Transcribed from the recording and lightly edited for readability. The presenters' views are their own and do not represent the ARC-PA. Confirm specifics against the current ARC-PA Standards and Compliance Manual.
0:00 — What this session is, and is not
Jennifer Eames: Today we are going to talk about service learning, and connecting your program and institutional mission to outcomes.
Jennifer Eames: First and foremost, what this session is not. We are not representatives of the ARC-PA, and so we are not here to offer any sort of official interpretation of the standards. We will reference the standards as we go through this presentation, because it is important to keep in mind some of the standards that apply when talking about service learning and how it aligns with your mission. Everything that's quoted, that we have documented here, comes word for word from the ARC-PA manual — specifically the Sixth Edition Standards. And again, there's no CME offered for this session.
0:57 — Institutional missions are vague. That is workable.
Jennifer Eames: It is the program mission. We all either start a program, or take over a program, or are part of a program. That's a key requirement — that you must not only have a mission statement, but that you must review it regularly, and that all principal faculty and the medical director must engage in ongoing analysis of the mission. Then, in addition, you have to have goals and lots of other things.
Jennifer Eames: But when you're initially writing that mission, or when you're revising it, how do you know that it aligns — which is another required component — with the mission of the institution? So first and foremost, you have to start by looking at your institutional mission. Now, those can be all over the map. Most of them are pretty broad and vague. Many of you are at institutions that are allied health centers, health science centers, schools of medicine and nursing. So your mission may be quite nicely and tightly aligned.
Jennifer Eames: However, a lot of you are at larger institutions. Some of you may be the first medical program on the entire campus, and if so, the university's mission may have absolutely nothing to do with what you're trying to do in your school. Well, how do you connect that?
Jennifer Eames: A lot of institutional missions are vague and broad, and they say things like “make wonderful learners for life,” or “serve the greater good.” And many are actually religious institutions. We found ourselves in that situation, where religion was in the core mission of an institution where we both worked, and so we were trying to connect how that aligns with the mission of the program. And we did determine, for us and for many of you, that a lot of times service learning can be a way to align the two — to build it in from the beginning and make it part of your program's mission, so you can connect the big picture.
Jennifer Eames: We also see a lot now — and we'll talk about this a little bit later — how we're seeing a new generation of students coming in that is perhaps in some ways less ready or mature than previous cohorts of learners to enter a workforce situation. And through service activities, we often find they can grow in many areas and gain potential for their future career. So this is a great way to align missions.
Jennifer Eames: Even if you're at an institution that's religious — for example, if they said “uphold the modern principles of Judaism,” or the institution's mission is “make disciples of Jesus,” or something like that, that's very, very specific — you can whittle that down into something service related. In most foundational religions there's a service core, of serving the greater good. So you can definitely connect that with medicine, and more tangibly connect it through a service learning experience you build into your curriculum.
4:12 — B1.01a: the curriculum must be consistent with the mission
Jennifer Eames: So let's look at some of the standards that will align with that mission work. B1.01a says that the curriculum is consistent with the mission and goals of the program. And again — are we aligning what we've created within our program mission to the mission of the university? Because things should be in alignment there as well.
Jennifer Eames: And the institutional mission typically is submitted as part of your accreditation application submission. So if you're a new provisional program that's getting started, that's one of the first places to start: to create that mission. And what is it that you want to do at the end of your program? What kind of provider do you want to be putting out there into the workforce?
Tina Butler: And so, like Dr. Eames referenced, we are part of a religious private university, and there is a lot of faith-based language that is being used within our mission. And so we really wanted to tie that in to the mission of our program. Both of us are extremely passionate about serving mankind and serving others, and so it was a natural fit within our program to extend that part of that faith service orientation to our students, with service and volunteer hours. That's how we sort of tied some things together within our own program.
5:46 — A1.10b: international sites carry electives only
Tina Butler: One thing to remember in relation to travel SCPE policy is that all of the rotations that are used for the core rotations must be located within the United States. Global experiences cannot be used for core rotations. You can use them for elective rotations.
Tina Butler: And so if you decide within your program that you want to build a global elective rotation, and that really aligns and is something that you can connect to your university's mission, then you can create a supervised clinical experience. But it has to be an elective. It cannot be a core experience. So just keep that in mind when you are creating some of these things, and how you want them to be delivered.
6:43 — Call it service learning, not a mission trip
Jennifer Eames: So just a little caveat before we move forward with the accreditation standards. There's been a lot of language about mission trips — many programs still call them mission trips. But the purpose of this: we call it service learning, because that's really nonspecific and can be translated across many areas.
Jennifer Eames: You also want to be sure that anytime you do write a mission statement, you make it inclusive and not exclusive. Even if there is a component to it, you want to be sure that it is going to pass muster with the ARC-PA, because you want to always be inclusive to all groups with that statement.
