U.Va. Students and Care Givers in South Africa Forge New Path to Health Care Delivery

REVISED, Sept, 4, 2 p.m., to change the headline.

The garden hose and the red balloon, stretched and filled to overflowing with water, did the trick.

Tasked with explaining the biology behind hypertension and diabetes to home-based caregivers in rural South Africa, University of Virginia graduate nursing students Meg Wightman and Christina Luckett – along with students from U.Va.’s School of Medicine and Frank Batten School of Leadership and Public Policy and from the biology program at the University of Virginia’s College at Wise – saw lights of understanding flicker. Filling a garden hose (representative of the body’s arteries) and covering the nozzle to create a high-pressure spray, they demonstrated the effect of overabundant sodium and dietary fat. A repeatedly filled-to-bulging red balloon represented a heart overcome by high blood pressure.

A room full of about 30 home-based South African caraegivers, most of whom spoke English only as a second language, nodded their heads and smiled. They understood. And now they’d be able to communicate hypertension’s pathophysiology – along with its remedies, risks and ways to reduce it – to their patients.

The U.Va. group, seven students and four faculty strong, created a curriculum for South African home-based caregivers, a critical health care resource in areas that often have few doctors or nurses in a country stricken with high incidence of HIV/AIDS, diabetes, hypertension and heart disease. While the month-long experience offered U.Va. students a chance to teach hypertension, diabetes and heart disease’s signs, symptoms, risks and remedies, equal focus was given to developing the collaborative practice of these physicians- and nurses-to-be. Practicing together, across disciplines – dubbed “interprofessional education” – is among the schools’ core focuses because today’s health care practitioners are, more often than not, part of teams.

“It was great to truly facilitate a learning experience for a group of learners without regard for discipline,” nursing professor Cathy Campbell said. “If students are given the chance, they will collaborate in outstanding ways. That was certainly the case here.”

With support from U.Va.’s Center for Global Health and funding from the Josiah Macy Foundation to cover travel and medical costs, Wightman and Luckett were joined by first-year medical student Ashley Keller, second-year medical student Christopher Winstead-Derlega and fourth-year medical student Rochelle Zarzar, along with second-year student Katherine Stanley from the Batten School and fourth-year biology major Laura Stamper, who’s enrolled at U.Va.- Wise. Faculty mentors included Campbell, Dr. Jim Ogan, Dr. Rebecca Dillingham and nursing professor Marianne Baernholdt.

In addition to the garden hose and balloon demonstrations, the group also designed an interactive lesson about diabetes, role-played a host of maladies and outlined and practiced a variety of action plans based on a simulated patient’s symptoms. A half-dozen third-year nursing students from the University of Venda took part in the exercises, too, providing translation for the home-based caregivers (who largely spoke Tshivenda, a local language) and greasing the wheels of trust for the U.Va. contingent.

“In a broad sense, and from the outset, I hoped to gain perspective,” Zarzar said. “A perspective that goes beyond what is taught in the classroom and rationalized with statistics; a perspective that can only be forged with my own eyes and through a personal engagement of the community. That’s just what happened here.”

And while cross-cultural collaboration was buoyed, the understanding developed between the physicians- and nurses-to-be was also profound. The students compared classes, the timing of certain subjects and the two schools’ routes through courses like pharmacology, pathophysiology and anatomy – and worked as a team.

“The idea that an engineering student, a medical student, a nursing student and a policy student could all learn something from one another breaks through the silos and towers of academia,” Winstead-Derlega said. “Like all clinical experiences, the nursing and medical students had the same goal, and as students and future professionals, we are on the same level, equal in our ability to heal, equal in our desire for happy outcomes and equal in our ability to listen to patients and partners.”

“Interprofessionalism is a good thing,” Keller added, “but it’s hard too. I felt we all had a voice to share and were able to share that voice effectively and efficiently, even though, with so many voices in the mix, sometimes it slowed down work progression. But the work was good to do and very important; being tolerant of so many different opinions really helped strengthen the depth and applicability of the project.”

The cultural backdrop provided Ogan – who’d protested South African apartheid to the U.Va. Board of Visitors back in the 1970s – with a fresh set of memories of a nation he “profoundly respects.”

“We can learn so much from our South African partners about how to provide care for chronic diseases,” he said. “Effectively including home-based caregivers in a team-based approach to delivering health care in their communities is something we hope to develop here.”

Baernholdt said the process was as important as the work itself. “The twofold aim of projects like these – the interprofessional component and the cross-cultural piece – are critical in the development of compassionate, collaborative clinicians who work together seamlessly,” she explained. 

“This interprofessional education offering was a pilot,” Dillingham added, “but both our partners in South Africa, the faculty at the School of Health Sciences and the local department of health and the U.Va. faculty will continue to work together to expand these experiences and the research collaborations already in place.”