Thursday, October 24: 12 pm – SON T661
Learn about the Graduate Certificate in Global Health Nursing, the perfect certificate for graduate students interested in mentorship, foundational knowledge, skills, and hands-on practical experience in global health fields including infectious disease, sexual reproductive health, maternal child health, mHealth, and non-communicable diseases.
The School of Nursing, has been collaborating with a multidisciplinary team of UW and Peruvian researchers in Iquitos since 2016 with support from generous donors, including the estate of Barbara Wyman.
UW SON students first began coming to Iquitos as part of the project in 2017. Yvette Rodriguez, a PhD student, and Austin Bidman, a BSN student conducted an assessment of the litter found in the community of Claverito.
Claverito is a floating neighborhood on the outskirts of Iquitos. Many people who live there are recent migrants to Iquitos from the interior of the Amazon and have limited access to the cash economy. Weather directly impacts their housing as their structures are alternately “floating” or on the muddy flats. Residents experience high rates of waterborne diseases.
Yvette and Austin found a huge amount of little and also that most of the litter surrounding the neighborhood was plastic. They worked together to research the impact that plastic litter could have on human health and discovered a connection to mosquito-borne diseases, through its creation of physical reservoirs for water, which attract breeding mosquitos. Rodriguez returned to Claverito in 2018 to disseminate her work with the local nursing school. Learn more about Rodriquez’s work here
In the summer of 2018, Morgan Busse, Jane Kim and Marissa Mashidas, all in the Doctor of Nursing Practice (DNP)-Family Nurse Practitioner program, joined Yvette, on this project in Iquitos. They worked collaboratively with local nurses and local nursing students from the National University of the Peruvian Amazon (UNAP) to further strengthen climate and health resilience with the residents of Claverito. They established the Academia Familiar del Amazonas (AFA), which translates to the “Family Academy of the Amazon.” Through the AFA, the team provided health education to the children and families of Claverito. Learn more here
In 2019, two nursing students visited the community of Claverito, Andrea Shelton DNP-NM and Hannah Bridgeland, DNP-FNP. They met with women and families to determine their reproductive and sexual health needs and to discover how they were accessing resources in the community and subsequently created a resource map based on the women’s priorities and needs. You can see their work here: Service Mapping for the Community of Claverito.
In 2023, Miyuki Watanabe, DNP PNP-PC student, participated in the program with the goal of updating this resource map. Upon arrival, she conducted a community meeting to assess whether community members had accessed the resource map. It was quickly determined that only four community members of the 20 attending had seen it. After this, her objectives pivoted to identify gaps in the communication of this resource and determine how living conditions and limitations might affect their access to resources.
Our program began in Iquitos, a landlocked city of half a million people in the rainforest region of Peru. Iquitos, only accessible by plane and boat, is a vital access port for travel and commercial transit in this Amazonian region which includes borders with Brazil and Colombia. We spent a few days in Iquitos for orientation. Our team then traveled deep into the Amazon rainforest by boat. Five nights of camping allowed for our group of university professors and students to explore the tremendous ecological diversity of the Amazon. Each morning and evening we further explored the region via boat rides, providing amazing views of sunrises and sunsets. These excursions also offer opportunities to see many of the animals that live in the Amazonian rainforest. Sightings of pink and gray dolphins, amphibians, caimans, monkeys, sloths, macaws and a variety of other birds were commonplace. We were able to fish from the boats and even caught a few piranhas. Our team took hikes through the jungle allowing us to further explore the myriad of native plants, trees, and the creatures that thrive within this unique environment.
After five nights of camping, our group traveled back to Iquitos for another few days. Time in Iquitos was filled with a variety of activities – lectures/discussions, field trips, and site visits. We enjoyed lectures from local researchers. We learned about the history of Iquitos’ urban development and how government policy has impacted its current design. We spent time walking through local markets. We visited museums, health care satellite facilities, the local university, and a mosquito lab. At the mosquito lab, we learned about two different mosquito species and the specific diseases that each carries including dengue, zika and malaria. Scientists at the lab are working on ways to decrease the incidence of such infections, as well as prevent mosquito breeding.
Then, we traveled to a peri-urban Amazonian lodge for another five nights. Here, running water (not potable) and electricity were available from morning until evening, but not overnight. Boat rides provided transit to explore new areas of the jungle. We were able to visit a number of animal sanctuaries. One, on the way to the lodge, was Fundo Pedrito. This sanctuary is home to animals that have been rescued from the illegal trafficking market or those who had been wounded and found. Another, La Isla de los Monos, or “Monkey Island,” serves the same purpose as Fundo Pedrito, housing a variety of monkeys with the intent to release them back into their natural habitat. During our time at the lodge, we visited the community of Bombonaje. The local medical technician met with us and guided our tour of the school and the medical outpost so we could see the health and educational resources available to local communities.
