Since 1995, Duquesne University nursing students have spent their Spring Breaks traveling to Nicaragua to participate in global service learning opportunities, encompassing a broad spectrum of volunteer work. From extremely urban to the utmost rural areas, the students provide health assessments, nursing care and health education to lower-income Nicaraguans and their families.
The students work with people of all ages in a variety of settings, including public clinics, homes, schools and neighborhood health centers. Prior to departure, the students are questioned about their expectations. Most respond about overall fears but also about their eagerness to share their wealth of materials and knowledge with those less fortunate. When they return to the U.S., they realize this was the least important aspect of the trip.
The following accounts are from Lisa Patel and Amanda Watts, two nursing students, asked to describe their most meaningful experience during the 10 days spent volunteering in Nicaragua.
My experience at the Barrio was unlike any other. I was paired with another student and we worked with a family of 12 ranging in age from 2 to 76. While I was expecting this family to have health issues and other needs, I was not prepared for what I was about to experience.
I was shocked to see that their home was made out of scrap metal and wood. The dirt floor extended throughout the interior of the house and into the yard. There were a number of beds in poor conditions in the house—some had gaping holes in them, cardboard on top of metal springs and most had unstable bed frames. I learned that three to four people slept in the same bed at a time. Although there was electricity, there were no light sockets or light bulbs. Because there are no windows, keeping the front door open during the day provided necessary light, and when the sun would go down, they would just “deal with it.” The kitchen had a small table and cement sink overflowing with dirty dishes and fruit. An open fire was located in the house near the back door—a definite hazard for small children and a 2-year old with asthma. A crib in the backyard served as a trashcan. A hammock served as a resting place for adults and a napping area for the baby. In a corner of the yard, there was a latrine and an outdoor shower/washing area. Scrap construction materials and other trash items were scattered in the yard. In another corner was a rusting, uncovered water barrel, with mosquitoes and eggs lying on the surface—a potential malaria risk. I was shocked to learn this water was for drinking, washing dishes and bathing. To them, some water is better than none, regardless of the condition.
The family shared 2 towels amongst themselves and had no toothbrushes, toothpaste or soap. The toddler with asthma hadn’t visited the Centro de Salud for healthcare and had no medication to treat his condition. The 2 teenage boys no longer attended school because they lacked the required school uniforms, shoes, books and supplies. It wasn’t unusual for them to eat only 1 meal a day, often bread, fruit and occasionally rice and beans for dinner. We discovered that the grandma with diabetes and hypertension hadn’t eaten for over 24 hours when she collapsed in the midst of our visit. She also hadn’t received healthcare attention in over a year. The family just doesn’t think the Centro de Salud is necessary. They stated that they had gone there a few times by foot but hadn’t been back in awhile—I was overwhelmed when I heard this.
Despite the overwhelming issues, this family welcomed us every day, making us feel at home. We performed assessments on the individuals and environment, and provided guidance and education regarding identified issues. Visiting the Centro de Salud was stressed as key to providing the family with ongoing attention to their health problems.
Bringing donated clothing and shoes as well as utilizing money from our Nicaraguan Health Fund, we provided the family with necessary clothing and supplies including school shoes, uniforms, clothing, beds and mattresses, medications and food. This by far was the most rewarding part of the entire trip.
From the experience I had in the Barrio and with this family, I not only learned more about nursing, I learned appreciation. This family, regardless of the poverty and lack of essential resources, was extremely happy every single day. The children didn’t cry or complain because they did not have books or toys. The elders in the family always laughed and talked to one another. I am most grateful for the opportunity to work with them, to be welcomed into their home and to provide some small amount of assistance. I received an experience unlike anything I have ever seen in U.S. They opened my eyes to the world in countless ways.
I learned so much about the healthcare system and the people of Nicaragua from my experience working in the Centro de Salud (Health Ministry public clinic). Patients received care in clinics including immunization, oral rehydration, prenatal care and gynecology, communicable diseases, integrated care and urgent care. Everything was fast-paced, and there was very little privacy. The lines wrapped around the building, and there was never an empty seat in the hot, crowded waiting rooms.
In the urgent care observation area, there were 4 beds in one room and a bench where 5 patients sat receiving IV therapy. At first, the lack of patient privacy was alarming. Having HIPAA drilled into our brains throughout nursing school, I was speechless, but then thought maybe there are benefits to having patients in the room together to provide a support system and opportunity to talk to others. I was struck by how open and willing the patients were to us as minimally Spanish speaking U.S. nursing students. Working alongside Nicaraguan healthcare providers, we gave injections, performed assessments and pap smears, removed sutures, inserted IVs and provided health education. The patients were open, understanding and patient with us and the healthcare system in general.
The Nicaraguan nurses’ emphasis on patient education was remarkable. They took the time to explain health teaching, stressing the importance of what they were saying. The clinic hallways featured bulletin boards of health education topics such as breastfeeding, immunizations, HIV/AIDS and tuberculosis—all prepared by medical students! During my preparation for this trip, I thought I was going to contribute to the Nicaraguan healthcare system and teach the people I worked with all about health promotion. And maybe I did, however, after those few short hours there, I walked away with more lessons learned and insight into a different healthcare system and a different patient population. The attitudes of the people and staff were remarkable, despite the lack of resources, long waits and brutal heat. It was fascinating to see such an incredible resiliency and is something I will incorporate into my everyday life from this point forward.