BINGHAMTON, NY – Twenty years after the Rwandan Genocide left nearly 1 million dead and 2 million homeless, Binghamton University is playing a role in improving the nation’s healthcare. Karen Feltham, a clinical instructor in the Decker School of Nursing, spent the 2013 fall semester in Rwanda working with women in the Rwandan Midwives Association. Feltham was hired through the Clinton Health Access Initiative; a non-profit designed to strengthen health systems in developing countries. "It was quite an experience," Feltham said. "It supports my theme of ‘There’s no substitute for adventure.’"

Also taking part was Laura Terriquez-Kasey, a clinical assistant professor who spent January 2014 in the Dominican Republic. Rwanda has come a long way in recovering from the 1994 genocide, Feltham said. The poverty rate has decreased from 77.8 percent in 1994 to 44.9 percent in 2009 and universal healthcare is provided to "the poorest of the poor," she said. In a nation that is 81 percent rural, Rwanda now stresses the use of community health workers, who diagnose and treat those with pneumonia, malaria or HIV/AIDS.

Despite a more structured healthcare system, Rwanda still can make gains in birthing, Feltham said. She taught midwives at Muhima Hospital in central Rwanda and in nearby birth centers. These birth centers, however, often lack electricity, running water and basic equipment. "In the health centers, they have things that look like equipment, but don’t work," she said. "Just because something looks like an Ambu bag (a manual resuscitator) doesn’t mean it works like an Ambu bag."

A typical labor room consists of four beds, one CTG fetal monitor (a technical means of recording the fetal heartbeat) and no toilets. A pregnant woman usually does not receive pain medication, Feltham said.

Feltham said she tried to emphasize the importance of one-on-one interaction between a midwife and patient to her 32 students. "Rwanda is very much a community culture," she said. "They think: ‘Why would I want to sit by myself when maybe we all could sit together?’ This translates to midwifery care: ‘Why would I want to take care of this patient by myself when my four friends are over here?’ That is friendly, but it doesn’t make for good patient coverage."

Another obstacle to overcome is Rwandan midwives do not have an inherent love for the profession because they are not choosing it, Feltham said. Many times, the profession is picked for them.  "(Westerners) go into something because our hearts are full or we go into midwifery because we can’t imagine doing anything else," she said. "That’s our motivation. Still, the students were special and it was a treat to work with them."

Feltham enjoyed her "adventure" in Rwanda, calling the country "sunny and beautiful."

"It’s a good place to live as a minority. We developed a beautiful rapport and I am still in touch with many students and colleagues," she said.

For Terriquez-Kasey, there can be dramatic differences in healthcare within a country in South America, Central American or the Caribbean. Like Rwanda, these countries do not have enough electricity to support machinery donated from western nations. Terriquez-Kasey often leads students on a community health program overview in the Dominican Republic. There they can instruct local residents in CPR or first-aid classes. "We want them to take on the responsibility of doing a class," she said. "They can usually pick a health issue and present a class on their own."

Students are also able to travel in the countries and assist and educate the public on a variety of topics. One thing they must become accustomed to: the religious needs of their patients.

"What’s fascinating to me about community visits is that students not only visit a country but go into people’s homes to understand the level of spirituality that their clients have," Terriquez-Kasey said. Saying a prayer with a patient in the Dominican Republic – whether it is for the family member or safe travels for the nursing team – is part of healthcare.

"There is an expectation that you will assist them in saying a prayer," Terriquez-Kasey said. "It is an eye-opener for many students."