7:20 — A3.09b, word by word: publish it, and make it findable
Jennifer Eames: Moving forward, we want to talk a little bit more specifically about the travel health policies. A lot of times, if you're doing a service learning trip, it can be local or it can be global, and today we'll go through most of the different options. But specifically, the ARC-PA has language about anything global — as Dr. Butler referenced, it needs to be found in an elective.
Jennifer Eames: Additionally, even if it's not part of a course, even if it is a purely voluntary activity put on by your program, you must be sure that your policies and procedures align with the CDC — the CDC recommendations for travel and vaccinations and health-related mandates.
Jennifer Eames: So it's very important, when you look at any standard but specifically this one, that you need to break down the words. You can't just globally understand it. You need to break it down word by word. So at the bottom of this slide it very clearly says you have multiple obligations with this one standard, as with most standards.
Jennifer Eames: One, you have to publish it. What does that mean? You can publish it in your handbook, but I highly recommend that you put it on the website, because then it's available for both prospective and existing students, and you don't have to update some PDF somewhere on different sites. So just publish it on the website. That is our recommendation.
Jennifer Eames: Make it findable. So label it. Don't bury it in a page with a checklist. Label it “CDC health professional guidelines,” “mandates for international travel,” or even “A3.09b” — because what you always want to do when you're preparing for some sort of a site visit, or just in general, because they do use them to check websites for compliance, is be sure it's easy for everybody to know that you are meeting components. Label it and make it accessible.
Jennifer Eames: And then CDC guidance. I do want to mention there's been a bit of changes to the CDC website in the past year. And so we just want to be sure you're keeping current with what is recommended for health professionals. And that's the important keyword. It's not for infants or for elderly. It's for health professionals. So that's the category we're looking for here. And that can be age-specific, so depending on the age of your students you want to follow the guidelines.
9:51 — Apply it consistently, and what one exception costs
Jennifer Eames: Then the last part is applying it consistently. You never want to have a policy — and I was actually speaking with another program director this morning about this — you never want to set a policy and then provide wiggle room. That is not applying it consistently. You must set a boundary and hold the boundary.
Jennifer Eames: Once the boundary is set, you need to be sure you're holding students and faculty and others all accountable for maintaining that, and with the understanding that there's always going to be challenges to meet that. And occasionally there could be a circumstance where you could consider making an exception. But honestly, every time you make an exception, what you've done is open yourself up — because now all the other students that did comply have a valid case to say: why was I required to go through this, that you did not ask of this other individual?
Jennifer Eames: So trying to hold that boundary consistently, and applying it consistently, is very important. And that is often a question that visitors ask at a site visit. They might ask the students: hey, are there different rules for different folks? Or is it equal across the board, the application of policy? So that's something you want to be aware of.
11:04 — The questions a reviewer will ask
Tina Butler: So as you're looking — if this is something you're going to be incorporating into your curriculum itself — you do have some questions that you need to answer. And Dr. Eames definitely referenced several of these on the previous slide. But where are your travel health policies published? Are they in the student handbook? Are they readily available? Can you identify the page number to reference very quickly? Can you get to it within three clicks or less? You know, that's what readily available is — kind of the typical thing that we say.
Tina Butler: And what is the travel health policy? And again, where is it published, and are you applying it and following the CDC recommendations? It'd be good at least once a year to go through and look at the CDC, and look at your travel policy, and see: are they in alignment? And are we continuing to require our students, on their immunizations and health record forms, to be in alignment with the CDC recommendations?
Tina Butler: And if you're traveling out of country too — and let's say that this is an elective rotation — where are those immunizations being published? Because you also have to require them, not just to enter into the program, but also to attend this particular service-oriented elective. What are the requirements that that student would need to complete?
12:31 — Evidence files, and the safety standard
Tina Butler: And so the other thing that you want to make sure that you're doing is making sure that your files, and any discussions, from the beginning — that you have your evidence files in place, should the ARC-PA want to know: how did you come about this? How did you decide to do this? Why did you decide to require this versus this? You just want to have the evidence of all of that. Copies of your meetings. You know, maybe the group discussion that was held, the little brainstorming session. Just document any meeting that happens, so that there is evidence of how you went about doing this.
Tina Butler: The other thing that I want to point out as well is to make sure that if you are deciding to do an international mission trip — or whether it be a rotation, no matter what work that you're doing — that you're also remembering the ARC-PA standard that is related to safety. So what are your safety policies? How are you going to make sure that that student is safe when they're in another country, or when they're doing this other service project? Because what happens for all of our rotations needs to happen for this rotation as well.
