RWJF Nursing Scholar Studies Access to Health Care in South Asia

    • September 22, 2010

Problem: In order to have good health, people must be able to access good health care. But millions of people around the world lack access to quality, affordable health care. The problem is especially dire for the poorest of the poor—the rural and isolated people in developing and undeveloped countries around the world.

Background: As a nurse and as an army lieutenant, John Ringhisen, R.N., has dedicated his life to serving his country. Now he plans to serve the world.

A recipient of the 2010-2011 Fulbright Award, Ringhisen departed for Bangladesh—an impoverished, densely populated country directly east of India—in September to study ways to improve access to primary health care in Central and South Asia.

The one-year research project is the realization of a dream Ringhisen first had as a student in the nursing school at Pace University in New York. It was there that he became a distinguished scholar of the New Careers in Nursing program (2008 – 2009), which provides scholarships to accelerated baccalaureate and master’s nursing students who are traditionally underrepresented in nursing. As a part of his program, Ringhisen was invited to attend colloquia about leadership in nursing. One speech in particular—about former students who had gone on to do work in Tanzania, Scandinavia and the Far East—sparked his imagination.

A native of Kansas who had served in the U.S. Army in South Korea, Bosnia, Kosovo and Iraq, Ringhisen was eager to experience life in yet another part of the world. So he decided to postpone his desire to be a nurse anesthetist in the United States and apply for a Fulbright award.

Ringhisen received the award in April, one month after earning his registered nurse degree. He would not have considered the opportunity were it not for New Careers in Nursing, which he says opened his mind to alternative professional paths in nursing. “I still have the same ultimate goal, but I’m taking a different path to reaching it,” Ringhisen says.

He decided to focus on Bangladesh because of the many barriers to health care there: the entrenched poverty; the densely crowded population; the high cost of health insurance; the inadequate supply of health care providers; and inadequate transportation systems.

For many Bangladeshis, these barriers to care are insurmountable.

Those who are able to get adequate care often go bankrupt afterward. Take, for example, the case of a rickshaw driver Ringhisen studied who had to sell his business in order to afford surgery and orthostatic pins and plates for a son who broke his leg in a traffic accident. “The son was able to get the care that he needed,” Ringhisen says. “But his father now has no livelihood—and no clue about how to settle his enormous hospital debt.”

As India’s smaller, poorer cousin, Bangladesh is often overlooked by the global research community, Ringhisen says. But the dire health situation there is no less deserving of study. “Bangladesh seemed like a place that could use help and more study,” Ringhisen says. “I felt like I could have an impact there.”

Solution: In September, Ringhisen departed for Dhaka, the capital of Bangladesh, where he is studying Bengali for three months. In January, he will begin a nine-month period as a registered nurse and observer of local primary health care in urban and rural settings.

He plans to study how and when Bangladeshis access professional health care. When individuals are injured or ill, at what point will they seek help outside their family and community? Does the injury or illness have to be traumatic or debilitating before they take further action? Does the illness or injury have to disrupt their livelihood or interfere with activities of daily life before they seek care? And what kind of approval must individuals—particularly women and children—receive before seeking care?

“I want to find out why people are coming in to care facilities,” Ringhisen says. “I’m taking an optimistic view, and one that is more heavily grounded in nursing research.”

For the project, Ringhisen will interview some 1,500 community and public health officials and patients about why people seek professional health care. He will summarize the data and share it with hospital managers, physicians and community leaders. He hopes to start a discussion with the nation’s health care decision-makers about how best to appropriate funds and set policies.

The information, he hopes, will provide answers to key questions about the most effective ways to improve health care for all Bangladeshis. His questions include whether clinics should spend money on new equipment or door-to-door van service or whether the country should overhaul its health care payment system or provide incentives for microloans for patients and families.

“Ultimately, I hope to bring some discussion points to key decision-makers so they might be able to have a better feel for what the population wants or needs in order to be able to have better health outcomes.”

RWJF Perspective: The Robert Wood Johnson Foundation created the New Careers in Nursing Scholarship Program in 2008 to help alleviate the national nursing shortage, increase the diversity of nursing professionals and enhance the pipeline of future nurse faculty. Expanding opportunities for nurses like Ringhisen who pursue research projects and careers fits neatly into that goal.