Hands holding stethoscope and globe

A Global Crisis Sinks In

April 13, 2020

In a normal year, students in Columbia Nursing’s Master’s Direct Entry (MDE) Program have an opportunity to spend six weeks during the spring semester at one of the school’s 18 global clinical sites, working in hospitals and community health centers around the world. In 2019, almost half the MDE class participated—78 students, out of a total of 170.

But due to the COVID-19 pandemic, this spring has been very different.

“In early March, starting with China,” explains Jennifer Dohrn ’05, DNP, assistant dean for Global Initiatives, “we realized we needed to close that global site, then Italy and Spain, out of concern for the safety of our students and not wanting to be a burden to the sites who were in full response to the pandemic. We quickly realized that we would have to shut down the whole program.” Then after the outbreak spread to New York City, the school canceled clinical rotations entirely for MDE students and moved all classes online.

For most students and faculty members, as for most Americans, the COVID crisis has been like nothing they’ve ever experienced before. For Dohrn, however, it has brought back powerful memories. Beginning in 2003, she spent a decade in the trenches of Sub-Saharan African countries’ HIV/AIDS pandemic, first as a clinician and later as the project director of the ICAP Global Nurse Capacity Building Program, based at Columbia’s Mailman School of Public Health. She’d seen nurses acting as the front line of response to that crisis, providing heroic care to AIDS patients before effective medications were available. And she had watched many die of the virus themselves. 

More recently, she immersed herself in the stories of nurses and midwives who battled the Ebola epidemic of 2014 to 2016. As the leader of a project sponsored by Columbia’s Center for the Study of Social Difference, she spent a week last August in Liberia and Sierra Leone interviewing health-care workers about their experiences during the outbreak. All had lost colleagues and loved ones to Ebola, while working frantically at under-resourced clinics—often without pay—to save whatever lives they could.

As the current pandemic gathered steam, Dohrn, an associate professor, heard similar stories from her counterparts at Columbia Nursing’s global sites (see sidebar for some examples). She knew that students, faculty, and staff at the school would soon face challenges like those she’d encountered—especially after NewYork-Presbyterian Hospital issued an urgent call to nurses who’d left practice, asking them to return to patient care.

Because of her own health vulnerabilities, Dohrn wasn’t sure that would be the wisest use of her skills. “My son Amilcar said, ‘Mom, you’ve got so much experience that no one else has had,’” she recalls. “‘There must be ways you can share that to support this effort.’”

Circles of Care

Indeed there were. Dohrn’s work in Africa had taught her that one thing nurses desperately need during an epidemic—and too often don’t receive—is emotional support. She’d also learned, in part from her own spiritual practices, that one of the surest places to find such help is in so-called “circles of care”: structured gatherings where anyone can speak, and everyone is expected to listen. Such circles, Dohrn felt, could help foster resilience and minimize burnout and long-term trauma within the Columbia Nursing community, as its members grappled with the impact of COVID. But to avoid the risk of contagion, they would have to take place virtually—via Zoom.

Based on her own experiences leading healing circles at Commonweal in California, and at The University of Texas Health Science Center at Houston (UTHealth), Dean Frazier agreed that this is something that could be offered at Columbia Nursing, and has partnered with Dohrn to lend her expertise, and to help influence, drive, and design a structure for circles of care that aligns with the school’s needs.

Once a proposal was in place, Dohrn sent out an email blast to the whole school community. Since March 26, Circles of Care for faculty and students involved in clinical nursing have been held every Wednesday at 6 p.m. and every Thursday at 5 p.m.; one for Advanced Clinical Management and Leadership students convenes on Tuesdays at 4 p.m. A Circle of Care for MDE students going to work in the hospital as ‘nursing techs’ has also started. 

Dean Frazier and Dohrn have teamed to facilitate each hour-long session. Although participants are encouraged to freely share their experiences and feelings, they’re asked to follow certain guidelines. Attendees check in one by one; then comes a moment of silence, after which those who wish to speak raise their hands. There’s no cross talk or dialogue—instead, the group simply absorbs what each person has to say. To foster openness within the circle, participants must maintain confidentiality outside of it, describing the proceedings only in general terms. The sessions have been so successful, that there are plans to train other faculty members to lead the circles. “It’s a true team effort that will continue over time,” said Dean Frazier.

At a recent circle for clinical students and faculty, with 44 attendees, the talk was intense and raw. Those present spoke of overwork, exhaustion, and isolation; of their concern for coworkers (one had to help in the intubation a colleague); and of their fears of falling ill or infecting their families. They vented frustration over the sheer numbers of sick people and the deaths. They also marked the incredible spirit of working together as a team that has emerged.   Some confided that the crisis was triggering flashbacks to prior traumas, such as 9/11 or the darkest days of the AIDS epidemic. Nurses who can’t work on COVID units for health or other reasons described wrestling with guilt and shame. Others assured them there could be courage in staying home. Several participants shared their coping strategies and ways for self-care.

