Island journey provides up-close look at true community nursing
By Sandra Snyder
Sometimes success in travel can be measured by how quickly you can lose a suitcase. Ask Kimberly A. Subasic, Ph.D., a University of Scranton nursing professor, to tell you how that works.
She and 25 others, called the University of Scranton Island Impact Team, recently returned from a medical mission trip to the Dominican Republic. The mission, organized by the grass-roots Island Impact Ministries team, was led by a physician and 1985 University alumni couple: orthopedic surgeon John Juliano, M.D., and his wife, Mary, a dentist. The Julianos have made four previous such trips but this year asked University student nurses and faculty to join them for the first time. Nine nursing students along with faculty gave up their Easter break, and their work was instrumental and even revitalized the regular contingent, Dr. Subasic and Dr. Juliano said.
A medical resident, nurses and nursing faculty, including University faculty specialist Cristen Walker, made the journey, along with interpreters, coordinators, lay persons, some high-school students – and 32 suitcases. Those contained not travelers’ essentials but donated medical supplies and medications weighing nearly 1,650 pounds. From Palm Sunday to Easter Sunday, as the crew traveled by bus from mobile clinic to mobile clinic, emptying a suitcase and leaving it behind for someone was considered another victory.
“We got excited to see the suitcases dwindling,” Dr. Subasic said.
That’s because, on the Island of Hispaniola, shared by the Dominican Republic and Haiti, residents often don’t have even a closet to store a change of clothes. Medical problems are rampant yet treatment options are few, particularly for Haitians, who largely populate the various villages to which the group traveled but are typically shunned when it comes to medical care, Dr. Subasic said.
If they show up at a Dominican hospital, they are “the last ones treated, the last ones looked at in the ER,” Dr. Subasic said.
The Island Impact Team, therefore, identifies people in need of better care, provides a month’s worth of medications and refers them for follow-up treatment.
Over the course of five service days, just under a thousand patients were treated.
“To see that many people in such a short time and actually treat them is incredible,” Dr. Subasic said.
Dr. Juliano reached out to the University nursing department, he said, when he learned his previous contingent, consisting mainly of high-schoolers, would be unable to make this trip. The nursing students re-energized the other regulars, Dr. Subasic said, noting those regulars told her how impressed they were with the work ethic of the University contingent and said they would most definitely make the trip again if nursing students came along.
The group also brought along Janet Grahn, a 1983 Scranton alumna who teaches at St. Stephen’s Elementary School in Warwick, N.Y., where the Julianos practice. The Julianos’ daughter Katherine is a 2013 Scranton nursing graduate but, having recently started a new job, could not make the trip.
Dr. Juliano said the overall mission is to identify people with chronic disease and direct them to an existing clinic, operated by Island Impact Ministries, that often has a hard time reaching these patients.
The daily routine, Dr. Subasic, said, started with intake – height, weight, blood tests and such – and moved on to examination and pharmacy. Patients served ranged from newborns to 90-year-olds, and conditions included everything from lice, scabies and fungal infections to diabetes, high blood pressure and unmonitored pregnancies.
Christina Wambach, a junior nursing student from Haddon Township, N.J., said the clear differences in health-care delivery were painfully apparent. The students often became the teachers.
For diabetic patients, she said, “We tried to teach them about diets.” For fungal infections, “we’d talk about cleaning habits.” Because of the conditions and climate, she said, “They can get infections so easily.”
Kelsey Buongiorno, a junior from Westchester, N.Y., said perhaps the most difficult part is knowing you can’t provide permanent help.
“You just want to do so much for them because they have nothing,” she said. “It’s so overwhelming.”
“I learned a lot about them, and I learned a lot about myself,” she said.
Other students who made the trip were Meghan Maguire, Meghan Chambers, Sarah Woronecki, Maryann Cwalinski, Meaghan Connelly, Kaitlin Reznick-Lipina and Tricia Leavy.
Education of these nursing students, as well as of the patients, is central to the mission, Dr. Juliano said. “This is what I would call the softer side of medicine. It’s really all about the one-on-one relationship. It’s normally about the technology – and the technology is so important – but the art of medicine is really about the interaction with the patient.”
Both patient and team interaction made a stunning difference in short order, Dr. Subasic said.
During an evening reflection, she remembered, “Everyone was in awe of how effective 26 people could be on a dime,” she said, noting unexpected circumstances required quick adjustments.
For senior nursing students, Dr. Subasic said, accustomed to clinical rotations not nearly as unpredictable, fast-paced or exhausting, the experience was especially meaningful.
“This was truly community nursing, end of story,” she said.