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Harford Community College nursing students teach HIV prevention to high school students in Estonia

High school students in Narva, Estonia, listen to Harford Community College students about the importance of safe sex in preventing the spread of HIV.

HIV is at epidemic proportions in Narva, Estonia, the sister city to the Town of Bel Air, but some recent nursing graduates from Harford Community College are hoping their visits with students will help turn the tide.

Instead of the typical practicum they need to graduate from HCC with their associate’s degree in nursing, six students traveled to the city on the Russian border o educate high school students about how to prevent HIV.


“HIV infection rates are very high in Estonia, particularly Narva,” HCC Nursing Professor Tina Zimmerman said.

Over the course of five days, the HCC nurses taught at least 625 10th, 11th and 12 graders on HIV and AIDS prevention.

Harford Community College nursing students Meaghan Butterfield, left, and Kirsten Smith discuss with high school students in Narva, Estonia, the importance of safe sex in the preventing the spread of HIV.

“If we can prevent what people have, we don’t have to take care of them in that way,” HCC student Julie Rinker, whose focus was on public health when she was in the military, said. “I’ve seen a lot of young children with multiple STDs. To know I made a difference even in one person’s life would be a huge success, accomplishment.”

“We taught them what it is to abstain from sex, about condom use and healthy relationships,” Emily Parker, of Abingdon, said a few weeks after their return.

Other students who made the trip were Meaghan Butterfield of Bel Air, Stephanie Crutchley of Bel Air, Abigail Shibley of Bel Air and Kristen Smith of Forest Hill.

They were accompanied by a committee of nurse educators – Zimmerman, Barbara Tower, professor emeritus of nursing at CCBC, Julie Siejack, clinical nurse manager for community health improvement at University of Maryland Upper Chesapeake Health – and Barbara Hallock, HCC’s coordinator for global education and engagement, who were working together to see what initiatives they could undertake with Narva from an educational, workforce development and health perspective, Zimmerman said.

“HIV was identified as being the primary health initiative they wanted us to see if we could partner on,” she said. “That got me to thinking, is there some way I can involve nursing students, rather than three educators going over there and doing this.”

It proved to be a good move, Zimmerman said after the trip.

The students in Narva responded well to their teaching, Crutchley said.

“I was concerned about how we would be perceived. I was expecting stoic, quiet Russian students,” she said. “I was pleasantly surprised at how well we were received.”

Harford Community College nursing students and their supervisors take in the sights of Tallin, the capital city of Estonia, during their 10-day trip to the country to teach HIV prevention to high school students.

Bel Air Town Administrator Jesse Bane, who revived the Bel Air-Narva partnership when he began working for the town, said he was “thrilled” when he find out the HCC students would be able to go to Narva and was pleased at how well it went.

“For the students, from what I understand, it was the experience of a lifetime for them. I think it’s going to make them better nurses,” he said. “The experience you gain from that, what that does for you as an individual, knowing you had an opportunity to take advantage of your education and share that with students in high school – money can’ buy that. It will be with them for a lifetime.”

Preparing the curriclum

In their senior years, HCC nursing students have to complete a practicum experience. While most go to hospitals in the Harford or Baltimore County area, Zimmerman thought a handful of students could fulfill their practicum obligations in Narva.

In the spring, Zimmerman sent letters to the students who would be graduating in December to let them know about the trip possibility, but cautioned that it was contingent on funding.

Nine students applied and six were chosen after a review.


As part of their practicum requirements, the students worked over the summer with the nursing coordinators to develop the curriculum they’d use when they traveled to Narva.

“They put together games, interactions, Power Point presentations,” Zimmerman said.

The students would meet every few weeks to practice their teachings, review them and make necessary adjustments.

A health professor at HCC who teaches about HIV asked if the nursing students could teach her class.

High school students in Narva, Estonia, listen to Harford Community College students about the importance of safe sex in preventing the spread of HIV.

“I thought that was perfect. She had three classes and the students were working in teams of two, so each team could practice on a real live class,” Zimmerman said. “It was incredibly helpful. We got feedback from real live students.”

