Sometimes all it takes to accomplish a task, to move forward, to succeed is that one thing that’s just out of reach. But with it, everything will fall into place.
Such appears to be the case for the nursing program at the Hubert Kairuki Memorial University (HKMU) in Dar Es Salaam, Tanzania. The private university seeks to play a larger role in addressing the drastic health care shortage in that country and sees online instruction as a viable way to increase the number of nurses – as well as future nursing faculty – it educates. However, one main barrier to moving forward is lack of expertise in developing such a program.
With over 30 years of delivery nursing education via distance learning methods – most recently online—California State University, Dominguez Hills is uniquely equipped to help HKMU. During winter break Jim Katzenstein, a full-time lecturer in the Department of Management and Marketing, emeritus faculty of management Barbara Chrispin, and Cynthia Johnson, professor of nursing, chair of the Master of Nursing Program and graduate program coordinator, traveled to Tanzania to help HKMU with that one thing, which in this case has many parts.
Healthcare “Brain Drain”
Tanzania has a population of more than 43 million people and is reported to be the fifth poorest country in the world. According to the World Health Organization, the sub-Saharan region in which Tanzania is located has the lowest availability of qualified medical resources and the highest disease burden. The severe shortage of health care workers is considered a main factor in the high infant and maternal mortality rates, high infectious disease rates, and low life expectancy.
Universities like HKMU are educating doctors, nursing and other health professionals, but it is estimated that Tanzania would need tens of thousands of health personnel to even meet minimum international standards. On top of that, universities have no guarantee that their graduates will remain. Tanzania’s “brain drain,” in which African medical professionals leave their country for a better quality of life and better resources elsewhere, is considered a major problem.
“A trained nurse in Tanzania frequently earns less than $200 per month, and a physician frequently earns less than $800 per month. When a country cannot afford to pay its best and brightest health care workers a wage consistent with the effort and time required to obtain competency, people gain knowledge and then go elsewhere,” explained Katzenstein, whose nonprofit HealthSpan International has been helping the Tanzania medial community for over 15 years, coordinating medical supply donations, facilitating remote medical clinics, and working with facilities on ways to be more efficient.
The solutions are multi-faceted and are not quick, Katzenstein went on to say, and would involve, among other things, expanding the use of information and communication technologies, which could do a lot to lower costs and improve efficiencies so medical facilities are able to pay elevated wages. But then there is a question of filling the gap in health personnel needed.
When one of HealthSpan’s partners, HKMU, expressed a desire to explore ways to be a part of the solution, not only on the management side but also looking at alternative options aimed at educating more health professionals, Katzenstein initiated talks between HKMU and CSU Dominguez Hills.
In spring 2010, officials from the two universities signed a memorandum of understanding whereby CSU Dominguez Hills would assist HKMU in establishing HKMU’s —and Tanzania’s—first online nursing education program, from providing expertise in how to develop curriculum for an online nursing course and delivery of those courses, to consultation on strategic planning to maximize cost efficiencies.
The Business of Delivery Nursing Education
While it would seem odd to have two business faculty members involved in a project to establish an online nursing program, Katzenstein disagrees, saying, “Ultimately this is a business problem.”
“From a systems perspective, they’ve got an entire medical complex, a university, and a hospital, and they have a lot of management and business types of issues that need to be dealt with,” Chrispin added. “We’re a sort of microcosm of what it takes to engage in this kind of effort. You need people from different disciplines and different orientations focusing on different parts of the problem to bring it all together.”
According to Kaztenstein, his and Chrispin’s role, therefore, is to work with the university on how to integrate technology, nursing, strategic management, organizational development, and marketing and student recruitment as part of the large-scale systems change at the institutional level.
Kaztenstein and Chrispin made their first trip to Tanzania for this project in June 2010 for initial meetings to, as Katzenstein explains, “get people to understand that it’s something they could do, and it’s also that they had the wherewithal to do it.”
HKMU’s nursing faculty was understandably skeptical, they said.
“You’re dealing with faculty that haven’t gotten involved with this in the past; there’s a great deal of resistance,” Chrispin said. “Having Cynthia on board, somebody who could ‘speak their language’ as a nursing faculty, and who has been an expert in developing these kinds of program, work with them, that does an awful lot to essentially reduce those barriers.”
The Nursing Process
All nurses learn the nursing process: assess, diagnose, plan, implement, evaluate. So it seems fitting that the same process is being used as Chrispin, Katzenstein and Johnson assist HKMU in developing its online nursing program.
“The very first thing we did is assess their needs. Then [together with HKMU] we made the diagnosis of what their needs were,” Johnson said. “Then we started to plan the trip of what we do– a three-week course.
