In early May, a team of 43 students, faculty and alumni from the Division of Physician Assistant Studies, the Division of Physical Therapy and the Bernard J. Dunn School of Pharmacy traveled to Nicaragua for their annual medical mission trip. Accompanied by a Winchester cardiologist and a United Methodist minister, they put their collective knowledge into practice in rural Leon, Nicaragua, as an integrated health-care team. The team focused on bringing general medical care, gynecologic services, medications and physical therapy services to areas of need in communities surrounding Leon, Nicaragua. Over a four-day period, they treated more than 1,000 patients. This year’s trip also included an inter-professional oral health focus that involved all students and faculty. More than 600 children received fluoride varnish treatments as a result of this combined effort. The SU team brought with them over $10,000 worth of medications and supplies that were donated or purchased for the trip.
During the seven day trip, the group spent four days seeing patients, working in tandem with several translators to set up mobile clinics in village schools and churches. Breaking into cross-discipline teams, they listened, advised, treated and prescribed medication to a variety of patients. While their time in Nicaragua was brief, the teams worked as efficiently and effectively as possible to make a difference in the lives of the people they met.
From the moment the plane lands, the group sets to work. They bring their own supplies and medicine and travel to various villages, where they set up temporary clinics and provide medical services within the limitations of the field environment.
“When we first arrive, we often have no idea who we are going to see,” said Assistant Professor of Physical Therapy Thomas Turner, Ph.D, P.T. “As physical therapists, we treat people with mobility problems, from children with cerebral palsy to adults with shoulder injuries or back pain, and others with cervical paralysis or stroke sufferers with movement problems. This year, we went to a school for children with special needs, and half our time was spent there. We not only treated children, but we also taught caregivers and mothers how to follow through with care.”
Each team worked with two to three local interpreters with translation support from several Shenandoah participants who spoke Spanish.
“I typically do my best to help communicate with patients,” said Assistant Professor of Pharmacy Practice Emily Scopelliti, Pharm.D., who teaches a Spanish class at Shenandoah’s Bernard J. Dunn School of Pharmacy. “It’s amazing to see how students learn through this experience. My pharmacy students knew the doses for pediatric medications, made interventions on their own, talked to PA students and PAs about the medications available and what they could do to help and counseled patients. I watched as they increased their knowledge in only four days of clinical time.”
“People often accuse Americans of ‘medical tourism,’ but we’ve worked very hard not to let that happen,” said Miller. “Students aren’t going down there to ‘see something.’ They’re going there to practice what they’ve learned and to provide something sustainable,
like leaving water bottles behind or providing fluoride treatments.”
Students also came to see faculty as human beings rather than instructors. “We’re wearing scrubs, sweating, eating the same food and sleeping in the same bunk-bed dorms,” said Miller. “We’re all working hard. I’ll never forget, two years ago, one of my second-year students said to me, ‘I guess you really are a PA. I thought you were just somebody who sits behind a desk.’ It was a ‘light bulb’ moment,” he said with a smile.
Listening Deeply & Practicing Patience
“From a PT perspective, two things struck me—the amount of listening required and the need to think quickly on your feet,” said Dr. Turner. “Deep listening is necessary, since most patients come to us with little medical knowledge. You’d hear about things that happened to them when they were 10—and all the things that happened since—that, in their minds, were probably related to their current disability or issue. It was a great experience to listen deeply and allow the patients tell us their critical information.”
The team also learned to think and act quickly.
“We treated people from such diverse backgrounds, ages and needs, that we had to switch quickly from orthopedics to pediatrics to neurology,” said Turner. “Once we parsed through the listening and determined what was wrong, we had to determine how to best treat the patients in the 15 minutes available to help them. For me that was challenging, and I know for the students, it had to be a very odd experience to pull that together without the normal equipment we use to determine those answers.”
Learning from Field Experiences
After returning to campus in June, 20 members of the Nicaragua PA team met with faculty to share their experiences and offer ideas for workable solutions for next year. One of the four groups–the women’s health group–focused on educating Nicaraguans about the prevention of sexually transmitted infections. Other groups focused on respiratory illnesses, Type II diabetes and ocular issues.
“It was interesting to see how the medical model can work and to see the interactions of pharmacists, PTs and PAs as we worked together in a holistic manner, especially in a minimalist environment like we had in Nicaragua,” said PA first-year student Jessica Gandhi. “The key to treatment is to follow up, but we could only see patients for a short period of time. The best thing we can do long-term is to educate them about prevention.”
Preparing Medical Professionals as Community Advocates
Medical mission trips also serve a broader purpose; they encourage graduates to serve as volunteers in the communities in which their patients live.
“[The need] is actually bigger than the Nicaragua trip,” said Miller. “This program is about service, volunteerism and developing a servant’s heart. This trip sets a pattern of giving back, and that translates into our graduates serving as volunteers in their own communities. I strongly believe that those of us in the helping professions need to do more than just what we do in the patient encounter. We should make it a responsibility to not only care for our patients when they’re sitting in front of us in an exam room, but also care for the communities in which our patients live.”