mobile health

Global Mindset and Mobile Health Education Exchange Initiative

by Marsha E. Nickerson



The Global Mindset Mobile Health Education Exchange will be an empirical encounter between North American and Central American professional healthcare students implementing Mobile Health (mhealth) Tools in Belize Southern Regional District.  The initiative to bring US healthcare professional students to Placencia Belize to aid in the wellness, decreasing of chronic illness exacerbation, and disease prevention for Belizeans in the public health system. This endeavor would foster partnerships with worthy organizations and aid in bringing experienced faculty, senior-level student support, and telehealth capabilities to Belize.

Keywords: Global Mindset, Mobile Health, Chronic Illness, Education, Student Exchange


The Global Mindset Mobile Health Education Exchange is a proposal to bring US healthcare professional students armed with Mobile Health Technology to provide support to chronically ill Belizeans in the public health system. This endeavor would foster partnerships with Placencia Belize to aid in the wellness, decreasing of chronic illness exacerbation, and disease prevention and aid in bringing experienced faculty, senior-level students support, and telehealth capabilities to Belize.

The cultural exchange between Belizean healthcare patients, professionals, and students with US students will foster a global mindset among the participants involved. The proposal will also provide a means for Belizean students eligible for high school to get funding to continue their education, and to journey to the United States to participate in classes in the academic setting and gain clinical experiences in the US healthcare system.

It is hoped as an overall purpose to increase holistic improvement of the quality of care of Belizean patients and advance the cultural understanding and humility in healthcare learners. The project will educate Belizean nursing students and faculty on innovative technology and treatments used for rural and shut-in patients in need.

The partnership project will begin as a pilot and scale up to a full-fledged sustainable effort, (Kumaranayake, 2008), to have an ongoing interchange between healthcare workers and professionals in the US and Belize.  The proposal has multifactorial implications and the possibility of accommodation for all involved. The hope is for nursing student cultivation to cultural norms and mores that are integral to care, US students interfacing with an international healthcare system, gaining a global mindset and learning to provide congruent transcultural care to native Belizeans in acute, community, and home setting.

Another facet of this action would be, the University of Belize Department of Nursing, Allied Health, and Social Work partnering with Mount Saint Mary’s University (MSMU), Los Angeles Nursing Department to exchange students. And the integration of mobile health technology to boost healthcare in Belize, increase access to proper care, and provide 21st-century chronic illness management.

Scope of Problem

Healthcare services in Belize are limited for most native Belizeans due to an ineffective public siloed Ministry of Health system with ephemeral Cuban Brigade nurses and doctors rotating through the clinic and hospital settings, and conducting limited home visits to chronically ill patients, with a native skeleton staff. There is a high demand for more skilled professional personnel to aid in providing chronic illness care.

According to the World Health Organization (2018), Diabetes Mellitus and Hypertension are major chronic maladies striking Belizean individuals, monitoring of blood pressure and glucose levels and patient teaching on nutrition, exercise, and medication regimen are needed to aid in keeping chronic illness exacerbations at bay, (CDC, 2017: W.H.O., 2018).

As reported in the Central Intelligence Agency World Factbook: Belize, only 5.8% of the GDP is spent on the public healthcare system, (country comparison to the world is the 109th place).   The physician density is  0.77 physicians/1,000 population (2009), compared to 2.57 physicians/1,000 population (2014) in the US,  and the hospital bed density is 1.3 beds/1,000 population (2014) compared to 2.9 beds/1,000 population in the United States (CDC, 2017; CIA, 2017).

It is essential that US healthcare students engage in an international experience to understand the transcultural care context.  There is a need to increase access to chronic illness, holistic, mobile healthcare for Belizean patients interfacing with the public healthcare system in the acute, healthcare clinic, and home care settings.

Mount Saint Mary’s University, (MSMU), a liberal arts women’s academic center in Los Angeles has grant opportunities to pilot global clinical experiences with nursing students. There is the need to instill a global mindset in US health care students by employing them to provide mobile healthcare and interface with the health care system in a developing country.

