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…”