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Having a Global Perspective Is a Two-Way Street

Thursday, August 3, 2017

Having a vision statement of “take DUSON to the world, and bring the world to DUSON” might seem a little daunting, but in the Office of Global and Community Health Initiatives (OGACHI), they are very clear about their mission — creating successful, two-way global partnerships.

“It must be mutually beneficial,” said Michael Relf, PhD, RN, ACNS-BC, AACRN, CNE, FAAN, associate dean for Global and Community Health Affairs. “Our vision for global health right now is guiding everything about our work.”

What this means in real terms for DUSON is working not just to offer opportunities for nursing students and faculty to travel and study abroad but to create opportunities to bring international students and scholars to DUSON so that they may share their practice and insight with our students here. It is a way to experience the impact of globalization here in the United States.

“We’re not trying to be this ethnocentric, paternalistic entity that’s just going out to the world, taking advantage of the world and telling the world what to do,” Relf said. “We’re doing this so we have an opportunity to learn from the world as well because there are many things in terms of global health and nursing that the world does much better than we do. ... It needs to be bidirectional.”

Started in 2006 by Professor Emerita Dorothy L. Powell, EdD, RN, FAAN, for the past decade OGACHI has developed courses and opportunities for DUSON students and faculty to participate in its global mission. A visiting scholars program was created in 2008 and has grown in popularity. For the 2016-2017 academic year, the School will have had 12 visiting scholars from five different countries: Egypt, China, Norway, Taiwan and Korea.

Some scholars are PhD students doing research on their area of study; others are university faculty. For example, Marjolein Iversen, a senior faculty member at Bergen University College in Norway, spent her six-month sabbatical at DUSON doing collaborative consultation for her research related to diabetes. Atiat Osman, a PhD student from Egypt, will complete her two years at DUSON in October studying premature infant care under Debra Brandon, PhD, RN, CCNS, FAAN.

For DUSON students, as part of the Community and Public Health course, OGACHI offers global clinical immersion experiences in countries such as Barbados, Nicaragua, Tanzania and the Philippines, Relf said. Statistically, about half of the ABSN students — about 60 to 70 students — travel abroad for the two-week immersion program in a community health clinic. Graduate students can register for a two- to four-week program to fulfill a course requirement or conduct research related to their MSN or DNP projects.

For some students, the cost of travel abroad is prohibitive, Relf said, noting that it can add thousands of dollars to a semester’s tuition cost. But do students have to go abroad to do global health? Relf said the answer is no.

OGACHI has found a way to bring global health issues to our own backyard by offering a clinical immersion program in Durham County, where students work with culturally rich and diverse populations. “They’re going to clinics and hospitals and community settings every day and working with immigrants, political refugees, asylum seekers, citizens, who like many of our parents, are first generation,” he said. “Global health is here.”

Sending DUSON students and faculty out into the world has been working well, and visiting scholars have been bringing the world to DUSON for years. But unsatisfied, Relf created a course that expanded on the second part of the goal. “We’ve sent students out to the world to do global health, but we never had a clear mechanism that could bring students to DUSON,” Relf said.

Last summer, a new course, Exploring Global Patterns of Health and Illness, was created and was a huge success. Students from Barbados, Japan, the Netherlands, the Philippines and South Korea came to Durham and joined several DUSON students for the two-week course focused on finding common ground and exploring new health care solutions. This summer, 29 international students and eight ABSN students will participate in the course’s second year offering.

OGACHI works in conjunction with Duke University’s mission, which includes global initiatives as one of its pillars of strategic planning. For example, within the Duke Global Health Institute, the School of Medicine and DUSON, there is a focused priority in East Africa, Relf said. The School enjoys a developed relationship in Tanzania, where DUSON students work with other health science students on multidisciplinary projects.

Another example of international collaboration is China, where Duke opened Duke Kunshan University in 2013. The annual US-Sino Nursing Forum, led by Fudan University and Duke University, is a collaborative effort among Chinese schools of nursing and U.S. partner institutions that promotes the exchange of ideas among advanced nursing researchers, practitioners and educators.

Currently, DUSON has a memo of understanding with the Florence Nightingale School of Nursing and Midwifery at Kings College, London, the world’s first professional school of nursing. The two institutions are in the process of funding collaborative joint research projects.

Strategic planning for OGACHI includes looking at global relationships that Duke or other faculty members may have to determine if DUSON might fit in and bring a new perspective to the partnership. “Included in our decision-making principles that are a part of our strategic planning is looking at whether or not we have a faculty champion,” Relf said. “Have we had a past relationship with this country or institution? Is there a mutually beneficial opportunity?”

One example of this type of strategic partnership process is OGACHI’s collaborative effort across the health sciences programs at Duke, including physical therapy, medicine and the physician assistant (PA) programs, to examine how each school deals with issues like the paperwork and pre-deployment training of its students.

“These are people at Duke who are doing the exact same thing we’re doing,” Relf said, adding that now the group meets three to four times a year. “It’s a network of problem-solving but also collaboration.” As a result of this collaboration, students from DUSON and the PA program will work together at a hospital in Tanzania, expanding their global experience to include inter-professional opportunity.

Whether here or abroad, globalization affects everything from economics to education to health care. According to the U.S. Census Bureau, by 2060, one in five Americans will be foreign-born. “What happens in Asia stock markets impacts us. What’s happening in Africa as a consequence of HIV impacts us,” Relf said, underscoring the necessity for mutual partnership. “We’ve seen all this infectious disease, but we also see a growing pattern of global non-communicable disease: hypertension, diabetes, heart disease, etc. … There are opportunities and, I would say, almost a necessary mandate that we help the nurses of today and tomorrow understand global health, global context.”