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Crossing Borders

Shoulder to Shoulder
By Dave Shelles

Volume 12, Number 3 | May 2011

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In a remote part of the world, Nicole Cova's life changed. Now she's part of an effort to change the lives of the people who changed hers. The University of Wyoming senior nursing major spent two weeks in Honduras. She ate food that had been harvested that same day. She and 12 other college-aged nurses got schooled on a rutted soccer field by a pair of 6-year-olds. She walked to work every morning and home every night wearing a headlamp, because there were no streetlights in the rural village. As a result, she gained a new perspective on her chosen field while working in Spartan conditions and helping those who needed it most.

Cova and her colleagues spent two weeks in Honduras through UW's International Health Care Immersion Program. This program partners with an international non-governmental organization called Shoulder to Shoulder, which has worked in Honduras for more than 20 years, specializing in healthcare, health-care education, and environmental hygiene.

In 2007, Penelope Caldwell organized and led the first group of UW nursing students to Honduras. Caldwell, a certified nurse midwife and an assistant lecturer in the Fay W. Whitney School of Nursing at the University of Wyoming, is now the program's coordinator. To date, there have been seven trips to Honduras and more than 90 nursing students have participated.

"Down there, you don't worry about insurance, paperwork, or charting. You don't worry about anything [bureaucratic]," Cova says. "You just worry about your patients. It's the most amazing feeling to come back and know how many people I helped in the short amount of time I was there. It totally reminded me of why I was in the health-care field."

From sunrise to sunset, Cova and the rest of the UW student nurses saw patient after patient in Agua Salada. Deep in the forest, and separated from a more modern clinic in Concepcion, were narrow strips of crushed gravel that passed for roads. Sometimes patient ailments were more than what the UW nursing students could cure or heal temporarily. Those patients were sent to the clinic in Concepcion, where the students also assisted, or to other clinics. Other times, the solutions came more easily.

"I saw an 80-year-old man, and I was the first provider he'd seen in his whole life," Cova says. "He came because he wanted to continue working, and he said he needed Tylenol or Advil. He was nearly crippled from his arthritis, and all he wanted was some aspirin so he could keep working. Stuff like that reminds you why you're here."

Cova praises Caldwell as the heart and soul of UW's connection to Shoulder to Shoulder. Caldwell acknowledges her passion for helping the students get the most out of their Honduras experience, though she points out that students such as Cova keep the program going with tales of their own experiences. "I don't sell it. It sells itself," Caldwell says. "These trips are kind of magical. I'm just a facilitator. At this point I say first-come, first-serve, this is when we're going to leave, and this is how much it's going to cost. My email just fills up, and I'm just awed every year that more people want to go. It's people like Nicole saying, 'This was awesome, this is what happened to me, this is how the people live, this is how my world was changed.'"

Student nurses aren't the only ones traveling to Honduras. Along with Caldwell, Dr. Ronald Iverson of Wyoming Medical Center in Casper, and Dr. Zach Deiss of Family Medicine Residency-Casper provided additional medical support. UW pharmacy and engineering students also made the trek; pharmacy students helped determine medications and treatment protocols, while engineers helped draft plans for building a clinic in Agua Salada under UW's auspices.

While each person had a job to do in Honduras, Cova says job descriptions expanded over time to better meet the needs of the patients. Cova says it was ultimately up to each student nurse to determine the course of action, thanks in part to the doctors' leeway and instruction.

"We would triage a patient and if we needed help we'd bring in a doctor," Cova says. "I came back with so much more confidence in my skills. It showed me I know what I'm doing and that I'm capable of providing the care people need."

Mary Burman, dean of the School of Nursing, says students gain valuable experience through interactions with other medical professionals and being immersed in a different culture.

"In healthcare we don't always have the best interprofessional experiences, places where a nursing student can practice alongside a physician or medical student, pharmacy student, or a social worker," Burman says. "When you're in Honduras, some of the hierarchies inherent in healthcare in the U.S. disappear. So you see a resident coming up to a nursing student to figure out how to handle an interesting challenge with a child.

"I think it's going to become one of our most meaningful experiences, where students can come to appreciate what they bring to it, but gain a better understanding of what others can do. For nursing, that part of it is really critical."

Meanwhile, Cova is serving her senior practicum in obstetrics at Campbell County Memorial Hospital in Gillette, Wyoming, and says her future plans also include a Doctor of Nurse Practitioner degree. She also hopes the future includes a return to Honduras — thanks to all she learned at UW.

"The nursing program has prepared us for something like this," Cova says. "To be able to stand on my own in a foreign country and provide nursing care says a lot about our program. It says a lot about the professors enabling us to do all this."

Indeed, the plan is to set up a clinic, staffed year-round by a nurse and temporarily by the annual brigades from UW. Caldwell says the fundraising goal is $100,000, of which $45,000 has been raised. It's a project that will take money and volunteers who aren't afraid to get their hands dirty. The volunteers seem to be the easy part.

"Right now our timeline is if we get the funding we need, and we're halfway there, we'd like to finalize the building plans in July with the local people and contractor, and then break ground in November," Caldwell says. "We hope by July 2012, we're putting the last touches on the clinic. The only reason it could be a problem is not enough funding, but by July 2012 we could have a clinic."

Burman says support for the project extends beyond the College of Health Sciences. President Tom Buchanan's office, the International Programs Office, and the State of Wyoming all have backed the program financially or in other ways. Students from across the university, in addition to pledging their time and talents, find other ways to contribute to the efforts, too.

"Penelope Caldwell is totally the backbone of this operation, and it's her passion for people and UW that made these trips possible," says Cova. "It's the people who have faith in us and believe in us enough to donate to our cause to help us get down there. If it weren't for UW, we would not be where we are today. We would not be in the middle of raising $100,000 to build our own clinic. We're so thankful to put Wyoming's name on the side of our building when we get down there."

In that respect, expect UW to change some lives.


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