A recent Gallup poll reveals that nursing remains the most trusted profession in the United States for the 22nd consecutive year. However, the noble image of the nursing profession is not universal. Research published in Social Science and Medicine (2007) demonstrates that Bangladeshi culture associates nursing with “commercial sex work,” given nurses’ night shifts and close contact with strangers. Moreover, a 2022 article in The International Journal of Public Health discloses that Bangladeshi nurses experience workplace bullying, violence, and burnout.
Professor Emerita, Psychiatric Clinical Nurse Specialist (at Massachusetts General Hospital), and American Academy of Nursing Fellow Anne-Marie Barron and Associate Professor of Practice Kelly Marchant counter this stereotype by refining and ennobling the nursing profession in Bangladesh through education and training. “Part of our approach is to honor the work of nurses,” says Barron. “We want to show the Bangladeshi community why nurses should be respected for their great skill and expertise. And given their limited resources, Bangladeshi nurses’ dedication to their practice and patients is all the more remarkable.”
Barron’s interest in Bangladesh began in 2008, when Dr. Bimalangshu Dey, a colleague of hers and Director of the Bangladesh Initiatives at the Center for Global Health, Massachusetts General Hospital (MGH), approached her about a collaborative opportunity. Dey, who specializes in bone marrow transplantation, desired to give back to his home country of Bangladesh by addressing its healthcare and nursing shortages. Under his leadership, a partnership emerged between MGH, Simmons University, Dhaka Medical College Hospital, AYAT College of Nursing and Health Sciences (ACNHS, Dhaka), and the government of Bangladesh (under the auspices of the Ministry of Health and Family Welfare).
Barron’s involvement with the partnership involves training Bangladeshi nurses in oncology and palliative care, as well as consulting with leaders and faculty at ACNHS. Marchant, Barron, and current Simmons PhD candidate/former Nursing faculty Katherine Robbins offered faculty development sessions remotely throughout 2019. In June of 2022, while in Dhaka, Barron and Marchant met with fourteen nursing school deans (or “principals,” as they are called in Bangladesh) and forty faculty from across Bangladesh to focus on the future of nursing and nursing education, arranged by ACNHS.
Over the years, Barron has made many trips abroad. Former Nursing Deans, Dr. Judy Beal and Dr. Lepaine Sharp-McHenry, are strong advocates of the partnership and sometimes accompanied Barron to Bangladesh. Marchant joined the project in 2018, upon her arrival at Simmons. Marchant and Barron have led “Train-the-Trainer” intensive programs related to end-of-life and palliative care in the Boston area and have taught similar courses and certification programs at Simmons at both the undergraduate and graduate levels. Marchant recently traveled to Bangladesh to offer faculty development and nursing education.
Marchant, Barron, and collaborators Emily Erhardt, Jocelyn Hulburt ’08BSN, and Nisha Wali ’21FNP received the 2023 Award of Excellence from the End-of-Life Nursing Education Consortium, or ELNEC, for their work in Bangladesh. “ELNEC has been at the forefront of establishing educational resources and palliative care education for nurses since 2003, so to receive this recognition from them was a true honor and delight,” says Barron. (Moreover, in 2019, ELNEC inducted Simmons into its Hall of Fame).
Elevating Nurses and Comforting Patients
According to Marchant, “it was Dr. Dey’s vision and the bedrock of our program that we must elevate nursing practice and the status of nurses in Bangladesh in order for healthcare and patient care to improve. . . It is humbling for someone from the United States to see all of the obstacles their nurses must confront. Supporting nursing development will help realize our initiatives moving forward.”
