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USU Students Find Purpose Through Austere Clinical Rotation

By Vivian Mason

In the lushly beautiful South Pacific islands of American Samoa, students from the Uniformed Services University of the Health Sciences Daniel K. Inouye Graduate School of Nursing (GSN) and F. Edward Hebert School of Medicine are enhancing their ability to effectively meet the mission of a
ready medical force, while finding purpose through a clinical partnership with the American Samoa Department of Health.

This educational experience offers students an opportunity to work with medically underserved populations on the islands of American Samoa to address critical health issues, such as diabetes, chronic kidney disease, obesity, and others.

“The clinical rotations in American Samoa were developed to provide a different type of clinical experience outside of the traditional military treatment facility,” said Dr. Jill Schramm, assistant professor in USU’s Graduate School of Nursing.  “Students and faculty have recognized the need to conceptualize clinical experiences into a broader humanitarian context. Future military clinicians require exposure to the real-life challenges of practicing in an austere and resource-limited environment.” With an increased emphasis on operational readiness, she said, it is paramount to not only develop clinical skills, but also to provide a platform for ‘emotional readiness.’

USU Graduate School of Nursing students, including Army Capt. Chelsea Johnson (fourth from left), conducted
clinical rotations in American Samoa through a partnership with the American Samoa Department of Health.
(Courtesy photo)

“These experiences,” Schramm said, “also offer an avenue for the development of military leadership skills needed for future deployments and humanitarian missions, a responsibility of the Department of Defense.” And with each student rotation, faculty continue to learn about the unique challenges that clinicians might encounter in an austere environment.

The initiative began in 2015, but was officially established in 2017.  It was initially supported by GSN students.  However, in an effort to expose students to interprofessional, team-based healthcare, the rotation was expanded to include the first School of Medicine students in December 2019.  The students, Army 2nd Lts. Bradley Pierce, Josephine Pucci, and Elizabeth Rich, spent seven days learning about the local medical system and disease burden.  Like their GSN counterparts, they spent the week shadowing healthcare staff in the Lyndon Baines Johnson hospital and the local health clinics. It offered them an opportunity to learn from the island health professionals and to see the different challenges that are faced being on an isolated Pacific island.

Army 2nd Lts. Elizabeth Rich Bradley Pierce, and Josephine Pucci with LBJ Hospital pediatrician, Dr. Aguilar.  The students were the first three Hebert School of Medicine students to participate in the American Samoa clinical
rotation. (Courtesy photo)

“We greatly appreciated this opportunity from USU School of Medicine to learn more about the healthcare system in American Samoa and the challenges associated with providing medical care in a resource constrained environment. The GSN has an active program to send nursing students to the islands and we hope that future cohorts of medical students can have the same opportunity to work alongside interdisciplinary teams of medical providers to positively impact the people of American Samoa. The lessons we learned from this experience have given us a better understanding of what future deployments may be like, where access to advanced medical and diagnostic equipment may be limited,” said Pierce.

Last August, GSN student Army Capt. Chelsea Johnson was among several family nurse practitioner students who participated in the clinical rotation. She kept a diary of her experiences (see sidebar) that offer a reflective look at the people, conditions, situations and culture she encountered while there.

“What I learned here is how to treat people in an environment that does not have all of the tools we are used to,” Johnson said. “If there is one lesson to gain from reading about my experiences, it’s that the success of your clinical [rotation] is dependent on what you make of it.”

When she completed her time on American Samoa, Johnson had mixed feelings.  “I felt as though I was  leaving family and friends. As we made our rounds to the various clinics to say goodbye, I saw a few of my pregnant patients and realized I wouldn’t see their new infants at the postpartum exams. I was sad for a minute. But what made me smile is the fact that I had found my purpose again. Graduate school is filled with challenges that can distract you from the ‘why.’ But, American Samoa helped me to remember the reasons I began this journey in the first place, which was to serve others in a more meaningful way. I’m so grateful to USU for giving me this wonderful clinical experience that not only touched my heart, but also my soul.”