My placement was in India, a country with a population of over 1.1 billion – 17% of the world’s population in 2.4% of the world’s area. . Whilst the economy of India is growing, is still has a vast number of problems, particularly in relation to healthcare.
My placement was in Dehradun. This is the state capital of Uttarakhand. It has quite a high literacy rate and lower rates of poverty than in other states. Dehradun is known as the ‘city of schools’, as it has a high number of India’s most prestigious schools, some of which offer free places to local children. It is very close to the foothills of the Himalayas though, and as such has large numbers of tribal people who may require access to healthcare. These individuals tend to be very poor and lack transport to reach health centres – this can be highly problematic. As my placement was last minute it was still being when I was there. It effectively comprised three different ‘mini placements’…..
I carried out the first week of my placement with the Latika Roy Foundation. This is a non governmental organisation (NGO) for children and adults with disabilities. The main focus is in providing education to children who would be unlikely to receive appropriate teaching in a standard government school. Yet the charity also provides training for individuals over 16 years old, healthcare assessments and is an avid campaigner for disability rights and awareness. My week was mainly spent with the Doctor who works for the organisation, carrying out MDT assessments and working directly with the children and their parents. The quote at the bottom is the motto of the organisation. They are working towards inclusive schools for those with and without disabilities.
Week two was spent at the Rewati Nursing Home. This is basically a small private obstetrics and gynaecology hospital. I had a fantastic week here working alongside the Consultant Obstetrician who was very eager to teach and show me everything that happened at the hospital. I assisted with births and caesareans in the delivery room, assisted with medication rounds in the NICU and helped with history taking in the OPD. I was taught how to suture and maintain good infection control using different methods to the NHS. I learnt about healthcare systems in India. The system is incredibly complicated - private and public facilities appear to operate with minimal regulation. Continuity of care across services did not seem evident. I saw instances of problems which do not occur in the UK. For example, women would come to the hospital for an abortion as they knew they were pregnant with a girl. Female foeticide is becoming increasingly common in a country where male births are celebrated and female births are seen to cost more (through lower wages, dowries etc). Dr Rita who I worked with does not perform abortions for this reason, but some doctors in India carry out these terminations solely as they can make a lot of money from them. The child sex ratio has changed over the last twenty years for this reason. IN the 1991 census there was 945 girls to 1000 boys. The 2001 census found that it had changed to 927 girls to 1000 boys.
My final two weeks were spent at the Herbertpur Mission Hospital, about an hour and a half’s drive by bus from Dehradun. Although I’m not religious myself, this seemed like an interesting opportunity to see how a Christian hospital would operate in a country predominantly made up of Hindu’s and Muslims. The hospital was in quite a rural area, designed to be more accessible to hill tribe people. It was a great experience as I got to work across various departments and was fully involved in all aspects of nursing care. In terms of my learning outcomes I experienced the health inequalities which can occur and also saw the impact of environmental factors upon healthcare. Patients here were expected to pay for their care, they were billed for every medication, syringe and bandage they used. For many families this was very difficult. Whilst as government welfare system was available to the poorest of patients, this scheme appeared to have been abused. It was also interesting seeing patients arrive when their condition and symptoms had become unbearable. As it was monsoon season and many hill people did not have their own transport, they would only come to the hospital when they felt their condition could no longer be managed or contained. As such, patients would present with deteriorating symptoms and during the late stages of illnesses. I was also interesting to see conditions which would be unusual in the UK. Many women who worked in the fields presented with snake bites on their hands and feet. There was also many cases of malaria and dengue fever.
I think I learnt many skills during the planning and implementation of this placement. Organising a placement on your own can be frustrating and slow going but it is very worthwhile when it all falls into place. If you’re going abroad though there is a lot to think about – from what do you want to achieve and where do you want to go, to how will you organise your visa and what vaccinations do you need?! My placement was still being organised when I reached India. Adaptability is essential – but also don’t be afraid to say what you would like to see and experience. It’s a fantastic opportunity so get what you can out of it. It is also quite difficult immersing yourself in another culture, especially to work. I found that by learning a few basic Hindi phrases I was able to gain a lot more from the placement. Learning some of the local languages is definitely beneficial.
