GUATEMALA
HEALTH CARE PROJECT:
A Nurse Practitioner
Educational Opportunity
in A Developing Country

Patricia Ludder Jackson, RN, MS, PNP, FAAN
Clinical Professor
University of California, San Francisco
School of Nursing
Department of Family Health Care Nursing

ABSTRACT

In June 1998, 1999, and 2000 nurse practitioner faculty and students spent eight days in Guatemala providing episodic health care and health screening to children and families in remote villages and returnee camps under the guidance and coordination of the Pediatric Foundation of Guatemala.

The goals of the project are to:

1. provide students with an opportunity to deliver episodic health care in a developing country under faculty supervision;
2. increase student awareness of health risks and health conditions in Central America; and;
3. enhance students' cultural sensitivity through a mentored experience in a developing country.

Weekly meetings are held for two months prior to the trip to review common health conditions encountered in Guatemala, recent history of the country and political issues affecting health care, cultural and ethnic variations among the people of Guatemala, and to plan fundraising events. Students actively participate in fundraising to purchase medicines and supplies needed to deliver care.

Students and faculty pay their own travel expenses but the Graduate Student Association has offered partial scholarships to offset the student expenses. Students can also obtain 2 units didactic credit to meet School of Nursing requirements for a course on culture by participating in this experience.

This document will present a pictorial review of this unique educational experience. The pictures will show the beauty and dignity of the Guatemalan people and the harsh living conditions they endure. Students are shown working side-by-side with local health workers in makeshift clinics in remote villages with limited access to health care.

• Largest country in Central America
• Equivalent land area to Tennessee
• 22 Departments (States)
• Population approximately 10-10.5 million in 1995

• Two ethnic groups of approximately equal size
• Indigenous people of Mayan descent are poor with limited access to health, social, and educational services
• 21 different dialects
• Landinos found in all social classes with control of land, government, health care, and education

• 75% of people live in poverty
• 58% live in extreme poverty
• 93% of indigenous people live in poverty
• 91% live in extreme poverty
• 65% of land owned by 2% of population

• 65% of population lives in rural areas
• 80% rural population living in
  communities of less than 500 people
• Many communities only accessible by dirt roads

• Birthrate in 1995:
  37.3 per 1,000 population
  (USA 14.7/1,000)
• Average 5.1 children per woman
  (6.2 in rural areas)
• 19% of women 15-49 years of age
  use contraception

• Maternal mortality rate
  is 200 per 100,000 live births
  (USA 8/100,000)
• Infant mortality rate
  51.0 per 1,000 live births
  (USA 7.5/1,000)

• Pneumonia & influenzæ: 16.5%
• Perinatal causes: 13.5%
• Intestinal infections: 8.9%
• Nutritional deficiencies: 5.7%

• Less than 60% of people have coverage
• Limited coverage through Ministry of Public Health and Social Assistance
• Private sector care for needy
• Traditional medicine and healers

• Four decades of "Civil War" pitting indigenous people and their supporters against the military and established political/economic structure
• Formal peace accord signed in December 1996
• Democratic elections held in 1998
• Restructuring of healthy system ongoing

UCSF Guatemala
Health Care Project

• FPG started in 1985
• Privately financed care for needy children
• Arrange and organize short-term surgical teams from the USA
• Screen children for treatable conditions
• Evaluate health care needs and resources for children for Ministry of Health (2000)

• Provide students and faculty with opportunity to deliver care in a developing country
• Increase student awareness of health risks in Central America and developing countries
• Enhance students' cultural sensitivity
• Demonstrate potential role of the Nurse Practitioner or Advanced Practice Nurse in international health care delivery

1998. 6 students (PNP and FNP), 3 faculty
1999. 12 students (PNP, FNP, ANP, Midwifery), 4 faculty
2000. 9 students (PNP, FNP, ANP, PhD), 2 graduates,
      3 faculty, 1 MD

1998. Provided care to over 800 people, including 2 refugee camps
1999. Provided care to over 1,200 people,
      including established Mayan villages
2000. Provided care to over 1,700 people in
      Western Highlands region of Guatemala

• Malnutrition/growth retardation
• Intestinal parasites
• Skin infections/infestations
• Respiratory illnesses
• STI
• Eye infections/conditions
• Occupational injuries/stress

• History and assessment skills
• Diagnosis and treatment of conditions
• Planning and organization of care in nonmedical facilities
• Adaptation of care to local situation and culture
• Coordination of care with community health promoters
• Enhancement of language skills