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Students promoting healthcare practices in Belize

Natale, Mary Lou De EdD, MS, BSN; Sabatini, Lisa M. MSN, BSN

doi: 10.1097/01.NURSE.0000431140.90156.60
Feature: Global Insights
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Participating in a nursing partnership and global immersion project, nurses and nursing students improved their cultural competence while providing health education to residents of a small Central American town.

In California at the University of San Francisco, Mary Lou De Natale is an associate professor at the School of Nursing and Health Professions and Lisa M. Sabatini is the director of Clinical Performance and Simulation Centers.

The authors have disclosed that they have no financial relationships related to this article.

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HAVE YOU EVER CONSIDERED getting involved in an international health education program or an immersion experience? Teaching international health promotion is more than just providing health education—it's a rewarding experience that can improve nursing practice at home. Nurses and nursing students become more culturally competent as they learn first-hand how cultural diversity and traditions influence health and wellness in other countries.

This article describes a nursing partnership and global immersion project about nurses and nursing students who provided health education in Dangriga, located in the Stann Creek District of Belize, Central America. This Central American town is located in the heart of the country's citrus industry and has approximately 10,800 residents. The official language in the country is English with other dialects of Creole, Spanish, Garifuna, and Mayan. The per capita income is approximately $8,200 a year with a weekly wage note of $125.00 to $150.00 for 6 days of work.1,2

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Developing the health education program

The immersion project was started because of the success of the Arrupe Immersion Program in Belize, sponsored by University Ministry at the University of San Francisco (USF), which began in January 2004. Since 2007, this immersion project, called Project Learn Belize, has sponsored a number of USF School of Education programs. The School of Nursing and Health Professions participated in this particular Project Learn Belize venture, the Healthcare Advocacy Program, in May 2010.

In the planning stage, nursing faculty and students decided that each day in Belize would focus on a healthy theme with supportive resources and educational materials provided by donations. Health themes included hand hygiene, nutrition, first aid, and dental hygiene. Supportive educational resources and school and healthcare supplies were donated by the USF School of Nursing and Health Professions, nursing students and families, local Boy Scout troops, local dentists, and San Francisco Bay Area grammar school students and families. Curricula were prepared and materials for each presentation were sent to the local Dangriga school principal several weeks before arrival.

Overall, the nursing students collected over 400 lb (181.4 kg) of healthcare supplies, including first-aid kits, gauze, bandage wraps, tape, hand sanitizers, toothbrushes, toothpaste, soap, and so on, to support and distribute to the local students, faculty, and hospital.

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Community education

A 5-day health education program was provided to the local school-age children of Dangriga and their teachers (who also happened to be local caregivers in the community). The purpose of the program was to give the children new insight into simple, daily healthcare practices such as performing hand hygiene, eating a balanced diet, brushing their teeth, and caring for themselves when ill. The school children verbalized that they'd share what they'd learned about their own health and spread further awareness to their families and the community.

Additional classroom education included interactive learning lessons on first aid and what to do for blood loss, fractured bones, and cuts or scrapes. Wound care proved to be especially interesting to the students, who enjoyed practicing how to clean and dress wounds. The power of teaching and learning within this school environment facilitated building a community network for teaching and sharing information that was supported by a collaboration of the teachers, teaching assistants, and administrators in Dangriga.

Despite the best efforts of everyone involved, however, education wasn't always easy. The nursing team faced many challenges while trying to educate the children and community, including teaching hand hygiene without access to running water, finding affordable ways to offer more vegetables and fruits in the students' lunch program, and explaining how to read food labels when many products are unlabeled.

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Discussing choices

During the immersion experience, the most important teaching opportunity was presented when the nursing team went through the community and assessed how individuals access basic healthcare products, including first aid and over-the-counter (OTC) medications. First, the nursing team spoke with local grocery store owners. The first grocery store owner was very informative. The nurses asked him, “What do people buy when they're sick?” He replied, Aspirin, because aspirin is only 0.25??? per pill versus 0.75??? per pill for Tylenol [acetaminophen].”

