First armed forces nursing students to complete clinical rotation in American Samoa

By Sarah Marshall

Located in the South Pacific between Hawaii and New Zealand, American Samoa is the home of pristine waters, five volcanic islands, rugged cliffs, and a 350-acre coral reef. Those who call American Samoa home, though, face challenges with poor drinking water quality, inadequate clinical capabilities and a shortage of health care providers, and health disparities, such as diabetes, renal failure, and obesity, are rampant. Now, thanks to a new educational agreement, Uniformed Services University of the Health Sciences (USU) Graduate School of Nursing (GSN) students are working to help address some of those issues.

American Samoa governor Lolo Moliga signing the MOU
that allows GSN students to complete clinical placements
in the remote U.S. territory. (courtesy photo)

Recognizing the value that such an experience could offer to both USU’s nursing students and American Samoa’s underserved population, GSN Dean Dr. Carol Romano initiated discussions about two years ago to forge a partnership that would allow students to complete clinical rotations there. Dr. Jill Schramm, assistant professor in the GSN’s Family Nurse Practitioner and Women’s Health Nurse Practitioner programs, worked with leadership at American Samoa’s Department of Health, a VA clinic there, Medicaid Services, a federally- qualified community health center, and a federally-operated tropical medicine center to establish a memorandum of understanding (MOU). In April 2017, the MOU was signed by American Samoa governor Lolo Matalasi Moliga and USU President Dr. Richard Thomas, officially initiating the partnership.

In September 2017, the first two GSN students completed a three-and-a-half week clinical placement there and two more will go later this month. While there, the first two GSN students, Navy Lt. Christopher Johnson and Army Maj. Douglas, saw patients with a wide variety of health concerns, ranging from major depressive disorder to elephantiasis. The advanced nurse practitioners traveled around the islands, providing counseling, well-woman and well-baby visits, pap smears, and prenatal care. They also met with epidemiologists from the Centers for Disease Control and Prevention and provided care to patients with infectious diseases, such as Zika and malaria, which are prevalent there. Only recently the American Samoa Department of Health began using ultrasound for the first time in their obstetrics and gynecological care and the two USU students provided basic training to providers on how to use the equipment.

The U.S. island territory of American Samoa, located in the South Pacific, is a tropical paradise, but its citizens face a number of health care challenges. Students from USU’s Graduate School of Nursing may now complete clinical placements to help address those issues. (NPS photo)

American Samoa residents aren’t always able to drive down the road to see their doctor. Instead, they might have to spend the day traveling by boat, crossing several islands, to receive the care they need, so Johnson and Taylor conducted several home visits, which was especially helpful to those suffering from physical ailments with limited mobility.

This educational opportunity provided the GSN students executive leadership exposure as well. They had a chance to meet with interdisciplinary health and health business professionals to provide ideas on improving the access and deliver of care in the island territory.

Lt. Christopher Johnson, far right, stands next to Maj. Douglas Taylor, on a boat ride in American Samoa. The two GSN students traveled to the remote U.S. territory in September for a clinical placement.

But the opportunity means much more than just a new location where these advanced nurse practitioners can meet part of their training requirements. They’ll also be able to make an impact on the medically underserved population. Schramm said that the students will also have a chance to educate and mentor citizens and providers on the remote islands, which span an area roughly the size of Washington, D.C. The plan is for students to make a lasting impression on the younger generation while they’re there, too, hopefully inspiring them to become future health care practitioners and remain in their native land, where there’s a shortage of health professionals of all disciplines.

Both Johnson and Taylor, who will graduate from USU in May, agreed the clinical placement allowed for an invaluable cultural experience. As health professionals, they said, cultural competence is essential to providing relevant treatment.

Taylor, who is currently in the Psychiatric Mental Health Nurse Practitioner Program, added that the clinical rotation expanded their ability to effectively meet the mission of a ready medical force.

“I have to be ready to engage local leaders, local health providers … American Samoa provided a real-life testing of these skills,” he said.

GSN students Maj. Douglas Taylor, far right, and Lt. Christopher Johnson, second from left, recently traveled to American Samoa for a clinical placement. (courtesy photo)

Johnson, who is currently in the Family Nurse Practitioner program and specializing in Women’s Health, said the unique opportunity allowed him to blend his training and the curriculum at USU with his prior deployment experiences. He felt well prepared to apply his knowledge and care for these patients, and to mentor and educate other providers. The exposure in this austere environment also prepared him for future deployments, he said, and for his journey ahead as a doctoral-prepared nurse practitioner.

“It was an opportunity to see things I wouldn’t have seen here [in the U.S.],” Johnson said. “It was a tremendous experience.”