Tina Butler: So we'll talk here in a little bit about how you go about maybe looking at potential sites that you could use for a clinical rotation or for a service learning experience. So we'll talk through that, and maybe some of the things that you might need to consider in the future.
14:06 — Program goals, written and unwritten
Jennifer Eames: So now we're going to be doing a little bit of show and tell. We're super proud of some of our student experiences. This is a fantastic picture that illustrates a great service learning opportunity, and Dr. Butler can share more about what was happening here. But this was one of our happy students.
Jennifer Eames: What we'd like to do now is talk a little bit about how your program goals can be written and unwritten. Obviously, we all know that you have to have program goals. They must be measurable, and they must be published on your website. And evidence of achievement must be very clearly outlined for each one of your goals, and updated regularly, or you will be potentially contacted by the ARC-PA.
Jennifer Eames: So your goals might have things that are measurable, like PANCE results and things. But a lot of you — if you look at your website now, look at your goals. You might have vague language in there, and you really want to make something a goal, but you can't think of a way to measure it. So what about something that says “lifelong learner”? How do you measure that? Competent graduates. Growth. Empathetic providers. Serving the greater good. Those are all somewhat nebulous words, and very challenging to measure.
Jennifer Eames: Also, you probably likely have unwritten goals. What do you really want that may not be published on the website? You just want to have great students that do great things for the world, that you would trust as your own provider, that you would send your family to. You want them to give back to the profession lifelong, right? So those are some things you may not have as tangible. But we're going to give you some strategies about how to make some of those nebulous concepts more measurable and more tangible, through designing activities specifically with benchmarks that will help.
Jennifer Eames: So, Dr. Butler, can you share what was going on in this picture?
15:54 — Hawaii: a domestic project inside the foster system
Tina Butler: Yeah, absolutely. So this was one of our mission trips where we actually went to Hawaii, and we were working with a local foster group. And we were doing a back-to-school ramp-up and really trying to get supplies for the foster children within that community. Because while we know that Hawaii is a lovely place to visit and travel to, it's very expensive to live, and there are a lot of individuals there who are within the foster system.
Tina Butler: And so this allowed us an opportunity to, one, expose our students to the foster care system, and then how they could have an impact domestically. You know, even though Hawaii is a little bit further away from where we are located, it still was a domestic service project that we were a part of.
Tina Butler: And so one of the things that we did on the side while we were there — they had a little local, just sort of charity location where you could get clothes and other supplies for individuals who are within the foster system. And so we were helping to sort of clean things up on one of the days that we were working there. And so this is just a picture of one of our students. I'm in the background sorting out clothes. And this is some books that we were putting together and packaging so that we could give out as well, when they had individuals come to visit the store.
17:21 — Service in admissions, and in the program's culture
Tina Butler: I'll talk about this picture here in just a minute, as far as what we're doing here. But service is something that for our program is very, very important. And so we are very intentional. When we're looking to bring a student into our program, we want to see: what has your service been like before you've even come to our program? What are the expectations when you get here?
Tina Butler: Because some programs may say that you don't have time to do service — you're so busy with PA school. But our perspective has been very different, because it is a core foundational part. Part of our program is grounded into our mission, and so we intentionally carve out time for our students to be able to do service projects, whether they be local, domestic, international. I mean, we are all over the place when it comes to service.
Tina Butler: And so we really set the example. So when we have our interview sessions, and we're looking at recruiting really high quality students, when we're introducing our faculty and our staff, we're talking about the service projects that we're involved in. We put information into their interview folders so that they know what are some of the things that we're doing as a program. And so we're very intentional about building that and showing that to our potential applicants. And even with new faculty and staff hires: this is what we do. This is what the expectation is — for you to be involved.
18:56 — Boots on the Ground: wheelchair ramps with a local church
Tina Butler: We work a lot with our community partners. And so this picture is us partnering with a local church. It's called Boots on the Ground. And so what we do is, several times a year our program will go partner with this organization, and we will build wheelchair ramps for individuals within our community who have mobility access issues.
Tina Butler: And so this is maybe an individual who is wheelchair bound and cannot leave their house because there's no ramp. And so it makes it very difficult. It's a burden on their family, and that individual really feels trapped within their own home. And so our students get an opportunity to meet members of the community and do a service project for them. So in this case, building wheelchair ramps.
Tina Butler: And at the end of it, because we are a private university, we also incorporate that faith aspect of it. And we pray over the resident of this home, and we give them a Bible. And it's a very rewarding experience. And the students get an opportunity to use power tools, which is really fun. And, you know, maybe if they're interested in orthopedics, it might kind of prepare them for that orthopedic surgery rotation. So it's really exciting. My husband doesn't really let me use his power tools, so this is my opportunity to be able to use some power tools. And I get yelled at oftentimes because I don't know how to use it properly. But it is an exciting thing to do. And we really get the students involved in this.
