Visiting Nurse Notes: Scholar & Student Partner with Community Health Workers in Nicaragua

image3How would you help your patients with PD if levodopa were unavailable? It is a difficult question. But it is one that Elizabeth K. Keech, Ph.D., R.N., an adjunct clinical assistant professor from Villanova University College of Nursing and a scholar with The Edmond J. Safra Visiting Nurse Faculty Program at PDF, sought to answer along with one of her students, Elizabeth Yates, B.S.N., R.N.

The EJS-VNF Program at PDF trains nursing faculty in Parkinson’s disease, so that they can prepare the next generation of nurses — their students — to care for the growing number of people living with PD.

After Dr. Keech completed the program, she partnered with Ms. Yates, to improve care in PD in communities that need it most. As part of a partnership between Villanova and community health workers in a rural area of Nicaragua, the two put together educational materials to help local workers identify PD and encourage people living with it to seek treatment.

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Elizabeth Keech, Ph.D., R.N.

Q. Why did you participate in the EJS-VNF program? Can you tell us what you learned and how the program impacted your teaching?
A. As an educator, I know that our knowledge of many health conditions, including Parkinson’s, is constantly evolving. This program seemed like an excellent opportunity to substantially increase my own knowledge of PD, so I could pass that knowledge onto my nursing students.

It’s hard to pick key lessons, because I learned so much! The program brought me up-to-date with the latest information about Parkinson’s, including medications and surgical therapies, and it shed light on the importance of complementary therapies and exercise for people with PD.

The program absolutely impacted my work as a nursing educator. Soon after completing it, I began to teach the neurology portion of the curriculum to our nursing students, a course that has been taken by approximately 300 students in the three years since I completed the program. The information that I gained as a result of the EJS-VNF program strongly impacted the PD content that I was able to provide.

The program also impacted my work with an international health program at Villanova’s College of Nursing, ultimately inspiring my partnership with a student, Elizabeth Yates, to bring educational resources to health workers facing Parkinson’s disease in rural communities in Nicaragua.

Q. How did you and your student come to focus on Parkinson’s care in Nicaragua?
A. Villanova’s College of Nursing has a long-standing partnership with community health workers in Waslala, Nicaragua. Our senior nursing students collaborate with the workers to identify areas of need and to develop educational resources. We travel to Nicaragua a few times a year. After undergoing the EJS-VNF program, I wondered how Parkinson’s was handled in these communities where resources are scarce.

I encouraged my student Elizabeth Yates to focus her senior project on the topic. After researching for several months, she put together educational resources, including a presentation for health workers and handouts they could use in their communities to help people understand PD.

Q. What are the challenges to PD care in this region of Nicaragua?
A. Waslala is a rugged, mountainous region, where most people have limited access to basic health care. For many people, the nearest hospital is several hours away and sometimes accessible only by a dirt path. There is almost entirely a lack of running water and electricity. For their health needs, the community relies heavily on volunteer workers — the group with whom we work.

In terms of Parkinson’s, there are no specialists in the region, and generally no medications (there is little access to Western medications). On a previous trip, when we asked about PD, several educators in the region had no knowledge of medications. When we asked, “What happens to the people with PD?” they replied that people with PD receive “home care” (care at home by the family).

Q. How did you partner with community health educators to improve PD education?
A. Ms. Yates presented to a group of 50 community health workers, most of whom have basic health training but little to no formal education. She provided a basic overview of the neurological system using charts and pictures. She prepared a laminated handout about common neurological problems, including symptoms of PD that the leaders took back to their communities to use as a teaching guide.

She included tips for helping health workers to understand who might have PD, and how important it is for people with PD to stay active and (if they can) to see a specialist in one of the larger cities where they can be correctly diagnosed and treated. Because of the lack of medications available in the region, she also generated tips for keeping people active and for using complementary therapies.

The health workers were very attentive and appreciative of the handout which enables them to be more clear and informative when talking to their community members.

Q. What’s your hope for PD education and care in Nicaragua?
A. Our hope is that communities become more aware that there are several distinct neurological diseases, including PD, which can be medically managed. We hope that the basic assessment tools we provided help them to identify people who may be suffering from PD. We hope that these workers can spread the message that seeing a specialist is important, because that specialist can provide medications to ease symptoms and help people experience a better quality of life. We want people to know there is hope and that there are things they can do to feel better.

Thank you to the supporters and the faculty of the EJS-VNF project. It was a valuable learning experience that, through the ripples of education, has benefited my students and their patients.

Dr. Keech has been a nursing educator since the late 1960s and has spent most of her career teaching undergraduate nursing students at Villanova University. She completed her B.S.N. at Villanova, and an M.S.N., an M.A. in Social Gerontology and a Ph.D. at the University of Pennsylvania.

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