmental barriers to participation, with poverty as a leading cause of disability.[4] The major objectives of CBR are:
During this visit, participants were able to expand contacts with community healthcare providers by inviting them to an open discussion forum about the state of elder care and how we might work together to address health concerns of elders. Moreover, participants were able to connect with a variety of community members willing to share in the experience of working with the elderly. Lastly, a relationship was formed with the Ministry of Health who supports the development and implementation of educational offerings for government employed health providers.
Since initiation of the program, health service for elders at La Providencia now includes regular health visits by the local gerontologist, bi-weekly access to physical therapy, the foundations of a dental clinic, and educational opportunities for caregivers. The Nicaraguan Ministry of Health supports development of a rehabilitation course aimed to educate local providers in elder conditions, rehabilitation, and health promotion strategies. After completing school in Nicaragua, there are no opportunities for practitioners to continue their educational training; our students and practitioners will assist them to obtain this education to facilitate the best evidence-based practices.
The Minister of Health also supports the establishment of a dental clinic at La Providencia in collaboration with local dentists - which will be used as a site for future dental health student internships. This opens the possibility of faculty and students staying an extended period of time to provide much needed education and dental care.
The inter-professional team approach was found to be an effective strategy to deepen participants' understanding of what each health service offers and revealed novel ways in which the programs can further collaborate for enhanced service delivery and classroom instruction. Students report increased understanding of alternative cultures, health disciplines, and community practice.
It is the vision of the Granada health community, with support of the Ministry of Health and continued collaboration with the Jessie F. Richardson Foundation and the College of Health professions at Pacific University to make La Providencia a model elder home upon which other elder homes in the country may be modelled.
It is the vision of the College to include all University health professions to assist in this endeavor. This coming year, students from Physician Assistant Studies and a faculty member from the College of Optometry plan to join the project.
Plans to further enhance the use Web technology include the addition of a chat room to facilitate participant communication for project preparation and planning.
Sustainability of our work depends grant funding and tax-deductible donations. Donations may be sent to:
Pacific University | Nicaragua Fund
2043 College Way
Forest Grove, OR 97116
Brockington, J.L., Hoffa. W. & Martin, P.C. (2007). NAFSA's Guide to education abroad for advisors and administrators. (3rd ed.). Washington DC: NAFSA: Association of International Educators.
Cushner, K. & Karim, A.T. (2004). Study abroad at the university level. In D. Landis, J.M. Bennett, & M.J. Bennett (Eds.), Handbook of international training (3rd ed., pp. 289-308). Thousand Oaks, CA: Sage Publications.
INEC (2005). National Institute of Statistics and Census of Nicaragua. Retrieved May 2009 from http://www.inec.gob.ni/censos2005/ResumenCensal/Resumen2.pdf (Spanish).
NAFSA Task Force on Institutional Management of Study Abroad. (January 2008). Strengthening Study Abroad: Recommendations for Effective Institutional Management. NAFSA: Association of International Educators. Retrieved May 10, 2009 from: http://www.nafsa.org/knowledge_community_network.sec/international_education_4/chief_international_education/practice_resources_14/internationalizing_the/imsa_epub
WHO (2004) CBR: A strategy for rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities: joint position paper. Available online: http://www.who.int/disabilities/publications/cbr/en/index.html
[1] INEC, 2005
[2] Brockington, Hoffa & Martin, 2007; Cushner, 2004; NAFSA, 2008
[3] See: http://www.pacificu.edu/chp/international/
[4] WHO, 2004
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