20:29 — A class officer, and priority review for volunteer hours
Tina Butler: We have a class officer position, so that that student works with the faculty and works with the students to help coordinate these service learning projects, especially a lot of the local ones that we have going on. We do expand this throughout. Our service projects are definitely local, they're at the state level, and they're also international. This is something that we feel really sets our program apart, and we have individuals who are very interested in giving back, who are very motivated in service.
Tina Butler: And one of the things that we have changed this year with our recruitment process is to do a priority review for those individuals who have more volunteer service project hours that have been recorded on their CASPA application. We publish it, because this is something that we're looking for. We make it readily available. We want applicants to know that we're going to look at your application first if you have more volunteer experience — because again, it's such an integral part of our program.
21:40 — Make it stick: the 50-hour benchmark and three logs
Jennifer Eames: Great, great work there. And, you know, some of these projects only take an afternoon, like that wheelchair ramp. It's less than a day. So that's pretty great. You can make a big impact in a short Saturday, where some are long term.
Jennifer Eames: So to build this sort of a program with this sort of a culture, and you want to make it stick, you want to tie this to expectations. And this is what I was talking about, making it measurable. So perhaps you set a benchmark. And that's what our program has done — that every student will have a minimum of 50 service hours before graduation. Or if it's at another benchmark, you could do 20. There's many variations of this. Whatever you feel is achievable for your program.
Jennifer Eames: And we put it on the website under the goals, that we have met this goal, because we can demonstrate it — we track this over time. We make them turn in a log at the end of the didactic year. They turn in a log at the end of the clinical year. And then they turn in the log at graduation, to be sure all of these are met. And honestly, most of the time the students far exceed the benchmark. They greatly exceed the benchmark, which is great to know that they are committed.
Jennifer Eames: This is a true through-line. It's connected all the way through from our admissions processes — Dr. Butler was talking about that. It's not necessarily a requirement for us, but it is preferred. And you get extra points and priority review on the application process if you have these sorts of volunteer hours and service projects in your background. And it's something you can talk about in your interview, that you're passionate about and that you would want to connect with in our program.
Jennifer Eames: We also want to be clear on the website and in the handbook that this is a commitment from day one. So if this is not what you're into, you just want to come and learn — perhaps you need to select a different program, because we are going to require that you participate in some service learning. Whether it be this type of activity, building wheelchair ramps, or — here's another example — packing backpacks full of school supplies for children in need. So these are great activities that you can give back locally, internationally, globally, anywhere in the world.
Jennifer Eames: Now we're going to transition our slides to just a little bit more about these local trips. And back to you.
23:45 — Meals on Wheels, the food bank, and a puppy team
Tina Butler: Yes, thanks. So we're involved significantly within our community. We have things that maybe happen once a year. We have things that are an ongoing process as well, that we're doing on a regular basis. So for example, our students do Meals on Wheels. They have adopted a route, and that is something that started with our very first cohort. And now we have just matriculated our tenth cohort, and that cohort is picking it up as well. So every Monday that cohort delivers meals — hot meals for lunch — to individuals who are homebound. And so this is something that has been ongoing since we started our program. And we thought that this is such a huge impact on our community that we, as a program, carved out that hour of lecture time. So we don't have lecture every Monday at 11 a.m., so that our students can go and deliver meals to individuals within our community.
Tina Butler: We do short term stuff as well. We've done a little bit of work within the food bank. So this is a picture of us just sort of helping the food bank out, because they had received a ton of donations and they needed help being able to distribute and pack all of this. And so we went in and we said yes to that. So we are often sharing with our community and telling them about the work that we want to do.
Tina Butler: We have ongoing projects that are long term, so we partner with Canine Companions. And so one thing that's unique about our program is that we have dogs in our program. Canine Companions is an organization that helps to raise future service dogs. So we've created a puppy team, and individuals that want to serve on the puppy team, they will keep that dog and help train that dog and socialize that dog. We get it when it's eight weeks old and we keep it until they're about 15 to 18 months of age, and then that dog will get turned over to professional training to see if it will make it on to become a service dog.
Tina Butler: This is an extremely rewarding and sometimes tearful experience, because you have to say goodbye to this beautiful dog that you've had, you know, for the last year and a half. But then you're really excited, because you know that this dog is going on to impact somebody else's life in a way that is so unimaginable to me, you know, as a human without a disability. And you also get the added perk of just having little snuggles from the puppy. So when it's test day, everybody gets to do a little extra pet with that little dog, so that everybody can pass the test. But it really kind of helps some stress relief as well for some of the students.
