Essential first steps to improve rural health in Nicaragua

Student-faculty collaboration enhances multidisciplinary project

No one understands that “A journey of a thousand miles must begin with a single step” better than Elizabeth Keech, PhD, RN and Ruth McDermott-Levy, PhD, RN. Both are assistant professors at Villanova University College of Nursing and are passionate about helping the underserved people of Waslala, Nicaragua access and receive appropriate health care. Their steps on a recent week-long visit in May included carefully taken ones as they trekked through mountainous terrain and waded across a river during rainy season. Why? They and four nursing students were taking another first step, assessing the specific needs of CHW (community health workers) for a collaborative project “Improved Rural Health Care Through Low-cost Telecommunication in Waslala, Nicaragua.”

The nurses are working with faculty and students from the College of Engineering and Villanova School of Business. Using inexpensive cell phone text messaging capability, the nurses and engineers will be working with CHWs and licensed health care providers in Waslala to transmit health information from rural villages to the small community hospital in the town. Their business colleagues are investigating business opportunities created by the introduction of the new technology. The nurses and engineers are building on the presence they have maintained in Waslala for several years promoting health and working towards a safe water supply.

Because of lack of infrastructure and health care providers, as well as the distance from the hospital, those in the rural communities often do not receive health care in a timely manner. This project will connect the CHWs with licensed health care providers to provide “real time” care and information. Through text messaging from the CHW and a clinical algorithm system, patients with conditions such as high blood pressure will be flagged for review by a licensed provider at the hospital who can direct the on-site CHW to treat the patient or bring him in for care. The CHW can also text distant pharmacies for medications as needed which can then be delivered to the patient.

Dr. McDermott-Levy conducted CHW interviews for a qualitative study, with senior nursing student Katie Wetherby and the translation assistance of student Fruna Lara, a nurse from Venezuela who is completing her bachelor of science in nursing degree at Villanova. They were identifying the learning needs of the CHWs, as well as their understanding of the health issues of their region, to help support this and future programs. “I was impressed with the under-resourced community health workers’ ability to provide appropriate care with the available resources given their education, knowledge of pathophysiology, and lack of references and diagnostic tools,” says Dr. McDermott-Levy of the care provided in these highly cohesive communities. Two other seniors, Becky LaMarca and Caitlin Krenek helped conduct or observed the interviews. The nurses also shadowed a CHW overnight in her home where she treated several children and adults who had burns or infections. In addition, they conducted a focus group with 14 CHWs and, along with campus colleagues, met with the medical director of the Waslala hospital, priests, local officials and the Director of the School of Public Health in the National University, Managua to gain support and collect more information.

Becky is doing an independent study working with the faculty to create the algorithm for child growth and development so that data can be recorded in Waslala. Caitlin is collaborating with Dr. Keech to determine outcome measures for the project—a difficult task in an environment where data such as births and deaths are not consistently and broadly captured. They first need to build that foundation of health records before comparisons can be made as the project progresses. “The need is really desperate,” says Dr. Keech, describing why she is involved. “Those who live in the rural areas of Nicaragua just don’t have access for emergent health problems or for those that can be managed without a trip to the hospital by getting a consultation via the cellular technology.” The group plans to return to Nicaragua in the fall semester to begin the pilot phase of the project. Dr. Keech summarizes how essential their work is to the future health of the Waslala community, “If the people could only make a phone call…”

Changes in South Africa

A young girl at St. Leo's school demonstrates tooth brushing technique she learned from Villanova nursing students Lindsey Waters and Christina Trunzo. The students donated a new toothbrush to each of the 685 first through seventh grade students at St. Leo's.

Young boys at St. Theresa's Home for Children hold their health screening record created by faculty Prof. Elise Pizzi, MSN, CRNP and used this year during screenings performed by faculty and students. They assessed 66 children.

A young boy practices his handwashing technique taught by the nursing students.

Meghan Barowski shows a stethoscope and blood pressure cuff to a boy who... ...hears his heart sounds for the first time.

Dr. Elizabeth Blunt, a family nurse practitioner, examines a boy at St. Theresa's Home for Children.

Dr. Elizabeth Blunt (left) and Dr. Fran Keen flank the Villanova nursing students in Durban.

Dr. Blunt and students with the four Augustinian sisters with whom they lived while in Durban. The yellow shirts relate to World Cup soccer in South Africa.

Since 2008, Villanova Nursing faculty have been accompanying students who are participating in the International Nursing elective to Durban, South Africa each May. The nursing students, partially supported with Connelly-Delouvrier International Nursing Scholarships, learn about the health care system and Zulu culture in South Africa as well as the impact of poverty and the former apartheid system on the community. They see young and old ravaged by the effects of HIV/AIDS and new definitions of “family” as school-aged orphans or grandmothers (“go-gos”) run households. The impact of the experience? Change—in both the students and those for whom they provided care.

“I bring back a new passion for helping the poor and marginalized communities in the U.S.,” says Alyssa Canino who traveled to Durban with seven other students from May 8 to 23, 2010. She reflected on the eagerness of the children in St. Theresa’s Home for Children. These children, aged five to ten, wanted to learn the hand washing and tooth brushing skills taught by the Villanova nursing students and reveled in the nurses’ encouraging words during return demonstrations. Canino, who learned Zulu phrases to communicate with the younger children and aspires to be a pediatric nurse practitioner, notes “Working with the Zulu children was the most rewarding aspect of my experience in Durban.” Similar teaching was done at St. Leo’s school where nearly 700 students were provided with new toothbrushes by the Villanova nursing students.