No running water or electricity
This is where the doctor lived and worked (3km away from our village)..and serving 16,000 up to 20km away..the nearest hospital and dentist 150km away, the nearest telephone signal 5 km
Due to the prevalence of malnutrition and diarrhoeal disease in Madagascar, we did a lot of hand hygiene and latrine use, and the importance of good nutrition in fighting disease. We used painting, role plays, songs and games to get our messages across. Malaria – $5 nets babies and pregnant women mainly used the ones they had Dentist 150km away!! Breast feeding – darkened room for 2 months after cry-free birth Family planning – requested by elders and teens
1. Remoteness and lack of money..high use of traditional medicine to supplement western medicine (no dentists!) 2. Imp of community involvement in the process...and discussion of their health practices/beliefs (if it doesn’t fit – it won’t work! Eg breastfeeding/family planning/childbirth) 3. Funded the trip myself – which required a lot of time management the 6 months before..then while we were there, we worked together, to navigate the day and our tasks 4. When people don’t speak the same language, difficult, but do-able – used our interpreters, but also games and role-playing, used body language and lots of smiles and the odd bit of malagasy (afaka mahazoo rano mafana azafady tompko) – much appreciated 5. Banana bread and brick throwing, without damaging your eyes! 6. don’t wash your clothes if there are clouds in the sky – wait for the sunshine 7. The adults wanted us to teach the children, but after they had done their work for the day (all hands on deck for the farming), and wouldn’t take a day out for a bad tooth (too far, too expensive, and work to be done)...
reassured me that nursing was a great profession and skill to take with you to the developing world (where role of health promoter very imp – small changes can have a big impact eg, hand washing, careful food prep, drinking safe water and diet... in reducing childhood diarrhoea... Currently still have desire to work overseas, in public health, and doing a dissertation on asylum seekers
Internationalisation of the Bachelor of Nursing (Hons) curriculum Carol Paisley, Chloe Clayton, Alison Hobden, Julie Crane
Aim of the session <ul><li>To outline how we include internationalisation within the undergraduate nursing curriculum </li></ul><ul><li>Discuss the opportunities for an elective placement within the undergraduate nursing curriculum </li></ul><ul><li>Share the experiences of our students who undertook global health elective placements in their programme </li></ul>
Background <ul><li>Programme due for re-validation in 2009 </li></ul><ul><li>Increasingly asked by students at interview whether we offer an international placement </li></ul><ul><li>‘ Internationalisation’ a key part of the University’s strategy </li></ul><ul><li>Opportunity to combine student and University requests </li></ul>
What we wanted <ul><li>For the placement to be an integral part of the programme </li></ul><ul><li>For students to be able to use experiences of the placement during the rest of their programme </li></ul><ul><li>All students to be involved in the ‘elective’ </li></ul>
Integration with the programme: Global Health Elective Placement <ul><li>2010 </li></ul><ul><ul><li>18 students remained in Liverpool </li></ul></ul><ul><ul><li>4 went elsewhere in the UK </li></ul></ul><ul><ul><li>14 went overseas </li></ul></ul><ul><li>2011 </li></ul><ul><ul><li>14 students remaining in Liverpool </li></ul></ul><ul><ul><li>17 going elsewhere in the UK </li></ul></ul><ul><ul><li>13 going overseas </li></ul></ul>
<ul><li>India has a population of 1.1 billion </li></ul><ul><li>26% of the population live below the poverty line </li></ul><ul><li>Life expectancy is 63 years old for men and 66 years old for women </li></ul><ul><li>More than one third of women and 47% of children are undernourished </li></ul><ul><li>Over 2.4 million children under five years old die each year (one quarter of the world’s global child mortality) </li></ul><ul><li>64.8% of Indians are illiterate </li></ul>Information from the World Health Organisation Country Co-operation Strategy 2006-2011 (WHO, 2006)
<ul><li>In Dehradun, Northern India: </li></ul><ul><li>Population: 447,808 (Government of India, 2001) </li></ul><ul><li>10% of the population is under 10 years old </li></ul><ul><li>Literacy rate is 77% </li></ul><ul><li>Learn how social and cultural factors impact on health in India </li></ul><ul><li>Learn about the education process for nurses and the attitude towards nursing in India </li></ul><ul><li>Increase my knowledge of the Indian healthcare system and its structure </li></ul>