This study abroad program in Peru is a fantastic field-based opportunity to learn as part of a
multidisciplinary team. I found this aspect of the program to be the most unexpectedly beneficial. I learned from students from environmental science, landscape architecture and other majors about their work and how they think through their projects. Prior to attending the program, I would have never thought to consult with a landscape architect or other urban development specialists on health initiatives. As a nurse, my first thought is health of the individual. My nursing experience has taught me to include the environment where people live and how that relates to both their physical and mental wellness. My view of health and nursing is now more holistic and includes, more intentionally, the built environment of my patients and the communities I serve.
Before going to Peru, I believed that urban development was synonymous with diminished health outcomes for people, animals and the environment. But what I learned from the perspectives and knowledge of my multidisciplinary colleagues has changed this single-minded view. Landscape architects and development specialists are really thoughtful about their designs. They not only consider the use of space, but also the plants and materials to be used for each project. They are able to incorporate practices that create safe and healthy environments for all living things, in urban and rural settings. So now, I am hopeful that through collaboration with a variety of fields and perspectives, urban development can be good for overall health. The heart of One Health came to life.
Another important aspect of the program was how it provided a new and vivid view of the social determinants of health (SDoH) which I had formally learned about the throughout nursing school and informally, through my own upbringing and lived experience. This program took me out of the world that I previously knew and uniquely highlighted the impacts of the SDoH – especially by highlighting the different experiences for people living in different levels of urbanicity in Peru. 
Overall, this program centers on landscape architecture and the built environment – and encourages a reflection of impact of urban development on human and environmental health. Students on this program are from landscape architecture, urban development, design engineering, public health as well as nursing. It is important for nurses to understand that this program is not nursing-centered. While you will see the SDoH displayed, and you get to visit sites like the mosquito lab, health clinic outposts, the university that researches indigenous medicine, and talk to various providers, the program is designed around landscape architecture. Adding the nursing perspective enriches the experience for all participants.
Meet the Participants
Photo Credit: Miyuki Watanabe
Miyuki Watanabe
DNP- Pediatric Nurse Primary Care Practitioner Student
Reason for going: “Interested in health care access in limited resource settings.”
Favorite part: “I was able to interact with local people and hear lectures from local researchers.”
Recommendation: “I recommend that you do preliminary research or literature reviews [on governmental structure and current events], a simple one is fine. That would be really helpful to connect with the experience.”
Photo Credit: Nhia Yerkes-Yang
Nhia Yerkes-Vang
DNP- Population Health & Leadership Student
Reason for going: “[To gain a] broader, global perspective of what health is. How different countries, cultures, and people define health care and wellbeing.”
Favorite part: “Being outside; being in the rainforest. That was just amazing. And then too, learning about all of the local plants and animals that are there, and utilizing those resources that exists within the rainforest.” “I really loved all of the activities that were planned.”
Recommendation: “Research the area. Learn a little bit of context before you go. Especially weather-wise, infrastructure-wise. Know a little bit, but also don’t make assumptions and make sure you pack light…[and] take the health recommendations seriously.”
“I wish I spoke Spanish… [The experience] could have been so much more rich…That was my biggest regret.”
Photo Credit: Mollie Killion
Mollie Killion
DNP- Population Health & Leadership Student
Reason for going: “Learning about how other disciplines complement nursing for more holistic population-health interventions/ experience with interdisciplinary teams…I like to go on adventures and push myself to try new and difficult things!”
Favorite part: “So many! Seeing so many amazing animals (dolphins, monkeys, sloths are a few of my favorites) and learning about them and their home. Fishing for piranhas. Waking up to howler monkeys in the jungle. Sunrise and sunset canoe rides on the Amazon River- the most magical experience of my life!”
Recommendation: “Lots of packing recommendations: bug spray, mosquito head net, antibiotics and anti-diarrheal medicines, hydration tablets, mini rechargeable/battery operated fan. Go into it with an open mind and be ready for a big adventure! You will sweat more than you ever have before and be eaten alive by mosquitos and biting flies, but it is all part of the adventure and all worth it for the incredible experience! Talk with the local guides and biologists as much as you can- I learned so much from them!”
Photo Credit: Ronnie Tecsi
Ronnie Tecsi
DNP- Population Health & Leadership Student
Reason for going: “Explore a part of the world that I had not been before and learn from a multidisciplinary team.”
Favorite part: “Experiencing the jungle, the rivers, the animals and interacting with the local people.”
Recommendation: “Pack light. There is a laundry mat close by with next day service, sometimes sooner. Be mentally prepared for dry camping while in Pacaya Samiria – no running water, no electricity. You will be provided boots to wear for walking through the jungle. So, no need for heavy boots, just a good pair of walking shoes. A light air mattress is worth it.”
Andrea Shelton and I have had a busy couple of weeks here in Iquitos. Our last couple of weeks have centered around continuing the Academia Familiar del Amazonas (AFA) program started by last year’s Peru Scholars. The intention of this program is to support the women of the Claverito Community with education sessions addressing issues they have identified as priorities. Therefore, we spent a week planning and implementing a community meeting meant to identify their priorities. We even held a train the trainer’s event where we prepped two facilitators on the planned activities and purpose of the meeting.