The students toured St. Mary’s Hospital and went to area clinic sites reached by its mobile vans used for voluntary HIV/AIDS testing and counseling. They also helped with patient care at 1000 Hills Community Center and the Hillcrest Respite Center for HIV/AIDS patients. For Ali Spicer, “The packed clinics, the babies and people in Hillcrest made the numbers real, unmistakable.” The senior says, “With each site visited, each child or go-go I came in contact with, it became increasingly clear that there are two main components in terms of the spread of HIV and the health consequences of such an illness: the issues of education and sustainability.” The sentiment is echoed by Christina Trunzo, noting the critical need for early health teaching after seeing children with decaying teeth due to lack of education about mouth care. She values “heath education from personal hygiene to more serious topics such as sexual development.”

Students assisted Frances Keen, DNSc, RN, assistant dean and director of the Undergraduate Program with health screenings at St. Theresa’s as colleague Elizabeth Blunt, PhD, CRNP, coordinator of the nurse practitioner programs, completed more complex physical exams on each of the 66 boys evaluated. The physical exams for the boys had started two years ago when the same faculty initially visited the Home. They documented assessment data on health screening forms developed by Assistant Professor Elise Pizzi, MSN, CRNP for a visit in 2009 as there were previously only very basic records.

A Villanova nursing group will return to Durban in May 2011, continuing the health screenings, HIV/AIDS care, health promotion and human connections that are expanding the professional and personal horizons of the new nurses.

Building relationships is foundation for health in Peru

Violet Uttaro checks the blood glucose level of a man in a Chulucanas community center.

Senior Tara Martin listens to the breath sounds of an elderly woman in Peru during a home visit.

Students provide health promotion information in Spanish to members of the Chulucanas community.



For the 11th consecutive year, Villanova Nursing students and faculty have promoted health in Chulucanas, Peru as part of the senior level health promotion clinical practicum option in March. Led by faculty Elise Pizzi, MSN, CRNP, assistant professor and Karen McKenna, MSN, RN, clinical assistant professor, the group of eight students and two translators toured a hospital and made home visits in Chulucanas.

The nursing students, partially supported as Connelly-Delouvrier International Scholars, researched, developed and translated into Spanish multiple educational programs for local residents and lay health promoters in three parishes in the Diocese of Chulucanas. They addressed such topics as type 2 diabetes management; sexual development; and women’s health issues including fitness, osteoporosis, nutrition, self breast exams, thyroid disease and high blood pressure. At their teaching sessions, the students used glucometers to test more than 150 people for high blood glucose levels since diabetes is so prevalent in the community. They later donated 12 glucometers to the parishes and Diocesan center, along with funds they had raised which went towards the care of a brother and sister with diabetes and a woman with ovarian cancer who could not afford pain medication.

Additionally, the students educated the community on environmental issues. They focused on food safety, clean water, waste disposal, plastics, the hazards of burning plastics, the negative effects of smoke from poorly vented stoves and pest control. They even created fly traps using discarded plastic bottles. “The students were shocked that the residents and health promoters took notes and asked questions” during education sessions, says Prof. Pizzi. Prof. McKenna concurs, “It’s very affirming. The education is important.”

A group of nursing students and faculty will return to Peru next March to continue the health promotion progress made by the 2010 nurses.

Villanova’s College of Nursing Welcomes Robert Wood Johnson Foundation Scholars

Ten Robert Wood Johnson Foundation New Careers in Nursing scholars enjoy their first day on Villanova’s campus on May 20th before beginning classes in the second-degree accelerated nursing program. They are (L to R) Flower Habte, Lou Pagnoni, Dorris Ogbuehi, Emily Lang, Gregory Calucci, Mona Akhlaghi, Anthony Ruffo, Jordona Ndon, Shawn Ellison, and Lauren Dornin.


Villanova University College of Nursing has welcomed ten Robert Wood Johnson Foundation New Careers in Nursing (NCIN) scholars to campus to begin the 14-month second-degree accelerated program –called BSNExpress—for adult learners who are earning their bachelor of science in nursing (BSN) degree.

The NCIN Scholarship Program, initiated in 2008, was developed to help alleviate the shortage of nurses and increase diversity in the workforce. The grants provide scholarships to college graduates from underrepresented and disadvantaged backgrounds who are transitioning into nursing in an accelerated BSN program.

The College received a grant of $100,000 to award scholarships to ten students who met the criteria consistent with the goals of the NCIN program. Four men and six women who were admitted into the class beginning May 2010 received the scholarships, and as part of their program, a Leadership Development Plan has been established to facilitate successful transitioning into the nursing profession and to foster leadership development for each RWJF NCIN Scholar.

“The plan provides support and advocacy in the areas of academics, professional development, community involvement and mentoring,” said BSNExpress Program Coordinator Maryanne Lieb, MSN, RN. “Based on personal experience and professional goals, the Scholars are mentored by nurse leaders who share a mutual interest, and also serve as advisors to prospective students who have applied to the following class,” she continued. All RWJF NCIN Scholars meet monthly for seminar participation, collaboration and open discussion. To support the activities proposed in the Leadership Development Plan, the BSNExpress program received an additional $1,500 grant from the Robert Wood Johnson Foundation.