Dorothy Powell’s office in the new School of Nursing building is small, when you consider that it’s a gateway to the world.

As director of the School’s Office of Global and Community Health Initiatives (OGACHI), Powell’s goal is to broaden the skills and values of Duke nursing students and the capacity of faculty to help reduce health disparities in vulnerable populations across the globe. “One of the first things we did when I arrived was to buy a world map,” she says. “Because that’s our playground.”

It’s a playground that includes not only communities in nations far away, but also the neighborhoods where Duke makes its home. OGACHI’s charge is to be a catalyst for programs to reduce health disparities in three spheres: among local populations, across North Carolina, and around the world, particularly in developing countries.

Catherine Gilliss, dean of nursing at Duke, established this office in January 2006 to complement the also-new Duke Global Health Institute. She then lured Powell from her 18-year post as dean of the College of Nursing at Howard University to lead it. It was an offer that Powell, who holds a doctorate in education as well as a nursing degree, couldn’t refuse. “To have all the things that are my passions,” she says -- community engagement, interdisciplinary partnerships and international development work -- “come together in one job was really quite exciting and quite a privilege.”

Thinking Global, Starting Local
In OGACHI’s first year it has wasted no time in going global, but it began here in Durham with service learning programs such as “Raising Health, Raising Hope” at Genesis Home and the Vial of Life program. Genesis Home, a transitional shelter for homeless families in Durham [featured in the January 8 issue of INSIDE], is the first of what Powell hopes will be many homelessness organizations through which nursing students and faculty work and learn. “Responding to the issue of homelessness will probably be one of our hallmark projects,” she says.

Nursing students in the Vial of Life program are interviewing residents of high rise senior citizens residences, collecting patient histories (to be stored in a vial in the residents’ refrigerators). Emergency Medical Service (EMS) responders are trained to look for this information and use it to give that person appropriate care during an emergency. “These are low income, elderly people, most of whom are African American,” Powell says. “So while we’re providing services and establishing relationships with these groups, the students increase their understanding and sensitivity about a population and culture that may be different from their own.

“It’s an opportunity to work with people to identify what their needs are and then design interventions that are culturally relevant, appropriate, and meaningful,” she says.

Globetrotting
These kinds of opportunities are what OGACHI seeks on the global scale, as well. Last summer Powell, along with nursing faculty member Susan Denman, R.N., Ph.D., and Catherine Lindenberg, R.N., Dr.P.H., an independent consultant, took a three-week exploratory trip through Ecuador, Costa Rica, Panama, Nicaragua, Honduras, St. Kitts, and Barbados. The team met with health-care leaders in those countries to learn about their needs and discuss collaborations. “We had 41 meetings and met 141 people,” says Powell, who calls the trip OGACHI’s “reconnaissance mission.”

Based on the educational priorities identified during her meetings with nursing and health care leaders throughout the Caribbean, Powell has committed to establishing an annual Caribbean Institute in collaboration with the Pan American Health Organization. The first Institute, which will bring experts from Duke to the Caribbean in 2007, will focus on education of nurse for care of the elderly.

Caring for increasing numbers of elderly people is one of the most common quandaries in these countries. Because of migration, economics, and social indicators, many people who would traditionally stay with their children and families as they age no longer have that support infrastructure. “These countries are asking, ‘How should that shape the training of nurses and the curriculum in schools of nursing?’” says Powell.

She expects geriatrics to be a focus of OGACHI’s Pan-American efforts for some time, but future focus areas will include cardiovascular nursing, nursing education, technology transfer, pediatrics and HIV/AIDS.

These burgeoning relationships will soon yield internship options for students, beginning with an anticipated new project in Barbados this summer. “Eventually we want at least 40 percent of our students to have an international experience during their studies,” says Powell.

Michael Merson, M.D., director of the Duke Global Health Institute, says OGACHI embodies the ideal of the university’s new global health paradigm. “I have been very impressed with what Dr. Powell is building [in the School of Nursing], with her work in Durham, the Caribbean and Central America to provide opportunities for students and faculty,” he says. “I’m sure we’ll be doing a lot of collaboration with the School of Nursing as the Global Health Institute moves forward.”

Maximizing Capacities
When Duke students go overseas, they usually provide health services in a local clinic. “That’s wonderful and important,” Powell says, “but equally important is how can local providers keep giving those services when we’re not there? We want to help them build their capacity to effectively run their clinics and meet their health care needs. We want to aid the training of knowledgeable nurses who can provide the services and follow-up that are needed.”

This philosophy drives OGACHI’s international projects, but it also applies to the local and state arms of the office. “We don’t go in with a tonic that says ‘you take this as prescribed by us you’ll be all well.’ We’re seeking ways of working with communities to increase their understanding and help them develop skills that can better serve their populations and their needs,” Powell explains.

And building capacity works both ways, she says. “It empowers us to do better; it empowers our students to be better nurses. When we educate our students to have a broader perspective through working with people who are vulnerable, their values are enhanced. And that translates into what their own philosophy of caregiving will be as a nurse.”

“I think you have to give people a broad education that exposes them to a continuum of health care situations and settings and a variety of ethnic, racial, and lifestyle experiences, because that makes up the people that we minister to in our work,” Powell says. “That makes up America -- that describes the world.”