Duke University School of Nursing Students Make a Difference in Guatemala

As students at Duke University School of Nursing, Lindsay Salisbury and Shelby Strockbine entered their third semester with a new perspective on the importance of global health and their roles as future nurses.

Lindsay Salisbury and Shelby Strockbine, along with other DUSON students, traveled to the western highlands of Guatemala to work with community health workers, visiting pregnant mothers, and providing trainings.
Lindsay Salisbury and Shelby Strockbine, along with other DUSON students, traveled to the western highlands of Guatemala to work with community health workers, visiting pregnant mothers, and providing trainings.

Last summer, the two women joined other Duke nursing students in a global clinical, cultural immersion program with the global health nonprofit Curamericas Global. The group traveled to Curamericas’ project sites across Guatemala. The School of Nursing has partnered with the Raleigh-based organization for years and provides students the unique opportunity to expand their understanding of the world and deepen their knowledge of community health and wellness issues.

Curamericas Global’s mission is to partner with forgotten communities to save the lives of mothers and children. In partnership with the Guatemalan Ministry of Health, Curamericas supports five community-operated or owned Casa Maternas, birthing homes, which are open 24-hours a day, seven days a week, throughout the rural highlands of northwestern Guatemala. Curamericas’ Casa Maternas are culturally-adapted birthing facilities that provide Mayan women with medical care and support during their pregnancy, delivery and after the birth. 

For Lindsay, choosing the global experience option of the School of Nursing program was easy. She had never traveled internationally, and she was excited for the opportunity to see what health care was like in other areas of the world. “I wanted to know if there were practices that they were incorporating that we could use in the U.S., especially with the lack of resources,” Lindsay said. While Shelby had traveled internationally most of her life, she was excited for the opportunity to gain experience that would help make a difference in others’ lives.

The student group, led by clinical instructor Melisa Crane, BSN’16, set out for Guatemala in early August, 2019. Arriving at the airport, Lindsay realized it wasn’t at all what she had prepared herself for. “It was relaxed and welcoming compared to what we’re used to in the United States,” she recalled. “There were so many family members, waiting to greet one another. There was so much going on, I could not look in a different direction fast enough to take it all in.”

Since 2002, Curamericas has been working in the region to reduce the mortality of mothers and children through community-based, primary health care services and community engagement. Persistent challenges that have led to the area having one of the highest maternal mortality rates in the Western hemisphere include the extreme geographic isolation of the communities, lack of transport, and the cultural traditions.

The Duke nursing students experienced the isolation first hand as they embarked on a six-hour journey up the mountain-region to reach Curamericas’ Casa Materna. Coupled with the rocky roads, Lindsay and Shelby were struck by how the colorful culture they experienced in Antigua, had slowly evolved into rural land, filled with dilapidated homes, trash, dogs and chickens now welcoming them to the country.

Once they arrived the Casa Materna, the group was immediately welcomed by the local health care workers. These facilities are conveniently located, community-owned, and community-maintained birthing centers. They are staffed permanently by one of three teams, each consisting of a nurse and volunteers. One team is always present to attend deliveries in a culturally acceptable manner around the clock. Patients are attended to in their native language, and their family members are permitted to visit and perform traditional, spiritual practices. The Casa Materna program is linked with a strong outreach system using the volunteers to reach every household every two weeks to give educational messages and register vital events, like illnesses, births or deaths.

The students would spend the next two weeks visiting three of the Curamericas’ Casa Materna facilities, training the staff, teaching them new skills, learning from them, and shadowing them during births and home visits. “The staff wanted to learn and practice newborn resuscitation, and our group came in prepared for that training,” explained Melisa. “They actually have a baby model that Duke University donated, which allows them to check the baby’s heart rate and practice putting a mask on a baby.”

With a background in basic life support, Shelby helped lead the infant resuscitation trainings. The experience was also a teaching moment for her. “Following our training, we went on a round of home visits, and I had the opportunity to watch the staff share that knowledge with mothers who had given birth or would soon be in labor,” said Shelby. “It was a magical moment to see how that education empowered those volunteers, and even the mothers they cared for.”

Lindsay focused on training the nurses and volunteers about birthing positions, and how to discern if the mother or baby are in stress. “We were able to share with them that propping a mother on her left-side is more beneficial, because it can easily get the baby more oxygen or blood,” said Lindsay. The students also taught the staff about signs of preeclampsia, the different stages of labor and how to manage it, delivering the placenta and risks of postpartum hemorrhaging.