Tina Butler: We are oftentimes, like when we're doing our local service events — like when we do Boots on the Ground — we bring our families in, and we have the students bring in people that they want to help serve as well. So we don't limit it to just our students. We invite additional individuals that we know and within the community, because it's just doing good for somebody else.
Tina Butler: Again, Dr. Eames had on a previous slide: how do you grow good humans? You teach them how to serve other people, and how to give of themselves, and to allow an opportunity for them to serve people when they're in their most vulnerable states. That's how you make good humans, right? And that's what we want. We want you to be more than just a provider and know the medicine. We want you to be a good human. And so there are so many things that are easy, low hanging fruit, that you can do within your program that has a lasting impact and really helps to create and grow good humans that will continue to serve their community outside of their capacity as a health care provider.
27:43 — What community partnership does for clinical placements
Backing up just a little bit, one thing that we haven't talked about is the benefits of the community that you serve. Obviously, there is a direct benefit to the organization. However, there's also a benefit to you as a program. In an era of highly competitive clinical placements, it never hurts to have some key partnerships where your community partners, your soon-to-be partners, know your students are there for the long haul. They are engaging the community. They're not just coming for a degree and leaving. They're actually putting back into your community while they're there.
And I mean, I'm shameless about putting it out on social media because of that reason. We need to let the community know we're here. We always frequently say: what else? What should we do next? What's our next project? Comment. Let us know. We need to get out there. That's how you find out about these things. You start with one project, you connect with another, you connect with another, and it makes a future legacy, basically, for your program.
28:44 — International: partner with sustainable work, go as a learner
So we're moving on to international service learning trips. And the most important thing I can say about international service learning is that you want to be sure you are not coming in as somebody just flying in for a week and thinking you're going to make an impact. But the key is to partner with sustainable work — that you need to value-add, not value-subtract. Anywhere you go, with any project, and specifically on international trips.
You never want to go in thinking you're going to change things in a two- or three-week experience, or a one-month location. Go in as a learner. You're going to learn from what you're doing, and you're going to be humble about it.
But the key is the sustainable organization. So really put a lot of time and effort into researching the partner that you're going to be working with. Are they ethical? Do they have trust in the community? Is this something that the community — whatever you're doing as part of your service — is going to need and appreciate? So, for example, you always hear about everybody bringing in water filtration. Well, maybe that's not what the community needed. Maybe they needed a farm or something. So always research what the community needs, and what the nonprofit you're working with will actually be doing to benefit them.
30:00 — Safety: immunizations, the State Department, the pilot trip
Safety is key. We've talked about immunizations, and immunizations do take time, so throwing together a service learning trip in 6 to 8 weeks is almost impossible — to get all your immunizations and timing done, and planning. So we do recommend planning at least a year in advance for these trips, and kind of really being thoughtful about scheduling time to plan on a regular basis.
You do want to register with the State Department. For those of you who've never done an international service learning trip, there's actually a page at the State Department. You register what dates you're going to be there, and they provide safety alerts. And we put the onus back on the students. We have them do this, but then we have one person report back at every one of our planning meetings: what's the latest safety update? Please remind us all, if they haven't been monitoring their emails. So that way we're getting them involved in that buy-in.
If you're going to a place that has been not as safe at some point, consider a pilot or exploratory trip — especially if there's going to be a language barrier and you don't have a lot of students with language capabilities, and a lot of faculty with those capabilities. We want to be sure you do a pilot trip with just a couple, a handful of faculty or leadership, and even university leadership, to be sure this is a doable thing. You're going to want to think through logistics. You're going to want to think through: where are we staying, what are we eating? What does the schedule look like? What does the transportation look like? All of those things, before you show up with a group of learners. That's very important.
31:27 — Training, and giving every student a job
Training, training, training. We're going to do lots of training about being able to be respectful. We're going to do lots of training about anything that we're doing — what we can and can't do, what are the limitations of the organization, et cetera. So everybody is going in eyes wide open. This is not a beach trip. This is not an all-inclusive. You may be sleeping on cots or a floor or whatever. I mean, you need to tell people going in.
And as part of that planning, as I mentioned, making sure every student has a responsibility. We have set up our service learning trips with stations, oftentimes. So, for example, we'll have an eyeglass station. And most of our trips we do the vitals station and other things. And so each student has a job, and they deal with planning that section — obviously with faculty oversight. But dividing and conquering is better than just signing up, paying a check and showing up. They need to have buy-in from day one and be part of this planning process.
And when we talk about buy-in, and we referenced it earlier: it's not just the faculty and the student. I would say staff too, because every single international mission trip, we've taken a staff member or two with us, and they've been a huge help. Just when we do clinics like this and we have somebody working triage, the students learn what that intake process looks like. But that's a great role for somebody who doesn't have medical experience. And it doesn't tie up a student — it allows that student to be able to observe multiple things that are happening — and it doesn't tie up a provider.
