Under African Skies
four stories - winter 2010
As the world becomes more and more interconnected, nurses from Boston College are motivated to understand international health care needs and develop the cultural competency required to lead in an increasingly global society. While many students choose to develop these skills through formal programs at Boston College, others take a more individual path.
These students may be “on their own” in a global setting, but they bring with them a wealth of support from Boston College in the form of relationships, clinical skills, and financial assistance. We present here four personal accounts of Connell School students who have traveled to Africa, both to address health disparities and to increase their own knowledge about global health.
A Maasai boy poses in front of his home in one of the villages that Meaghan Bradley ’09 visited during her time in Tanzania.
meaghan bradley ’09 in tanzania
After 24 hours of traveling, I take my first step into the cool night of Tanzania. I walk through the airport and out into a large crowd of people. Glancing quickly around at the names on the cards, I see mine held by a thin Tanzanian man surrounded by adorable children. I walk toward them, embarking on what will be the greatest adventure of my life. On the ride to my new home for the next seven weeks, I can’t stop staring out the window, straining to catch my first glimpses of Africa through the penetrating darkness. We eventually pull off the road and around the back of a large white building. The children rush to take my bags inside as I cautiously step out of the car. My first night, I hear every sound as though it were through a loudspeaker. Every creak of the bed and drip from the faucet catch my attention as I crane my neck to make sure the sound is harmless. I am terrified that first night, wondering to myself what kind of crazy mistake I have made.
The daylight and an orientation to my surroundings brings a welcome change in mindset. I spend the next seven weeks falling in love with Tanzania. The natural beauty, the kindness and caring that surround me, and even the once-strange smells all begin to feel like home and capture my heart. By the end of my time there, I feel like I am never going to clean the red dirt off my feet, and I know Africa has become a part of me forever.
Working at Light in Africa (LIA) started as somewhat of a dream during my sophomore year in college. I was intrigued by the Maasai culture of Tanzania and focused my efforts on finding a volunteer project there. Orphanages and health care organizations were appealing because of my love for children and interest in international health. After many conversations, I was eventually connected with Mama Lynn Elliot, a social worker originally from the United Kingdom who founded LIA at the site of a derelict orphanage in the foothills of Kilimanjaro. LIA now operates multiple children’s homes, food outreaches, and medical dispensaries.
Maasai patients at a medical dispensary in the remote Tanzanian village of Tindegani.
One thing I loved about Tanzania was the opportunity to make an impact each and every day. Every day at LIA was an adventure. Whether it was feeding and holding a baby, giving an HIV seminar to a local village, or working on a construction project, there was always important work to be done. At one of LIA’s sites, Tudor Village, I witnessed children’s lives changing. Tudor Village offers children from extremely difficult backgrounds a more comfortable and stable living situation. Some were malnourished, others disowned by their families, and still others orphaned by AIDS. Yet every time I saw these children, their smiling faces shone up at me. They were the happiest, brightest, and most loving children I had ever met. It was not uncommon for toddlers to comfort one another, help another child to finish a meal, or give up toys for one another. The older children all helped take care of the younger ones. Each child seemed to truly appreciate the loving atmosphere of LIA. Tudor Village was just one of the LIA sites where I and other volunteers were able to make a difference.
My experiences in Tanzania have changed my perspective on the world and altered how I interact with my environment. I see the world as a connected place. I realize the importance of respect for the world as a whole and acknowledge that my actions can have global impact. In the future, I plan to employ my nursing knowledge in the global arena. By incorporating practices I am learning in American hospitals with cultural knowledge I have from volunteering abroad, I hope to improve the health of mothers and children worldwide.
A volunteer plays with children in the Light in Africa program, which operates children’s homes, food outreaches, and medical dispensaries in Tanzania.
katya wheelwright in uganda
Last year, Colleen Simonelli, a nursing professor at Boston College and a longtime family friend, suggested I apply for the Advanced Study Grant offered to freshman and sophomore Boston College students. Not realizing that it might actually happen, I made a joke about returning to Uganda, where I had been a volunteer the previous summer. Seven months later, I was on a plane heading to Uganda for the second summer in a row.
When I applied for the Advanced Study Grant, I wanted to create a project that incorporated my love of traveling, volunteering, and nursing all into one. Working in a local medical clinic in the Kibale National Park region of Uganda and carrying out a health and hygiene education project at local schools did just that.
