According to the United Nations, climate change is the single biggest health threat facing humanity. In their role on the frontlines of public health, nurses are witnessing firsthand the impact of a changing climate on human health, and as a result are intently working to build a more sustainable healthcare system better positioned to respond to climate change and ensure a healthy future for everyone.
One of these nurses is nurse scientist Roxana Chicas, PhD, RN, assistant professor in the tenure track at Emory’s School of Nursing, who conducted the first field-based intervention study examining methods to reduce core body temperature and improve health among farmworkers in the US, using real-time biomonitoring equipment.
As a bilingual, bicultural investigator with research experience in occupational health, environmental health and nephrology, Chicas embodies how diverse nurses can bring unique strengths and skills to solving public health challenges in a way that actionably improves human health.
Chicas’ path to nursing wasn’t a straight one. Rather, it came to life through a village of mentors and supporters. Her story begins in El Salvador, where she left with her mother as a child to immigrate to the United States. She was undocumented before receiving temporary protected status that allowed her to work in the U.S., which she did in lieu of graduating high school.
“I came from a family that knew education was important, but didn’t really know how to guide me to go to college. It was just, get a good job, do good work, so that you always have a job. So that’s what I did.”
She began working in a pediatric office as a billing administrator, and became an unofficial interpreter for patients and families, which gave her an initial taste of working in the healthcare field. It was also where she first considered nursing, on the advice of Dr. Gerald Reisman, a pediatrician with whom she worked.
“I’d never thought of myself as a professional or going to college,” she said, but Reisman’s belief that she had what it takes to become a nurse gave her the confidence to apply to Perimeter College at Georgia State University. However, she ran into issues related to her temporary protected status. That’s when an attorney in Georgia, Charles Kuck, took on her case pro bono, successfully advocating for her immigration status and program eligibility.
“Mentors have been able to see something in me that I didn’t see in myself,” she says. “There are people who want to guide you, out of just genuine care and seeing something in you and wanting to see you succeed.”
With supporters behind her, Chicas enrolled in an associate degree nursing program, where she learned about a new partnership between her school and Emory University to enroll more nursing students from diverse backgrounds in BSN and PhD programs.
“I didn’t know nurses could get a PhD, I didn’t even know what a PhD was,” she said. With continued support of mentors and faculty, she applied, eventually enrolling in a PhD program at the Emory University School of Nursing. The school’s dean, Linda McCauley, PhD, RN, FAAN, FRCN, became her advisor, and introduced her to existing research on farm workers and the Latino community.
The farming community faces particular risk from increasing temperatures due to climate change, making the environment a key component of equity efforts. Survey studies had found farm workers were experiencing heat related illness symptoms like headaches, nausea, and cramping, but the impact hadn’t been measured in an objective way.
Chicas had an immediate connection to the work. “About 50% to 70% of farm workers here in the United States are undocumented, and my parents worked in agricultural fields in El Salvador, she said. “I thought that it would be great for a Latina nurse to go and do research, to be down there in the field with them, and provide health education in their native language. I shared a lot of my background with them.”
Her first project, called The Girasoles (Sunflower) Study, was one of the first to objectively track, monitor, and document the factors that lead to increased heat-related morbidity and mortality among farmworker populations. Using biomonitoring data, Roxana and her team measured the physiologic responses of heat stress and the prevalence of heat-related illness among farmworkers in Central Florida.
Roxana’s team gave the agricultural workers a sensor to swallow, which would record their core body temperature every 30 seconds. Workers also wore a chest strap that monitored their heart rate and physical activity. The study found that 10 percent of farmworkers experienced a fever due to heat-related stress, while others experienced acute kidney injury.
Her dissertation focused on interventions, like wearing a simple bandana, a cooling vest, or both, as well as hydration interventions like drinking electrolyte water, to determine how to best protect workers from rising core body temperatures, dehydration and kidney injury.
Currently, Chicas is working to receive an expanded grant to conduct these studies on a larger scale and develop evidence-based solutions that improve working conditions through federal policies and protective standards.
This is one of the things Chicas likes best about research – “If you do really good research, you can affect an entire population.”
It’s also why diversity in nursing is so important – nurses like Chicas bring powerful cultural insights and experiences to the work of improving human health at every scale.
