Objective: Train Nurses that will Work in the Rural North
Our project (delivered with the partners identified in the following section) aims to improve the quality of health care in rural communities of the north of Guatemala by focusing on nursing education, with the following strategy.
- In the first instance train auxiliary nurses, because this can be done relatively quickly. Tailor the curriculum to the needs of rural communities. Define a course for a ‘rural primary health care nurse’, which can be covered in 18 months.
- Recruit students who have roots in those communities, so that they will be comfortable working there; and because they know the culture and environment, they will be more effective than outsiders.
- Decentralize education so that prospective nurses can receive training close to home. (There is an excellent nursing school in the north, the Escuela Nacional de Enfermeria de Cobán—ENEC—in Cobán, but that is days away from many remote communities.)
- Use the municipal health centers as local training centers for nurses.
- Deliver lectures from professors at ENEC via computer-based distance education.
- Use local professional nurses at the health centers as tutors, and use the health center for clinical experience. Offer support in indigenous languages where needed.
- Work with the Guatemalan Ministry of Health and NGOs to ensure that graduating nurses are employed where they are needed.
Implementation
The project combines all elements of the Tula philosophy: build up manpower and systems; as far as possible, work with established local organizations; see if and where technology can help; marshall Canadian expertise where it is needed.
The project was originally conceived by the Centre for Nursing Studies (CNS), St. John’s Newfoundland. The project drew upon CNS’s 50-year history of training nurses in remote regions of Newfoundland and Labrador, and the technical expertise of Memorial University's Telehealth Education Technology Resource Agency (TETRA). The program has received funding and logistical support from the Canadian International Development Agency (CIDA). It was crucial that CNS and TETRA had distance education experience in the 1980’s and 1990’s when voice-grade telecommunication capability in Newfoundland was similar to that encountered initially in northern Guatemala. The technology employed was the TeleWriter system that had been used successfully in Newfoundland for many years.
The Tula Foundation has supported the project since its inception in 2003. CNS and CIDA will discontinue support at the end of 2008, whereupon the Tula Foundation, via the Guatemalan entity TulaSalud, will assume full responsibility.
Success has been due mainly to the energy, ingenuity and professionalism of our partners at the ENEC nursing school, who have driven the project forward and made it a success. In addition, the project has received excellent support from the Ministry of Health and its affiliates, the University of San Carlos of Guatemala, and other agencies such as the National Council of Science and Technology of Guatemala (CONCYT).
Progress So Far
The first intake of the course was a pilot, which concentrated on a few training centers in the department of Alta Verapaz. Started: 2004. Completed: 2006. Graduated: 34 auxiliary nurses.
The second intake of the course expanded to include twelve training centers in the departments of Alta Verapaz, El Quiché and Huehuetenango. Started: 2006. Completed: 2008. Graduated: 134 auxiliary nurses.
The third intake of the course, now fully the responsibility of the Tula Foundation, started in November 2008. Details: twenty-two training centers in the departments of Alta Verapaz, Baja Verapaz, El Quiché, Huehuetenango, San Marcos, Totonicapán and Chiquimula. Participants: approximately 400 auxiliary nurses in training will graduate in spring 2010.
Next Phase: Train Professional Nurses
ENEC and and the Ministry of Health asked that Tula extend the program to include a new course that will train professional nurses using the principles employed for the previous course. The course, designed by ENEC, will be a three year program.
The first intake of this new course began in June 2008, and includes approximately 100 students. Eight training centers are located in Alta Verapaz, Huehuetenango, El Quiché and El Petén.
The telecommunications infrastructure in most of northern Guatemala has improved to the point that we can use high spead Internet to deliver the course. This improvement allows ENEC to employ Elluminate Live as a teaching platform—the same platform now used by CNS and in many distance education programs in the developed world. Via Elluminate’s Community Partner program, Tula and ENEC receive Elluminate Live free of charge, which we all greatly appreciate.
Graduation day for auxiliary nurses
From the department of Huehuetenango: diverse styles, all nurses
Professional nurse and course tutor, at the Health Center in Lanquín, Alta Verapaz
Nursing professor from ENEC at the Health Center in Ixcán, El Quiché