Image courtesy: Maria Meyer
In October 2018, Boston College officially embarked on a strategic alliance with seven other Catholic research universities from around the world. Their goal: to jointly engage in collaborative research projects and increase the impact of Catholic institutions in confronting global challenges.
Among the participants is the Pontifical Catholic University of Chile (Pontificia Universidad Católica de Chile, or PUC) in Santiago, Chile, which U.S. News & World Report has ranked as the second-best university in Latin America.
With some 28,000 students, the Chilean university is approximately twice as large as Boston College. But both institutions are rooted in the Catholic tradition. Both combine an emphasis on research and professional training with a focus on service. And both are leaders in nursing education—which is among the reasons the Connell School has developed a multifaceted partnership with PUC during the past seven years.
CSON is collaborating with PUC to bolster Boston College’s global efforts on three fronts: developing a master’s program designed to educate the country’s first generation of nurse practitioners; building a service learning program in Santiago that is open to BC undergraduate nursing students; and expanding Global Health Care: Meeting Challenges and Making Connections, a four-week international study elective Connell established with two Swiss universities, Haute École de Santé Vaud (HESAV) and LaSource, in 2012.
Building an advanced practice nursing program
Associate Professor Susan Kelly-Weeder, the Connell School’s associate dean for Graduate Programs, is working with PUC to build the first-ever nurse practitioner (NP) master’s program in Chile. Graduate programs in nursing exist in the country, explains Kelly-Weeder, but virtually all of them prepare nurses to pursue research rather than primary care practice.
According to a 2019 American Association of Nurse Practitioners report, an estimated 270,000 licensed nurse practitioners are living and working in the United States. The U.S. produces NPs at three times the rate of other countries—40.5 NPs per 100,000 vs. 12.6 in the next highest country, the Netherlands. NPs are prevalent in Canada, Australia, and Europe as well. But “the licensed advanced practice nurse” is a “new concept in Latin America,” according to the Pan American Health Organization and the WHO.
Nurse practitioners pursue “a different model of care that would enable Chile to add more providers in a situation where there is a tremendous need for more providers,” Kelly-Weeder says. “This need is especially acute in rural areas and particular specialties, such as oncology and primary care.”
Educating nurse practitioners “would enable Chile to add more providers where there is a tremendous need … especially in rural areas and particular specialties.”
She is working with Chilean hospital and government officials to increase understanding of what a nurse practitioner does, and to introduce legislation that would establish and govern the professional role. In addition to helping craft a curriculum for the new master’s program—which is to be modeled on Boston College’s two-year Family Nurse Practitioner M.S. degree—Kelly-Weeder teaches an accelerated version of one of that program’s classes, The Role of the Advanced Practice Nurse.
She expects that physicians will play a crucial part in training the first nurse practitioners in Chile, just as they instructed the U.S.’s first NPs in hospitals and clinics in the 1960s.
Training Chile’s first nurse practitioners
In addition to building a new master’s program in Chile, Connell and Pontifical Catholic have sponsored two Chilean nurses’ enrollment in the Family Nurse Practitioner M.S. program at BC.
These nurses—Magdalena Correa Duque, M.S. ’21, and Sandra Leyan, M.S. ’19—are poised to become the first clinical nurse practitioners in Chile’s history.
Leyan has returned to Santiago, where she and her colleagues are working to establish foundations of NP principles and practice. She and Duque have also agreed to teach on the faculty of PUC’s new master’s program.
Both Duque and Leyan say that although the process of fully integrating nurse practitioners into Chile’s health care system may take time, their presence has the potential to significantly improve access to health care, particularly for underserved rural communities.
“I see this starting in the capital,” Duque says, “but I hope it will spread to the rest of the country.”
“If we succeed with this,” Leyan says, “it could actually change nursing history in Chile and open doors for nurses in the entire country.”
Service learning and community service
Each January, select CSON seniors travel to Santiago to participate in a three-week service learning program. Besides taking classes on the Chilean health care system at PUC, they visit clinics, hospitals, and other care sites in and around Santiago. This year, students also heard from experts on HIV and STD care, and learned about Chile’s two-tiered health care system: universal public health care is available to all, but private options are also open to those who can afford them.
“For those on the public health plan, there are long waits to be seen and real problems with access, whereas the private system is not much different than ours,” says Kelly-Weeder, referring to the United States.
Since the Connell School’s pilot visit to Chile in 2015, 28 undergraduates and two graduate students have participated in the service learning program. On the most recent trip in January, Maria Meyer ’19, M.S. ’20—the winner of the 2019 Edward H. Finnegan, S.J., Award, Boston College’s top undergraduate honor—led a group of six seniors on the expedition.
“The service trip was a formative part of my undergraduate experience,” she says. “It’s eye-opening for U.S. students to learn how we look on a global scale.”
CSON students stay in a hostel called Casa Suecia and cook communal meals while they are on the service trip. International students from France and Switzerland who are in the same exchange program as the BC students often join them.
On visits to hospitals and clinics, the students observed Chilean nurses at work and witnessed the differing standards of care in the private and public systems. Meyer, who is training to become a nurse practitioner, says that many of the students and nurses she met were interested in learning about what NPs do.
“I spent a lot of time talking to the Chilean undergraduates about how to actualize the possibility of that role in their country,” she says.
“This could actually change nursing history in Chile and open doors for nurses throughout the country.”
This winter’s service trip took place against the backdrop of political upheaval in Chile. In October 2019, a subway fare hike spurred demonstrations that quickly expanded in scope, and on October 25, more than one million Chileans took to the streets of Santiago, calling for change in such long-term, pressing issues as the minimum wage, utility and transportation costs, retirement pensions, and public health care. Although Meyer says that BC students felt safe in Santiago, the continual protests were a presence that altered their plans. In previous years, students spent the final week of the trip visiting homes and clinics in rural areas on the outskirts of Santiago. But political unrest kept them in the city this year.
Global Health Care: Meeting Challenges and Making Connections
The Connell School’s collaboration with PUC dates to 2014, when Dean Susan Gennaro invited Chilean nursing students to Boston to take part in Global Health Care: Meeting Challenges and Making Connections. In this interdisciplinary course, whose location alternates between Chestnut Hill and Switzerland each summer, students exchange perspectives on global health policies and practices that serve the needs of diverse and underserved populations.
Clinical Professor and Associate Dean for Undergraduate Programs Colleen Simonelli has led the Connell School’s involvement in the course since it began. She sees it as an opportunity for nurses-in-training to “broaden their horizons” and build cross-cultural understanding. Students from Pontifical Catholic have attended the course since 2014, and in January 2016, they hosted the Global Health Care course in Santiago. BC students have much to learn from exchanges such as these, Simonelli says. She points to Chile’s complementary care tradition—and its long-term history serving diverse populations by integrating indigenous health practices with conventional medicine—as exemplary.
On one trip, for example, Boston College students visited a healing hut built on the campus of a major hospital in Santiago to provide care to Chile’s indigenous Mapuche people. In this hut, or ruka, a Mapuche healer administers traditional care and palm readings to patients while prescribing herbal infusions for their ailments. Since the 1990s, when Chile’s government began to introduce rukas to its hospitals, the huts have provided a place where Mapuche healers can collaborate with patients and doctors, encouraging them to consider non-indigenous approaches, and vice versa.
Through such experiences, Simonelli says that “students get to see effective ways to meet patients’ culture, values, and beliefs, so that people feel cared for.” Whether her students end up practicing abroad or at home, she says, she believes that the exposure to other methods of patient care and the workings of another health care system will help them develop a cultural humility that will serve them well in their careers. ▪