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University of Colorado College of Nursing

College of Nursing

Pam Prag

Going Global Where It's Needed Most

Pam Prag

Pam Prag is no stranger to health care in developing nations. She has volunteered in Uganda, Indonesia, Zambia, Haiti and Afghanistan. Her more recent foray was to Banepa, Nepal, last fall, where she was asked to evaluate the possibility of a partnership between the Scheer Memorial Hospital College of Nursing and the CU College of Nursing. Prag was on a team of health care professionals volunteering under the auspices of Centura Health’s Global​ Health Initiatives (GHI). She returns to Nepal this May.

Prag (BS ’85, MS ’95, MPH ’12) is a certified nurse-midwife and a senior clinical instructor in the University Nurse Midwives faculty practice of the College of Nursing. Her specialty was needed on the interdisciplinary Global Health Initiatives team, whose mission is to promote health, wellness and health education and to improve access to medical services to underserved populations around the globe. Their work in Nepal historically has been focused on the enormous problem of uterine prolapse, Prag says, but the team is also focusing on prevention.

Two faculty members from Scheer Memorial College of Nursing in Nepal are preparing to apply to the College of Nursing PhD program as a part of the CU partnership. Prag sees an opportunity for our graduate students to assist Nepali nursing students with research. Other goals include faculty exchange, curriculum development focusing on prevention of health concerns prevalent in Nepal and collaboration on research projects.

Like many developing countries, “Nepal has layer upon layer of health problems,” Prag says, including a high maternal and infant mortality rate. Most births are unattended; or those that are attended are by a traditional birth attendant layperson who may have had only some cursory training.

The World Health Organization has identified uterine prolapse as a major cause of maternal morbidity in Nepal, mainly attributed to factors such as closely spaced pregnancies, poor nutrition and intense labor--especially in rural areas. “It’s not surprising,” Prag says. “Women give birth and are up and carrying one and a half times their own body weight in baskets on their heads, often within several hours.”

Other factors, some of them cultural, contribute to the problem. Women giving birth are considered unclean until they stop bleeding, so in rural areas childbirth might take place in a barn. And Nepali doctors aren’t paid as much to deliver babies as they are for other health care, so adequately trained medical professionals are rarely present. “Improving health has to come from within the culture,” Prag says. “The women who are the educators there agree that it’s not the way girls should grow up.” But improving the health picture for women and infants won’t happen overnight.

The right place to start is education, which leads to prevention. “One idea that was well received by the Scheer Memorial faculty was to focus on the community health rotation of the student nurses,”Prag says. “Educating girls is a beginning. Mobilizing these young women to educate their own community will give credibility and sustainability to this process.” Fortunately for the team of volunteers and for the Nepali people, help from others is welcome and valued, but it’s clear they are not looking for short-term hand-outs. The Nepali people want to improve their own system, and they recognize that it starts at the grass-roots level--with education.”

Prag is passionate, and it shows. “The experience really got to me,” she says of the fall trip. “The Nepali people are so warm and genuinely interested in participating in a solution to a problem. They want their country to be recognized as a country that’s moving forward and becoming a player in the western part of the world.”

Another concrete challenge is the need for basic resources such as computers for online studies, improved internet access, mannequin simulators and books.

With her own children grown, Prag avows that devoting more time to teaching other health care providers to address health issues in places like Nepal is her “greatest joy.” That’s one reason she and her colleague Amy Nacht are developing a global health practicum, a three-credit elective for College of Nursing graduate students, and potentially graduate students in the Colorado School of Public Health, that will entail a three-week concentrated course in Nepal. The objective of the course is to address public and community health topics that cross disciplines and allow for collaborative efforts across the medical community and beyond.

Prag is collaborating with the CU School of Dental Medicine, the School of Public Affairs and the Colorado School of Public Health, all of whom are in the formative stages of developing similar programs in developing nations. “We’re using resources well, and the collaboration is very satisfying,” she says. “So we’re really on the edge of some exciting things.”

Prag hopes to offer the Global Practicum course every six months, to “spark an interest” among College of Nursing students to develop a long-term, sustainable partnership. “This partnership isn’t the kind of effort where you take two weeks and go and do good things and then come home,” she says. “There’s nothing wrong with that, of course, but what we’re doing has to be sustainable. With a partnership for the long haul, we can make such a difference. Education, leading to prevention, is a huge solution.”​​