Amy Boswell looked down at her hiking shoes and sighed. The deep tread on the bottom had long since filled with mud and was now useless. She had known there would be a lot of trekking on the trip, but this went beyond that. Going straight up the mountain, no switchback trails, she wondered how the native guides ahead of her did this day in and day out. Suddenly her foot slipped. Startled, sliding, skidding, she fell. Finally stopping, covered with mud, she looked up to see a smiling guide, hand stretched out to help her back up.
In spring 2016 BYU College of Nursing students traveled to Vietnam for the first time. There they experienced a clinical practicum for the Public and Global Health Nursing course unlike any other. Students journeyed to a remote region in northern Vietnam, visited the hill tribes there, lived with local families, and provided instruction on healthcare. This cultural immersion provided an exceptional experience for students to gain perspective they will apply in their future careers.
Associate teaching professor Cheryl A. Corbett (BS ’89, MS ’96) knew she needed to find a site where students could learn from a truly foreign culture. She knew Vietnam would fit the bill, but she did not know how enthusiastic students would be.
“One of my concerns was if I would have students who would want this kind of experience,” Corbett says. “We needed students who could sleep with the bugs, live in the rafters with the people, and eat their unique foods—things which might put someone out of their comfort zone.”
Corbett pressed forward with her plan and traveled to Vietnam for a two-week scouting trip. She found great clinical opportunities among some amazing people and came back ready to take students who were willing and ready to go on an adventure.
Nestled near the Chinese border in the hills of northern Vietnam is a town called Sa Pa. Residents include people from several ethnic minorities, including the Hmong, who also live in scattered tribes across the surrounding countryside. Nursing students spent three weeks trekking up and down mountains to reach these villages. With the help of their three Hmong guides, the nursing students were able to reach several isolated communities, sometimes hiking 10 to 12 miles per day.
“Our guides were literally in slip-on sandals running up and down the mountains,” says Boswell, a sixth-semester nursing student. “Here we were in these beautiful hiking shoes slipping and falling everywhere we went. I remember one guide, named Mai (we called her Mama). She would always help us up after a fall. I especially had a reputation for falling up and down the mountains.”
With the nearest healthcare facility more than eight hours away, students had to rely on their own abilities and use caution. However, even though the trekking was more intense than expected, the group realized it was worth it as they became immersed in the unique culture.
“The people in the hill tribes are shy, but they want to share,” says associate teaching professor Karen M. Lundberg (AS ’79). “Our Hmong guides were able to get us into tiny villages that we wouldn’t have been able to get into otherwise.”
The group found that simply spending time with the people worked best to help them open up. Rather than quickly asking to see homes and healing practices, they stopped and took the time to communicate with them through gestures, smiles, and exchanges. And with the help of their guides, the students felt the Hmong people become receptive.
HMONG HEALING PRACTICES
None of the group members will ever forget the elderly female shaman they came across performing a ceremony in one of the villages. The Hmong people believe they have a certain number of spirits in their body. When they get sick the spirits leave, and it becomes necessary for a shaman to perform rituals to collect the spirits and put them back in the bodies of patients. The memorable healing ceremony included the shaman sacrificing a duck.
Following the experience, group members were struck by the reaction from the people of the village. Lundberg recalls the trust that developed because they were accepting of the Hmong culture. “After we had that experience, the shaman asked us to see one of her grandchildren, who suffered from something like cerebral palsy,” Lundberg says. “She wanted to know if the child could be cured if he went to the hospital; the family wanted our opinion. I believe if we had just walked in and asked if there were something we could teach or do, they wouldn’t have let us in to see this child.”
Although a hospital trip wouldn’t have cured the child, students were able to provide him with care to make him more comfortable. They found this developmentally delayed child lying in a state of atrophy. His feet had been tangled in a fishing net so tight that it cut off his circulation. The students checked his skin for breakdown, cut the nets off his toes, and explained what needed to be done to further care for him. The students smiled at the child and called him by name, hoping to provide the comfort he needed.
