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

This 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. DUSON has partnered with the Raleigh-based organization for years, and provides students at the nursing school the unique opportunity to expand their understanding of the world and deepen their knowledge of community health and wellness issues.

Curamericas Global partners with forgotten communities to save the lives of mothers and children. In partnership with the Guatemalan Ministry of Health, Curamericas supports five community-operated/owned Casa Maternas, or birthing homes, that 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 DUSON’s program was easy. She had never traveled internationally, and she was excited for the opportunity to see what healthcare 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 US, especially with the lack of resources,” Lindsay said. While Shelby had traveled internationally most of her life, she was excited for the opportunity of an experience that would help make a difference in others’ lives.

The student group, led by clinical instructor Melisa Crane, set out for Guatemala in early August. 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 rates of mothers and children through community-based, primary healthcare services and community engagement. Extreme geographic isolation, lack of transport, and cultural traditions have led to persistent challenges. The area has one of the highest maternal mortality rates in the Western hemisphere.

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.  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 at Casa Materna, the group was immediately welcomed by the local healthcare 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 Curamericas’ Casa Materna facilities, training the staff, teaching them new skills and learning from them, 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 background in basic life support, Shelby helped lead the infant resuscitation training. 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 mile-long walks 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 US 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 with several births. When the opportunity arose, 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 pay close attention to breathing and I remember they dressed the baby immediately afterward.”

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 in 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 lessons to other local mothers, who can then share them with their daughters. This approach is changing their future, and generations to come.”

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