Side Trip Forges Lasting Relationships in the Middle East

November 2011Catherine Rauch

On the sixth floor of UCSF School of Nursing, a wall of papers reaches across the globe. Many of these papers feature research in Arabic populations, and all are authored by students or faculty from the Middle East, primarily Jordan. Individually, they cover topics from neonatal pain medication and childhood obesity to cardiovascular disease risk factors in teachers. Together, they tell a tale of how one professor’s passion can forge broad and meaningful educational relationships between countries and institutions.

In this case, the link is between UCSF School of Nursing and Jordan, with shoots extending throughout the Middle East.

A Coincidence

Erika Froelicher In 1999, Erika Froelicher, now a professor emerita in the Department of Physiological Nursing and the faculty member behind the sixth-floor display, was planning for a critical care nursing conference in Israel when one of her UCSF students, Rafat Qahoush, suggested she pop over to his home country of Jordan for a few days.

“I’m an avid traveler, but I’d never before visited anywhere in the Middle East,” says Froelicher.

Qahoush, who now runs a private nursing school in Southern California, reassured Froelicher that he’d make all the arrangements, including a visit to the University of Jordan’s Faculty of Nursing in Amman.

Froelicher quickly accepted. She didn’t know then that the trip would cascade into a dozen-year professional relationship with Jordan, including a Fulbright Scholarship year at the University of Jordan, a stream of Middle Eastern nursing students at UCSF, a network of new colleagues and that wall of journal papers – the product of students and faculty with whom she has collaborated and advised.

“A large number of our students have gotten published,” says Froelicher. “This is a statement about the high quality of the science that’s being done – publications that meet the rigor of international journals.”

A Personal and Professional Relationship Takes Hold

“I grew up in my grandmother’s house with a very large family of eight kids,” says Froelicher, who immigrated to the United States from Austria. “After having been in Jordan, I realized just how much the tradition of the large family is comforting to me. As a single woman without kids, what people did is invite me to be part of their family. Thus, you belong.”

Personally drawn to the family spirit of Jordan, Froelicher was professionally drawn to the challenges of nursing care, particularly to training high-quality, doctoral-level nursing professionals. A cardiovascular clinical nurse specialist and epidemiologist, Froelicher was invited back several times after her initial visit to present on topics such as cardio rehabilitation, lifestyle change, and smoking cessation in a country with high rates of smoking and heart disease.

Then, in 2006, she returned to the country on a research and education Fulbright Scholarship. The University of Jordan was building its first doctoral program in nursing, and Froelicher was asked to help by advising students, assisting faculty and designing the curriculum.

Facing a nursing brain drain because its nurses can earn much higher salaries in oil-rich neighboring countries, Jordan welcomed international expertise in building its doctoral program, says Wasileh Petro-Nustas, then dean of the University of Jordan’s nursing school.

“The nursing career is still growing in the Middle East, so preparing faculty to help in providing the best care and education is essential,” says Qahoush. “The school in Jordan is young and one of the rare PhD programs still open.”

Doors Opened in San Francisco

As often happens, the connection Froelicher forged with Jordan became two-way. She assisted with students and programs there, and increasing numbers of Jordanian students started applying to the School of Nursing at UCSF.

According to Jeff Kilmer, the School of Nursing’s assistant dean for student affairs, Jordan and Saudi Arabia now represent relatively large numbers of the School’s current international enrollment, along with Korea and Taiwan. These trends ebb and flow, says Kilmer, based on a variety of factors, including faculty expertise.

And other UCSF nursing faculty members do have expertise in the region. The group includes Professor Emerita Juliene Lipson, who co-authored the book Culture & Clinical Care and conducted research on Afghan refugees, and Shari Dworkin, who works on HIV/AIDS policy in the Middle East.

Froelicher’s efforts combine with these to create a sort of School of Nursing-Middle East synergy, says Sally Rankin, the School’s associate dean for international programs and global health.

“It has solidified our work in the Middle East; there were these glimmers of it before, but she really has strengthened it,” says Rankin, who is also director of the UCSF World Health Organization Collaborating Center for Research and Clinical Training in Nursing, and leads her own Fulbright project in Malawi, Africa.

“Around the world, nurses provide much of the health care, so it’s extremely important that Erika’s done the kind of work that she’s done,” Rankin says. “Once this group of nurses have become empowered and then communicate what they’ve learned to their students in Jordan, they’re improving health care.”

“UCSF has a long tradition of excellence in educating health professionals in this country, and in more recent years, partnering with developing countries to provide high-quality training that meets the needs of local populations,” says Jaime Sepulveda, executive director of UCSF Global Health Sciences.

Cultural Sensitivity Is a Key

Of the roughly 20 Arab-authored journal articles displayed on the sixth floor of the School, some are by University of Jordan students, but most reflect the research of UCSF students, primarily from Jordan, but also from Lebanon and Sudan.

Some are still studying. Some are now professionals in their home countries, while others have followed career opportunities to other nations, including the United States. Together, they represent an expanding body of skilled nurse researchers prepared to become leaders, Froelicher says.

They’re also a rich resource for the effective delivery of health care in Muslim communities in the United States and abroad. “Being culturally sensitive with Middle Eastern patients is key when providing care,” Qahoush says. The Orange County school he runs specializes in training nurses from the Middle East.

Health practice and policies are influenced by a number of Islamic traditions and customs, such as modesty, where men and women don’t touch each other outside of marriage; dietary laws; and prayer rituals. As for the training of nurses, in sharp contrast to the United States, at present the majority of nurses in Jordan are male, a trend common across the Middle East for a complex set of reasons, including that according to Islamic tradition, women rarely travel alone.

So one major impact of the University of Jordan’s doctoral nursing program is that it helps more local women to advance their studies. “Since it is very difficult for Muslim women to leave their countries unescorted, this nursing program is a way the profession can advance,” says Froelicher. “Nurses prepared at the PhD level can even take a seat at the table where policy is made.”

Now six years old, the Jordanian program is already affecting the nursing field, say faculty and alumni, even as it experiences the normal growing pains.

“The program itself is well designed, but needs a lot of resources,” says Bushra Al-Ayed, a professor at Jordan’s Applied Science University, who was also the school’s 12th graduate. She cites a wish list of faculty development, access to literature and assistance in English writing skills for journal publication.

Still, doctoral graduates already are teaching in a variety of Jordanian nursing programs, reducing the need to recruit faculty from other countries. “Most PhD holders work in teaching due to the shortage of PhDs in nursing education,” Al-Ayed says. “But if we have enough PhDs, then patient care areas will also improve.”

They’ll get there, says Froelicher, who continues to stay active in nursing education internationally. “I strongly believe that if you go to another country to work, the ultimate success story is to work yourself out of a job.”