Boston University Medical Campus
International Health Program

Costa Rica

This summer I went to Costa Rica for three weeks and attended a medical Spanish immersion program at the Rancho de Español in La Guacima, a small suburb northwest of San Jose. At Rancho, I took Spanish classes in the morning in which I reviewed grammar and vocabulary. In the afternoons I either returned to school for classes that specifically taught medical terminology or I went to the local clinic to observe.

The doctor that I shadowed was great and really allowed me to practice my Spanish skills. Typically she would interview the patient while I listened and observed; when she was finished, I would get a chance to ask my own questions. She also let me take my own vital signs on the patients after she had taken her own. The clinic was small with only one doctor and one room. She was essentially a family medicine doctor – her patients ranged from newborns to the elderly; she also did prenatal care for pregnant women. I would say the most common illnesses I saw were very similar to what is seen here in family medicine clinics: colds, diabetes, high blood pressure, and high cholesterol. It was interesting to see how patients were treated; usually they were given similar drugs that we use here but in generic form. The most unique cases I saw were those patients that had contracted dengue fever (transmitted via mosquitoes).

I truly had a great experience there because I was able to practice the Spanish I was learning with real patients. I was received very well by the patients. I most definitely recommend this program to other students interested in learning Spanish.

Guatemala (1)

I spent a few weeks this summer working with Mayan Medical Aid in Santa Cruz, Guatemala. This is an organization that provides medical care for the indigenous population from the small town of Santa Cruz La Laguna on the shores of Lake Atitlán. These communities have incredibly poor health outcomes because of low-income levels and limited access to governmet resources.

I was able to both see patients and developed better diagnostic tools for causes of diarrheal illness (community project). The patients that I was exposed to had health problems as varied as scabies, parasitic worms, malnutrition, solar dermatitis, and late stage breast cancer. One of the most common problems was diarrheal illness, which the physicians previously diagnosed solely using symptoms. For my community project, I assisted in setting up the clinic’s diagnostic laboratory, which allowed us to differentiate between viral, bacterial, and nematode pathogens in fecal samples. This has been crucial for the clinicians, as it allows them to more accurately treat patients, particularly those with recurring gastrointestinal health problems.

Challenges

The original goal of the community project was to study the relationship between water contamination and gastrointestinal disease in three local communities. I had planned to take fecal samples from patients presenting with diarrheal illness, interview the patients about their water use practices, and take samples from their water sources. However, when I arrived in Guatemala, it became clear that it would be logistically too difficult and expensive to procure the necessary supplies to do such a large amount of sampling. Instead, I assisted with the development of a laboratory that would be a more sustainable method of diagnosing patients and worked to develop a questionnaire to be asked of all patients presenting with gastrointestinal illness.

Guatemala (2)

1. Testing of Local Water/Efficacy of Ceramic Filters There was some disbelief that the local water was clean/filtered, therefore my objective was to look into how it was managed, how often it was to be maintained, and what were the possible causes. Also, I was required to learn how their water filtration and disinfection system worked. I designed a study to take snapshot viewings of certain days and test the water from four different locations within the town. In addition, part of this study was to assess the usefulness of the Ecofiltro (a ceramic filter used to filter water at individual homes). Our results found that the chlorine levels were always 0.0 mg/L when they should be 0.5 mg/L and that neither the Ecofiltros nor the tap water was free from bacteria. This project was not a pre-established project; it was one that I developed with Dr. Sinkinson.
2. Patient Follow Up My other project was following up on patients who had been to our clinic. Often, patients would not follow their medications as prescribed for various reasons. Therefore, I was sent out with an interpreter 1-2 days after the patient came to the clinic to ask questions. This project was one of my favorites because I was able to go to into the patient’s houses, see how they lived, and see the dynamics of their family life.

Most weekends I did some traveling with other students working with Dr. Sinkinson. I journeyed to the northern part of the country in to the region of Peten and Tikal, and there were also trips to the Caribbean (Livingston) and Pacific coasts (Monterrico). Recommendations: I would have a detailed outline and project description before heading down to the clinic. There is a lot of down time, and Dr. Sinkinson is not always available to answer your questions. Therefore, get as much planning finished before you get down there. An intermediate level of Spanish is required, and the more fluent the better. There is no one to interpret for you!

Guatemala (3)

My summer in Guatemala was spent doing a combination of activities that expanded my knowledge of Spanish and traditional medical practice within the indigenous population of the Guatemalan highlands. I participated in Pop Wuj’s Health Services & Medical Care Program that has four parts: (1) language instruction; (2) home stay; (3) a supplemental curriculum; and (4) clinical placement.