Besides social stigma, another challenge Bangladeshi nurses face is severely understaffed hospitals. Under Dr. Dey’s leadership, the partnership opened the first bone marrow transplant (BMT) unit in Bangladesh. This BMT unit is located in the country’s largest public hospital, which serves the most people in Bangladesh. This entity will help meet the high demand for bone marrow transplants in Bangladesh (due to the prevalence of thalassemia, a condition that necessitates transplantation, among Bangladeshi patients). “While a bone marrow transplant is usually curative, it is nevertheless a grueling process that requires an able and vigilant nursing staff,” explains Barron. “The BMT unit requires a high ratio of nurses to patients, e.g., one or two nurses per patient. But in Bangladesh, the ratio may be as high as two nurses per every 40 or 50 patients.” Many nurses and nurse practitioners, including Barron, traveled many times to Bangladesh to provide bone marrow transplantation and oncology nursing education.
A key element of the nurses’ training involves palliative care. As Marchant explains, “palliative care shifts the focus back to the patient and helps them maintain their comfort. The term is often invoked in the context of chronic or terminal conditions, but palliative care does not necessarily entail end-of-life or hospice care. Rather, it is a comprehensive approach to maximize the quality of life and comfort of the patients. In nursing, we can often get caught up in procedure, but we also need to prioritize our patients’ pain response and practice holistic care.”
For Barron, palliative care gets to the crux of the nursing profession. “This intense focus on comfort and addressing suffering really encapsulates the essence of nursing. And we have observed that the nurses in Bangladesh aim to offer this kind of care to their patients.”
In the years since the program’s implementation, Barron has identified several positive outcomes. “Of the patients treated with bone marrow transplantation, there have been no mortalities linked to transplantation itself, which is a remarkable statistic that reflects the excellence of this program and the vigilance of the nurses.”
Moreover, Barron and her Simmons and MGH colleagues have collaborated with partners in Bangladesh as they established ACNHS. This institution offers high-quality nursing education that attracts hundreds of students. In addition, AYAT leaders have organized palliative care initiatives in Bangladesh, including the five ELNEC training programs recognized by the Award. “Their [nurse participants in the ELNEC trainings] hunger to improve their professional practice was the most positive outcome of the work that I have experienced,” adds Marchant.
Alumnae/i Mentorship
Simmons’ School of Nursing alumnae/i have traveled to Bangladesh to bolster the initiative. When Jocelyn Hulburt ’08BNS, who is now a Family Nurse Practitioner at the Community Health Center at Cape Cod, visited Bangladesh, she was shocked by the hospitals’ overcrowded and understaffed conditions. “The Bangladeshi nurses focused their energy on how they could improve even a moment of someone’s health care experience because a moment was all they had. It was a great lesson for me.”
Nisha Wali ’21FNP, currently a hematology and oncology Nurse Practitioner at MGH, participated in the partnership prior to her studies at Simmons. Under Barron’s guidance, Wali realized that there is always an opportunity to learn something new. “Approaching learning with humility is such an integral part of our global health work,” she explains. “When you are working outside of your most familiar clinical practice setting, you have to approach teaching with an open mind and heart. In settings with limited resources, there can be great innovation and possibility.” Nursing School Dean Heather Shlosser (who will be traveling to Bangladesh in May), Teaching Professor and Nursing Chair Chaluza Kapaale, Barron, and Marchant would like to organize future exchange programs with Simmons Nursing faculty and students and ACNHS faculty and students.
Wali found her experiences with Bangladeshi nurses especially meaningful. “Despite differences in culture, language, and customs, we all share the same worries when it comes to serious illnesses. Providing mentorship to peers fosters a sense of ownership of our nursing practice and belonging to the fraternity of nursing around the world. Perhaps the most important thing I have learned from teaching both professional nurses and undergraduates is that the language of nursing is storytelling. The stories we share with each other serve to foster resilience and community and help us make sense of the most difficult parts of being a human.”
Marchant will never forget the sheer gratitude of the Bangladeshi people with whom she worked. “They went out of their way to express thanks to us in every way that they could. This opportunity was truly remarkable.”
“Their generosity was profound,” recalls Barron. “We come from every trip saying that we have received far more than we have given.”