And when we do our international mission trips, we're now at the point where our alumni are joining us on these trips. So when you start within the program doing these activities and these service projects, and the students just absolutely adore it and love it, they want to continue serving and going back. I've had two alumni that have gone on three international mission trips with us, and so that has been a very rewarding partnership that we've been building from day one, when they started as a student with us.
33:31 — Fundraising 101
And in order to be successful at this, you need to have money. So it takes money to travel internationally, and you know that it is not in my budget to be able to fund everybody to go. While I wish that it was — that would be fantastic. But fundraising has to start on day one.
So what we do on orientation is we talk about what our mission trips look like, what our volunteer opportunities look like, which ones would require the student to have monetary buy-in in order to be able to attend this. And then we start fundraising. So within that first month of them starting the program with us, we are already fundraising.
So we get websites set up so that they can get donations that are being placed within their names, that could be tax deductible. We do profit sharing. We go around town and we find all kinds of businesses that are willing to share their profits with us. The students have done garage sales and bake sales. Garage sales are very profitable, so we do one every single year — sometimes twice a year we'll have garage sales. We'll do bake sales here on campus. We have chapel that the undergraduates have to attend, and sometimes our students will sell donuts and coffee afterwards, just like if you were going to church and there's donuts and coffee afterwards for everybody to continue with fellowship.
It's an option that you could build this in as a fee or a tuition, depending upon what your structure looks like. We have not done this yet, but this is definitely an option depending upon how your program is. And then there's always an opportunity for grants and scholarships. So be on the lookout to see: is there anywhere that maybe you could apply for a grant, or is there a special scholarship that is out there? Because people want to help. There are so many generous people out there. So do some research, see what you can find. Because for our last trip, when we went to Peru, I mean, it was about $3,000 a person. It's not cheap, and it's not cheap to go to school. We all know this. And so whatever you can do to help fund your students and your faculty and staff to be able to get there, do it. Start early.
35:53 — Supplies: why shipping fails and checked luggage works
Jennifer Eames: So, supplies. How do you get supplies with you there? Well, this is a tricky thing. My first time taking a student to central Guatemala, in the highlands, was an interesting experience, because I assumed, incorrectly, as a young faculty member decades ago, that I could get the address of where she would be living and mail items to them. And that is an incorrect assumption. In much of the world there are not reliable addresses in many, many regions of the world. There's just colloquial terms for where things are. But shipping is challenging.
Jennifer Eames: Additionally, there are parts of the world where shipping requires customs approval, and things that come up in customs, and there are delays, and then there are corruption issues. Unfortunately, not in that specific location, but in other locations that I've worked there have been big challenges with shipping.
Jennifer Eames: And so we found a workaround that is amazing, and has worked really well for us strategically on lots and lots of trips, for us to take volumes of supplies — I mean supplies enough to treat upwards of 1,000 patients in just a few days. Okay, so lots and lots of supplies. And that is cheap checked luggage. And now, if you can ship, ship. By all means, please ship in advance, if it works and the organization is sustainable on the ground and can receive it. That's the greatest way to get supplies down there. However, we found out early on you can go to the thrift store and find discounted, cheap, almost-falling-apart luggage that is one or two dollars. Pack it full of supplies, pay a checked bag fee — or some people have the right credit card and you get a free checked bag. And if every student takes one extra checked bag, and every faculty member takes one or two extra checked bags, that's a lot of supplies that you can get for a relatively low cost. And you can keep kind of eyes on them when they arrive in the airport. Hands on them. They're not lost somewhere in the universe.
Jennifer Eames: So you collect supplies in advance. You need to know what you're doing when you're there — what is the actual activity that's going to be? Is it a school supply drive? Is it a medical clinic? So be sure you research what is legal and what is not legal to import. Most countries do not allow expired medications. You often have people say, well, this is expired, can I donate it? Most countries will not allow you to import that, so be aware of that. That is a challenging area. It's nice to have for practice and things, but it's not allowable in places.
38:31 — Sourcing: Blessings International, Americares, the dollar store
Jennifer Eames: And there are companies — I put a few there. Blessings International. Americares is another one; Americares is a big one. You can buy bulk products if you're going to be in an international location. Interestingly enough, those two do not allow for domestic location trips, but they do allow for international. And if you give the location of the international trip, and you have an international partner that you can identify, they will allow you to buy, you know, 700 doses of amoxicillin, or whatever you're taking with you. Lots and lots of medications, and antihypertensives, and things that you can take that are still within date. And they're very, very inexpensive, so you can get them for basically the cost of shipping. So those are great organizations to partner with.