The nursing students also learned about the culture of Estonia – what to expect – “because we wanted the students to be very sensitive to them going over there,” Zimmerman said.


While the students were preparing their curriculum, Zimmerman and her colleagues were also pursuing funding for the trip, so students wouldn’t have many in terms of out-of-pocket expeses.

The Harford Community College Foundation contributed $4,200; University of Maryland Upper Chesapeake Health, $6,000; the Town of Bel Air, $2,000 for printing and brochures on HIV; and the U.S. Embassy, $5,000 for test kits to be left in Narva. The town of Narva also paid for the students’ and facilitators’ food and lodging while they were in the city and bought their tickets for tourist visits.

Students teaching students

When they arrived, each team of two students was supervised by one of the nursing educators, who evaluated the students for their practicum grades.

The HCC students wanted their lessons to be interactive, not just standing in front of a classroom lecturing, Crutchley said.

“We gave them scenarios, like a girl and a guy at a party, and the girl wants the guy to leave and he tells her no,” how the girl can get out of the situation, she said.


“It’s important to balance abstinence and safe sex, and there are different ways to go about it,” Crutchley said.

They also taught them about safe sex and how to use condoms.

The Narva students are just like students in the United States, and “some of them speak English better than I do,” Butterfield said.

“And they have a really good grasp of American slang,” Crutchley said.

Their first day, though, Butterfield was teaching an all Russian-speaking class through a student translator. The students opened up through him, she said.

“They don’t want to talk about sex in front of their teacher,” she added.


Sex education in Narva is similar to in the United States.

“Many families feel it’s the school’s job to teach kids about safe sex,” Crutchley said.

The Estonian students reacted to the HCC students.

“They were receptive to us being there. Rather than us asking the questions, they were asking the questions of us,” Rinker said.

Some of the students are sexually active and some took as many condoms as possible, Parker said.

“Some didn’t know what to do with them,” she said.


Zimmerman was pleased with how the trip went, she said.

“What impressed me most was how adaptable the students were in Narva. They never knew what type of classroom they were walking into – they adapted to the classroom,” she said.

The HCC students were very kind to the high school students and treated everyone with respect, and the high school students they were teaching respected the HCC students.

“I really am so proud of my students because I feel they took it so seriously. They were so adaptable and made sure they were getting the point across about HIV,” Zimmerman said. “They presented it in such a relaxed, informative method those students really related to my students.”

The evaluations of the workshops were outstanding, Zimmerman said, and the Narva students indicated they are now more aware of the importance of HIV prevention by practicing abstinence or safe sexual practices through the use of condoms.

Outside the classroom


In addition to teaching students, the HCC students also visited the Narva hospital, visited the Linda Clinic, a free HIV clinic in Narva and made a youtube video of the clinics. They visited international youth workers to talk about teaching and their experience in Estonia.

“It was more than just the high school students in the school system there,” Zimmerman said.

The HCC students were also accompanied by representatives from the Linda Clinic, who provided information to students about the testing the clinic offers.

“They said they learned so much from the teaching by the students.” It’s so much more effective by young people,” Zimmerman said.

The HCC students had different reasons for going.

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Parker said she applied because it was different than a hospital practicum and she wasn’t sure she’d have a chance like it again.


“I don’t know if I’ll leave the country, experience another culture,” she said. “It would put me out of my comfort zone.”

Shibley thought the trip might put her at a disadvantage after she graduated that she didn’t complete her practicum in a hospital.

“But I realized I’d focus on another aspect of nursing – adaptability and flexibility – all characteristics to be a leader,” she said. “It was an amazing experience, an amazing way to see ourselves not just as nurses at the bedside.”

Smith doesn’t like the cold – and it was cold in Narva – and public speaking, but the trip gave her a chance to see a different culture. She said she learned how to “adapt, teach and hone in on what each individual needs.”

When Butterfield applied, she wasn’t really sure if she wanted to go, “but I could not change it,” she said after her return.

“It was so interesting to see someone else’s culture,” she said.