The Objectives of the Initiative are to:

  1. Provide equal access to complete culturally congruent care to chronically ill Belizean patients as a hallmark of social justice
  2. Create a means to provide mobile health chronic illness monitoring and education for Belizean citizens.
  3. Aid students in developing a global mindset in professional clinical practice
  4. Develop a cultural, educational exchange for US and Belize healthcare students to confer and learn about health care outside of their domain.
  5. Build a technology investor climate in an emerging market.
  6. Establish an ongoing sustainable partnership by creating an international experience as a 1 unit capstone course at a university to be taken by senior-level healthcare students in the spring semester before graduation.

Context and Economic Policy Change Recommendations

Although Belize has the third highest per capita income in Central America, the average income figure masks a huge income disparity between rich and poor, and key government objectives remain to increase education, reducing poverty, and inequality with the help of international donors. High unemployment, a growing trade deficit, and a heavy foreign debt burden continue to be major concerns. Belize faces continued pressure from rising sovereign debt, and a growing trade imbalance (CIA, 2017).

The per capita per Belizean citizen is $8300.00  (2017), $8,400 (2016), and $8,700 (2015). The unemployment rate 10.1% (2017 est.), 11.1% (2016). The population below poverty line is a whopping 41% (2013). The cost for education per person is $50.00 at the elementary level, $1000.00 at the high school, and college costs average approximately $10,000.00 for a 4-year degree (CIA, 2017; WHO, 2018). The government’s expansionary monetary and fiscal policies, initiated in September 1998, led to GDP growth averaging nearly 4% in 1999-2007, but GDP, ($3.23 billion in 2017, $3.151 billion in 2016, $3.176 billion in 2015), growth has averaged only 2.1% from 2007-2016, and only 2.5% growth estimated for 2017 (CDC, 2017; CIA, 2017; WHO; 2018).

The economic picture in Belize reflects the need to increase healthcare expenditures for the health and welfare of Belizean citizens and the three following economic policies are warranted:

  1. Macroeconomic Stabilization Policy, which attempts to keep the money supply growing at a rate that does not result in excessive inflation and attempts to smooth out the business cycle (Mell & Walker, 2014; Rashid & Antonioni, 2016).  This policy can work in Belize by not increasing prices on goods and services for the citizens to stimulate a rise in the purchasing value of money to stabilize the economy.
  2. Revisit the Expansionary Monetary Policy, which allows the government to increase the money supply to lower interest rates. Lower interest rates to make loans for education, cars, homes, and investment goods cheaper, which means increased consumption spending by households and increased investment spending by businesses in technology and healthcare (Mell & Walker, 2014). This policy can work in Belize by aiding more citizens to pay for their high school and college education.
  3. Revisit Expansionary Fiscal Policy, which occurs when increasing government purchases of goods and healthcare services or decreasing taxes can stimulate the economy. Growing investments increases economic activity directly, giving businesses money to hire new workers or pay for increased orders from their suppliers. Decreasing taxes increases economic activity indirectly by leaving households with more after-tax dollars to spend (Mell & Walker, 2014). This policy can work in Belize by helping increase Belizeans ability to gain employment and have more money to save, live, and spent. It also can help achieve more expenditures for health care and technology infrastructure to aid in the utilization of telehealth capabilities for monitoring and education of chronically ill patients.

Alternatives to Project Proposed

A worthy alternative to the Global Mindset Educational Exchange initiative is to create a crowd raising campaign like Global Giving to generate funds to aid Belizean students to complete high school and financially sponsor Belizean high school graduates to attend university in the US with the stipulation the students return to Belize to engage in needed STEAM careers in the country.

Collaboration to Success             

A collaborative partnership between Nursing Education, Mobile Health Technology, and the Belizean Healthcare System will need to be established.  After definitive grant approval, I will partner with The Department of Nursing at Mount Saint Mary’s University (MSMU), The Department of Nursing Allied Health, and Social Work at the University of Belize, a Mobile Health Technology Company ( Apple Healthcare, TytoClinic or Dimagi),  and Pepperdine University Doctoral Student Scholars, Theresa Dawson, Judy Johnson, and Faculty Global Leadership Scholar, Dr. June Schmieder- Ramirez.

