Nursing practicum in Africa – lessons from Penn State students

Introduction

Every year hundred of Americans travel to Africa to provide short-term medical relief. Can American nursing students learn and provide medical relief during an international nursing practicum. We document some striking cultural and clinical lessons from12 nursing and allied health students.

Background

Kazungula is a small rural town near Livingston, Zambia. It has a population of 90 000, 19 clinics (with no laboratory, blood supply or operating theatre) and no hospital. The district has 32 nurses, three physician assistants and no physician. Nurses provide about 80% of primary health care services in the district.

Methodology

We conducted five medical clinics in Kazungula Zambia in collaboration with two Zambian doctors and the local health management team. Our services included, taking history, physical exam, antenatal care and participating in diagnosis and case management with consent from each patient.

Results

Lessons learnt include:

• 480 patients were seen altogether, about 100 per day).

• Patients walked 2 hours average (range 1 to 4 hours) to the health centre and on average waited 2 hours for care.

• About half of patients had never been seen by a doctor in their life, one third of them aged 50 and over.

• A patient satisfaction rate of 95% was reached even when no major intervention was provided.

• Vital signs are very clinical for making a medical diagnosis, almost 90% of patients in Kazungula clinics are treated based on syndromes.

• Participation in international clinical practicum allows students to see common (such as Malaria, Malnutrition and rare conditions (such as elephantiasis) that they would never see in the U.S.

• Vision, dental and HPV screening are common unmet clinical needs. About one quarter of patients had dental cavities that required tooth extraction and 20% of adults had vision issues that required major medical intervention including surgery.

Conclusion

International nursing internships provide a rare opportunity for American students to learn and share experiences with their peers in developing countries, such opportunities must be encouraged and adequately funded.