What follows is a tangible story of 91¶ĚĘÓƵ’s global perspective: A current student connected through a faculty member to an alumna for a meaningful research experience.

Last year, as a sophomore on a semester cross-cultural to Guatemala, Yoder jumped at an invitation from leader and nursing professor Ann Hershberger to learn about an 91¶ĚĘÓƵ alumna’s ongoing work there with , an international organization that in part trains villagers to become their own health-care providers.

That invitation was “the seed,” Hershberger said, for the biology and psychology double major’s biology independent research project this year.

The alumna, Jeanette Nisly, had also traveled on cross-cultural to Guatemala – two decades ago. After graduating in 1996, she returned there to stay. She is married to an architect restaurant owner, homeschools their children, teaches online nursing classes for 91¶ĚĘÓƵ, and volunteers with Concern America. Nisly lives and works in PetĂ©n, the department of Guatemala that makes up one-third of the country’s area but less than five percent of its population. Read more about her work in this 2013 article.

As part of her graduate nursing studies through 91¶ĚĘÓƵ, Nisly had already assessed the effectiveness, safety and affordability health promoter services in area clinics. But she wanted to take another look, this time specifically focusing on diabetes control, to establish baseline data for continued evaluation when she hopes to enter 91¶ĚĘÓƵ’s new doctor of nursing practice program next year.

Yoder could aid in the design, collection and evaluation of that research.

Diabetes in Petén

In what Nisly described as “an amazing learning activity,” she and Yoder visited clinics to explore variables impacting the treatment of diabetes at clinics and evaluate patient access to care and knowledge about their disease, information that will prove useful to Nisly in her future studies.

The duo was particularly interested in diabetes, a disease on the rapid rise in Petén. One theory is that its spread is a direct result of infrastructure development outpacing of health education, Yoder said.

Improved transportation “has its goods and evils,” Yoder said. “If someone’s having a health emergency and they need to get to somewhere quickly, it’s really helpful that transport is so much easier. But then in a weird way, it’s causing this chronic disease.”

Better roads and transportation options mean increased access to the city – and increased consumption by rural residents of nontraditional foods such as sodas, chips and cookies. Knowledge about diabetes and its management is slower to arrive, leaving people vulnerable to the ill effects of processed, unhealthy foods.

“Health education is just so crucial,” Yoder said, “because if people aren’t learning about what is diabetes and how to care for it at a young age, then it just doesn’t make quite as much sense when you’re older and trying to learn about it, when you already have the disease.”

Takeaways

The spring break trip gave Yoder a taste of research methodology, and Nisly said that she performed “in a very sensitive manner, continuously evaluating how her work could best support our work.” It also provided Yoder a chance to observe “the challenges that affect marginalized populations in a developing country,” Nisly said – and gave her a glimpse of Concern America’s model of healthcare.

It’s “a functioning, effective health program built with community volunteers who have little formal education,” Nisly said, one that is so different from the U.S. medical model that “it is difficult to understand and appreciate without really seeing it first hand.”

Yoder called it “really sustainable in practice,” since as Guatemalan health promoters learn more – and teach others more – broader health know-how expands and spreads. More difficult care still relies on licensed physicians and hospitals, but the number of international health workers in Petén has decreased, Yoder said, as local health promoters gain efficacy.

For example, Yoder learned of an international study exploring the effectiveness of different ways of administering a medicine in alleviating a common insect-caused skin irritation. The study started losing patients, though, because to access the test treatment, study subjects had to travel much more than was convenient.

And besides, health promoters already had a cure that worked for most patients: a hot-water bath.

The connector

Nursing professor Ann Hershberger – the group leader who introduced Yoder and Nisly – said that the student-alumna collaboration was an impactful opportunity for Yoder.

“Maria is unique in that she is interested in a wide variety of issues,” Hershberger said. “She catches on quickly and is willing to work very hard.”

But in the bigger picture, Hershberger said, “being in Guatemala expanded her language and her understanding of the broader social, cultural and historical issues that impact a situation like diabetes, and living with a host family in the city, then several days in a rural indigenous village, along with language and context study, opened her to really understanding more than what a lab test tells her.”

Connections? You bet.

“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.

Her experience reflects the new ways and new places that education takes place these days for 91¶ĚĘÓƵ students, including , , grant-funded research and practicums, and being part of a cohort at a site to which 91¶ĚĘÓƵ faculty come for classes.

