Category Archives: Profile Stories

Hayes’ helping hand

By Monica Grice

Overwhelmed. This is how Maria Hayes felt walking through the rain forest of Nicaragua.

It’s day three of the Texas State University nursing student’s trip, and they set out to complete census’ of a rural community located in the rain forest.

“Many of us went into this experience being very timid and unsure of what we have learned up to this point,” said nursing student Logan Smith. “However, once we got accustomed to conducting assessments and communicating with patients, the uncertainty melted away and confidence was built.”

Confidence is something Hayes exuberated without fault while abroad. Her adaptation to the Nicaraguan culture communicated her will to help people, and her love of nursing.

Next Stop Nicaragua

The Denison, Texas, native fell in love with healthcare when she was a student in high school.

Hayes spent 12 hours a day for a week shadowing doctors and nurses at her local hospital and experienced everything from surgeries to deliveries, which made her want to be a nurse midwife.

“The first delivery I saw, I cried; it was the most amazing thing I’ve ever seen,” said Hayes. “That’s the moment I knew I wanted to be a nurse.”

Hayes on day two in Nicaragua. Photo by Monica Grice.

Hayes went to Nicaragua with her nursing school colleagues in January hoping to see what it was like to practice global health as a travel nurse, and to brush up on her Spanish.

Hayes originally enrolled at Texas State University in San Marcos as an engineering major.

“I wasn’t really connected to that; I knew I would get a job and went with it for that reason,” said Hayes.

After talking with her father, she ended her engineering major and pursued a nursing career.

Clinic Days

While in Nicaragua, the College of Health Professions students split into three groups and spent four days in three communities.

On the first day in the community, the teams were guided through the villages to interview community members and take a health census. The census would give them a better understanding of what illnesses were in the community, and how to prepare for them when clinic days arrived.

Hayes saw patients at a clinic located deep in the rainforest of Ticuantepe, Nicaragua.

“She just jumped right into whatever challenge was set before her,” said fellow nursing student Jessica Yehl. “She communicated well, assessed her patients with all the skill of an actual nurse, and was so prepared to help the team in whatever way she could.”

Hayes during day two of clinics. Photo by Monica Grice.

Hayes remembered meeting a young woman in her 20’s on the day they collected census. The woman was emotional because she had a lump in her breast that she believed to be cancerous. Since the team didn’t have any medical supplies on them that day, Hayes urged the woman to come to the clinic. She came on the first day, but became nervous and left, leaving Hayes worried for her health.

Day five was frustrating for Hayes. The woman still hadn’t shown, and another patient’s blood pressure was dangerously high. Hayes and other healthcare students urged the woman to go to the hospital, but never found out if she did. It left Hayes feeling like she wanted to do more, but she couldn’t.

“I think her ability to be realistic sets her apart,” said Yehl. “A lot of nurses can be tempted to sugar coat hard situations, but she just gives it straight.”

On the third, and last day of clinics, Hayes felt rewarded.

“I feel really proud of the team and how much work we accomplished,” said Hayes.

The Woman From The Rainforest

After the last day of clinics, the Texas State group returned to one of the clinics for a day of giving back. Games, balloons, and a piñata were brought for the children and triage stations were set up outside of the church for any remaining community members who hadn’t been assessed.

Hayes’ clinic was chosen.

The woman from the rainforest was there. Hayes helped assess her and found out the lump was mastitis.

“I’ve been worried all week,” said Hayes.

Mastitis is an inflammation of the breast most common during the first six months of breastfeeding. Although painful, it’s not serious and can be remedied easily.

The emotion Hayes expressed was pure joy. She got the reassurance she had been waiting days for. Her worries were alleviated.

“That was really good, it was so relieving,” said Hayes. “I told her ‘I was ready to climb back up the mountain and find you,’ she thought that was really funny.”

She made a warm compress for the woman and explained how to continue treating the inflammation.

Hayes recalls this day as being the best part of the trip.

Returning Home

“I feel like I don’t need to be home,” said Hayes.

After the clinics, the team had a few recreational days and went to the nursing home in Masaya.

The nursing home was a unique experience for Hayes. As a career, she loves working with children. She seemed a bit hesitant, the whole team did. However, she molded quickly to the environment and left happy.

“She was able to adapt to the different culture and conditions of Nicaragua and perform confident and competent assessments on patients,” said Smith.

The day before the team’s departure, Hayes didn’t want to leave.

“It’s a bitter feeling to leave,” she said. “I wish we could have a few extra days.”

