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Primary Practice

Samuel Merritt University FNP students start international clinic close to home.

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PRACTICE MAKES PERFECT: Samuel Merritt University FNP student Tiffany Chan, RN, does a physical exam on a Himalayan immigrant at the Davis Street Clinic, San Leandro.

For Samuel Merritt University (SMU) FNP student Nisha Thapa, RN, the idea to provide a day-long screening for uninsured immigrants came from the heart. The Tibetan nurse knew people from her homeland needed care they might not be receiving. Thapa approached SMU Associate Professor Valerie Dzubur, EdD, FNP-C, and the result was a free health screening day for uninsured immigrants from Bay Area Nepal, Bhutan and Tibetan communities.

More than 20 FNP students provided screenings and follow-up management for a wide variety of ailments, including urinary and upper respiratory infections, diabetes, hypertension, asthma, sexually transmitted infections, infectious disease, gout and musculoskeletal injuries. Health referrals, medications, education and resources also were provided and attendees were screen for TB.

Dzubur said Nepalese immigrants face several challenges; many who attended were receiving check-ups for the first time in the U.S. San Francisco is a popular resettlement city for Nepalese refugees, but the economic decline is making it tough for non-English speakers.

"It occurred to me these families, who may be undocumented, have fallen into the healthcare gap and do not have access to care," she said. "Many of these people have been displaced from their homeland due to political unrest, and we want to be able to provide support. The primary care service we provide supports the university's value to serve the underserved."

Individualized Care, Hands-On Learning

Each patient received an individual health passport on registration, then went to nursing stations where vitals, health history and blood glucose were checked and recorded. Then each had a 30-minute individual visit with an FNP student to go over the history, have a physical exam and ECG if indicated, followed by the treatment plan. Students were supervised by licensed FNP faculty members, who reviewed each plan of care before they were given to patients. Patients needing further consultation were seen by FNP supervisors; complex issues were handled by two emergency department physicians who volunteered to provide consultations and review ECGs. Patients were referred for follow-up care as needed.

MAKING A DIFFERENCE: Samuel Merritt University FNP students provided care during a free clinic day for Bay Area uninsured Nepalese in the Davis Street clinic in San Leandro. The Himalayan healthcare team included team lead Valerie Dzubur, EdD, FNP-C, Samuel Merritt University associate professor, back row, far left, Sandeep Sivia, RN, Angela Campbell, RN, Laura Davis, RN, Julie Hood, RN, and Monica Gardner, RN. In the front row is Almita Heramia, RN, Kathy Huynh, RN, Farhat Surti, RN, and Rhonda Ramirez, EdD, FNP, Samuel Merritt University faculty. photos courtesy Samuel Merritt University

"The real life story of patients and the immediate management of healthcare problems provides the ideal learning environment for FNP students," Dzubur said. "This was a hybrid event where we did health screening in the traditional sense, but we took things a step further by providing individual examinations, treatment and follow-up care."

The clinic took place at the Davis Street Family Resource Center in San Leandro; the FNP students were assisted by local Nepalese nurses and nursing students who acted as interpreters. These included nurses Tenzin Dasal Chuteng, RN, Yangchen Dolkar, RN, and Dechen Dolkar, RN, and nursing students Pasang Lama, Dawa Lama and Dekey Sangmo, who also was a physician in Tibet.

Future Planning

Funding for the project came in part from the Scott Beamer Community Service grant, student fundraisers and the Bay Area Nepalese alliance nonprofit group, Sahayeta.org. In addition, the students raised $4,000 at the clinic to be used for additional clinics throughout the year and received equipment donations that allow for extended testing.

"The support has been strong," Dzubur said. "Thanks to the funding, we are able to extend this primary care service to the Himalayan community until the end of the year. So the benefits of this effort will continue."

Based on the success of this first clinic, others are in the planning stages.

"I am meeting with the community organizations we partnered with to plan future healthcare screening events," Dzubur said. "We are exploring the possibility of planning a clinic at SMU in the future and are looking at working in the school system with public health nurses. There are many ideas and needs to respond to - the possibilities for partnerships are only limited by our imagination, time and money."

Candy Goulette is regional editor at ADVANCE.


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