The Remote Area Medical (RAM) program provides valuable clinical experience that helps students grow in autonomy, confidence and interdisciplinary collaboration and teamwork. Participants provide high quality care to individuals from rural and underserved areas while improving their cultural competence.
Published April 24, 2020
Earlier this year, a group of University at Buffalo School of Nursing faculty and students—along with volunteers from the Schools of Dental Medicine and Public Health and Health Professions—traveled to Knoxville, Tennessee, to provide health care services to underserved individuals.
“Knoxville is part of the Appalachian region, which has one of the U.S.’s highest incidences of dental problems related to non-fluoridated water, limited access to care and tooth loss,” says Molli Oldenburg, DNP, RN, FNP-C, global initiatives coordinator and clinical assistant professor.
Oldenburg, along with nursing faculty members Joann Sands, DNP, RN, ANP-BC, and Linda Paine Hughes, DNP, ANP, PNP, PMHNP-BC, FNP-C, led six nursing seniors on the weekend experience from Jan. 31 to Feb. 2, 2020.
For those three days, volunteers from all over the country gathered at a mobile clinic at a local exposition center to serve 1,534 patients, totaling $896,282 worth of medical, dental and vision services.
"Every single person that we interacted with was incredibly grateful to finally get the care they needed,” says Elle Piscitelli, a nursing senior who participated in the trip. “Every volunteer was so happy to be there helping. The best word I can use to explain the experience is magical.”
Since 2015, the School of Nursing has partnered with the School of Dental Medicine to volunteer for Remote Area Medical (RAM), a major nonprofit provider of free mobile clinics for underserved and uninsured individuals. Globally, the organization has more than 155,000 volunteers—including licensed dental, vision, medical and veterinary professionals—that have treated more than 835,000 individuals and delivered more than $150 million worth of free care.
“Patients came to the clinics from miles around, with many sleeping in their cars and waiting anywhere from 24 to 48 hours to receive care,” says Oldenburg. “The students are always in awe of the actual condition of their health because they don’t have regular access to these services. It gives them a better appreciation for serving this population.”
In appreciation for their support, RAM covers the costs of the hotels and provides some meals to the volunteers. Students and faculty also received financial support from the School of Nursing’s Carol S. Brewer Global Health Fund.
Starting bright and early at 5:30 a.m., nursing students were put to work triaging patients—checking blood pressure, pulse rate and other vital signs; reviewing medical histories; and determining which medical, dental or vision services were required.
“I think the interprofessional collaboration experience is immeasurable for these students,” says Oldenburg. “We do interprofessional education sessions at the school, so this is a really nice way for students to get more hands-on practice in a real-life setting.”
In addition to putting their nursing skills to the test, nursing students also had the opportunity to assist volunteers from the dental school. Once their triaging was complete, usually around noon, the nursing students would transition to assisting dental students with their patients.
“One of the coolest parts of this experience was working with so many different teams to provide care,” says Piscitelli. “Our main job was triaging patients, but when triaging slowed down, we assisted UB dental students, which meant that we had to step out of our comfort zones and learn new skills on the spot.”
Rural areas, such as the Appalachian region, face many challenges related to accessing health care services. According to the Health Resources and Services Administration, these communities often have fewer primary and specialty care physicians and mental health professionals, which contributes to a range of health disparities, including greater obesity and disease burden in children and adults, higher mortality rates and shorter life expectancy compared to urban areas. They also face social risks, such as limited employment and education opportunities.
“I was overjoyed by my experience with RAM,” Aubrey Herbert, another nursing senior, says. “The idea of being able to walk into a clinic and not have to open your wallet felt very liberating to me. There is so much confusion and anxiety around health insurance and coverage. The free medical care offered by RAM felt approachable and less stressful because there were no financial responsibilities.”
“This trip teaches students a lot—to be a little more understanding, a little more compassionate and a little more patient," Oldenburg says. “You don’t always get that when you work in a hospital with access to everything. Working with a different population gives you a better understanding of the health disparities many people face.”
The students agree that the experience provided them with an incentive to do better in their practice as nursing students and as future nurses.
“RAM was hands down one of the most amazing experiences of my life,” says Piscitelli. “I learned more about the community I was serving and myself, both personally and professionally, in a three-day span than in my entire clinical rotations.”
“I would like to have a career working with the underserved community,” she adds. “I was able to connect with people, hear their stories, and it moved me. And they could tell that I cared. I think this is what it really means to be a nurse.”