Jennifer Eames: You can also get things at the dollar store when they're on the penny sale. And we've found a lot of things that we can buy that are products — you would be surprised. A lot of places in the world, things that we take for granted are godsends to have on hand. You know, when somebody has a fever, when somebody's arthritis flares — little simple things that you can give somebody that are really helpful for them. Obviously that's not a long-term medication, but for short-term help, for when they're going through a problem, to have on hand and use as needed — very, very beneficial for people.
Jennifer Eames: Glasses are one of the most rewarding things, because it's an instant change in their life. You know, they go from not being able to read to being able to read, and it's pretty impressive. And it's a pretty amazing moment when you give somebody a pair of readers, and their face just lights up. Wow, this is amazing. Again, you can get readers often for a dollar at the dollar store. You know, cheap readers, a bulk Amazon order of readers.
40:19 — Customs, donation forms, and caring for your own students
Jennifer Eames: I can tell you a funny story. One time — so this is a picture of us with all our donated suitcases that we plan to leave in the country, so we don't have to bring them back. And then that's another blessing: somebody else gets a surprise.
Jennifer Eames: So one time — you do have to be careful about tags. We had bought a ton, and we had a lot of donated glasses, but they still had tags on them. And so one time in customs we got stopped and really almost got in trouble, because the customs officer at this country was convinced we were about to try to sell these illegally. We didn't have a sales ticket, we didn't have a permit to sell glasses. And I said, no, we're giving them away, and had to show them the form.
Jennifer Eames: So that's another thing. You want to be sure you have a form in every checked bag that says exactly what you're doing for your humanitarian organization: this is all donations, none of this will be sold. So you want to be very clear that your partner organization has given you a form to put in each checked bag, and put it in your own bags, that none of this will be used for sales — and in the language, in the local language. That's really important.
Jennifer Eames: The other thing to do is think about student care. So a lot of the countries we go to do not have safe drinking water, and we tell students: do not drink the water. Inevitably they drink the water. You do want to have on hand a few medications for diarrhea, a few packets that you can pass out to your own students. I know you're supposed to be a health care provider, but somebody else on the trip — an alumni — can be their health care provider. Okay, that's fine. But something on hand that they can take. And then also, a lot of places we've been, we give everybody an anti-parasite medication afterwards, in case they picked one up. They're so cheap. They're just passed on out, if they agree to that, of course. We also encourage our students to buy a LifeStraw.
42:11 — Finding a right-fit partner
Jennifer Eames: This is another example of a wonderful partner. This gentleman is a wonderful man. He's a clinical officer. That is the Kenyan term — in many parts of Central and East Africa, the equivalent of a PA is a clinical officer. And he was a great partner in one of our clinics in Kenya that we did. And so we were very, very lucky to have him.
Jennifer Eames: You never just want to show up and set up a tent and run your own clinic. Use local providers to build that trust, to be sure you're following local customs, local respect, et cetera. So he was fantastic. He actually had a spinal condition as a child, and lived in the facility that we were serving in, where children were in assistive devices and learning to walk. And he was able to learn to walk, and now even rides a motorcycle and serves community. So he's a success story. So he was the right fit partner for us. And then many of his other coworkers — obviously it was a big organization.
Jennifer Eames: And you want to be clear about the time commitment for students. And then you don't want to directly fund individuals, so just be careful about that. You never want to send money directly — like we didn't pay this gentleman directly. You pay the organization. Just because that can get into muddy waters about payments and international funds. And then don't be afraid to say no. Sometimes clinical partners across the world will ask for things that you're not comfortable with or unable to provide, and it's okay to say no. But try your best to fit the needs.
43:44 — Build a community team: PT, pharmacy, and the plumber
Tina Butler: So you can't do this by yourself. You definitely need a community, so bring people along with you. When we were in Kenya, we had our physical therapists come with us, because there were a lot of orthopedic issues. And I think that was probably my all-time favorite one that we've ever done, because everybody came in with back pain, and it was wonderful to do a referral to PT so that they could teach them really good stretching exercises. We've brought a pharmacist with us on multiple international trips, and he's amazing and is able to make suspensions of antibiotics from a pill. It's actually quite impressive.
Tina Butler: Consider bringing a dentist with you, or an optometrist with you. And who else can you partner with? If it is a faith-based organization, then maybe somebody from a ministry division within your university, or within the community, may want to come and join with you. Because you can't do it all by yourself. You definitely need community. And the more people that you bring with you, the more people that you're serving, and the more blessings that you can provide to other people. And you enhance the opportunity of learning for the students, and potentially they get to see interprofessional educational experiences. Because, you know, we had our students rotate through the pharmacy, rotate with physical therapy, see what they're doing with wound care. It was an amazing, amazing experience for our students on those trips.