The students also accompanied the staff on home visits to the local communities. To reach the families, the workers’ journey often involves long walks, sometimes miles, up and down mountains. The volunteers use these visits to record data that can help them assess the community’s biggest health concerns, as well as new births, pregnancies, illnesses or even death. During the visits, the students helped with weighing and measuring babies who were under two-years-old, administered de-worming medication and performed many prenatal visits.

These experiences were very memorable for Shelby, as she realized these intimate visits are not normal back home. “Watching the volunteers sit down next to the mothers and talk with them, it was a very therapeutic relationship,” she recalled. “In America, I feel like we rush things so much. The volunteers really take the time to get to know and care for their patients.”

The home visits are also used to help educate the families about basic skills that many people in the U.S. might take for granted. “The staff provided written materials that went through so many things: a mother’s health, a baby’s health, environmental surroundings, including the safe places to wash their hands or when they should be washing their hands,” said Lindsay. “It was clear that the visits helped ensure that the families had the best quality of life possible and that they had the best resources to make that happen.”

The students also had the unique experience of assisting several women give birth. When the opportunity happened, Melisa, the clinical instructor, would pull names out of a hat to choose who could go in the room. Lindsay and another classmate were the first two students who had the opportunity to witness a birth. The first one happened in the middle of the night. The mother arrived at the Casa Materna in labor and fully dilated. “I have seen quite a few births at Duke, but experiencing it in a different culture was remarkable,” Lindsay said. “The mothers were fully dressed, it was a very modest experience. The staff pays close attention to breathing and I remember they dressed the baby immediately afterward.”

Strockbine with fellow nursing students and community health workers at Curamericas Global’s casa maternal facility in Guatemala, where they document health information from local families.
Strockbine with fellow nursing students and community health workers at Curamericas Global’s casa maternal facility in Guatemala, where they document health information from local families.

For Melisa, it was important to see the students have this experience and witness something, such as childbirth, unfold in a different way. “It was life-changing,” she said. “One night, there was a full moon and there were four births, allowing eight of our 10 students to be a part of the incredible experience.”

What may have resonated most for the students is learning how vital their work is to Curamericas’ mission. Curamericas’ Community-Based, Impact-Oriented methodology is designed to create sustainable programs, so future generations can take ownership of their health, despite the challenges that once stood in the way for their communities. “Everywhere we went, each community knew that we were with Curamericas, and we were there to help and care for them,” said Shelby. “There would be 80 people lined up at the Casa ready for screenings and consultations. It was so inspiring to see the impact these facilities were having on women and families.”

Melisa hopes this experience will help shape her students and provide a new perspective on their personal lives and their future professions. “As a nurse, there’s a lot we do in the hospital that’s not sustainable,” she said. “Experiencing another culture, and how they can do so much with so little, it makes you think twice about all that you can accomplish in your job, and any part of your life, when you have a community-based approach.”

For Lindsay, she felt like she came away from the experience more impacted than the women she went over to teach. “I know I learned more from them than they did from me, they have so little, but they make the most of everything,” she said. “We taught this group of volunteers, who are in turn going to take those learnings to other local mothers, who can then share them with their daughters. This approach is changing their future, and generations to come.”

By Andrew Herrera
Herrera is executive director of Curamericas Global.

Volunteer Opportunity: DUSON Students Need Spanish Speaking Volunteers to Provide COVID-19 Information to Latinx Populations

We are a group of second-semester ABSN students participating in an alternative Global Clinical Immersion Experience because our trips abroad were cancelled due to the current pandemic. We are working with Curamericas Global to assist in its ongoing effort to provide COVID-19 information for over 15,000 people in the Latinx population in four southern states. We would like to invite you to participate in this project with us. 
Today, Spanish-speaking volunteers around the country are helping Curamericas Global make informational COVID-19 phone calls to Spanish-speaking clients to educate the population with basic information regarding the outbreak and resources to learn more. Our goal is to provide evidence-based information to reduce the burden on the health system and flatten the curve. More individuals who are conversational in Spanish are needed to provide correspondence with Latinx individuals. English speaking volunteers are also needed to perform tasks such as organizing volunteer outreach and training English-speaking callers. As social distancing is a priority at this time, Curamericas has developed an online program which includes training and standardized protocols for phone contact.

For more information, please contact Andrew Herrera at Andrew@curamericas.org. To begin the volunteer process, read this document first and follow the instructions listed on the document. Please check out the Curamericas website at www.curamericas.org to see more of the incredible work this organization is doing. 

ABSN Global Clinical Immersion Experience students and Curamericas Global