The art and science of nursing have no boundaries. As advanced technology makes the world smaller, the nursing discipline is expanding, reaching out to underserved populations through the eyes, ears and hands of nursing students and faculty. One such population is the poor of the Himalaya Mountains in India.
The Himalayan Institute Hospital Trust (HIHT), a nonprofit organization located in the foothills of the Himalayas, serves a population of more than 10 million. The mission of HIHT is to develop integrated, cost-effective approaches to health care and development that address the local population and serve as a model for India and underserved populations worldwide. To carry out this mission, the trust uses a two-dimensional approach that focuses on education and service.
The educational infrastructure includes Himalayan Institute of Medical Sciences, a medical college that offers both undergraduate and postgraduate programs; Himalayan College of Nursing, which offers diploma and degree programs; and Rural Development Institute, which serves more than 1,000 villages, providing primary health care, income generation, child and adult literacy education, and water and sanitation programs. The service infrastructure consists of a 1,000-bed, tertiary-care hospital and a regional cancer institute.
HIHT has been hosting students and faculty through its international exchange program for close to a decade. Medical and nursing students from all over the world, along with faculty members from both disciplines, have participated. Pranati Barua, MSc, MPhil, principal of Himalayan College of Nursing; Narender Nagpal, MSc, MPhil, professor emeritus; and Kathleen Marie McKeehan, PhD, RN, nursing adviser at the school, have provided valuable assistance in implementing the international program. All three are members of the Honor Society of Nursing, Sigma Theta Tau International.
Most program participants come from England and the United States. Nursing students from England usually come for one month each year as part of HIHT’s exchange program with Northumbria University in Newcastle. Faculty from Northumbria and nurse administrators from its sister hospital, Sunderland, have spent time at Himalayan College of Nursing to help design their students’ experience. Faculty members and students from various colleges and universities in the United States also participate in the program. The director of Alverno College Division of Nursing in Milwaukee, Wisconsin, USA, has been a recent participant, as have faculty members and students from the University of Wisconsin College of Nursing in Oshkosh.
Experiential benefits
Initially, Himalayan Institute Hospital Trust administrators were hesitant to enter into an international exchange program; they questioned whether individuals from abroad would be able to embrace the cultural and economic differences that exist between developed and developing nations. However, as time passed, experience proved that there were numerous benefits for students, faculty members and institutions on both sides of the exchange.
Our mission will always be to “serve the underserved,” and it appears that international arms will always be reaching out to help us along the way.
Foreign visitors to India are always interested in our holistic health approach, which integrates alternative systems of health care with allopathy. They are also interested in observing how we treat tuberculosis, leprosy, polio, malaria and parasite conditions, diseases that are relatively rare in their own countries. Most visitors are deeply drawn to the majesty and beauty of the Himalaya Mountains and request sightseeing ventures to villages nestled in its ranges.
Student benefits
One of the most important benefits for students attending the Himalayan College of Nursing is exposure to individuals from abroad, who frequently share their pride of “freely choosing” nursing as a professional career. It becomes obvious that students from abroad have many more career options than Indian students. Often, these encounters make Indian nursing students feel more secure and proud that they are a part of a global professional family. Many make lasting friendships, and Indian students often voice dreams of going abroad for work and further study to enhance their professional careers.
Students visiting Himalayan College of Nursing have the rare opportunity to travel to rural mountain villages and experience how community health needs are integrated into various national health programs, such as maternal/child health and tuberculosis control programs. In addition to learning about modern allopathic medicine, these students observe holistic approaches to health care through systems such as ayurveda and homeopathy. A separate hospital building is devoted to pancha karma, the five cleansing techniques of ayurveda that are aimed at both disease treatment and rejuvenation.
In the mind/body medicine and combined-therapy departments, students see how yoga complements a client’s allopathic treatment regime. Holistic health care workshops are provided at our ashram on the Ganges River in Rishikesh (about 18 kilometers from HIHT) for groups of visitors, including students, who spend weekends or even months working on self-awareness and its impact on prevention and treatment of many chronic diseases, such as heart disease, cancer, diabetes, arthritis and respiratory disease. The combination of these holistic health care activities is what makes the Himalayan Institute Hospital unique, even in India.
Faculty benefits
Surprisingly, faculty members seem, at times, to benefit even more than students from these international exchanges. Faculty members from the Himalayan College of Nursing see hierarchical barriers between students and teachers from abroad soften as they witness India’s less formal communication patterns. Faculty members from India are exposed to the commitments that their counterparts from abroad have to continually update their clinical expertise and how this affects their teaching, in both the classroom and clinical realm. As a result, Indian faculty members often broaden what they expect of themselves and their students in clinical areas and are enthusiastic about enhancing their own professional endeavors.
The former principal of the Himalayan College of Nursing and the nursing superintendent of the Himalayan Institute Hospital had the opportunity to spend a month in England to witness nursing education and health care delivery in that country. This experience gave them firsthand exposure to interdisciplinary communication and teamwork that emphasized equality and respect among multiple disciplines.
Faculty members from abroad are mesmerized by the complementary approaches to health care they observe in India and are surprised by the successful results achieved in many situations. They eagerly take part in yoga workshops and early morning hatha yoga classes to enhance their own personal health. Some faculty members take advantage of meeting with holistic health care physicians to discuss treatment of their personal health problems.
Institutional benefits
The greatest benefit for our institute, as well as for schools from abroad, is the opportunity for long-term collaboration and support. This collaboration can take many forms. Over the years, support for HIHT has included donations of textbooks and audio/video aids. In the early 1990s, California State University, Dominguez Hills, donated several thousand books that the World Bank arranged to ship by sea. Many publishing companies in the United States also donated books. The University of Wisconsin Oshkosh donated two full manikins and four manikin arms that were shipped—duty-free—to enhance our nursing arts laboratory.
HIHT and institutions abroad have discussed future collaborative research opportunities for both faculty members and graduate students. Multiple international agencies—the Bill and Melinda Gates Foundation, USAID, World Bank, World Health Organization and Tata Ratan Foundation, to name a few—have provided funding for HIHT. Curriculum development continues to be enhanced through consultation with various schools from abroad, such as Alverno College in Milwaukee, Wisconsin. In addition, expert library services are available to us through the generosity of personnel at the Alverno College Library. There is not enough room to name all of the individuals and institutions that have helped HIHT survive and grow to the deemed university status it has achieved. Our mission will always be to “serve the underserved,” and it appears that international arms will always be reaching out to help us along the way.
Most foreign visitors have never been exposed to an institution that has a strong spiritual base without attachment to any formal, organized religion. Individuals from all creeds are equally welcome at HIHT as patients, students, staff and faculty members, as voiced in the morning prayer that is sung daily (except Sundays) in front of the hospital, with speakers inside the building to reach patients and their families.
In expanding its horizons, the HIHT International Program has proved that health care professionals are indeed part of a global family that has the potential to solve many problems if its members continue to work together and pool knowledge, experience and resources. Solutions to the problems of inequality of world resources are available. We just need to reach out and touch one another. We are grateful to those who have touched us and pray that the experiences they have with us will enhance their ability to touch others. RNL
Renu Dhasmana, MBBS, MS (ophthalmology), is director of nursing education and nursing service, Himalayan College of Nursing, and Kamili Prakash, MSc, RN, is professor of nursing, Himalayan College of Nursing. Direct inquiries to Renu Dhasmana at renudhasmana@gmail.com