When junior Ashleigh Ontaneda traveled to South Africa as part of the College of Nursing’s Global Health Concepts course, she expected to find a health care system that lagged behind America’s. After all, the average lifespan in South Africa is just over 65 years, more than a full decade younger than it is in the United States.
Instead, Ontaneda found that even in rural townships where many of the residents live in poverty, there were effective, well-established public health systems.
“I was surprised when I saw that they did have a system in place that worked and was organized,” Ontaneda says. “They didn’t have as many resources on hand and people were living in really close quarters, so there was a lot of room for the spreading of infections, but there were times when we all thought some things that they practiced should be implemented in the United States.”
Students found themselves frequently challenging their preconceived notions during the trip. For two weeks over winter break, a group of future Marquette Nurses visited public health sites in and around Cape Town, the country’s legislative capital and oldest city. Clinical Assistant Professor Dr. Kelli Jones and Clinical Professor Dr. Christine Schindler led the trip; they hoped that their visit to South Africa would allow students to see America with fresh eyes.
“There are longstanding issues in South Africa around race relations, forced migration and disproportionate climate impacts on poor communities, so it’s a great place to highlight the impact of health-related social needs on overall well-being,” Schindler says.
“When you travel over there, you get a different lens on how racism impacts public health,” Jones says. “Once you have a different perspective, you can compare and contrast with what’s happening here.”
From 1948 to the early 1990s, the authoritarian government of South Africa enforced a racial segregation system known as Apartheid that resembled American Jim Crow laws. Although apartheid legislation was formally repealed in 1991, the effects of four decades of racial segregation against the country’s Black majority is still evident, highlighted in part by the disproportionate rate at which citizens have appropriate access to health care. In 2018, only 10 percent of Black South Africans reported having access to private health insurance, compared to 73 percent of white South Africans.
Students saw the public health challenges firsthand when they visited an orphanage for children whose parents died in the country’s AIDS epidemic. According to the Center for Strategic and International Studies, roughly 20 percent of all people living with HIV are in South Africa; the country also accounts for 20 percent of all new infections. This has created a generation of children without homes.
“It was so impactful to spend time with the kids,” Ontaneda says. “It was so beautiful to see such happiness and light in their eyes regardless of their situation. They were just kids being kids, and we all enjoyed being with them.”
Schindler modeled the program on the Sibanye Cape Town program, in which Marquette students spend a semester living in the city, taking classes at a local university and volunteering with community nonprofit organizations. She began taking nursing students in 2017, leveraging the partnerships Marquette built through Sibanye to give undergraduates experiential learning opportunities.
During their two weeks in the country, students visited domestic violence shelters and historically segregated townships where Black and Indigenous citizens live, learning about the realities of life in South Africa through its health care system.
“We want this trip to activate in students a desire to change the systems we have in order to make them more equitable,”
Dr. Christine Schindler, Clinical Professor in the College of Nursing
“Through our partnerships with community organizations, students were able to visit several townships that are a legacy of the segregation system built during Apartheid. This gave the students a chance to see a different side of Cape Town than the average tourist,” Schindler says. “I hope that as they took in all the inequities, they would start to view health care through a human rights and social justice lens.”
Although they witnessed difficult situations, the group also saw plenty of reasons for optimism. Students and professors alike noted the strong leadership roles nurses played in their neighborhoods. Organizations from all corners of society work together to maintain a high standard of care, even if they don’t always have an abundance of supplies with which to do it.
“They have an incredibly robust primary health care system and the students picked up on the value they place on preventative care pretty quickly,” Schindler says.
“One of the biggest takeaways from that trip is how the nurses we met are empowered,” Jones says. “They don’t let anything stop them from doing the best they can for their patients and for the community.”
The College of Nursing prioritizes global education in its curriculum. In addition to its South Africa course, the college offers a Diverse Contexts of Health trip to Peru, as well as semester-long study abroad options in Dublin, Ireland, and Melbourne, Australia. All undergraduate nursing students are required to take a Culture and Health course that centers on caring for diverse populations.
Schindler hopes that by the end of their time at Marquette, the students will take after the nurses they saw in Cape Town and become courageous leaders in their own health systems.
“We want this trip to activate in students a desire to change the systems we have in order to make them more equitable,” Schindler says. “Good nurses provide high standards of care to their patients and work to restructure structural and systemic factors that impact health equity.”
After just two weeks in Cape Town, Ontaneda says she is a better nursing student than when she left, with a newfound devotion to fighting for health care equity. She even has a new career goal.
“I can’t wait to be an experienced nurse so I can take my skills around the world and volunteer in clinics with other health care professionals, which is something I didn’t really see myself doing until I went on this trip,” Ontaneda says.
