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A Different Kind of Distance Learning

Children’s Nurses Teach at Conference in Mexico

Most American nurses might feel misplaced attending a three-day conference in Mexico entitled, “Curso Internacional de Enfermería Nurses pose with staff from MexicoPediâtrica.” But nurses from Children's Hospital Central California have consistently jumped at the opportunity – not only to attend, but also to teach.

The seminar – known in English as the "International Course of Pediatric Nursing" – takes place annually to coincide with a week-long medical mission trip sponsored by the Rotary Club of Fresno. The free clinic provided by our doctors and other medical professionals has received a great deal of press, and rightly so. The annual “Project Niño” trip began after the Mexico City earthquake of 1985, and has continued every summer Patient receives treatmentfor 25 years. The history of the training seminar does not date back as far, but the selfless service provided by our nurses merits every bit as much praise. Nurses from throughout the greater Mexico City region await the event as eagerly as families in the nearby community of Santiago Tiautla welcome free medical care.

From the early days of the medical mission trip, a concurrent conference took place. The original training event was designed for doctors, not nurses, however. The intended audience switched five years later as a result of a questionnaire. Dr. David Hodge, pediatric surgeon at Staff member with Dr. HodgeChildren's and coordinator of “Project Niño,” conducted a survey of local nurses and learned they wanted a conference of their own. The Rotarians agreed to cover travel expenses for a teaching team to join the group in the coming years, and the first annual international course of pediatric nursing occurred the following summer.

The first few training events reminded our visiting nurses of a hospital’s lecture series, but over the years it has matured into a full-fledged conference with the same style and content offered nurses in the United States. Attendance has Team members in the early daysincreased exponentially since its inception in 1991, forcing this year’s host to move the event beyond the walls of their hospital to a nearby university. Approximately 250 nurses attended the July 12-14, 2010 conference in Cuautitlan, a municipality on the outskirts of Mexico City. A hospital in neighboring Tlalnepantla hosts the event every other year.

Eager to learn from our nurses, as well as professionals from their home country, registrants cleared their calendars to attend. Many conference-goers went directly from work to the seminar, and then Baby in isolettereturned to their nursing duties at day’s end. And unlike the clinic’s free medical care, the conference organizers charged admission. “They’re overworked and underpaid,” said Cecilia Ferrer-Heyne, a registered nurse from Children’s Hospital. “But they showed up. They were like sponges.”

The Mexican nurses weren’t alone in making sacrifices to be there. A handful of our dedicated nurses have poured themselves into this event year after year. Ferrer-Heyne spent approximately 60 hours preparing to deliver three different presentations at this year’s conference, but has no regrets. “I would definitely go again,” she said. “It Team members pose for picturewas an awesome, awesome experience.” Teresa Juarez, a registered nurse from Children’s, agreed. “It’s really humbling,” said the other member of last summer’s teaching team. “They appreciate the experience and the knowledge we provide.”

Neither nurse had previously travelled abroad to teach, and felt privileged to receive an invitation from Dr. Hodge. Jill Cielnicky, a nurse practitioner in pediatric surgery, understands their enthusiasm. She has made the trip four times since 2006. Cielnicky knows what it’s like to invest time and effort in the conference. “Teaching is hard work,” she declared to Staff members with Mexico teama chorus of agreement from her fellow instructors. Erin Berberian, trauma services midlevel practitioner, and Elizabeth Ramirez, house resource registered nurse, have each presented as many as a dozen sessions in Cuautitlan and Tlalnepantla, Mexico since 2004. The three professionals reminisced about stepping outside their usual roles to perform non-nursing tasks. They agreed putting together PowerPoint slides presented a new challenge. “We’re nurses!” Cielnicky exclaimed with a grin.

Norma Barajas, physician education specialist at Children’s, has also taught abroad more than once. She accompanied the team in Norma Barajas with children2008 and 2010, but instead of presenting for a second time at the nurses’ conference, Barajas delivered her seminars to a different audience last summer.

La Escuela Julian Villagran Santiago Tiautla serves as the regular site of the “Project Niño” clinic. Classrooms at the school morph into treatment centers for one full week, and yet one room remained a place of instruction. Barajas gave four days of lectures to anyone from the community who wanted to come. Because Cielnicky elected to participate as a nurse practitioner at the clinic rather than teach at the nurses’ conference that year, she witnessed the popularity of Barajas’ lectures first-hand. “She taught all day long in fluent Spanish to standing-room-only crowds in her classroom,” said Cielnicky. “I think she even lost her voice.”