The community meeting was held on a Sunday morning on the newly built community platform and was a huge success! All women ages 12 and over were invited to the meeting. We divided the women into two groups based on age: 12-17 years old and 18 years old and up. Then everybody completed two activities where they wrote down specific subjects they wanted to discuss. Subjects did not have to be directly related to their physical health, but all are linked to their overall well-being in some way. We were so pleased and excited to see the women express interest and a willingness to be part of AFA. We could not have completed this community meeting without tremendous help from members of the community and members of the InterACTION Labs team. When we arrived at the community on Sunday morning, members of the community had already put up a tent, table, and chairs for the women. The UW medical students and landscape architect students kept all of the little kids entertained with coloring while two members of the greater Iquitos community ran the meeting.
The next week was spent translating the answers and determining what local resources are available for addressing the identified priorities. We are now in the process of visiting several local government offices in order to learn about services already available and how Claverito community members can access the services. Since several resources are already available in Iquitos, our goal is to make sure the women know what services are available and how to access them.
We have also been shadowing several doctors and nurses in the maternity ward of the Regional hospital, Felipe Santiago Arriola Iglesias.” We were allowed to attend two births and multiple lectures. Besides the births, my favorite part was getting an in-depth description of the World Health Organization’s form used in the hospital to track progress during labor and determine high-risk situations.
For fun over the last couple of weeks, we have been exploring Iquitos and the Amazon. We spent a couple of days in the Amazon jungle fishing for piranhas, bird watching, searching for monkeys and learning what plants people living in the jungle use for medicine. We took a boat ride around Claverito community to look at the vegetation islands that get created as the Amazon water level rises. We saw countless different birds and plants. The water level is receding quickly and in about two weeks we will be able to walk through this same area! We also participated in a local “marathon” that is a fundraiser for four local houses serving vulnerable populations. We were very concerned at first because the race was being advertised as a marathon. Needless to say, we were very relieved to find out the marathon was a four-kilometer walk/run!
Until next time!
Hannah
Andrea Shelton and I arrived in Iquitos, Peru on July 1 eager to meet the Claverito community members and get to work on our projects. The weather is not nearly as hot and sticky as we expected, so we are both quite relieved about that surprise! During this first week we got a taste of Amazon weather with mostly warm, sunny days broken up by brief, unexpected showers. This weekend we experienced Amazon rainstorms along with the street flooding and loss of internet and slippery sidewalks that comes with the large amounts of water. So far, we have only got caught in the rain once, so we are surviving the unpredictable weather of the Amazon well!
We have a beautiful apartment situated on the Malecón Tarapaca, which is a large walkway filled with shops, restaurants and museums right next to the Amazon. We are a short walking distance to markets, grocery stores, gyms, the program’s office and almost anything else we could want. Andrea made friends with this talkative parrot named Lorenzo in the Mercado Central. He is very proficient in saying, “Hola!” but “Ciao” seems like a challenge.
The food is wonderful and trying different Peruvian dishes is one of our favorite hobbies! Our first night in Iquitos was celebrated at a restaurant on the Malecón with a variety of different dishes. Andrea is a fan of alligator meat while my jaw gets tired from chewing the tough meat! We both agree the ceviche, especially the sauce put on ceviche, is amazing, and we could get used to the consistent supply of fresh pineapple, papaya, oranges, and granadilla.
Besides getting settled into life in Iquitos we have been busy this week learning about the InterACTION Labs projects, the Claverito community and the specific needs of this part of Peru. Together with a first-year medical student, we created a presentation for the other members of the InterACTION Labs team highlighting our research findings on the most prevalent health and environmental issues in Iquitos. The most prevalent health issues facing the Claverito community, which is a floating, migrant community, are different from the rest of the city. From our previously collected data we have identified high rates of teenage pregnancy, tuberculosis, parasitic infections, vector-borne diseases (Malaria, Dengue, Zika), and malnutrition. As expected, our research demonstrated that many of the most prevalent health conditions in Iquitos are modifiable and many are directly related to the environmental issues of the area.
We have three main activities planned. First, we expect to continue the parenting intervention (Academia Familiar del Amazonas (AFA)) started by the DNP students last summer. This will include development and implementation of 8-week training modules, one for adolescent girls and another for women in the community. Previously identified topics of interest include reproductive health, management of respiratory illness, management of infectious disease, etc. We are meeting with community members this week to finalize their main interests, so we can best meet their expectations. We also plan to support the establishment and functioning of the floating library. The idea to build the library emanated from AFA activities last summer and the funds to support it were mobilized by last year’s DNP cohort. We are so pleased to be working with three UW landscape architecture students as well as the community in the design the library. Finally we are working with School of Nursing faculty and students to further cement collaboration across our institutions.
During our free-time this week, we enjoyed watching Peru’s team compete in the semi-finals and finals of the Copa de Americas tournament. We learned how excited Peruvians are about fútbol and experienced Peruvian spirit firsthand. We also had a potluck for the US women’s world cup championship. We like to think they heard our cheering all the way from Peru!
Until next time!
Hannah Bridgeland