Cross Cultural Healing
by Susan Sample

From medical and nursing service abroad, students learn that health care doesn't have to be high tech to be good.

Crossing continents as an exchange student to Kuopio, Finland, has helped Angela Parkinson BSN'97, now a registered nurse in Salt Lake City, to practice across cultures with sensitivity and respect. "I love to travel, and I was interested in seeing how socialized medicine worked, how the quality of care compared to ours," says Parkinson, who spent the fall quarter of her senior year at the Mikkeli Polytechnic School of Health Care. She returned to Utah with far more than knowledge of another health-care system: "It was more personal. I learned to respect individuals from different cultures and the reasons why they do some things differently."

At first, Parkinson found the silence of the Finnish people disconcerting. Although most speak English, some hesitated conversing with her. As she accompanied public health nurses on home visits, she realized that Finns are "a shy, quiet people. I learned to respect not saying anything at all."

As a nurse at Primary Children's Medical Center, Parkinson often cares for Native American infants. "The fathers don't look at you directly. It's a little uncomfortable when you're used to someone looking into your eyes and understanding what you say," she explains. "But I know they're not being disrespectful. It's their culture."

Programs in transcultural nursing and medicine at the U provide opportunities for students to provide service abroad while enhancing their skill and practice. "To read about and to listen to other people talk about different cultures doesn't give you the full picture," says Dr. John C. Christenson, professor and chief of the Division of Pediatric Infectious Diseases at the School of Medicine, who coordinates an exchange program to Guatemala. "You definitely have to live in another culture to understand it."

For fourth-year medical students who fulfill one of their electives in Central America, the "full picture" includes the realization that medical care doesn't have to be high tech to be good. "Our medical students will see tropical diseases not traditionally seen in the United States, as well as problems associated with malnutrition and poor sanitation," says Christenson. But more importantly, "they're working with physicians in Guatemala who are as knowledgeable as doctors in the United States, but who are limited by a lack of resources and technology. These physicians have to rely on skills you don't use as much here physical diagnosis and they provide good care. That's the most beneficial part for the medical students to see. We don't have MRIs [magnetic resonance imaging, a diagnostic tool] in every rural clinic in Utah."

Since 1991, three to four Utah medical students every year have participated in the foreign study program. Students spend four to six weeks in Guatemala City at the San Juan de Dios Hospital, which includes a pediatric hospital. They observe, but provide limited hands-on patient care, since the University's malpractice insurance doesn't cover them abroad, according to Christenson. The Guatemalan pediatric residents who spend three months fulfilling clinical rotations in Salt Lake City are only observers.

While in Guatemala City, the Utah medical students live with pediatric residents who typically speak English. The hosts and the hospital usually provide food. The students' major expense is airfare, which runs about $600-$800 round-trip. That cost is more than doubled for Porto Alegre, Brazil, the site of the medical school's newest exchange program. Offered for the first time last spring, the elective surgery rotation enables medical students to spend two months at the 2,500-bed Santa Casa Hospital, one of the largest county hospitals in South America. Three Brazilian students completed rotations in surgery and cardiology at the University. Dr. Renato Saltz, associate professor of plastic and reconstructive surgery, and a Brazilian native who spent his teenage years in Porto Alegre, coordinates the exchange.

While medical students fulfill electives abroad, nursing students can take required courses in Finland in community and public health. "One of the reasons we started with Finland is that is has an exquisite public health system," says Mary Duffy, professor and international coordinator for the College of Nursing, who developed the program. Thirty Utah and 15 Finnish students have participated in the nursing exchange program since it began three years ago. The Utah students pay U of U tuition and receive U credit for the courses. Utah faculty members grade all of the students' written assignments to make sure they're consistent with college standards.

As a result of the program's success, the College of Nursing last fall was named the lead institution for a federally funded project to teach collaborative community health planning and to develop a model for nursing student exchanges. Duffy received a three-year, $224,000 grant from the European Community/ United States Consortia for Cooperation in Higher Education and Vocational Education; $194,000 from the consortia schools; and additional funds from the U.S. Department of Education's Fund for the Improvement of Postsecondary Education (FIPSE). The consortia includes Northeastern University, Boston; Washburn University, Topeka, Kansas; University of Texas Health Sciences Center at San Antonio; Mikkeli Polytechnic, Finland, the lead European institution; and others in Finland, Northern Ireland, and Portugal.

Some of the grant money will help pay for students' travel costs. A larger number of students will participate in technological exchanges. For instance, "we're looking into shared video-conferencing for classroom teaching," says Duffy. Other options include student exchanges through e-mail and databases.

"I know the value I got personally and professionally from working not just traveling in another country," says Duffy. "As you see other ways of doing things, you learn about yourself in different situations. You gain an increased sensitivity to cultures and how important that is to health care. That's something about which we all need to be aware."

Susan Sample is editor of the University of Utah Health Sciences Report.