Upon the completion of grant documentation, MSMU has agreed to provide 25,000 dollars seed money via Margaret Mary Murphy Expendable Scholarships for Nurse’s Global Study to pilot an international capstone experience for senior level students about to graduate.  In the past, student nurses at MSMU have only had local faith community health, public health, and school camp nurse experiential courses and the Nursing Department is chomping at the bit to provide a global experience in a developing country.

At the University of Belize, there are BSN, Nurse-Midwifery, Nurse Practitioner, Pharmacy, and Social Work programs. We will conspire and create the education interchange between MSMU senior level nursing students who will rotate through government-run acute care, clinics, and home settings with Belizean healthcare professionals and students and also visit the University of Belize Nursing program for classroom conferring.  Students will utilize Mobile Healthcare technology in the provision of care and aid in teaching patients how M-Health tools can aid in gauging their chronic illness.

The students will receive preparatory Global Mindset educational content before the journey and learn to train others to use M-Health tools.  Then Belizean nursing students will be sponsored to come to the United States for an international experience and coursework.

We will partner with the Ministry of Health Head Office in Belmopan, Belize to coordinate clinical experiences.  The Ministry of Health has approved international clinical experiences for dental students from the United States in the past.

A  Pepperdine University partnership will enable us to write grants to branch out of nursing and provide participation for viable clinical experts to come to Belize for a transcultural healthcare engagement, e.g., Speech Pathology, Registered Dietitian, Occupational and Physical Therapy students, faculty, and consultants.  The specialty therapists would consult on interventions using Mobile Health technology to aid in the rehabilitation of patients with chronic illness.

Action Steps

  1. Complete grant funding process to gain funds to pilot, plan, and implement the proposal. The budget is complete and based on the $25,000. 00 quoted by MSMU Dean of Nursing.
  2. Create an application and interview process for students to be considered for the experiential learning experience. Interview students and choose number of candidates according to budget created.
  3. Plan for logistics for the budgeted number of students and faculty, e.g., hotel, meals, plane, etc.
  4. Begin exchange experience as a pilot with a small group of students and faculty from the US. The piloting the experience will allow for barriers to a broader effort to reveal themselves.  An analysis of short run to extended run data and what occurred in the pilot experience with m-health tools, WIFI, and bandwidth capability, and other revealed stimuli will enable reviewing, revamping and refining of the initiative.
  5. Develop a one unit sustainable international experiential course focused on Belize itself and on Healthcare Global Mindset, Roy Adaptation Nursing, SPELIT Power Matrix, Mobile Health Technology, and Transcultural Care Theory (Kim, 2005 ; Schmieder-Ramirez & Mallette; 2007; Roy, 2009; McPhee et al. 2013; Betancourt, 2015; Edmonson et al, 2017).
  6. Implement the global experiential course offering by bringing US students, mobile health technology to augment health services in Belize’s Healthcare system.
  7. After analysis of the pilot experience, write grants to replicate the experience for other specialty health professional students, e.g., speech pathology, social work, pharmacy.
  8. Petition for funds to sponsor Belizean elementary students to complete high school and provide funding opportunities for the University of Belize nursing students to travel and interface with the US healthcare and education system to broaden their cultural mindset.



Devising a plan that addressed health care and the use of technology in a developing country seemed daunting until the task forced me to focus and take action steps to bring the thing to life.  There is a great more to be considered but I do understand the importance of the social, political, economic, legal, intercultural, and technical drivers shaping the environment that can impact the result produced.  This endeavor opened my eyes to the possibilities regarding how to be an active participant in making a small difference in the world, which is quite meaningful, gratifying, and empowering.

Marsha E. Nickerson, RN, PHN, MSN is an Assistant Professor of Nursing at Mount Saint Mary’s University and is completing doctoral studies in Learning Technologies at Pepperdine University.

E-mail: marsha [dot] nickerson [at]


Thank you to Theresa Dawson, Judy Jackson, and June Schmieder-Ramirez who helped tremendously with the development of this initiative.


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