TEACHING AND LEARNING
Throughout their experience students learned how to build trust and listen to the people, incorporating Hmong beliefs with Western medicine to create healing together. They were also able to teach some simple healthcare practices and deliver much-needed supplies.
Eyesight is crucial in Hmong culture. Villagers make all of their own clothing, from growing the hemp plants to dyeing the finished product. The women are expected to do intricate hand stitching on all their clothing, but as they get older, they cannot see up close and can no longer be productive.
Corbett remembers distributing reading glasses they brought to these Hmong women. “To watch them put on these glasses and see a whole new world open up was so amazing,” she says. “They could see little things again. Seeing their smiling faces made me think of how much we take eyesight for granted… Getting these eyeglasses was like the best present they ever had.”
Students also got to teach dental hygiene and hand-washing techniques to the Hmong people they met along the way. The students were happy to give away toothbrushes and eager to teach good practices. They found that many families had only one toothbrush to share and would often use it for cleaning purposes, including scrubbing the mud from their shoes when they got home from the rice fields
LIVING AMONG THE HMONG
The BYU group spent nights in the homes of the people they were visiting. They slept on mats in rafters where the families usually store their rice. During long treks and the quiet nights in the villages, students had time to reflect on the people they were around.
Boswell found the generosity of the Hmong people particularly impressive. “While trekking, those we met would invite us into their home, asking if we had eaten that day and if they could share their rice,” she says. “The Hmong people have so much less to give than I do, and they were so willing at any second to just give it. I came back realizing I need to open my heart and be more hospitable and kind to people.”
The group was also impressed by the Hmong family dynamic as the villagers sat together on the dirt floors of their homes and cooked over open fires. The Throughout their experience students and families would have dinner together, talk together, and laugh together.
“Dinnertime is notable for the Hmong,” Lundberg says. “Even though they just have one small light bulb hanging over the table, they sit around and talk and laugh late into the night. It was so awesome seeing how connected the families were, with several generations living in the same home.”
The Hmong people are subsistence farmers. During the planting season, whatever rice they plant is what they will live off of for the next year.
In one village, the students found a widow who was unable to get her rice planted. Instead of just observing her predicament, the students got to work in the rice paddy.
Corbett remembers how much the group learned from this experience. “Rather than put on someone else’s shoes to learn about them, we had to take ours off,” she says. “We were in the mud up to our knees for over five hours doing backbreaking work. It was so eye-opening to learn the intricate process of planting. . . . I think we all left with a new appreciation for rice. None of us ever want to let a single grain of rice fall off a table ever again.”
BRINGING IT BACK HOME
Even though their Public and Global Health Nursing course was not in a hospital setting, students found that the things they learned had extraordinary applications in their own healthcare practice.
“When students step out of their ethnocentric viewpoint, they gain the ability to see the world in a different way,” Corbett says. “They can take that and use it whenever they treat a patient from another culture. They can understand the patient’s belief and use that to help heal them.”
And students learned that cultural beliefs can vary from patient to patient. They found that some Hmong people were culturally opposed to a hospital visit while others would choose the option when they need it.
“You can’t just assume something about an individual based on the culture,” says Megan Zitting (BS ’09, MS ’16), a graduate student who came on the trip as an assistant. “What an individual believes about healthcare and what they desire the moment they’re sick and need treatment might be completely different.”
The inaugural Vietnam trip provided an excellent foundation for coming trips. This year organizers plan on helping the Hmong trek guides learn first-aid and dental-hygiene education and practices.
Students will continue to bring a minimal amount of first-aid and dental hygiene items. They do not want to change the Hmong people, just provide them with healthcare concepts. “We want them to be self-sufficient and not rely on outsiders bringing things to them. Our plan is to bring materials they wouldn’t have access to but need,” Corbett says.
Zitting adds, “You have to dig deep and establish connections in a place before you can help them. You have to be able to see what their needs are and see what you actually can or cannot do to help them. Some people have this idea that they can just help people everywhere, but it takes some time and relationship building to be able to get in there and make a difference. And we’ve got a great start in Vietnam.”