The visits are as much an education for Hunter as they are for her students. With each visit she learns something new about the children she cares for, their families, and their communities. And, inevitably, even after a career that spans more than four decades, she continues to gain unexpected insight into the craft of nursing.
It is insight – which Hunter maintains can only be gained when totally immersed in a different culture – she hopes will shape her own students as they embark on their own careers in nursing.
“Overseas work has a huge impact on a person’s understanding of being culturally responsible,” Hunter says. “When you move out of your home environment – out of your own comfort level – and work and live in a completely different setting, then you really gain an understanding of the people you are working with. You begin to listen differently, treat a person differently, and communicate more effectively.”
For the past five years, Hunter has led medical missions to Mbarara, Uganda, first as a member of the faculty at the University of San Diego (USD) and, since 2010, as Chair of Dominican’s Department of Nursing.
On each trip, Hunter and her colleagues take with them nursing students from both Dominican and USD to work alongside health care professionals at Holy Innocents Hospital, Uganda’s only children’s hospital, which Hunter and her USD colleagues helped establish, largely thanks to donations from parishioners from San Rafael Catholic Church in San Diego. The hospital has treated more than 60,000 children since opening in 2009.
Hunter and her team assist local doctors and nurses with medical care while also working with administrators at the fledgling hospital as they move toward the facility becoming a self-running entity. However, for the students, it is the lessons learned on the ground that will prove the most valuable. Extensive work is being done in the community to help promote a healthier environment so as to prevent disease; however, that work will take a long time to see fruitful outcomes. Overcoming cultural beliefs and practices is challenging.
Two years ago, after a close assessment of community priorities, the team started working on a research project to determine underlying factors related to the area’s high incidence rate of developmental delays in children.
After studying medical records for 340 hospital patients aged from birth up to six years old, the researchers discovered a strong correlation between malnutrition, malaria, and delayed development in children.
The findings, which were presented in September at the Pan American Nursing Research Colloquium in Miami, revealed that only 10 percent of the 340 children studied received more than one meal a day. In addition, 80 percent of the children displayed stunted physical growth. About half the children were too old for their grade level, with eight being the average age of first graders. The majority of these children also were late in achieving developmental milestones, including talking, walking, and fine motor skills.
Many of the children surveyed had experienced four malaria attaches by the time they reached age six. The most vulnerable age for sever malaria attacks is between birth to age 5; however, an increasing number of severe malaria reactions are now occurring in older children, most likely due to resistance to the malaria medications.
The findings underscore the importance of educating parents about proper nutrition, and this January Hunter and her team will travel to some of the villages served by Holy Innocents Hospital to further extend the education of parents about nutrition and malaria prevention for their children.
“It does not matter if you are well-nourished or malnourished, you will still contact malaria,” Hunter says. “But if you are malnourished then your immune system is weakened, then the effect of the malaria is worse, and the mortality rate will be higher.”
Researchers also uncovered another startling finding – one that they plan to study further in terms of its significance as a variable impacting complications related to malaria.
“When we tested the water the children were drinking – including well water, processed city water, and bottled water – we discovered that arsenic levels at any one site were from 30 to 70 times higher than what is allowed by world health organizations,” Hunter says.
She and her colleagues already have made government officials in Uganda aware of their arsenic findings and have met with members of the local community to determine both present findings and discuss next steps.
“We know the community wants us to work on projects focused on water purification, so this winter we will work with villagers to help create home units for water purification,” Hunter says
“This is a critical part of international work – to help teach the local communities how to do something themselves and turn it over to them.”
For the students, the Uganda experience will shape them as they embark on their own careers.
“Through engaged learning, we provide opportunities for students that pull students out of comfort zone and into arenas where they can see, listen, learn,” Hunter says.
“Experiences like this help students to think and respond in an intelligent, critical and analytical way. The students gain a new perspective that helps them to make good decisions that will help improve life of their patients.”