Last week I had the pleasure of leading a service-learning trip to Playa Gigante, Nicaragua as the faculty advisor for Student Association for Medical Spanish (SAMS) at the University of Texas-Pan American. Eleven undergraduate pre-med students and I spent the week living in a small rural town with local families while supporting the local healthcare providers in conducting a house-to-house hypertension evaluation and survey organized by the non-profit Project WOO. The members of the student organization SAMS fundraised since last fall to prepare for this trip, but the beginnings of this collaboration go back almost 10 years. As a Peace Corps volunteer in Honduras from 2004-2006, I met two other volunteers in my training group, Nick Mucha and Adam Monaghan, who decided to start this non-profit grassroots sustainable community development organization after our service. When I heard that Project WOO was starting a health project, I sought an opportunity to travel with my students to collaborate in a sustainable health intervention and participate in an international service-learning trip. This trip provided a very unique learning opportunity for my students and in a small way helped to improve access to healthcare in another community that, like the Rio Grande Valley, has limited access to health services.
The Project: Hypertension in rural Nicaragua
In planning this trip, the executive director of Project WOO, Bo Fox, put me in touch with Dr. Lane Robson, a Canadian physician who is the Advisory Board Chairman for the WOO health initiative. Dr. Lane explained to us that he became involved with Project WOO when he was volunteering with another internationally-funded clinic in a town close to Playa Gigante. While Dr. Lane was seeing patients one day, Bo drove a truckload of sick children over to see him for consultations and stayed to interpret for him. Now Dr. Lane visits Playa Gigante regularly and supports Gigante’s local physician, Dr. Mariana.
Dr. Lane took information about the skills of the UTPA SAMS students and the learning objectives of the Medical Spanish for Heritage Learners program and designed a project that we could complete in the time that we were in Gigante that aligned with the priorities of the personnel of the centro de salud. One significant health problem in rural Nicaragua is hypertension, or high blood pressure. Since there are many undiagnosed hypertensive individuals in Gigante, Dr. Lane suggested a house-to-house blood pressure screening and a survey about hypertension risk factors. He designed a survey that we translated into Spanish, along with a follow-up evaluation form for Dr. Mariana to use in the clinical setting.
Medical Spanish Fieldwork: Conducting the Screenings and Surveys
To carry out the project, students were divided into pairs and matched with a community volunteer identified by Project WOO. Each group was assigned to a different area of the town, which they covered over three days in order to reach as many of the adults of Gigante as possible. A summer health volunteer, UCLA MPH student Logan Hitchcock and Project WOO’s health coordinator, Lindsay Mayock, prepared spreadsheets using census data with names of adult residents and house numbers for the entire community. The goal was to reach 200 adults, and during the week, thanks to community support, we were about to meet and even surpass that mark.
The student and community member groups went door-to-door introducing themselves, presenting the project, and asking for 15 minutes of their time to conduct the survey and blood pressure assessment. The students had practiced measuring blood pressure over the summer and spent many months raising money for their trip and funds to donate to Project WOO in order to sustain the Gigante health center. Their native language skills, combined with their study of medical terminology and effective interpersonal communication techniques as minors in Medical Spanish, made the UTPA students uniquely effectual in carrying out this project. The community was very welcoming of the volunteers and willing to participate in the survey.
Results, Follow-up, and Impact
In initial results, it was found that approximately 30% of the evaluated population had undiagnosed and untreated hypertension, and 9 individuals had severe hypertension that required immediate intervention. All patients whose blood pressure had measured high in the home between Monday and Wednesday were advised by the volunteer groups to visit the centro de salud on Thursday or Friday morning to have Dr. Mariana diagnose them and follow up with treatment or intervention. Dr. Lane had brought a donation of hypertension medications for the patients who required pharmaceutical intervention, which Dr. Mariana prescribed as necessary. The SAMS students had the opportunity to shadow Dr. Mariana as she performed the follow-up examinations and determined treatment plans for the hypertensive patients.
Through the hypertension project, the students practiced their Medical Spanish knowledge and skills while developing professional connections and learning how grassroots organizations determine health needs and community priorities. They were able to help Dr. Mariana identify the patients with the greatest need for intervention, and at the same time they learned from Dr. Mariana about patient care and follow-up.
Living and Learning: Homestays, Surfing, and gallo pinto
Su armazón es de varas y troncos sin labrar—es decir, su esqueleto, es arbóreo—, techo de paja o de palmas; paredes de cañas o de palma tejida, o de paja, o de tablas; piso de tierra; muebles esquemáticos (pata de gallina, tapescos); cocina de barro y las tres tradicionales piedras o tenamastes del fogón. Ningún adorno. Es la tienda vegetal de un nómada del trópico. Está hecha con los materiales que se tienen a mano. Nada retiene en él para que el peregrino reanude su marcha.
–Pablo Antonio Cuadra, “La Casa del Nicaragüense”
The second valuable learning element of this trip was the opportunity to live with local families. The Project WOO volunteer coordinator, Lisa Bisceglia, matched pairs of SAMS students with wonderful host families. It took a little while for some volunteers to get accustomed to the physical conditions in the homes (from latrines to bathing outdoors), but the warmth of the host families made everyone feel very comfortable during the week we were in Gigante.
Being native speakers of Spanish made it easy for the SAMS students to share with their host families, and they also enjoyed comparing regional differences in the language itself. We ate new foods prepared by our families, and students spoke of looking forward to trying their first nacatamales with pitaya juice. The SAMS students also had their very first surfing lesson, since surfing is a part of the culture (both local and the culture of tourism) in Gigante. At the end of the week, Project WOO arranged a special trip, a sunset sailboat ride, for us and our host moms. By the end of the week, we had made many new friends from our homestays and from working with the community volunteers on the hypertension surveys.
The Next Steps: Applying Learning to the Rio Grande Valley
The hypertension brigade with Project WOO gave the SAMS students the opportunity to practice their Medical Spanish skills and introduced them to grassroots development practices. The homestays and community involvement taught them about Nicaragua. What about this experience can the students take back to the Valley to improve the health of their own community?
One of the most obvious points of comparison between Gigante and the RGV are barriers to access to healthcare. While some of the barriers in the RGV are not an issue in Nicaragua (for example, language barriers), some of the limits to access are the same—cost, lack of reliable transportation, distance to services, too few providers based on the population of the community. The access situation in Gigante is extreme; the centro de salud just opened its doors in April, and Dr. Mariana told us that when the Church was not available, she sometimes had to set up shop under a tree and attend her patients there, and that before there were examination tables, pregnant women had to lay in hammocks so she could listen to their babies’ heartbeats.
Some of the health problems seen in Gigante are common to the RGV as well; for example, chronic diseases that can benefit from early interventions in lifestyle and habits, such as hypertension and diabetes, are prevalent in both communities. Improving women’s health is a priority in both communities as well. The SAMS students can take their experience in Gigante and apply it to the RGV by collaborating with local organizations and healthcare providers to organize brigades to ameliorate these health problems in their home community. Right now, as a new academic year begins, they are preparing to fundraise for another trip to Gigante in order to help Dr. Mariana with another community health intervention.