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Posted: 8/9/2011

There's no way Kirsten Blomberg could have been completely prepared for what she encountered when she flew to Uganda to gain hands-on experience at MulagoGlobal Health Hospital as a Johns Hopkins University School of Nursing (JHUSON) student. And that's precisely the idea.

Blomberg was shocked at the conditions and practices of the low-risk labor and delivery floor of the hospital where she was assigned to work. She quickly learned that patients are expected to supply necessary accoutrements for delivering their babies, including sterile gloves, razor blades to cut the umbilical cord, blankets and more. Feeding tubes of various sizes taking the place of catheters, chronic understaffing, and a labor process that excludes pain medication also came as a surprise to Blomberg.

But the lack of resources did not deter her. "My interest is to work with underserved populations…my work at Mulago did nothing but confirm that I have chosen the right career," Blomberg says.  

Blomberg crystallized her professional future during the transitions practicum, considered the capstone of the JHUSON program. The course affords students the opportunity to apply the skills, concepts, and theories they’ve learned in the classroom to real-world experience. For students like Blomberg who apply for and are admitted to the international program, there’s much more to master.

Nursing  instructor Mary Donnelly-Strozzo coordinates the SON’s International Transitions Practicum, an option within the requisite three-credit transitions practicum course whereby students complete 168 clinical hours at a hospital under the guidance of a preceptor. “They learn new social and cultural factors that impact health. They need also to learn the organizational structure and philosophy of [that country’s] health system,” Donnelly-Strozzo explains. But students who embark on the challenging international practicum aren’t entirely without advance preparation or support along the way.

“I advise them ahead of time of the different scope of practice,” says Donnelly-Strozzo, who begins students’ indoctrination to the program six months in advance of their departure. When students are abroad, Donnelly-Strozzo conducts a once-a-week meeting with them via Skype. Plus, she sends each student abroad with at least one other classmate, for social and professional support.

These built-in support systems prove useful when students encounter challenges abroad, some of which Donnelly-Strozzo aptly describes as “traumatic at times”. In South Africa, for instance, students confront an inordinately high prevalence of HIV, AIDS, and tuberculosis. In Uganda, they may witness children dying due to a lack of resources and tertiary care and, as Blomberg did, conditions and practices vastly different from those in American hospitals.

But not all international experiences present the same level of culture shock.

Jamie Hatcher  is completing her practicum at Al Corniche Hospital, a major maternity hospital in Abu Dhabi, one of the larger cities of the UAE. The 200-bed hospital delivers approximately 8,000 infants annually. Managed by Johns Hopkins Medicine, the hospital is “well-equipped”, according to Hatcher.

Hatcher describes her experience in the international transitions practicum—though much different than Blomberg's—as equally fulfilling. The primary difference between Al Corniche Hospital and a hospital in which Hatcher would practice in the U.S. is the model of labor and delivery care, which is based on the UK model.

“There are no labor and delivery nurses—only midwives. The UK midwife scope of practice means that the midwife provides all the patient care and delivers the baby,” Hatcher says. “I have had to define my role [as a nurse-in-training], within an acceptable scope of practice, then explain it over and over again to midwives."

But she relishes the rewards. “Working with a midwife one-on-one here at Corniche and assisting in delivering at least one to two babies every shift has been an amazing experience.  I’m strengthening my nursing skills, but also learning so much more,” Hatcher says.

Currently, 15 of the 133 students enrolled in the transitions practicum have chosen the international option and they are completing their coursework in China, South Africa, Australia, the United Arab Emirates (UAE), Chile, and Uganda.

Read about Jamie's experience abroad in her blog
Learn more about Midwifery at Hopkins Nursing
Learn more about Global Nursing at Hopkins Nursing