Barajas addressed a few tough topics, as well as other issues of interest to parents and patients. Her subject matter included:

  • Healthy communication
  • Domestic violence
  • Positive parenting
  • Breast cancer
  • Alcoholism
  • Nutrition

Barajas selected the topics she presented at the clinic, and judging by the crowded classroom, she chose well. Instructors at the International Course of Pediatric Nursing received direction from Mexico regarding their topics.  Each year, the hospital hosting the conference identifies the areas of greatest interest to their nurses, and passes the information to the teaching team from Children’s Hospital. Our nurses must then prepare to present the requested subject matter.

Topics taught by our nurses include:

  • Early Stimulation and Its Impact on Child Development
  • Nursing Interventions in Invasive Procedures
  • Risk Factors in the Low-Birth Weight Infant
  • Profile of the Pediatric Nurse
  • Child Abuse Prevention
  • Adolescent Diabetes
  • Neonatal Sepsis
  • Pneumonia
  • Vaccines
  • Burns
  • STDs

Children’s nurses appreciated the attendees’ inquisitive responses to their presentations, and agreed the Mexican nurses posed profound and Mother and child pose for picturethought-provoking questions. Ramirez remembered their theory-based questions and noted their habit of incorporating theory into patient care. “They had huge knowledge of nursing theory,” she said.

When our team wasn’t teaching, they were free to attend portions of the conference taught in Spanish. The same interpreters who helped them deliver their seminars accompanied them to the sessions they wanted to hear. “We wore headsets,” said Juarez. Other than the language, she discovered the conference differed little from continuing education courses offered in California. “The quality of the speakers was every bit as good as here,” said Juarez .

Dr. and Mrs. HutchisonOur nurses were continually impressed by the character and intellect of the nurses they met at the conference.  “It was important to them for us to know that even though they were poor, they’re not dumb. They are very proud of their profession and of their country,” said Cielnicky. She, together with Berberian and Ramirez, came up with a phrase to describe the way Mexican nurses approach their jobs: The Art of Nursing. Medical personnel at Children’s Hospital routinely view their practice from a technical perspective. In contrast, nurses south of the border do not have the same access to technology. They must rely more heavily on sight and touch.

Project Nino team“For them it’s more like an art,” said Cielnicky. “The basic Florence Nightingale-type things are important to them.” And yet their old-fashioned ways do not inhibit the quality of healthcare. “They make do with so much less, but the diagnoses are the same and the treatments are the same,” said Cielnicky.

Ramirez agreed. “They can’t afford to waste anything,” she said, and recalled how they reused IV bags.

“We took disposable suture removal kits with us and they were like gold,” said Cielnicky.

Ramirez was reminded of another gift they brought. “We took pencils, too. They even valued a pencil.”

Team in front of Project Nino busCommon articles here at Children's Hospital are guarded and prized in Cuautitlan and Tlalnepantla. “They keep the toilet paper locked up,” said Berberian, amazed.

Juarez tried to paint a brighter picture. “It was not like a Third World country. They’re pretty up to date,” she said. “Their isolettes are up to par, but they made a comment that they’re not using them to their full extent because the light bulbs are so expensive. When they burn out they’re too expensive to replace.”  Thinking further about things we take for granted, Juarez exclaimed, “You know how we have ‘Gel-in, Gel-out’ everywhere? Project team membersWell, you’re lucky to find a sink anywhere!”

All the nursing charting and progress notes are done on a typewriter. Since medical records do not exist in a computer, the name, age and diagnosis are posted at the foot of each patient bed. “There’s clearly not HIPPA there!” Cielnicky declared.

“It was a different world. We’re very fortunate here,” said Ramirez.

The cross-cultural experience not only exposed differences, but also confirmed similarities. Cielnicky summed it up perfectly by saying, “We’re all nurses. We all have a bond, and we all just want to take care of our patients.”

Our nurses were moved by the deep respect shown to every member of the hospital’s Team members on planecommunity, regardless of position. “They’re very polite with each other. Very respectful,” said Berberian.

Ramirez nodded. “They served us tea and sandwiches like royalty,” she said. But the royal treatment did not translate into stuffy formality. Doctors, nurses and janitors greeted each other every day with a kiss on both cheeks. “They’re like family, and they treated us like family,” she said.

The Children’s nurses enjoyed reminiscing about how they’d adapted to the culture while there. “We got to call Dr. Hodge ‘David’ in Mexico, and we got to kiss him every morning on the cheeks. Now we’re back to shaking hands,” laughed Cielnicky.

Headed home on Mexicana AirlinesNurses at Children's Hospital Central California may not wear the plain white uniforms and vintage pointed caps their Mexican counterparts do, but underneath you’ll find the same sharp minds and warm hearts.

“They are the most humble people,” said Juarez of the professionals she met last summer. After years of sitting under our nurses’ teaching, the Mexican nurses would undeniably say the same about our own.


George the giraffe in Mexico