Having just arrived at the largest refugee camp in Jordan, the contingent of six Doctor of Occupational Therapy students was amazed at what they saw.
A line of 75 Palestinian refugees was waiting for them, having traveled up to four hours. Many were children. Some were in wheelchairs. Others came on crutches. Their ailments included spinal injuries, amputated limbs, and physical disabilities due to stroke. And they were just a fraction of the number of people in camp with chronic conditions that needed care.
“It was overwhelming at first,” says Hiba Hashim, a second-year student. “It was pretty inspirational to see the resiliency of these people.”
Along with Rawan AlHeresh, an assistant professor of occupational therapy who arranged the trip, the team dug in. A planned hour-long staff orientation was cut short after just 10 minutes so the students could begin helping clients more quickly. In those first four hours, 65 people were evaluated. By the end of their two-week stint, the team had treated or written therapy plans for more than 300 people.
“We came feeling we were just students and didn’t have the skills to do this kind of work,” says Hashim, whose fluency in Arabic was a big help. “But by the time we left, I felt we helped as many people as we could. It was a great learning experience for me and the first step to leaving a lasting impact on Jordan.”
Dr. AlHeresh explains that it took over a year of meetings with Jordanian officials, school administrators, and United Nations representatives to get her project off the ground. Her goal was to create something more than just a short service trip for students, so she designed a program that would train Jordanian health care professionals in community-based rehabilitation while teaching patients how to care for certain physical injuries. “I wanted to create a way to have a meaningful impact on that population,” she says. “The outcome needed to touch people’s lives.”
Originally created as an “emergency” camp to accommodate Palestinians displaced by the 1967 Arab-Israeli War, the sprawling and dusty Baq’a camp remains one of 10 UN-registered refugee camps in Jordan. It wasn’t exactly the kind of place OTD student Bria Mitchell-Gillespie expected to find. “When I heard we were going to a refugee camp, I expected to see a community of people desperate to return to their homes,” she recalls. Instead, students found a well-established village with shops, schools, and a tight-knit, friendly, and supportive community where she and her fellow students had a chance to really connect with the residents. Nonetheless, social problems are rampant, and as many as 10 people may live together in one shelter without indoor plumbing.
A Sustainable Approach
This trip was just one of a growing number of global experiences in which IHP students have participated each year since 2005, when nursing professor Dr. Inge Corless brought students to South Africa. While global experiences are nothing new in the higher education world, the Institute’s aim is to make the visits part of a sustainable, ongoing effort to improve the lives of people—as opposed to the more common practice of having teams of students and faculty swoop in for a week or two, leaving behind just a memory.
“It’s not just a matter of going in, giving back, and then leaving,” says Peter Cahn, the associate provost for academic affairs who works with the faculty on these experiential learning visits. “These experiences are part of the school’s mission to prepare students to care for patients from all walks of life. We want our students to learn what people in different countries face in terms of health issues, while also creating a sustainable program that will operate long after students have left.”
Jane Baldwin, an assistant professor of physical therapy, has taken DPT students to Guatemala for the past three years. Partnering with the non-profit Move Together, Inc., she has done such things as advising students as they spearhead equipment drives to provide much-needed medical devices for the clinics as well as training local physical therapists to treat the local population after she and her cohort of students have returned to the States.
“The challenge for all of us is that the education and concepts we’re providing need to be in a cultural and social context, and that can be challenging to our students,” says Dr. Baldwin. “We always need to be mindful of their recommendations to ensure patients can actually carry out those suggestions at home after we leave. Telling a patient to warm a wet towel in a microwave to alleviate a sore muscle doesn’t work if the person doesn’t have a microwave because they can’t afford one.”
For Efosa Guobadia, CEO and co-founder of Move Together, knowing teams of IHP students return each year allows the organization to maintain sustainable rehabilitation clinics that are tailored to individual communities. “The collaborative energy of the MGH Institute students has been nothing short of remarkable,” says Dr. Guobadia. “Their passion and focus have helped us solidify relationships, achieve objectives, and expand the scope of our work.”