Leading up to the trip, I collected basic medical supplies and hand washing products. Donations started flooding in after an article was published on the front page of the Metrowest Daily News (Framingham, Massachusetts). One man, whose wife was born in Uganda, donated 500 bars of hotel-sized soap. Others sent monetary donations, which I used to transport the supplies over to Uganda.
In Uganda, I stayed in a divided duplex at a field station in the Kibale National Forest, while volunteering and observing at the nearby health clinic. Each side of the duplex had a large living area with two bedrooms. One of the nurses from the clinic lived on the other side with his family. In order to use a flushing toilet, I had to walk up a hill, especially difficult at night because of the need to avoid baboons.
A major component of my project was educating schoolchildren about germs and the importance of hand washing. I taught them proper methods of hand washing and also touched upon first aid. Lucy, one of the nurses who works at the clinic, helped immensely by accompanying me to teach the younger children who don’t speak English yet. My hope is that Lucy will continue to teach the disease prevention program as she does outreach in schools.
Schoolchildren in Uganda
Life in the United States—and especially on the East Coast—moves so quickly. In Uganda, everything is done at a much slower pace. When planning my project, I had expected to work in five schools, but ultimately was only able to work in one. I wasn’t able to get into the schools until my third week there, and because each school has more than 1000 students, I realized that educating one school was a more realistic goal.
Initially, I walked away from the health education project uncertain about whether or not I had really gotten through to the children. On one of my last days in Uganda, I returned to the school and visited a classroom. Upon entering, the teacher spoke one word, and in unison the entire class brought their arms up to their mouths and coughed into the crooks of their elbows. It almost brought me to tears. Before my arrival, the children had been coughing into their hands, which is an easy way to spread germs. Realizing that the children had really taken in the information made me feel as though my entire project had been worth it.
Last summer, I stepped outside my comfort zone, and in doing so, learned things about myself that I never knew. I am still the same person, but I am more aware than ever before. I now realize that while my aid and the aid of other “outsiders” is helpful and needed, it is also important to help in a way that allows the people of Uganda to be self-sufficient. For example, the soap I brought this past summer is not sustainable, so I hope to set up an after-school soap-making club in the future. Projects like making soap provide schools and homes with a valuable necessity, and serve as a way of earning money for students and their families.
Katya Wheelwright worked in Ugandan schools to educate children about disease prevention and the importance of handwashing.
ashley younger ms ’09 in Ethiopia
Before entering the master’s entry program at Boston College, I spent two years working in Guatemala and Nepal. In Guatemala, I assisted midwives and translated for medical teams. Living in Nepal offered the opportunity to learn wound care in a leprosy hospital alongside Nepali nurses. Both experiences were extremely influential on my decision to enter nursing. I knew I needed more skills before returning overseas, and the role of nurse practitioner was ideal for my focus on preventative care in a low-resource setting.
After a year at Boston College, I was longing for some international experience to practice my new skills and regain a vision for why I chose nursing. A program at my church that sends a medical team to Addis Ababa, Ethiopia each year gave me the opportunity to make this happen. It was amazing how plans came together and seemingly impossible challenges were overcome once I took the first steps. Our team of physicians and nurses was scheduled for two weeks when I would miss school and clinical time. My women’s health professor, Holly Fontenot, helped create space in my schedule to make this opportunity work. Without her help, I could not have served in Ethiopia and would not have had the confidence to step outside my comfort zone to implement my new skills.
We arrived late at night in Addis Ababa and attempted to sleep through the time change, waking at four in the morning with the Islamic call to prayer chanting in the streets. We left for the health center early to meet the staff and quickly got to work. The setting was very basic but because of the model of bringing in medical teams each month, the clinic pharmacy remained stocked with supplies. Triage was conducted outside and the four providers, including myself, sat at desks in a larger room. There was one private exam room if we needed to do a physical assessment. With my pile of books to my right and my translator on my left, I saw patients and consulted with the local physician to write prescriptions. Luckily my translator was also a nurse and he was a great help. I soon discovered that the nurses in Ethiopia are extremely skilled and incredibly caring to their patients. Their jobs are never-ending and extend far beyond the 12-hour shifts of U.S. hospitals, yet the energy they bring to nursing is unparalleled. I felt really privileged to work alongside them.
While the basics in primary care existed, the most difficult challenge I faced was not being able to refer patients that needed specialist care. After consulting with a physician about one woman, we concluded that she had some sort of cerebral tumor that was slowly affecting her nervous system. With no neurosurgeons in the country, we had to tell her there was nothing we could do. She immediately began to cry. I hugged her for a long time, and sat with her as she cried. I felt helpless that for lack of medical care, even in the capital city, we could not help her.
