Purpose
The purpose of this practical application activity is to
increase the RN’s awareness of the impact of poverty, poor nutrition, early childbearing and lack of access to emergency obstetric care in developing countries on maternal/infant health outcomes
analyze the impact of United States emergency health care policy and State Health Department Programs on maternal/infant health outcomes and
gain experience in using public health models in describing and analyzing population health conditions and interventions.
Step One
Watch “A Walk to Beautiful”, originally a 2007 American documentary film. There are two versions available for you to chose from:
This version aired September 29, 2008 in Melbourne, Australia. Link: Walk to Beautiful (https://youtu.be/TPTA4g5rGrs)
This version was published by Ethiopia Forward in 2014 and might be closer to the original in length. Link: Walk to Beautiful (https://youtu.be/QlADfuqPdkU)
Watch “Obstetric Fistula: Every mother counts (https://youtu.be/hJHFifCmbuo)”
Read the World Health Organization fact files on obstetric fistula (https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula) and
[OPTIONAL] Living Testimony: Obstetric Fistula and Inequities in Maternal Health (https://www.unfpa.org/resources/living-testimony-obstetric-fistula-and-inequities-maternal-health)
Watch and listen to from “Despair to Dignity (https://media.un.org/en/asset/k16/k16618lxwk)”
Explore the Fistula Foundation Website (https://fistulafoundation.org/).
[OPTIONAL] Resources: fistulacare.org (https://fistulacare.org/resources/resources-training/) and Campaign to End Fistula (https://endfistula.org/)
Step Two
Imagine, if you were to visit your local hospital with emergency and obstetric departments. From your knowledge of the environments of an emergency department waiting room and triage areas and and the maternal/infant department, what would you see? As you “Walk through the Beautiful” hospital imagine yourself one of the women you met during Step One in Walk to the Beautiful and Every Mother Counts. Try to see your local facility through her eyes.
Step Three
Visit your State’s Health Department and Hospital Association websites and consider the availability of access to emergency obstetric care for residents. Explore the primary, secondary and tertiary prevention programs that impact maternal infant health outcomes.
Step Four
Analyze and document your experience:
What made the most lasting impression on you from Step One and Two? Why was it so powerful? What specific information, knowledge did you gain from this activity? Describe how this experience broadened your perspective of the population served. How did the activity give you insight to experiences that may impact the health needs of your clients? How will you be able to integrate this learning into your nursing practice?
Provide an example of one public health core function that would apply. Describe how EMTALA (https://www.cms.gov/regulations-and-guidance/legislation/emtala?redirect=/emtala/) and your State’s Health Department support assurance of primary, secondary and tertiary prevention of unfavorable birth outcomes for mother and infant in your state. Discuss alignment of the service/programs of your State’s Health Department with both, EMTALA and the level of prevention.
Global aspect:
Identify three social determinants of health that contribute to the development of obstetric fistulas in women in developing countries; provide rationale for your choice.
Provide examples of two primary prevention interventions/programs that could potentially reduce fistula incidences with focus on women/girls before they would/could get pregnant in developing countries; include rationale for your decision. Hint: Think social determinants of health.

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