By Marcel Kaganovskaya, BSN, RN, CHPN, and Nancy Cherofsky, DNP, RN, FNP-BC
Sixteen FNP students from Wagner College’s Evelyn L. Spiro School of Nursing, Staten Island, N.Y., took a trip abroad during their spring break to learn about healthcare and healthcare practices in remote areas outside the U.S.
The students traveled to the rugged Mexican foothills of the Sierra de la Laguna Mountains near Cabo San Lucas to the town of La Candelaria. The only access to the town is via dirt roads using 4×4 vehicles to altitudes of about 7,000 feet.
The global health course demonstrated the importance of adequate primary health, according to students. With limited resources and an adequate collection of subjective and objective data, they were able to connect the pathophysiological diagnostic criteria to certain diseases.
“This is real healthcare,” student Mia Vedensky said. “In the modern world. I would have sent the patient I saw with right lower abdominal pain for a CT scan. Instead, I spent time with an interpreter to gather subjective data to combine the signs and symptoms of what the patient’s complaints were to a diagnosis without all the high-tech scans.”
La Candelaria is a secluded town with a population of less than 100. The town’s original inhabitants were the Pericu Indians.
The town also has a boarding school that houses more than 95 children ages 3 to 16 from all areas in the mountains north of Cabo San Lucas. Local residents and the school children have limited access to healthcare and resources. Most of the town’s medical resources are appointed to people in town and at the school.
One such local woman, named Maria, has a key to the town medical clinic, which includes a tiny room with a metal table and another small room with a door to examine a child or adult.
Wagner students helped set up and stock the clinic with medical supplies last year. A physician from Cabo San Lucas visits the town fewer than once a month for four hours to examine more 50 individuals and refer them to primary, secondary or tertiary care if they can travel to the city.
“This is a wonderful and humbling experience and allows me to truly appreciate what we have to offer the world as healthcare providers,” Wagner student Gwendolyn Hernandez said.
Wagner’s program, according to faculty, is based on a community theoretical framework, which has included partnerships with Staten Island community outreach projects, such as El Centro del Inmigrante, a community center for Hispanic immigrants that helps facilitate resources. Working with local groups inspired Wagner graduate students to reach out globally and assist individuals with limited resources and a lack of access to healthcare.
Students in the FNP program learn about disaster preparedness and global health, focusing on diverse cultural populations and settings. This allows students, according to nursing faculty, to adapt to environments with limited resources, such as providing primary preventive healthcare in the rural areas of Cabo San Lucas.
Wagner faculty worked with a local fire chief, Juan Antonio Carbajal Figueroa, and “bomberos” (firemen) from Cabo San Lucas, who are responsible for the La Candelaria area. The firemen and George H. Pickett, a retired FDNY member, helped escort Wagner students to La Candelaria and local community centers and homeless shelters in the area, where they provided primary and secondary preventive care. The students visited a senior center where individuals suffered from undiagnosed chronic diseases such as high blood pressure and diabetes.
Students evaluated and examined individuals using minimal resources, including stethoscopes, blood pressure cuffs, glucometers, pulse oximeters and pen lights.
“I was amazed how assessment skills can be paramount to that of modern technology,” student Lefteri Theodorakis said. “We diagnosed a 29-year-old female with celiac disease just based on her complaints, which met its criteria.”
The students performed physical exams such as trans-illumination, which helped diagnose ailments such as sinusitis and edema.
They also focused on adolescent healthcare with teenage students in La Candelaria where primary preventive health practices were taught, including sexual health, hygiene and gender issues.
“I felt so humbled and realized that I entered the nursing profession to provide care for those less fortunate than me,” Wagner student Alexa Maestrone said. “I hope to utilize my FNP degree to the best of my ability like I did here in La Candelaria. This trip opened my eyes in regards to global health, and I realized how vital it is to have a primary care provider who can prevent the array of ailments which I observed. This trip inspired me.”
Screening techniques and education also were provided to students in the local school. Students were taught primary preventive techniques such as testicular exams for teenage boys. One of the teenage boys related to the teaching and expressed a loss he had with a young relative who died from testicular cancer.
Breast self-exams were taught for teenage girls. Soap was given out, and education provided for exams in regards to the menstrual cycle. Also included were cervical exams, blood pressure screenings, glucose monitoring, dental screenings, physical assessments and wound care.
After a hurricane hit the area last fall, school children used flashlights as a light source for hygiene and to study at night.
The area sustained damage to the school’s power supplies where the children were left six months later with no electricity.
“The school was utilizing two worn car batteries as a source of light,” Pickett said. “I am happy we can help those in need and provide this great work.” Pickett and Wagner supporters donated four car batteries to the school during the time FNP students spent there.
Students also visited a local homeless shelter and clinic in Mexico, near Los Cabos San Lucas where children lacked resources such as medications and clothing. Wagner College raised funds and donations such as clothing, toys, shoes, supplies and other necessities.
Marcel Kaganovskaya is an FNP student and Nancy Cherofsky is an assistant professor at Wagner College.