I began one-on-one Spanish classes the first week of the program; each class was four hours. The time was divided into general Spanish grammar and medical vocabulary and common phrases that would be used in the medical setting. Also during the first week, I attended conferences held at the school that addressed different themes of medical practice in Guatemala such as the Mayan belief system which influences the practice of both traditional and western medicine. I also traveled (along with a group of other medical students and one doctor from the U.S.) to a highland village dislocated due to a recent hurricane to hold a clinic in their schoolhouse. The medical students had the opportunity to practice Spanish by conducting patient interviews.

After the first week, I was assigned to shadow a midwife in a small town outside of Xela. The midwife delivered babies, conducted prenatal visits as well as basically ran a family practice clinic. Exams were conducted without any equipment besides a stethoscope. The midwife was able to use a simple abdominal exam to diagnosis illnesses ranging from parasites to urinary tract infections to gastritis. One of the things that surprised me about working with the midwife is that she actually prescribed a lot more western medication than traditional medicine. Almost all her patients received an injection for some type of pain along with other medications. The patients who most often were prescribed a type of traditional herbal medicine were pregnant women so that the medication wouldn’t harm the baby.

I enjoyed the program at Pop Wuj because in addition to the Spanish classes and the exposure to medicine, I was also able to participate in some of the volunteer and recreational activities that the school organized. An example is a tour of a coffee factory and hike to a lake that the school arranged for the students. The school also coordinates stove building projects, a daycare center, and a scholarship program for children to attend school; Pop Wuj students had the opportunity to engage in these programs. These activities provided me with the opportunity to learn more about the educational system and how people lived in the surrounding villages. I was satisfied with Pop Wuj because the program allowed me to explore many aspects of the culture and social structure of Guatemala.

Guatemala (4)

I found myself in Santa Cruz La Laguna, a small Mayan village on Lago Atitlan in Guatemala, during the summer of 2005. The doctor in the village clinic was researching child health and malnutrition, and my main task was to weigh and measure all of the children and enter the data I collected into the computer. I chose this project because I am interested in both Native American health and culture and pediatrics.

In addition to working on the research project, I was able to shadow the doctor and get a true sense of rural medicine in a developing country. This experience helped me to discover the type of doctor that I hope to become and further proved to me how rewarding practicing medicine can be. Here are two stories from my journal that I think best reflect my experience in Santa Cruz:

• "A Day at the Clinic" When we returned to the clinic after lunch, there was a four-day-old baby waiting to be seen. The nurse had not known what to do and was very relieved to see us come back. The baby was jaundiced and had a large bump on his head. It was a hematoma that was probably caused by a traumatic birth. The father was so filled with joy when the doctor told him that the bump would go away on its own and that the baby was healthy. After they left, the doctor explained how unique the case we had just seen was. It is very rare that a baby so young is brought to the clinic, and it was even more unique that a father brought the baby in, for infants are usually at their mothers’ breasts constantly. The doctor explained that the mother most likely did not come in because she may have been worried that her son’s disfiguration was her fault. Moreover, this case was a huge breakthrough because it showed how much trust that doctor has earned from the community.
• "My Thoughts on My Way back to the States" I think I am going to miss Guatemala more than I can understand now. The friendliness and warm smiles of the people, meeting and bonding with other travelers, feeling lit up from the energy of the children, getting stuck in the rain, watching clouds drift and lava flow on Pacaya (volcano), seeing temple peaks protrude from the rainforest at Tikal, disinfecting avocado trees at Earth Lodge (an avocado farm), the people that became my family at the youth hostel…I didn’t realize it while it was happening, but looking back, I have learned so much. I certainly have a better understanding of medicine in an impoverished, indigenous community. But I have an even better understanding of how people connect.

Guatemala (5)

As part of the Ohiyesa Summer Language Proficiency Program we spent four weeks in Antigua, Guatemala with 12 other medical students advancing our Spanish-speaking skills and learning about the Guatemalan health care system and medical issues pertaining to the Guatemalan way of life. Our schedule was as follows:

• Mornings (8:30-11:30 a.m.) were spent learning medical Spanish as a group, listening to a talk on some aspect of Guatemalan health care, or visiting different clinics.
• Afternoons (2:00-6:00 p.m.) we were at school learning Spanish one-on-one with a native Guatemalan, learning according to our respective levels.
• Evenings (6 p.m.+) we were free to study, go out on the town, or catch up on sleep.
• Weekends were spent visiting Lake Atitlan and Mayan ruins or volunteering in a clinic. Being that we were first- and second-year students, our help in the clinics was limited to what we could do as lay people without medical training.