During the trip from the end of December 2011 to mid-January 2012, Johnson worked directly with 10 HKMU nursing faculty, conducting two class sessions three days a week to introduce the nursing faculty to the online method of conducting classes. Using syllabi from her own classes, Johnson showed how a course was created to fit within the frameworks of an online class while still providing quality of instruction. They then examined their syllabi and discussed on how they could also be adjusted.
“We were able to open the eyes of those faculty members and let them have a peek of another way of delivering the curriculum,” said Johnson, who has been developing Internet-based nursing courses at CSU Dominguez Hills for over 15 years. “During the last two sessions Reza [Boroon, instructional design specialist in CSU Dominguez Hills’ Instruction Technology Center] developed two mock classes on Blackboard. HKMU nursing faculty members accessed Blackboard as I assisted them in inputting their syllabi.”
The three see more benefits to online beyond the increased accessibility such courses provide.
“One thing we feel strongly about is that not only do these students now become more involved with online technology through the courses, but this means that when they go into practice as nurses, they will be familiar with the technology that is critical to getting involved with telemedicine,” Chrispin said referring to Katzenstein’s involvement in using telecommunication and technologies to improve access to health care. “So there’s this bridge that’s being developed from faculty to students to essentially, the health arena, which is very, very important and is going to jump start what takes place in Tanzania.”
To further add to the educational nature of the trip, the three faculty members were joined by CSU Dominguez Hills senior business major Melissa Dastvarz, and business alumnus Iddy Mtango (Class of ’07, B.A, business administration information systems) as well as graduate student at the University of Santa Barbara, Amy Buchard, who all volunteer with Katzenstein’s HealthSpan International. Katzenstein said having students participate is a key goal for the project moving forward.
Dastvarz and Burchard worked on developing an understanding of the health care system in Tanzania, beginning with a trip to a rural village, where they observed primary health care being delivered. They visited and interacted with a variety of other healthcare facilities at the district level and at the national tertiary care hospital in Muhimbili. Kazetenstein said they are in the process of writing a paper comparing healthcare in Tanzania with the U.S. healthcare system.
“We attended every meeting, every session,” said Mtango, who is working as a customs compliance analyst at Sketchers Inc., a footwear company in Manhattan Beach while pursuing an MBA with an emphasis on cyber security at CSU San Bernardino. “Our goal was to take notes and learn [as HealthSpan representatives].
Mtango got involved in HealthSpan after taking one of Kaztenstein’s classes at CSU Dominguez Hills and learning of Katzenstein’s interest in Tanzania. Mtango too has an interest in Tanzania. It is his native country. He said he is impressed with the work HealthSpan and CSU Dominguez Hills are doing there.
“What is significant about this project is capacity building,” he said. “In other words, it trains people in Tanzania who can carry on the work. Because when you go there, spend a week or two and then leave, it means you can no longer do what you were doing while there. It leaves a vacuum. But when you train people, you build the capacity within the country. Whether Dr. Jim, Dr. Chrispin or Dr. Johnson go there again or not, the nursing program continues.”
Mtango said he came to the U.S. for the educational opportunities here, and once he has completed his studies he hopes to return to Tanzania and do his part to help his country. This trip in January was the first time he had been home since 2009.
“This was the first trip I made there where I felt I’m touching people’s lives or that I’m doing something which is going to have a lot of impact and help a lot of people who need it most,” he said.
Implement and Evaluate
Implementation of the first online course would be in March 2013. The class wouldn’t be completely online, but a hybrid where five class sessions will take place on campus. Johnson said that is the model CSU Dominguez Hills and other universities are moving toward. The team hopes to return in June of that year as part of the evaluation process. By the second semester, in October 2013, three additional online courses would be online, and by the end of three years, five online courses would be offered.
Now months after the trip, Katzenstein, Chrispin and Johnson are still busy working to ensure the project’s success. They have debriefed the deans of their respective colleges, and Provost Ramon Torrecilha. They’ve met with Ron Bergman, associate vice president of information technology and members of the Instructional Technology Center to assist with technology questions.
They are also writing grants to help support the project into the future to include faculty exchanges, student exchanges. They say they would also like to establish a cohort program that would allow Tanzanian nurses at HKMU to enroll in CSU Dominguez Hills’ online Master of Science in Nursing program.
It’s all part of giving HKMU that one thing.
“There’s a tendency to think that these people have nothing, therefore they can’t do anything. That’s not true,” Katzenstein said. “They need five things to get something done, and they have four, and they can’t find the fifth, and they’re stuck… They are perfectly capable of doing this job, they just need one thing. So we’re going to help them, together, with the one thing, and then they’re going to do it.”