University of Virginia School of Nursing
With university partner BICU, Bluefields, Nicaragua is a return site for UVA Nursing students

Bluefields, Nicaragua is a place of paradoxes, its vibrant, multi-ethnic, multi-lingual streets rich in beauty and culture juxtaposed against the impacts exerted by poverty.

For UVA nursing students, though, it’s something else entirely: A fascinating place to learn about health, health disparities, and social justice. A site to collaborate with Nicaraguan nursing students both in class and informally. A place to conduct research with UVA faculty and Nicaraguan clinicians that has global meaning.

Bluefields is also the first site of the School of Nursing’s reimagined global initiatives programming.

“Bluefields is the model for our new way of engaging in global health experiences,” explains Susan Kools, Jones Professor and director of the School of Nursing’s Global Initiatives. “We’re trying to be much more thoughtful and intentional about how we engage with other cultures and communities, and building a sustained, reciprocal alliance with our Bluefields colleagues gives us that chance to develop our new gold standard.”

The idea, explains Kools, is to transition the School’s global health experiences from a series of short-term medical missions to a model of sustained partnership with host universities and communities. With partnerships built around a core of research that is mutually beneficial, students’ educational experiences are centered on locally determined needs and priorities. By offering student experiences several times a year, relationships and initiatives will be nurtured across time without connectivity gaps that sometimes plagued the old model.

“Students often seek a global health experience with good intentions—to do good, to change the world,” added Kools, “but we want them to go deeper, to make relationships, and to learn about public health nursing in a culturally humble way by engaging in an environment different from their own and participating in research driven by local priorities.”

To that end, 16 nursing undergraduates recently spent their spring break analyzing the inner workings of several of Bluefields’ local, government-run public health organizations. Partnering with the nursing school at the Bluefields Indian and Caribbean University (BICU), UVA students did in-clinic simulations alongside their BICU peers, toured a coffee cooperative with novel health promotion strategies, interviewed teens enrolled in a public substance abuse program, worked with expectant mothers in Casa Materna, toured a cancer clinic and visited the city’s disaster preparedness headquarters. Faculty mentor Emma Mitchell’s research on health disparities, cervical cancer, HPV screening and vaccination provided the common thread that connected sites the group visited as well as their coursework and activities over the week.

For 3rd year BSN student Josh Moore, from Richlands, Va., who’d only been as far as Florida, the trip offered a vision for a Distinguished Majors Project as well as a way to flavor his state-side nursing with a public health tint.

“Public health nursing an entirely different way of looking at a patient,” explains Moore, who plans to be a pediatric nurse. “It’s not just, ‘You have high blood pressure and I’ll give you this medicine,’ but, ‘What sorts of food do you eat? What’s the closest market to your house? Do you get exercise, and are your streets safe when you do walk? Are there sidewalks?’ Public health is an extra tool in my tool kit – it gives me a broader perspective.”

3rd year Carolyn Saunders, from Purcellville, Va. – who was eager to try her Spanish fluency in Nicaragua – agrees. She appreciated the openness, ability and poise of her BICU peers, and her vantage into a system of care that has both challenges and strengths to learn from.

“We really learned how culture affects healthcare,” says Saunders. “It’s not just resources, or systems, it’s the culture of the location they’re in. And nurses must recognize where patients are coming from.”

Kools and Mitchell plan to repeat the Spring Break experience next year with another group of students and add in a similar experience for our RN to BSN students in October, 2016. Mitchell is also reimagining a January-term class on health disparities and social entrepreneurship in early 2017. They also hope to explore ways of bringing faculty and students from BICU here.

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