It was during the 2011–2012 academic year when Elissa Ladd, associate professor of nursing, was in India on a Fulbright Fellowship that she first conceived the idea of returning with a team of students from all of the IHP’s disciplines. Over the past six years, Dr. Ladd has brought more than 45 students to India’s Manipal University and its affiliate Kasturba Hospital, where interprofessional teams have observed how local practitioners rely on ingenuity, book smarts, and practical skills to treat patients with far fewer resources than are available in the States.
“I felt it would be the perfect place to bring students because it would be a true global educational immersion,” says Ladd. “It really showed them how health care is delivered in resource-poor settings.”
Faculty from several other programs have accompanied Ladd in recent years, including Mary Hildebrand, associate professor of occupational therapy, and Rachel Pittmann, instructor of communication sciences and disorders, each providing students with complementary approaches to patient care.
Jaime Tirrell Hassey, who graduated in 2018 with a masters in speech-language pathology, spent time working in a clinic where large patient wards and basic medical equipment made U.S. hospitals look futuristic. While she and the other students first learned of team-based care during their IMPACT Practice courses at the IHP, it wasn’t until she worked with her fellow students from other professions that the concept of applying interprofessional care to patients really began to take hold. “I learned you can find a way to deliver excellent care in a variety of circumstances and sometimes, being resourceful and having your own innovation and creativity can produce beautiful results,” says Tirrell Hassey, who found that high tech equipment and supplies were not necessarily a requisite for quality care. “It was truly one of the most life-changing experiences I’ve ever had.”
A second interprofessional cohort of travelers was added this year when John Wong, assistant professor of nursing, and Emily Zeman, assistant professor of occupational therapy, brought Bachelor of Science in Nursing and Doctor of Occupational Therapy students to Shenzhen, China. During the two-week independent study project at two local hospitals and several community health centers, the team learned about nursing care and rehabilitation treatments in that region and saw firsthand how traditional Chinese medicine is used in medical treatment and health maintenance.
Some students have had global experiences under the auspices of other organizations. Second-year DPT students Nathan Allen, Andy Covino, Danielle Davila, Carley Kaikkonen, and Natalie Miano traveled in January to Cordoba, Argentina, with Child Family Health International (CFHI), an organization that provides global health education programs for both undergraduate and graduate students. While individual students have gone on CFHI-sponsored trips since the school began its association with the group two years ago, this was the first time multiple students had traveled together. On their trip, the IHP students worked alongside peers in different disciplines from other schools, providing them with an interprofessional experience as well.
Domestic Experiences, Too
Being exposed to underserved populations who have little access to quality health care doesn’t require leaving the United States. For the past three years, nurse practitioner and physician assistant studies students have alternated monthly rotations at a Sioux Native American reservation in Rosebud, South Dakota. With a population of about 1,500 people, the remote town has just one store that offers gas, food, and supplies. A trip to the closest supermarket is a three-hour drive, so getting fresh vegetables and other healthy foods is a major challenge in a community with one of the lowest median incomes in the United States, unemployment hovering between 80 and 90 percent, and age-adjusted mortality rates among the highest in the nation.
“We saw patients with real chronic diseases there because they don’t have access to good food,” says Alana Scheibe, a nurse practitioner student, noting that many patients have diabetes, high blood pressure, kidney disease, and other chronic illnesses, while others experience depression, mental illness, and substance use disorder. Complicating things even more, she says, was the remoteness of the 35-bed hospital, where physicians and staff rotate in and out.
The Rosebud trips are coordinated by Matthew Tobey, a Massachusetts General Hospital physician who runs its Fellowship Program in Rural Health Leadership program. Its partnership with the IHP garnered a Partners in Excellence award in 2018 for its work, and the team included several faculty from the nursing school and physician assistant department.
With yearly trips by NP students to the Good Samaritan Hospital in the Dominican Republic, and new opportunities being planned to such places as Peru, it’s clear that the MGH Institute’s focus on exposing students to transformative experiences away from Boston will continue—and that their effects are felt even after graduation.
Anna Pietal, who went to Guatemala last year, graduated with a Doctor of Physical Therapy degree in 2018. Her experience made such an impact that she volunteered to accompany this year’s group of students on their trip. “It is a big commitment,” she explains, “but everyone should go if they can, because it’s life-changing to see another culture and use your skills to help people.”