Global Health & Medical Missions Program cultivates cultural competence among students

Cultural competence is rapidly becoming an essential skill for health-care providers in this increasingly globalized world. Not only do they need to communicate with and treat patients whose backgrounds and life experiences might be wildly divergent from their own, but they also need to be aware of and challenge their own inherent biases and preconceptions when it comes to different cultures. "The best way for a patient to heal is to feel comfortable," says Dr. Marlena Primeau, a clinical associate professor of nursing at The University of Alabama in Huntsville (UAH). "But if they’re out of their own culture, they don’t heal as well. So our job as nurses is to have that cultural competence that helps facilitate healing."

To ensure UAH’s students are fully prepared to engage with patients from other cultures, Dr. Primeau serves as the coordinator of two important efforts by the College of Nursing to cultivate the skills required: the Global Health Program (GHP) and the Medical Missions Program (MMP). Both are offered as electives – the GHP over three weeks in May, also known as the "Maymester," and the MMP over five weeks during the summer – and both combine classroom learning with hands-on experience in a foreign country. "The MMP is open to nurses in their junior-level courses or higher," says Dr. Primeau, "while the GHP is interdisciplinary and is open to any major as long as the student has an interest or focus in some aspect of health care, such as healthcare administration/business, pre-med, or biological research."

An interprofessional comparative health-care course, the GHP comprises one week of what is essentially a deep dive into the health-care system of another country followed by two weeks of travel in said country. "Everyone is assigned a topic, so they become the expert, whether it’s on access to care or on practitioner education and training," says Dr. Primeau. "Then we go to that country, visit the hospitals and universities, and talk to people in the street and ask them their opinions on health care, both in their country and the U.S." Destinations are selected, and the trip is organized in coordination with UAH’s Office of Study Abroad and a travel partner, such as CEPA, that specializes in university-level faculty-led study-abroad programs. Previous trips have included Budapest, Prague, Germany, the U.K, and the Netherlands. This coming summer, the class will head to Italy. "I try to find countries with health-care systems that will provide similarities and contrasts to the U.S. system," she says, "but safety is our number one priority."

By contrast, the MMP narrows the focus from a country’s overall health-care system to the specific challenge of delivering health care to its most vulnerable populations. After receiving a primer on the intended destination, to include any relevant humanitarian issues, the students then spend a week in the chosen country providing hands-on health care to patients. "It’s one thing to hear about people in another country, but it’s another thing to care for people directly and to see with your own eyes what they’re dealing with and what their concerns are," says Dr. Primeau, who coordinates the medical missions with assistance from UAH’s Office of Study Abroad and e3 Partners’ medical division. Each mission is then followed by two to three days of travel throughout the countryside. "This past summer we were in Lima for the mission, but then at the end we went to Machu Picchu," she says. "It put the mission in context and gave them a broader experience." Next year they will travel to Costa Rica, and future trips may include Greece and a First Nations reserve in Canada.

Students in both programs have interactional assignments and are required to keep a journal throughout their travels, which they review and discuss with the rest of the class after returning to UAH. Dr. Primeau says that, by and large, they describe the experience as "life changing." Several students have even accompanied her on more than one trip. "It just seems to make a significant difference in their lives, actually being there," she says. "It changes the way they look at patients, at other countries, at other countries’ health care, and at our own health care." Many also report gaining a better understanding of how the health-care system in the U.S. stacks up against those in other countries. "We have found that all countries have advantages and disadvantages to their healthcare system; no one system is perfect. We have quite a bit to fix in the U.S., but there are also good aspects of our health care system," she says. "The impact of the students seeing it for themselves is incredible." In turn, she adds, the students serve as positive ambassadors for their profession. "Nurses are an excellent example of who we are and a way to show people that we are not just the stereotypes they hear about the U.S."

Given the rewards that those who participate in the programs reap, the ultimate goal is to extend the opportunity to every nursing student. "Our dean, Dr. Marsha Howell Adams, feels strongly about our students learning about other countries and helping others," says Dr. Primeau. "She has been very supportive of us trying to work it out so that we can get the experience to more people." That, of course, would mean more work on Dr. Primeau’s part, but she’s never been one to shy away from a challenge – or an adventure. "Study abroad changes your world view, and I want to share that with students," she says. "I also get to combine my love of nursing with my love of travel, so I’m really passionate about the opportunity to do this!"

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