Dohrn listened with compassion and with a deep sense of familiarity. “I have such respect for my profession and such pride in watching my colleagues rally,” she says. “Their response to this catastrophe reminds me of a nurse I spoke with in Sierra Leone, Josephine Finda Sellu, who kept working at an Ebola clinic even after her boss and half her coworkers died. Her family begged her to quit, but she refused. When they asked her why, she said, ‘Because my people need me. This is where I need to be.’”

Letters from Afar

From the earliest days of the COVID crisis, Dohrn has been in close contact with program directors at Columbia Nursing’s 18 global sites. On March 25, she sent messages to all of them, expressing the school’s solidarity and support and reporting on the situation in metropolitan New York. Here are excerpts from their responses:

Italy

Dear Jennifer,

Thank you for your respect. Unfortunately, a dear colleague of mine has been infected and is not well, but we hope that with the treatments she will not go into respiratory failure. Like you, we are setting up counseling and staff support services here.

In Italy, as in the United States, we have fragile and vulnerable people, but our National Health Service has a spirit of equal care for all. This country has many problems, but health services are very good. Civil and industrial society is donating a lot of money to hospitals and civil defense. We are a sunny people with little use for rules, but we are following them. Fortunately, our shortage of materials is easing; some companies, even famous ones like Ferrari (!!), are working to build all the respirators we need.

At the university hospital, we are doing pre-triage in field tents; when parents and children arrive, we check each person’s temperature and complete a questionnaire (shared nationwide) to identify those at risk and send them on the appropriate path. Now we’re remembering why we taught these kinds of things to our students!

Speaking of global health, three teams of Chinese from the province of Hubei and two teams from Cuba have arrived in Italy … what a beautiful solidarity among people! From this major humanitarian crisis, I am sure, excellent things will arise.

I am writing you this email on a beautiful evening when everything seems normal, except for the streets nearly empty of people and the police cars announcing restrictions.

Sending hugs and wishes that you stay well and be strong.

Lilli


Liliana Vagliano, PhD, MSN, RN
Coordinatore del Corso di Laurea in Infermieristica Pediatrica
Dipartimento di Scienze della Sanità pubblica e Pediatriche
Scuola di Medicina
Università degli Studi di Torino

Spain

Dear Jennifer,

Thank you very much for your message. We are very happy to receive news from you, and we also hope that all of you are very well.

In Spain, the situation is confusing. In Madrid and Barcelona, it is worse; in Pamplona, we are a little calmer, but we are still on alert. Our nurses work tirelessly. And our last-year students, two months after graduating, have started to collaborate as health support personnel in different hospitals. They sent our dean a letter requesting to work and to see how to make it legal, since they have not yet finished their studies. The government of Spain has facilitated this hiring, even paying them for accommodation, transportation, and food. We are very proud of them.

Please stay safe. As you say, together we can defeat COVID-19.
Borja


Borja Centenera Crespo
Coordinador de Posgrado y Programas Internacionales / International Programs Coordinator
Universidad de Navarra
Facultad de Enfermería / School of Nursing

The Gambia

Dear Jennifer,

I am so glad to hear from you during such trying times. We are all fine here and confined to our homes, as all learning institutions are locked down.

Although there are officially only three persons found to be positive in The Gambia, we are bracing ourselves for the worst. We are doing our best to preempt an exacerbation, mainly by vigorous health education talks on radio and TV, as well as social media. Nurses, through our association, are selflessly in the forefront of this venture. The Gambia, being such a low-resource country, could suffer a heavy toll if we do not go all out to prevent it.

I am confident we shall overcome this deadly menace in due course. I take this opportunity to extend my sincere gratitude to you and your staff for being extremely supportive and a source of inspiration.
Momodou


Momodou Mousa Baro 
Head, College of Nursing 
Director, Nurse Anesthesia Program
American International University West Africa 

India

Dear Jennifer,

Appreciate your writing to us. We are all well by His grace.

Our students and faculty are engaged in door-to-door surveillance identifying potential cases, educating, ensuring that they are quarantined within their homes, and reporting to the municipality or village authorities.

It has been a challenging time for us, but our staff and students are working enthusiastically. We hope and pray that things settle soon all over the globe, and human lives are saved.

Yes, together let’s defeat COVID-19. Stay strong, stay safe.

Priyadarsini 

 

Priyadarsini John
Bel-Air College of Nursing
Panchgani, Satara
India