June 26, 2012 — The University of Virginia is partnering with the Ministry of Health in St. Kitts and Nevis on two student-led research projects that examine the use of primary and preventative health care in the two-island Caribbean nation.

Five U.Va. undergraduates – Ania Giffin, Suraj Mishra, Grace Ball, Rachael Hanna and Kenneth Perez Lorenzo – and their mentor, School of Nursing doctoral student Jamela Martin, received support from the U.Va. Center for Global Health and the Jefferson Public Citizens Program for one of the projects. The undergraduate students returned from the islands June 21, while Martin will be there until July 3.

In her dissertation project, Martin is collaborating with Dr. Patrick Martin (no relation), chief medical officer in the Ministry of Health, and pediatrician Dr. Ian Jacobs on a study exploring women\'s experiences of pregnancy, prenatal care and delivery services.

Jamela Martin is the daughter of Dr. Marcus Martin, an emergency medicine professor and U.Va.\'s vice president and chief officer for diversity and equity, who began the collaboration with the Ministry of Health in St. Kitts and Nevis five years ago via a U.Va. January-term course on health care and disaster preparedness in St. Kitts and Nevis.

Local residents often seek out more expensive technology-related health care, resulting in decreased use of the plentiful – and cost-effective – community health clinics. While visiting the islands, the U.Va. team collected the views of patients, health care providers and policymakers regarding their health system through 500 surveys, plus interviews and focus groups. The students hope to draw conclusions about how community health centers can better understand trends in utilization to produce a more effective health care system, in terms of cost and care.

"The great part of the Jefferson Public Citizens program is that it allows students to take learning further than in a classroom," said Mishra, a rising fourth-year human biology distinguished major in the College of Arts & Sciences. "It allows us to conduct research in the real world before we even graduate.

"We\'re learning how residents from other countries perceive their health care systems. The research provides us with a different outlook than what we see here in the United States. ... Something we didn\'t realize when we got there is that people in a culture like St. Kitts and Nevis may not know what other standards there are in other countries, so when asked for any criticisms of their community health centers or health care system in general, most people tried to pass on the question," said Mishra, a Richmond resident.

For instance, waiting for 90 minutes to see a doctor may not be excessive there, but Americans probably would perceive that as too long to wait, he said.

"One of the most valuable experiences was interacting with the local population, getting their perspectives and really being immersed in the culture," said Kenny Perez Lorenzo, a rising fourth-year media studies major in the College interested in health policy and nutrition. "Putting a face to a cause and actually engaging in discussion gave us exposure to slight nuances and cues that we would have never picked up on otherwise. The stories and anecdotes help to frame our research and have given us a new perspective that will undoubtedly improve our analysis of the data, and our experience as a whole."

Jamela Martin has been a neonatal intensive care nurse, but began her doctoral studies in nursing in 2008 while also working on her master\'s degree and Pediatric Nurse Practitioner certificate.

"Over the last several years, I have realized the importance, particularly in global health, of looking further upstream at the conditions that may affect mothers and neonates during pregnancy," she said.

She learned a great deal about women\'s experiences in St. Kitts and Nevis, including how women use different sectors of the health system and continue to practice traditional methods.

"One of the most interesting topics that I have discussed with the women is the use of \'bush tea,\' commonly made with lemongrass or basil, in daily life and also during pregnancy," she said. Bush tea is the common name for a traditional herbal remedy. There hasn\'t been enough research done to determine whether the tea is helpful or not. Bush tea can be made with a variety of herbs, depending on whether it is being consumed for a specific ailment or daily well-being; in Africa, it is commonly made with rooibos, the red bush.

The research may lead to the development of more effective methods for balancing health care delivery to St. Kitts and Nevis citizens, said Marcus Martin, the faculty adviser for the primary care project.

"We\'re working on putting out a couple of publications and presenting for the Jefferson Public Citizens," Mishra said. "We hope to submit to some other public health conferences to share our experiences and research." 

— by Anne Bromley