Enns, from Winnipeg, Canada, lived in the nation’s capital at . While taking two courses at the center, she worked at , an interfaith coalition that seeks to end anti-Muslim sentiment in the U.S. As an intern with the organization, she used her experience as co-editor of , 91¶ĚĘÓƵ’s student newspaper, to produce a bi-weekly newsletter, compile fact sheets, and otherwise pitch in on the group’s various initiatives.

An internship through 91¶ĚĘÓƵ’s Washington center is more than just a taste of real-world work and an opportunity to develop contacts, ideas, and credentials for life after college. It’s also a launching point for deeper examination of the relationship between faith, values, and career.

“How do we as Mennonites engage the state, and how much do we build our alternative systems?” asked Enns, whose great-grandparents were part of the mass migration of Mennonites from Russia to North America during the turbulent years after the Bolshevik Revolution.

What relationship, exactly, should a person of faith hold toward advocacy in a secular environment, she wonders. Doesn’t faith like hers, one that prescribes action on behalf of “the least among us,” require this sort of entanglement with the wider world? But does this very entanglement with the wider world undermine the foundations of her faith?

Enns doesn’t have answers to her questions yet, but she knows she would like to continue doing faith-based advocacy after she graduates this spring. In fact, her plans at this point are to join .

During her four-year career at 91¶ĚĘÓƵ, Enns took advantage of other non-traditional ways of learning.

Soon after she arrived on campus as a first-year student, she took an optional field trip with her Restorative Justice and Trauma class to a penitentiary, where she participated in three days of a Quaker-developed “Alternatives to Violence Program” with inmates.

In her sophomore year, Enns satisfied 91¶ĚĘÓƵ’s cross-cultural requirement by creating her own semester-long study experience in the African nation of Chad, where her parents were serving with .

For 10 weeks between her junior and senior years, Enns was part of a offered at 91¶ĚĘÓƵ that gives college students a chance to be an intern, mentored by a pastor, in a congregational  setting. Her assignment was at .

91¶ĚĘÓƵ offers a variety of other new ways and places for students to pursue their education.

More and more graduate students are taking their courses online, usually studying from their homes. The was the first unit at 91¶ĚĘÓƵ to offer distance learning, and now most of 91¶ĚĘÓƵ’s also offer courses online.

Nurses who are studying for a master’s degree in nursing leadership and management don’t have to come to campus very often (or to .).  The program is designed for working nurses who need to maintain family commitments and remain on the job. Jeanette Nisly ’96, for example, is and raising two children with her Guatemalan husband.

Sometimes the students are surprised to see that online learning actually offers more interaction with class members and professors than a traditional classroom. A faculty advisor provides ongoing support for students and helps with logistics, technology questions, and other issues. Students also receive support from staff, graduate writing tutors, and library staff.

Other non-traditional learning opportunities at 91¶ĚĘÓƵ:

• , which offers a mix of study through the annual Summer Peacebuilding Institute at 91¶ĚĘÓƵ and experiences in the students’ home countries. The first group, in 2012, included 12 women from Africa and the South Pacific. They were selected from more than 100 applications. Funds for the program are provided by USAID and the German development organization, EED/Bread for the World.

• . The latest example, announced in February, is a $20,000 grant from the United Service Foundation that will send eight undergraduates to foreign locations (Colombia and Iran in 2013), supervised by an 91¶ĚĘÓƵ-linked mentor. The grants are for peacebuilding and development majors, who are required to complete off-campus practicums.

• . Many of the students enrolled in 91¶ĚĘÓƵ’s programs run from Lancaster, Pa., don’t actually go to classes at the center’s facility in a business park. Students in the pastoral studies program, for example, attend classes this spring at Lancaster Mennonite Conference offices or sites in Philadelphia, Hatfield, and Morgantown. The three-year program, called , is for new pastors or prospective pastors.

• Taking trauma courses all over the world. In the wake of the 9/11 terrorist attacks, established a program to help community leaders deal with the trauma of disasters and conflict. Called , the program has trained more than 7,000 people worldwide. The training seminars take place at 91¶ĚĘÓƵ, across the United States, and all over the world in places like Lebanon, Haiti, and Mexico.

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.