Jennifer Eames: And I do have to say, on one of our trips at least, we took lawyers, doctors, everything. The most valuable player of the team was the plumber — it was one of the nurses' husbands. And let me tell you, he made a huge impact, forever, on that place. They were very thankful to have him. They had a therapy pool at one of the places for the children, and it wasn't working, and he fixed it, and that was a value-add we got to leave behind. So you never know where you're going to use people's skills. He said, what am I going to do? And I said, we'll find something. And sure enough, that was meant to be.
45:55 — The schedule: a set-up day, a rest day, and an end time
Jennifer Eames: All right. So we talked a little bit about making a rotation schedule, because you don't want a student to do the same thing every day. We want to be sure you have a building or a set-up day, to make sure everything is ready to go before you have any sort of activities related to service — or a rotation of duties. And then a rest day, if it's long term, more than ten days: maybe one in the middle and one at the end. But a rest day to get people acclimated, especially if there's a big time zone difference. You don't want to jump right into work the morning after flying on 12-hour, 14-, 16-hour flights. It's going to be challenging, so you have to build time in to be sure people can acclimate. If you're at high altitude, that's the same thing. And then time for travel home. We want to build your timeline in advance, but always be flexible. We say Semper Gumby, right? We have to always be flexible, because things change and you have to be able to adapt.
Tina Butler: And make it fun. So you're asking these students to do a lot of hard work. It is long hours. It is emotionally, physically, mentally taxing. And they're going to need release. They're going to need a break. You're going to need a break, okay? So make sure that you're including some sort of cultural experience in there. So (a) they get to learn about the culture, and (b) they get to have a little bit of fun, and it creates some wonderful memories, and might inspire them again to continue to serve alongside you even after they've graduated. So definitely work on that. We're going to show you a few pictures here in just a second, but work on really incorporating some sort of cultural experience on those international trips.
Jennifer Eames: When you're setting the schedule — I'm going to go back really quick. When you're setting the schedule, I learned the hard way to have an end. I did not do that on one of my trips initially, and we just said we'll serve until the last person is served. Well, at 16 hours, nearly 10 p.m. at night, there was still a line out the door, and we said: we cannot. This is not sustainable for the next seven days. So we do need to set a schedule where we're closing intake at this time every day, and you can come back tomorrow, you'll be first in line, whatever the case may be. But you do need to be sure there are benchmarks around that, and your in-country partners should know that. This was a partner that wasn't aware, and in response to that they were very pleasant, but it was not something…
Jennifer Eames: But all these are great pictures. I actually took this picture from behind the camera, so I got to see both sides of it. Both of these pictures I took. So this is Dr. Butler almost to the border of Tanzania. On the other side of that vehicle is Mount Kilimanjaro, and then you would see that in the background in the park. And this is Machu Picchu, outside of Cusco, Peru. That was one of our first international trips with this program that we did, and they did great, great work in that area, and then got to do a cultural day at the historic site.
49:07 — Who benefits
Tina Butler: So who benefits from service projects? You know what, we always say that we want to do this because, you know, I want to help somebody, I want to serve somebody. But I tell you, sometimes I think that I'm the biggest winner in this, because of how much more the community that we are serving gives back to you. You would not believe the amount of gratitude and joy that you will see from individuals in these impoverished communities. It is so uplifting. So yes, the community you're serving is going to benefit — but so are your students, so are your providers, so are all the other people that you bring along with you. So this quote is fantastic: the giver is always more blessed than any recipient. I would reiterate that a thousand times.
Tina Butler: Dr. Eames, I think you have a story about this picture.
Jennifer Eames: When I say be flexible. I didn't put any pictures intentionally of any patients on this slide. But this is someone who, before the clinic started, brought what she thought was going to be the first patient for the clinic — which is her animal. She wanted us to treat the animal. The animal had an injury. And that was the first request of the day, before we even opened: could you please help me? And so you never know what's going to be the need, and what's going to walk in your door. So we did attempt to clean the wound of the animal and give some assistance. But that was unexpected. Expect the unexpected, right? So you've got to be flexible, and always have gratitude in all we do.
Tina Butler: Thank you. And I think it really does allow an opportunity to enhance the students' perspective. Many of our students come from — especially, we are a private university — many of our students come from privileged backgrounds, and they just don't know what they don't know, and the expectation that things just happen magically here in the States. And so it really gives a really good perspective, that not everybody has it as well as we do here in the States. And so I think it's really a nice thing to see our students grow as humans, as caregivers, through some of these service projects that we've been involved with.
Tina Butler: So this is sort of the end of our presentation, where we definitely open it up to any questions that anybody might have.