Student #1 (Summer 2000):
The major reason I enjoyed the Ohiyesa Program was because of the structured exposure to Guatemalan health issues that I would not have seen on my own. Through this exposure, I was able to solidify my desire to someday return to the country as a medical student or doctor. This program is great for anyone considering practicing medicine internationally in the future and would like a structured program to give them an idea of what it would entail to practice abroad. Because there isn’t much time for exploring on your own, I wouldn’t recommend this program for anyone who enjoys the freedom of exploring and traveling as an individual. I had no previous Spanish and in one month, was able to lay a general foundation for future Spanish learning. However, because the group we traveled with consisted of all English speakers and because Antigua is a city full of tourists, I didn’t spend as much time speaking Spanish and therefore learning as much as I anticipated. I think I would have learned more if I had gone there with a foundation and then solidified that foundation through conversational practice with my teacher.

Student #2 (Summer 2005):
The Spanish teachers know very little English so you are forced to learn and speak Spanish the entire time. This was the best part of my day. The downside of Antigua is that while it is a beautiful city, it has also been discovered by others and has become a popular tourist site so you can get away with speaking English the whole time you are there. So I really enjoyed my one-on-one sessions because it was the only time I was able to learn and practice my Spanish. My friends and I tried to enforce a Spanish-speaking only rule but it was broken countless times. During some afternoons we had off and the evenings, we studied, slept, went to the gym, or explored the city, such as immersing ourselves in the Artesian Market using our knowledge of numbers in Spanish in a bargaining game. Weekends were free so we climbed Pacaya (an active volcano), visited the Mayan ruins in Tikal, and went to Lake Atitlan. The host family you stay with varies. The family I stayed with also housed many other students so I felt like I was in a hostel and did not have many opportunities to speak to my host family and practice my Spanish. However, it was the opposite for some other people in my group. We had 3 meals/day prepared for us, excluding Sundays where we were free to try the many restaurants in Antigua. I had a lot of fun in this program and got a lot out of it as well. I went to Guatemala without any previous knowledge of Spanish and came out in a month being able to have a conversation in Spanish and be able to continue to add on to that skill. I saw a lot of the hardships people face and the lifestyle in Guatemala that opened my eyes and forever changed my views of people who live in third world countries. It helped to reinforce my desire and passion to work abroad as a physician in the future and provide the much needed medical attention for the poor. It is up to you to make the most out of what this program offers. I know I did!

Honduras

My time in Honduras was a great experience for acquiring a few clinical skills, practicing my medical Spanish, and working with the doctors and patients of El Progresso Hospital. Each day we went to the hospital with no set structure. We went to whichever clinic was willing to let us observe. In the ER, one student learned how to insert a catheter. At the Diabetic Clinic, we learned how to to monitor blood glucose levels and received a brief introduction to the most commonly used drugs. Some students were able to observe several surgeries.

Dr. Hall, an internist, allowed us to shadow his outpatient and inpatient clinics. We practiced taking blood pressures and distinguishing the various sounds on auscultation such as ronchi and rales. Most of the inpatients we saw had coronary heart disease. Dr. Hall also shared with us his work on an asthma project to properly teach patients how to use inhalers. The doctors, residents, and nurses were extremely open to us working with them. Even the patients seemed to welcome the extra attention.

Whenever there was any downtime or slump in patient flow, we headed to the Obstetrics Department where we were almost always guaranteed action. There we worked Dr. Castillo, Dr. Moya, and several residents who were doing their “social service” portion of their residency. One morning, Dr. Castillo quickly and charismatically taught us the basics of Obstetrics. Even with his broken English, we learned how to calculate the expected delivery date, measure the fundus height, approximate the position of the head and spine of the baby, how to listen to the fetal heart beat, and manually measure the width of the cervix. Before we knew it, we were assisting in deliveries – always with one of the doctors standing right beside us. After carefully placing the slippery baby aside, we delivered and examined the placenta. There was something so exhilarating about a successful birth that made it clear why the expression for delivering a child is called, “dar a luz”- giving birth to light.

Sister Terre, our contact, took care of our food, lodging, and arranged our clinical experience. Sister Terre made certain that we were safe and well fed. In addition to our time at the El Progresso Hospital, Sister Terre set up visits with the some of the community organizations established by the Sisters of Notre Dame. During our free time, we once visited the Nutrition Center which was established for children with malnutrition or failure to thrive. Another day, we visited one of their orphanages and played with the children. One time we rode on the back of a pickup truck about one hour outside of San Pedro Sula to visit families who lived in these shacks on top of what seemed to be large mud plateaus. These families had lost everything to Hurricane Mitch. We assisted Sister Terre with a questionnaire for a project being conducted by one of the other sisters. There we also met the local midwife who was so excited to show us how she assesses her patients that she invited us into her home and sent for one of her expecting neighbors and demonstrated her skills to us.