This encouraged the nurses to investigate the availability and cost of OTC medications at other local stores. Each store clerk responded with the same answer: “Aspirin is the choice for children, adolescents, and adults because of its lower cost.”

After hearing this, the nurses prepared to educate parents about the potential for Reye syndrome in children given aspirin to treat illnesses such as fever, flu, and chicken pox. Since 1980, following discovery of the risk of Reye syndrome in children with viral infections who take salicylates such as aspirin, the number of reported cases of Reye syndrome associated with aspirin use has declined in the United States.3,4 Unfortunately, people in many developing countries are unaware of the connection, making public education crucial to preventing Reye syndrome in children.58

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Spreading the word

To raise awareness, the nurses developed an educational flyer for the school and hospital about the signs and symptoms of childhood illnesses (including Reye syndrome), and the importance of follow-up appointments with family physicians, the hospital, and/or health practitioners.

This information was important to explain and emphasize in order to change unsafe healthcare practices. Armed with new healthcare information, families now have the option to make more informed choices when selecting an OTC product for a sick child.

The costs of healthcare weren't discussed and it was noted that the government operates hospitals and clinics. Most Belizeans can't afford healthcare and have to pay out-of-pocket for medical or dental expenses unless covered by public insurance through the Social Security Board.

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The future of health promotion

As a group, the visiting nursing students appreciated the opportunity to learn first-hand how to promote health and education in an international setting. Each day offered them an opportunity to learn about the healthcare needs of this community and reflect on the best ways to educate patients in a foreign country.

Future immersion projects to Dangriga, Belize and other countries through the School of Nursing and Health Professions are ongoing and based on faculty/student collaboration. A follow-up Belize immersion project on health awareness and health assessments was conducted in 2013 with baseline measurements for each of the children in the school related to height, weight, BP, vision, and personal health information/wellness. Additionally, at this time, a change had been made to the local stores: aspirin is no longer as prominent in grocery stores. Ibuprofen and other alternatives are more readily available and supported by the community as first choices for treatment. Outreach opportunities to teach and provide health education to the larger community (beyond the school children), with individualized lessons on why and when to take medications, make an appointment with a physician or practitioner, or go to the hospital for direct care are ongoing with this Belizean population.

Although the experience in Belize was designed to provide health promotion services to those in underserved areas, it also taught nursing students how to navigate in an unfamiliar country with respect for the history, government, political conditions, and economy. Confronted with a culture clash, the students had to integrate their knowledge of best practices for health promotion and disease prevention with the cultural norms and economic realities of a very different environment. This immersion experience will stay with these students as they become culturally competent, caring nurses and it will profoundly and positively impact their future practices.

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REFERENCES

1. U.S. Department of State. U.S. relations with Belize: fact sheet. http://www.state.gov/r/pa/ei/bgn/1955.htm.
2. Belize First. What things cost in Belize. http://belizefirst.com/cost.html.
3. Boyer EW, Weibrecht KW. Salicylate (aspirin) poisoning in adults. UpToDate. 2013. http://www.uptodate.com.
4. Barnett AK, Boyer EW. Salicylate poisoning in children and adolescents. UpToDate. 2013. http://www.uptodate.com.
5. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB. Reye's syndrome in the United States from 1981 through 1997. N Engl J Med. 1999;340(18):1377–1382.
6. Ninove L, Daniel L, Gallou J, et al. Fatal case of Reye's syndrome associated with H3N2 influenza virus infection and salicylate intake in a 12-year-old patient. Clin Microbiol Infect. 2011;17(1):95–97.
7. Pugliese A, Beltramo T, Torre D. Reye's and Reye's-like syndromes. Cell Biochem Funct. 2008;26(7):741–746.
8. Bennett CL, Starko KM, Thomsen HS, et al.Linking drugs to obscure illnesses: lessons from pure red cell aplasia, nephrogenic systemic fibrosis, and Reye's syndrome. A report from the Southern Network on Adverse Reactions (SONAR). J Gen Intern Med. 2012;27(12):1697–1703.
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