Nursing student Kaylene Baugh on her global nursing education tour.
When Kaylene Baugh began thinking about where she wanted to go for her global clinical experience, China was not her first choice.
The opportunity to participate in an international cultural immersion experience through the Office of Global and Community Health Initiatives (OGACHI) program was high on the list of reasons Baugh chose Duke University School of Nursing. OGACHI sends participating students to one of six countries—including Jamaica, where Baugh was born and raised—to spend two to four weeks working with community partners in clinics and other health care facilities there.
Baugh’s initial impulse was to go somewhere closer to home: Jamaica itself, perhaps, or maybe one of the other Caribbean sites. But her faculty advisors urged her to cast her eyes on more distant horizons.
So she cast them on the most distant one of all.
“China was the furthest away from the culture I was born and raised in,” says Baugh, who graduated in December 2014. “I realized that the situations that are most different from what you’re used to are the ones that you can learn the most from. So I said, ‘Send me someplace where I won’t know what’s what.’”
They did. Baugh and five other ABSN students, along with a clinical instructor, DUSON faculty member Jennie De Gagne spent two weeks in Wuhan, China, last summer. They exchanged knowledge and perspectives with their Chinese counterparts, shadowed practitioners in hospitals and community health centers, made home visits, and took careful note of the differences—and similarities—between the American and Chinese systems of health care.
“We learned a lot from them, and I think they learned a lot from us,” Baugh says. “And just making those connections and seeing things from a different point of view gives you a whole new way of looking at what you do.”
Below: Statistics show number of nursing students who have participated in global trips over the past three years.
Opportunities and Challenges That’s the whole idea behind OGACHI’s cultural immersion program. Launched in 2006, the program already has established a strong network of international partnerships that offers ABSN and graduate students an unparalleled opportunity to gain experience and new perspectives on nursing care in vulnerable communities.
The program has sites and partners in the Caribbean, Central America, Africa, and Asia. Many of the sites are in rural areas with limited resources, and for participating students each destination offers unique opportunities and challenges.
But students return from all of them with a whole new level of understanding.
“Regardless of where they go, the students get to truly understand global patterns of disease,” says Michael Relf, who took on the directorship of OGACHI in mid-2014 after its founding director, Dorothy Powell retired. “They get to see what autonomous professional nursing looks like. They build their assessment skills and prioritization skills, and they learn to challenge their own assumptions. They have a cultural experience that always opens their eyes. And they realize that nursing is profoundly different and uniquely the same all over the world.”
Among the first lessons virtually all OGACHI students learn is that advanced medical technology is seldom available in most of the world—and that may not necessarily be a bad thing.
“When you don’t have access to CT scans, MRIs, advanced laboratories, you have to refine your ability to assess and treat without that technology,” says Relf. “You learn to work closely with the patient, the family, the community, and the resources at hand. Our students come to understand that technology is a tool, but it’s not the most important tool. The most important tool is their own knowledge and assessment and relationship skills. Many Paths
At Wuhan, Baugh experienced a health system that differed in many ways from our own. Most striking was the side-by-side availability of both Western and traditional Chinese medicine.
“One hospital had a Chinese medicine section on one side, and a Western medicine section on the other,” she says. “And in the center they had a section that blended the two. It was fascinating. Some of the patients we met didn’t believe in Western medicine, and they took herbs and so on. Another part of the population says, ‘Give me the Western medicine.’”
She and some of her colleagues even partook of Chinese medicine themselves. “I was not going to leave China without getting some acupuncture,” says Baugh.Hoping to relieve recurrent waking in the night, she sought treatment from a practitioner who performed both acupuncture and cupping therapy, an ancient practice in which heated cups are used to create suction against the skin.
Baugh says she came back from China with an entirely new perspective.“It helped me see patient care in a different light,” she says. “You always provide unbiased care. It’s not about you; it’s about the patient. It showed me that there’s not one right way to provide care, as long as the outcome is the same. How we get there might be different. What matters is that we get there.” Room to Grow
About 30 to 35 percent of ABSN students participate in global cultural immersion experiences. Other programs are available for graduate students. Many more students would take advantage of the opportunity if more scholarship or travel funding were available, says Relf. Students must pay for the trips themselves. And with a price tag of $2,500 to $4,000, the experience is out of reach for many.
“They can use student loans and other resources, but remember, the ABSN is a second baccalaureate degree, and many of our students already have existing college debt,” Relf says. “They say, ‘I would love to go to China, but I can’t add another $4,000 to my existing debt.”
Relf says he hopes more students will be able to participate in the years to come. Among his other goals is to build and deepen partnerships with other groups and initiatives within the university, such as the Duke Global Health Institute, and with Duke Kunshan University (DKU) in China and the Duke-National University of Singapore Graduate Medical School.
“The university has a Brazil initiative, an Africa initiative, and now we’ve opened DKU,” he says. “All those things are a natural fit for us. One of my roles is to facilitate those strategic alignments. We have some great opportunities for inter-professional global clinical education.”
Making a Difference
Relf says Baugh has gained important insights that will make her a better health care provider and leader.
“Kaylene is a perfect example of what students get from the program,” says Relf. “She has gained a lot of insights, and she realizes that there are more similarities than differences. That’s going to be valuable knowledge as she goes forward.”
Baugh agrees. “It was everything I needed to complete my education to be a nurse,” she says.
The global immersion experience doesn’t just educate students; it inspires them. Relf says the skills they learn, the perspective that comes with experiencing other cultures, and the motivation to serve will benefit not only the students, but also the patients they will ultimately care for.
And he reminds them that they don’t have to travel thousands of miles to find people in need.
“When our students come back, they want to save the world,” he says. “I tell them, ‘Please don’t ever lose that passion—but remember that we have vulnerable populations right here in Durham.’”
If he had told them that before they went abroad, he says, they might not have fully grasped what truly vulnerable populations look like.
“But now they’ve really seen it,” he says. “And I think at that point they’re a little more receptive to hearing the message that ‘In a few months when you’re an RN, yes, work in the ER and go on that medical mission trip every year—but also donate one evening a week to a free clinic. You can make such a difference in your own community.’”