<ul><li>Learnt about disability services in India </li></ul><ul><li>Worked alongside the MDT contributing towards assessments and reviews </li></ul><ul><li>Worked with the NGO Doctor to educate parents about the aetiology of their child’s condition and services available to help them </li></ul>Week One at the Latika Roy Foundation
Week Two at Rewati Nursing Home <ul><li>Private Hospital for Obstetrics and Gynaecology </li></ul><ul><li>Clinical skills – assisted with deliveries, caesareans, medications administration and ultrasounds </li></ul><ul><li>Learnt about the healthcare system in India and importance of private and public facilities </li></ul><ul><li>Learnt about culturally specific healthcare problems such as female foeticide </li></ul>
Weeks Three and Four at Herbertpur Christian Mission Hospital <ul><li>100 bed hospital in the foothills of the Himalayas </li></ul><ul><li>Practised plenty of clinical skills! </li></ul><ul><li>Observed how environmental factors contribute to health and illness </li></ul><ul><li>Realised the importance of cultural sensitivity in nursing care </li></ul><ul><li>Developed an understanding of the health inequalities which occur in this region </li></ul>
What did I learn? <ul><li>Improved nursing knowledge </li></ul><ul><li>Organisational skills </li></ul><ul><li>The ability to be adaptable </li></ul><ul><li>Reflection and critical analysis – of my own practice and that of others </li></ul><ul><li>Non verbal communication and the basics of Hindi! </li></ul>
In Conclusion <ul><li>Fantastic opportunity to see how healthcare and nursing work in a different country with a very different culture </li></ul><ul><li>A huge benefit to my nurse education and an experience which will remain with me throughout my career </li></ul><ul><li>Made some fantastic friends and met some inspirational people </li></ul><ul><li>Met my personal learning outcomes and the module learning outcomes </li></ul>
Contacts <ul><li>Email me at: [email_address] </li></ul><ul><li>Latika Roy Foundation: www.latikaroy.org </li></ul><ul><li>Herbertpur Mission Hospital: www.hch-eha.com </li></ul>
Nursing and Public Health Chloe Clayton Global Health Elective Madagascar 2010
Personal Motivations... <ul><li>Interest in public health and international development </li></ul><ul><li>Health issues and practices in rural communities </li></ul><ul><li>Women and children’s health </li></ul><ul><li>Grassroots/community involvement </li></ul><ul><li>Non-clinical </li></ul><ul><li>Pro-active </li></ul>
Madagascar...the facts <ul><li>50% of people live on less than 50p a day </li></ul><ul><li>47% have sustainable access to improved water supplies </li></ul><ul><li>Only 12% have access to improved sanitation such as simple pit latrines </li></ul><ul><li>Children are particularly affected </li></ul><ul><li>In 2004, 52.8% of under-fives were stunted and 36.8% underweight </li></ul><ul><li>Under-five mortality rate in 2006 was 115/1000 with 16.9% due to diarrhoeal disease </li></ul>
SKIP – Students for Kids International Projects <ul><li>12 branches </li></ul><ul><li>Aim to improve the health, welfare and education of children in the developing world </li></ul><ul><li>SKIP Southampton </li></ul><ul><ul><li>Health promotion through education </li></ul></ul><ul><ul><li>Building a youth centre </li></ul></ul>
Knowledge, Skills and the Unexpected... <ul><li>Cultural health practices </li></ul><ul><li>Impact of geography on health </li></ul><ul><li>Greater self awareness and sensitivity in our communications and interventions </li></ul><ul><li>Organisation and teamwork </li></ul><ul><li>Cooking/Building/Keeping clothes dry! </li></ul><ul><li>Learning we all have different priorities </li></ul>
In the end... <ul><li>Great opportunity to follow own interests </li></ul><ul><li>Life changing experience </li></ul><ul><li>New friends (the village and the volunteers) </li></ul><ul><li>Insight into another world </li></ul><ul><li>Learnt so much </li></ul><ul><li>Talked, listened, discussed... </li></ul><ul><li>Provided motivation – nursing is the right path to make a difference! </li></ul>
What we gained <ul><li>Every student had a valuable learning experience </li></ul><ul><li>Exposure to “field” </li></ul><ul><li>Transferable skills </li></ul><ul><ul><li>Leadership and management module </li></ul></ul><ul><li>Self awareness </li></ul><ul><li>Increased cultural awareness </li></ul><ul><li>Increased confidence </li></ul><ul><li>Enhanced clinical skills </li></ul><ul><li>More meaningful knowledge of public health </li></ul><ul><li>Greater appreciation of the NHS </li></ul>
Further Suggestions <ul><li>Timing of placement </li></ul><ul><li>Embed into curriculum (or not) </li></ul><ul><li>Importance of providing structure for placement </li></ul><ul><ul><li>Personal learning outcomes </li></ul></ul>
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