September 5, 2003

Nursing student Kelly Davison teaches girls in a San Salvador orphanage about STDs.

By Elizabeth Kiem

San Sebastian, El Salvador, is a rural village marked by poverty, earthquakes and the lingering social tensions of a long civil war. Only one provider of affordable medical services is open past sunset. The local Red Cross clinic, a dilapidated office with substandard lighting and no privacy, is manned by a single doctor and a handful of young volunteers who go door to door every week to collect donations to pay the rent.

But that is about to change. Last summer, a group of U.Va. students purchased a $6,000 tract of land in San Sebastian on which they plan to build a medical facility, complete with separate waiting and exam rooms and sufficient electricity and plumbing.

It is one of three projects undertaken by Nursing Students Without Borders, a student organization dedicated to empowering under-served communities through health education.
The group has joined with a local non-profit organization, Building Goodness, which will donate building expertise and labor. The students must come up with the cost of materials and airfare for the builders, a total of about $15,000.

"I personally hope it will be completed while I’m here," said third-year nursing student Connor Ginley of the San Sebastian clinic construction.

Founded in 1999 by two nursing students, Nursing Students Without Borders has become the model for similar groups at the Medical College of Virginia, Purdue University and the University of North Carolina at Greensboro. It has an enviable budget by U.Va. CIO standards, thanks to diligent fund-raising and significant private donations.

"They seized every possible opportunity to gain support and assistance both within and external to the university," said Jeanette Lancaster, dean of the School of Nursing.

Lancaster and another generous past donor, U.Va. President John T. Casteen III, were among the first to be tapped for funds to support the San Sebastian building program.

The San Sebastian initiative not only was the group’s debut program, but also is its most successful. Affiliated with the Red Cross only nominally, the local clinic has relied heavily on NSWB for medical supplies and volunteer training for four years. Members have also set up a teaching program for midwives and a diabetes support group in the town.

The completion of the new clinic would represent a successful closure, said Ginley, who is also vice president of the organization.

"Putting into place something that is going to stay there … would be a great way to end our time in San Sebastian," he said, adding that the NSWB mission is to engender sustainable infrastructure, not to act as a permanent courier of medical supplies for Third World communities.

In addition to the San Sebastian project, the group has started two other outreach programs.
Since July 2001, the Migrant Health Initiative has sent dozens of nursing students to migrant worker camps in Nelson and Albemarle counties during the summer peach- and apple-picking seasons. There the students refer laborers with health problems to medical providers and train settled Latino immigrants as lay health promoters in their communities. The effort is a joint venture with the Rural Health Outreach Program.

Students have also traveled twice to the town of Kysmolovsky, Russia, where they began an assessment of that community’s medical needs.

In all these projects, NSWB’s goal is to provide education and resources, as opposed to direct medical services.

"We’re not going there to see patients," said the group’s president Kelly Davison. "We want the local people to do the health care. We’re just trying set them up or provide them with materials that might help them to do that."

Theresa Carrol, assistant dean of the School of Nursing and adviser to the student group, said the interaction with health-care providers abroad was one of the most valuable gains for the Russian participants.

"Nurses here have a lot of voice in the health-care process," she said. "To go to a place [like Russia] is very, very different. Our 20-year old students probably were more comfortable doing more things than some of the nurses there."

Red Cross volunteers learn to suture on pig feet.

Several past NSWB members have taken their field experiences beyond U.Va. Former president Rosalind Delisser currently works with substance abuse patients on an American Indian reservation; another alumna, Esther Miller, is an active liaison with the Migrant Health Initiative through her new capacity at the Rural Health Outreach Program.

Lancaster applauded the program as an early application of the ideals of the nursing profession.
"This school is built on the premise that our graduates will be leaders both while in school and upon graduation. NSWB has been a visible sign and symbol for both commitment to caring and leadership," she said.

Recognizing that health outreach is most successful as a combination of skills, the group encourages participation from all University students as well as faculty. Translators, social workers and medical students have all taken part in past trips, and Carroll expects that many students will offer up their sweat and callouses for the next trip to San Sebastian.

"You may not know anything about health care but can really affect positive change for the people of this community by swinging a hammer," she said.

Ginley said, "It’s a humbling experience, it’s a grounding experience, it’s an inspiring experience." He plans to promote the work of the nursing students among his peers in the hope of "planting a seed in their head."