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As children cautiously approached a temporary medical clinic in the mountains of northern Peru, many associated the sight of healthcare workers in scrubs with one thing: vaccinations.

University of Maine nursing students worked to change that.

Many children in the villages had little experience with healthcare beyond routine immunizations, making trust one of the students’ first priorities.

Over eight days in May, the students cared for more than 150 people across two rural communities in Peru’s Amazonas region, building trust through conversation and compassion while gaining confidence in their own abilities as future nurses.

For Nadia Tarbell, one of the first things she noticed after arriving in Peru was how different daily life looked compared to the United States.

“My first impression when I arrived in Peru was that the living conditions were much different from what we are used to,” Tarbell said. “It showed me what I really take for granted where I live.”

She said she expected to see more illnesses tied to limited infrastructure, including unsafe drinking water and a lack of plumbing or refrigeration, but was surprised that many patients instead sought care for conditions related to physically demanding work, such as arthritis and chronic muscle pain.

“It was surprising to me to see how different the normal is for the Peruvian communities and how people have adapted to living in those conditions in ways I hadn’t anticipated,” she said.

Learning through service

The trip was part of NUR 419, Introduction and Service to Global Health, an elective course in 91����’s School of Nursing that combines classroom learning with international service-learning. Led this year by Colleen Marzilli, a professor of nursing, the course gives students the opportunity to provide supervised clinical care while learning firsthand about global health and culturally responsive nursing.

Eleven students traveled May 11-19, flying first to Lima before continuing to Chachapoyas in Peru’s Amazonas region. Working through International Service Learning, they established temporary clinics in the nearby communities of Huancas and San Jerónimo, where they worked alongside three Peruvian physicians to care for more than 150 patients.

The students also visited the Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, where they presented on nursing education in the United States and participated in a conference with Peruvian nursing students and faculty.

The experience is designed to strengthen students’ clinical skills while developing cultural competence, communication and adaptability. For many students, it was their first opportunity to provide healthcare outside the United States and work across language and cultural differences.

Tarbell said the experience reinforced that effective nursing communication extends far beyond spoken language.

“Since I am not fluent in Spanish, I had to come up with unique ways of communicating such as translation, hand gestures and body language,” she said. “Effective communication relies on more than just speaking.”

Tarbell said adapting to the language barrier helped prepare her for future patients who may communicate differently because of language, hearing or visual impairments.

Marzilli said one of the biggest takeaways from the trip was watching students become more confident.

“It was remarkable to watch the students grow,” she said. “Even though they haven’t graduated or become licensed nurses yet, many of them said they finally felt like real nurses. Seeing that transition happen while providing care in communities with such great need was really special.”

Caring across cultures

Each day began with a trip from Chachapoyas to one of the two villages, where students established temporary clinics. In Huancas, they worked in a government-supported community nursing clinic. In the more remote mountain village of San Jerónimo, they transformed a community center into a clinic after traveling nearly two hours along winding mountain roads.

Working alongside Peruvian physicians, students performed patient assessments, checked vital signs, measured blood pressure, gathered medical histories and presented their findings before physicians determined treatment plans and prescribed medications.

Patients sought care for a range of health concerns, including chronic back pain, hypertension, diabetes and intestinal parasites, which are common in the region.

Among the many patients they treated, one young girl left a particularly lasting impression.

Students identified a young girl with a mass on her back and worked with physicians to arrange a referral to a surgical center in Lima for further evaluation.

Marzilli said another memorable part of the experience was watching students build relationships with children who were initially hesitant to interact with healthcare workers.

Before the trip, 91���� students learned medical Spanish and worked alongside interpreters in Peru, allowing them to communicate directly with patients while helping children feel more comfortable.

“Our students spent time talking with them, making them feel comfortable and building trust,” Marzilli said. “That human connection became one of the most important parts of the experience.”

Lasting lessons

Beyond the clinics, students learned about the culture and history of the Amazonas region. In Huancas, they explored the community’s pre-Incan pottery traditions. At the Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, they met with nursing students and faculty to discuss nursing education and healthcare in Peru and the United States.

Marzilli said the experience also gave students a better understanding of what it feels like to navigate healthcare in a different language and culture.

“Maine is a predominantly white state, and many of our students have limited opportunities to care for patients whose backgrounds differ significantly from their own,” she said. “Being the minority, navigating a different language and culture themselves, gave them a much deeper understanding of what many patients experience when they seek healthcare.”

For Tarbell, that lesson will stay with her long after graduation.

“The biggest thing I will carry with me in my nursing career from this trip is how important developing trust and connection is when treating patients,” she said. “Even though we couldn’t understand each other, simply showing you are there to do your best, listen, learn and consider the patient’s values makes all the difference. I was able to make the patient feel like they mattered and were cared for. That’s something I’ll carry with me throughout my nursing career.”

Contact: David Nordman, david.nordman@maine.edu