St. Maarten may soon become a hub for nurse training. Nursing instructor Roxanne Amerson travelled from the lecture halls of Clemson University campus to our sun-kissed shores last week with the goal of beginning to lay the groundwork for a new initiative that will bring U.S. nursing students to our region.
Playing island host to the professor was Okama Epke Brook, who met Amerson during the Clemson Caribbean Initiative (CCI) conference in Greenville, South Carolina, last spring. The CCI conference brought all the wide-ranging faculty of Clemson together to see how they could contribute. Brook explained how the two met, “After my presentation, Roxanne came up to me and wanted to know more about the healthcare challenges in St. Maarten. I explained as much as I could, but ultimately said she should come down and observe the situation first hand.” And so here she is!
Amerson and her husband, Ray, have been touring the various offices and speaking with stakeholders regarding the possibility of collaboration between the health care workers here and Clemson’s deep resources vis-à-vis facilities, faculty, students, and researchers. Amerson, an accomplished public health researcher, as well as a nursing instructor, is interested in using St. Maarten as a base to reach out to islands across the region.
The conference at Clemson yielded another visitor a few weeks ago; Professor Jim Bennett came down to see what kinds of collaboration could be arranged regarding his area of interest: the youth. Bennett had consultations with many groups on the island that work with youth, including sports, arts, and after-school programs, as well as speaking with Government ministries. He visited and brainstormed ideas with NGOs such as Player Development, The Soil Centre, The Rotary Club, and other interested individuals just to see where resources can be pooled and efforts could be coordinated. The goal is to make the Clemson Caribbean Initiative long-lasting and effective.
Brook added that from her perspective, the goal was to enrich our own young people. “My interest is to expose St. Maarten students to the influences of a great university like Clemson. So that is why I encouraged them [Amerson and Bennett] to come down and meet with stakeholders to determine what the interest would be for research, services, technical assistance, outreach programs and student and faculty exchanges.”
Amerson explained that one potential area of collaboration might be helping fill a need to educate the nurses on the island on how to become nurse educators. “When you go through nursing school, you get your typical four-year nursing degree, you become an expert in clinical practice, but that doesn’t necessarily make you an educator, especially if you want to go on and teach in the school of nursing. So I am thinking that there might be a need to link up with our nurse educator program at Clemson. We have that track for our master’s level students. USM (University of St. Martin) doesn’t have a school of nursing, but there are other schools in the region that might have programs that could be linked, such as St Barths and St Croix.”
Amerson also talked with the Ministry of Public Health, Social Development and Labour regarding how we might be able to build capacity for research in health-related areas. “Whenever you do a research project, you want to go through an institutional review board to determine if the research is being done ethically and with cultural responsibility. The ministry of health told us about a research project they had wanted to do some time back, but the [lack of a review board] was a huge stumbling block. So that is something to explore: How to establish an institutional review board process that could facilitate successful research projects in health, the environment or education.”
“Another area we talked about is mental health, there is a foundation here, but there seems to be a lack of access for acute care. The hospital has a limited number of beds for mental health issues, and people with certain critical needs may have to be transferred out. So there may be some issues there for us to look into.” Other concerns on the table include diabetes, obesity, dietary habits, sexually-transmitted diseases, and tropical diseases. “We do look at treatment,” the professor said, “however, our focus in the Global Health Program is really more about social determinants of health. I encourage students to look beyond the physical. There are many factors that influence the occurrence of diseases, such as cultural and economic factors, political, education – all those things have an influence on health.”
The Clemson Global Health Program also focuses on leadership and collaboration, such as how to start or lead an NGO in another country. “When you work across geographical barriers or boundaries, you have to be sensitive and respectful. We shouldn’t go in thinking this is how we do it in the U.S. and so that is the best way and you have to learn to do it our way. I really stress this to my students that the host country, whatever country it is, they have to go in with humility and have an open ear to what the local people have to say. No matter what your initiative is, it needs to include the community and the stakeholders.”
This was Amerson’s first time to our island, but she is well accustomed to working in far-flung locales. She has taken her nursing students on working trips to Peru, Ecuador and Guatemala – seeking out those communities that rarely see medical professionals. There they have done health screenings and provided information and medical attention, collecting data for further research back at Clemson.
“In Guatemala, I had funding from NIH (National Institute of Health) and we established a promotor [promoter of health] program, which is basically the establishment of a community health worker program. There we trained local women to perform some of the duties of a local community health provider. In low-resource countries where you have poor sanitation, a number of children will die from something as common as diarrhoea. They become severely dehydrated. We showed our trainees of the community how to make oral rehydration solution from simple components they have at home. Then they could spread the information among the population.”
In Peru last summer, Amerson and a group of eleven student nurses were able to screen 160 children in high altitude villages 9,000-13,000 feet [2743 – 4000 metres] elevation. “We looked at children, from infants of 7 months through 6 years of age and we determined that 48% of them had anaemia (low iron in the blood), and we also found about one-third of the kids were stunted in growth, which we think is probably related to diet.”
The nursing team also found some issues that may be related to breast-feeding practices. In low- resource countries where mothers have limited access to food, they are encouraged to breastfeed for two years. “But we found a number of women who had stopped breast feeding at one year, which may have some negative effects.”
Amerson continued, “So that was a pilot study that we did; we took down the information and we will write a grant proposal to the NIH, and if we get the grant we will return to Peru and repeat the study using a larger population, and we will do a baseline assessment, design some educational interventions and try to discover if there is something unique to the high-altitude environment that is affecting the health of these communities.”
In Peru, the team stayed in a village called Ollantaytambo, “It was a very small town where we lived and then each day we would travel with the NGOs to the remote high altitude communities. We took a bus to the end of the road and then start hiking, or sometimes we would have to ride on mules! When you are there you feel like you are in the top of the world.”
I asked her if she is fluent in Spanish, and she replied with a laugh, “people always ask me that, but I don’t really speak it fluently, but even if I did, it wouldn’t help because the places we work are so remote the people only speak indigenous languages. They don’t speak Spanish, so we still have to hire an interpreter.”
On this trip the soft-spoken southern lady was accompanied by her husband, Ray, and both shared that they found the island very pleasant and the residents to be genuinely friendly and outgoing. “That is really standing out to me, how warm and welcoming the people are. You feel like they really want you here, I am looking forward to seeing what kind of projects that we can work on together. This is just a fact finding mission; I will take the information back with me and then I will look at the resources that we have at our university. If I bring students here I think they would gain a very valuable and rich cultural experience.
I asked: “Are you more nurse, educator or researcher?” She replied with a smile, “I feel like I wear a lot of hats, but I am always a nurse first.”