One morning, three of us went to visit HIV-positive patients in their homes. Most homes were made of tin and cardboard, large enough only for a bed and a few items. At times we had to whisper so neighbors would not know of the patients’ HIV status. If they can even afford a room, most families live together, sharing the same bed, cooking, and bathing in the same room. There are often animals gathered inside and lack of electricity makes the atmosphere very dark. In one home, a new mom wanted me to assess her baby and help her with breastfeeding. To do this, I pretty much had to get in the bed with her in order to see with the little light coming through the door. We had such a good time laughing with me there next to her in the bed. Going into these homes gave me valuable insight into the challenges these HIV-positive patients face.
My experience in Ethiopia has renewed my desire to work in global health in extremely resource-poor settings. I am currently pursuing a degree in public health at Harvard as the next step in this process.
Ashley Younger works with patients in Addis Ababa, Ethiopia
clara gona in Zimbabwe
I emigrated from Zimbabwe to the United States in 1990, but have kept up with news from home over the years. I was horrified by news reports about the HIV/AIDS pandemic ravaging the country, and would receive occasional news about friends and relatives who had perished from the disease. Yet I wasn’t moved to action until 2002, when I read a news report in the Zimbabwean daily newspaper regarding the government rollout of a drug used to prevent mother-to-child HIV transmission. The report went into great detail about the benefits of the drug to the unborn child, without any mention of the mother’s need for treatment. I was outraged at the tone adopted by the reporter, who looked past the pregnant woman, portraying her as a disposable and contaminated vessel. I wondered what it must feel like for women in such a situation.
I enrolled as a PhD student at Boston College to study the quality of life of HIV-positive Zimbabwean women, to build nursing knowledge that can be used in the care of HIV-positive women, and influence HIV/AIDS policy in Zimbabwe and throughout southern Africa. Several courses helped to refine my thinking, including a class discussion on Margaret Newman’s theory of health as expanding consciousness. I realized that to understand my phenomenon of interest—about which little is known—I would need to conduct a qualitative study.
During a visit to Zimbabwe, I had the opportunity to visit the University of Zimbabwe Clinical Research Center. Nurses at the center, where many HIV/AIDS clinical trials are conducted, passed along horror stories told by study participants. I became convinced that these participants’ voices needed to be heard. There were several advantages of using this site for my study, including support from and rapport with the director and staff. Still, getting all of the approvals I needed was one arduous process! It took me twelve months to get approval from Boston College’s Institutional Review Board (IRB), the Medical Research Council of Zimbabwe, the Parirenyatwa Research Board IRB, and the University of Zimbabwe Clinical Research Center Research Board.
Finally, in June 2008, I went to Zimbabwe to conduct fieldwork. At that time, the country was going through a major financial and political crisis with a severe shortage of basic food supplies and fuel. The political environment was polarized and extremely tense, and people feared for their lives. Nobody had a good sense of where the country was headed. I was embraced by the nurses at the research center, who were excited to see a fellow Zimbabwean nurse leading a research study. These amazing nurses took care of both my physical and emotional needs while watching out for my safety outside of the center.
On my first day at the site, I sat in the waiting room, just like an ordinary client, and observed the women as they interacted with the staff and each other. As I sat there, I was struck by the gravity of the HIV pandemic. Women, men, and children were sitting elbow-to-elbow. I had never seen so many HIV-positive people in one place. The following day, when I started interviewing, a participant recognized me from the previous day. She was very surprised that I was the one conducting this study, since the day before I had sat in the waiting room as if I were a client. I interviewed the women individually in Shona, my native language. They told harrowing experiences of being diagnosed with HIV, about their day-to-day struggles, and how anti-retroviral medications have given them their lives back. Despite what they have been through, the women had such grace and dignity. I was humbled by the women’s courage.
It was heart-wrenching to listen to the experiences of these women for days on end. The senior nursing officer at the clinic provided me a chance to debrief after each interview, and my husband back in Boston was on speed dial. With the support and guidance of my committee members, professors Rosanna DeMarco, Pam Grace, and Danny Willis, I completed the interviews in four weeks. After transcribing and translating these interviews into English, I am now analyzing the data. I hope to complete my dissertation this year, and continue my research to help with the care of women living with HIV.