Methods: An initiative began in 2012 using a cross disciplinary, service-learning approach to provide holistic solutions for safe water access for an underserved, rural community in the Dominican Republic. Initial faculty and students (graduate and undergraduate) represented the disciplines of nursing, agricultural economics, civil engineering, environmental and ecological engineering, and biological and food sciences. The class began as faculty driven and led; over time the course has evolved to being fully student driven with faculty guidance and support. Classes early in the process provided background from all disciplines to support understanding of the issue from multiple perspectives, an overview of the participatory research approach to be used, and discussions of possible solutions to provide access to safe water in collaboration with the selected community. As the class enters its fifth year, the focus has broadened to encompass sanitation and hygiene in addition to access to safe water and work has begun with three other communities in the Dominican Republic. Additionally, other disciplines have joined the project. Class time is now focused upon supporting ongoing communication and collaboration with the communities in the Dominican Republic, discussion of cultural, political, economic, and health aspects of water, sanitation, and hygiene issues, development of potential solutions to meet the needs of the communities, and identification of strategies to evaluate impact. Communication with the community is frequent and supports true collaboration and shared responsibility for the design, implementation, and management of solutions to provide access to safe water and improve sanitation and hygiene. Such collaboration is vital to effective global health partnerships and sustainability.
Every year, two to three visits to the Dominican Republic are made by faculty and students to maintain presence and enhance community trust. Various activities occur during these visits including: 1) meetings with community members, representatives from local service organizations, political representatives, and local health providers, 2) data collection via household surveys, focus groups, and visits to local health clinics, and 3) assessment of local resources available to support system design and implementation.
Results: Since the projects inception, 60-70 students have been involved, including 16 undergraduate nursing students. In 2014, the first system was built at a primary school located in the center of a poor rural community outside of Santiago. Several events surrounded the ribbon cutting ceremony including training related to safe operation and use of the system as well as education efforts led by the nursing students including a water, sanitation, and hygiene curriculum for implementation at the local schools and in the community. Since 2014, trips to the Dominican Republic have included visits to three new communities, along with return visits to the initial community to provide continued support, guidance and adaptations as needed for the water system. The process has not been without challenges, however each challenge is tackled collaboratively by the faculty, students and communities who consistently strive to reach the identified goals. The participatory research approach has allowed community members to participate in research, project design and review of policies which impact the issues surrounding access to safe water. For students, the impact has been truly transformative on both personal and professional levels. Knowledge of the complementary skill sets other disciplines bring to projects such as these has been broadened. Skills related to formal presentations, grant writing, manuscript preparation, leadership, fundraising, collaboration, and communication with non-English speaking populations have been enhanced. Students have witnessed issues not commonly seen in the US such as lack of access to soap and clean water for handwashing or water to flush a toilet as well as the giving nature of the Dominican people. This has led to development of respect, humility, and appreciation for the Dominican people; behaviors which are reciprocated by the communities they work with. As a result of this experience, several students have chosen to work in the public health arena locally and globally while others have gone on to additional degree programs in public health.
Conclusions: This project has provided many benefits in addition to access to safe water for the commmunity. Nursing students as well as students from other disciplines have been able to develop global competencies and a respect for cultural diversity and the role it plays in providing care to populations. Nurse educators have a responsibility to prepare nurses to function competently in relation to global issues (Wilson et al., 2012); projects such as these provide support for the development of such skills and competencies. Students who have participated in this project are able to reflect upon their feelings of global connectedness and the ways in which this experience has influenced and enhanced their education as well as their choice of future careers. These experiences can support development of individuals who can help lead the charge to address global health challenges.
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