“Our philosophy is very different,” said biology professor , PhD, who directs the program. “Biomedicine, health and healing need to be holistic. It takes more than biology, math and physic courses to understand the human person.”

Early visionaries decided to adapt the undergraduate cross-cultural requirement to biomedicine graduate students, giving it a medical twist. They believed that students needed exposure to the kind of diversity they were likely to encounter as biomedical professionals.

The result is a three-week summer course titled Cross-Cultural Health Care/Biomedicine in which students examine the“differentiation of resources, social, psychological, and spiritual ideas, contrasting the student’s personal culture with the explored culture,” according the course description. It also explains that students may study in a variety of different settings, but are expected to keep reflective journals and ultimately write a paper on their experience.

91¶ĚĘÓƵ professors recommend two organizations to biomedical students. One, , works in Guatemala, and the other, , has several locations in Kentucky. Four of the eight students that went on biomedicine cross-culturals this summer went to one of these locations. (One of the leaders in Guatemala of Concern America is 91¶ĚĘÓƵ alumna Jeanette Nisly.) The other four went to Tanzania, Costa Rica, Panama, and West Virginia, as well as to rural Bluefield, Virginia.

The student’s experiences were “eye-opening” said both Matt Tieszen (Guatemala) and Asad Ali (Kentucky) in separate interviews. Both Tieszen and Ali spent most of their time shadowing healthcare professionals as they worked in clinics and hospitals, or did home visits.

“You read about development work and the importance of improving things like maternal healthcare, but you don’t really get to see a lot of it in the States,” said Tieszen, who went to Guatemala (with fellow student Chris Dreikhorn). Tieszen hopes to become a physician’s assistant and is interested in practicing health work in an international setting.

Ali (along with student David Abraham) traveled to Hazard and Whitesburg, Kentucky. For Ali, who is from Harrisburg, Pennsylvania, rural Appalachia was just as foreign as crossing the border. He observed patients who came into the hospital with black lung from working in coalmines and shadowed a home health nurse on her house calls. “There were diseases there you just don’t see in a city,” he said. “I thought that small isolated towns didn’t exist anymore, but the cross-cultural was an eye-opener; it showed me that they do.”

Cross-culturals are “necessary for training health professionals because there is such a diversity in healthcare,” said nursing and biomedicine professor , PhD. She added that even though many graduate programs do not require cross-culturals, she believes that the healthcare immersion experience helps students to become more well-rounded, compassionate healthcare providers by exposing them to the kind of variety they are likely to encounter in practice.

Nisly, who majored in at 91¶ĚĘÓƵ, is the in-country coordinator for the Guatemala operation of a nonprofit group, . Located in PetĂ©n, the country’s largest department (equivalent to a large U.S. state), Nisly leads trainings that widely impact PetĂ©n’s population of 650,000, – one that has experienced much violence, including death threats and murders of healthcare workers.

Guatemala, under its current unstable and corrupt political system, is not an easy place for Nisly to work in some respects, yet she is passionate about Concern America’s philosophy.

“Concern America trains local populations in health, education, agriculture, and/or environmental health (appropriate technology),” according to its website. From its home base in Santa Ana, Calif., this international development and refugee aid organization aims to help local populations gain the knowledge and skills they need to staff and run their own fully functional systems.

Though she loves her work, Nisly looks forward to the day when she can offer her services elsewhere because Guatemalans are doing her work as well or better, she said in an interview via Skype in early January 2013. “Everything we do focuses on teaching and empowering other people to do things that maybe they didn’t realize they could do.”

The end of 2012 found Nisly training groups of health-promoting practitioners, who typically have attended local schools through grade 4, and midwives, many of whom are illiterate. These Guatemalans make a four-year commitment to study with Concern America for one week every two months. Between their studies, they put what they have learned into practice, attending to the health needs of some of the most marginalized populations in Guatemala.

The approach of alternating study and practice is one that Nisly herself is pursuing as a current 91¶ĚĘÓƵ graduate student, studying online for her . “All other [nursing master’s] programs I looked at required leaving the country and the work in order to go to school, and I wasn’t willing to do that.”

She also knew that the 91¶ĚĘÓƵ approach to an MSN would be compatible with her own religious beliefs and lifestyle practices. Raised Mennonite, Nisly now works closely with the Roman Catholic Church, with which Concern America partners for its work in Guatemala.

With 500 midwives and health-promoting practitioners trained by the Catholic Church’s health program in Petén, Nisly has seen basic health care rippling out to almost every hamlet of Guatemala. “They [the health promoters and midwives] provide most of the health care services for their communities,” she said. “I don’t know where [else] health-promoting practitioners are able to care for such a wide range of complex health issues.”

By the end of two years of training, these practitioners are able to attend to common digestive, respiratory, skin, urinary, reproductive, oral, traumatic (including basic suturing and tendon repairs), chronic (including diabetes, cardiac issues, and epilepsy), tropical disease and nutritional issues, says Nisly. “They are able to assist midwives in difficult births, like breech babies and postpartum hemorrhage. Their education includes a strong foundation in physiology, pathophysiology, and pharmacology.”

The Petén program is widely viewed as a model one, causing observers from other Concern America projects around the world to visit in the hope of adopting the model to their situations, said Nisly.

The workers trained by Concern America are up against a system that does not work for or with them, Nisly said. For instance, health-promoting practitioners and midwives are taught to refer pregnant women with high blood pressure to a hospital for more care, but sometimes these women are sent home without treatment, where some have died. “One of the big challenges,” she sighed, “is not having a referral system that we can rely on.”

She leans on this insight once given to her: “The only thing that is going to limit you, and what you can do here, is yourself.” As a result, she has learned to tap “the resources that are available to me,” rather than “being limited by what I think I know and what I should be able to do.”

After graduating from 91¶ĚĘÓƵ in 1996, Nisly worked for a three years with before beginning her work with Concern America. She is fluent in Spanish and the indigenous Mayan language of Q’eqchi’. She is the author of the first comprehensive health guide in the Q’eqchi’ language, published in 2005. It is similar to the well-known manual “Where There Is No Doctor.”

An 91¶ĚĘÓƵ cross-cultural group led by and Jim Hershberger stopped in PetĂ©n in February 2013 to see the work of Nisly and Concern America.

Although she functions in a leadership role, Nisly reiterated multiple times that, “we work here as a team” and that her work could not be successful without the help and support of others in the organization.