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OHSU Nursing Students Immerse Themselves in Mexico's Health Care System

   Portland, Ore.

The program, in its fifth year, offers students a view inside Mexican clinics, hospitals and homes

John Jessup, R.N., M.P.H., instructor in the community health program of the OHSU School of Nursing, noticed his students were primarily Anglo, while 10 percent of the Oregon population is Hispanic. Meanwhile, scarcely one-half of 1 percent of Oregon's nurses personally reflect this Hispanic heritage, a critical problem of the nursing shortage. So Jessup determined to prepare students to work with Latino clients and patients more effectively.

Even if students were not Hispanic, they could certainly be culturally competent. In 1997 he began escorting 10 OHSU undergraduate or four graduate nursing students at a time to La Paz, Baja California Sur, Mexico. There, the students are quickly immersed in a one-month total experience.

La Paz ("the peace"), a Gulf Coast city of more than 200,000 people, is the site of sparkling beaches and warm blue skies. Yet OHSU students seldom see this side of the city. They immediately begin work within the Mexican medical system, acquire Spanish, investigate the national health structure and live with local families.

Colleen Casey, a senior graduating this June, lived with a family of seven in a two-bedroom house of cinder block walls and a corrugated metal roof. She loved every minute. Chickens clucked throughout the house, and roosters woke her every morning. Her host family lacked hot water, and Casey shared a room with two teenage girls. "I adored my family and became part of it," she said. "They're very tight-knit. One of the daughters is a nursing student, and the oldest son plays in a local band. Essentially, he's the family breadwinner. We all pitched in. If the gas tank for the stove needed changing, everyone got up early to go get it filled. When the mother sold tamales during a national holiday parade, we woke up at 5 a.m. to help her put them together."

"The month is so intense," Jessup said, explaining that students leave host families at 7 a.m. each morning only to return at 8:30 or 9:00 p.m. each night. "Students learn what it's like to be a minority within the majority Mexican culture. They take public transportation, live in the barrio (ghetto), and often have running water only a couple hours each day."

The students begin each morning with four or five hours in various clinical sites -- hospital wards, barrio clinics, a Red Cross urgency clinic or rural mobile clinics. They offer immunizations, dental help, or health education on preventive care, such as lactation or diabetes -- all in Spanish. Followed by a 1 1/2-hour class on community and cultural health issues with Jessup, students spend the last four hours of the day with a Spanish tutor.

If the schedule isn't daunting enough, the homework certainly is. Jessup requires 20 new vocabulary words each day and a Spanish oral exam complete with clinical scenarios. Students also develop a friendship with a Mexican peer, conduct a complete assessment of both a local family and a health facility, write a hypothetical community health grant and, finally, assess, analyze and present the entire infrastructure of La Paz -- including health, public safety, economic, transportation and educational systems.

Casey muses about both the intensity and wonder of the experience. "We were embraced as nurses," Casey said, explaining she and her colleagues wore white from head to toe each day, as do all Mexican nurses. "We became invested in the community in a way only those who live there can."

Now when she helps patients in Oregon, she has a completely new perspective. "I try to meet them where they are. It's more than being able to speak Spanish or having a conversation about their health needs in their native tongue. It transcends that. I am beginning to understand where they come from, what their health system was like, and what their lives are. From now on, I'm open to expanding my horizons to considering health and illness completely out of the box. There's no doubt about it, I'm just going to be a better nurse," she said.

Jessup is awed by students who complete the immersion. "We have the cream of the crop here at the School of Nursing," he said. "I want to honor them. They rise to the intense challenge of the program and do an exceptional job. They will be our nursing leaders in the next 10 years, with knowledge and vision of the strengths of health care systems beyond our own.

"Additionally, each of them will forever know how diverse every culture can be," he said. "Any stereotypes they may have had are shattered forever. They come home with passion and skills to work with and advocate for all ethnic groups. It's a powerful vision of what it means to be a nurse. And ultimately, our entire health care system can only benefit."

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