The soon-to-be midwife gained a deeper knowledge of the people and the country during the trip. Fellow nursing students, Smith and Yehl, admired how Hayes was able to jump into any situation and tackle it.

In the 11 days the Texas State team was in Nicaragua, Hayes explored what it’s like to be a travel nurse and practice global health: she thinks she can do it.

“I definitely loved it and I definitely think I could see myself doing it long term,” she said.

Hayes with a village girl. Photo by Monica Grice.

Meet the respiratory therapy students that became the educators

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By: Taeler Kallmerten

Bubbly, free-spirited and stubborn are three words to describe the women of the respiratory therapy team from Texas State University.

Two respiratory therapy students, accompanied by their faculty, were a part of Texas State University’s first inter-professional study abroad program in Nicaragua.

Initially, the respiratory therapy team was not going, but clinical assistant professor Sharon Armstead and her two senior students Veronica Richardson and Amber Hazelett readily accepted the invitation from the trip’s lead faculty member, Marylyn Kajs-Wyllie. 

There are few countries that have a specialized role for respiratory care and Nicaragua is not one of them. Like the majority of the world, Nicaragua’s respiratory care is practiced by standard physicians and nurses.

This was a challenge for Armstead, Richardson and Hazelett. Instead of spending most of their time in the community clinics, Armstead and her team focused on giving seminars about respiratory care in local public hospitals.

As Armstead set up her MacBook to give a seminar, 12 nurses wearing white uniforms sat watching intently. The seminar took place in the cafeteria of the hospital and many employees passing by joined the lecture as they ate their breakfast. Richardson and Hazelett passed out brochures amongst the nurses, so they could follow along in the demonstration.

“I love to educate as I go,” said Armstead. “Not only do we learn from the community, but they learn from what we offer in education.” 

Through one seminar Armstead said she completely changed the way one hospital gave a nebulizer treatment.

“They were giving the nebulizer treatment without a mask or a mouth piece and the neb was just going out into the air,” said Armstead. “Until we showed them the proper way to use a nebulizer, they did not know.”

After educating healthcare providers in the hospital for two days, Armstead said it is important to recognize the hospitals are not wrong in their methods of respiratory care, but they are just different. 

Nicaragua respiratory isuues
Infographic of respiratory issues in Nicaragua. Graphic by Monica Grice.  

The work is personal

The irony of the respiratory therapy team is that all three women have asthma themselves.

Hazelett, a respiratory therapy major, said her asthma gives her the ability to empathize with her patients because she knows their pain firsthand.

“Growing up sometimes people would tell me, ‘there’s not actually something wrong with you,’ or ‘no, you can breathe just relax,’” said Hazelett. “I know that these people really cannot breathe.”

Hazelett said she understands that those who do not have asthma sometimes think asthmatics are making up their medical condition.

“Just because it can’t be seen on the outside doesn’t mean it’s not going on on the inside,” she said.

The first day outside of the hotel in Nicaragua required long hikes to get from home to home and Richardson constantly checked on Armstead’s breathing and reminded her to use her inhaler.

The family dynamic of taking care of each other was the anchor that held the respiratory therapy team together.

Richardson said having Armstead as a professor has made her more confident in her abilities as a respiratory therapist.

Richardson said she had an intense discussion with a doctor in Nicaragua about whether a patient’s lung problems were asthma related.

“I did a full chest assessment and I was right that there was something wrong with the patient’s lungs,” said Richardson. “In my mind, there was that split moment where I thought what if I’m wrong; then my confidence came back and I was like I know I’m right.”

As Richardson explained how Armstead’s teaching has impacted her, Armstead, who was sitting next to her, began crying, but with a smile on her face.

“I wanted them to see that in these countries, they don’t have RT, but what we can do is to promote our profession and to educate,” said Armstead.

Richardson and Hazelett will graduate in May. While Richardson has just finished her internship in the neonatal intensive care unit at St. David’s North, Hazelett has begun her night shifts at her internship. Richardson plans to eventually practice respiratory therapy abroad and Hazelett plans to get her masters degree and eventually teach at her alma mater, Texas State University. 

Journalism in the Jungle

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By: Taeler Kallmerten

In January 2017, five students were chosen from the School of Journalism and Mass Communication at Texas State University by journalism professor, Holly Wise, to take part in the Global News Team’s second trip to Nicaragua.

The Global News Team is a study abroad program created in 2015 that embeds mass communication students with international service learning teams.

This year’s Global News Team embedded with 28 students and faculty from the College of Health Professions on their service learning trip to Nicaragua where they assessed and treated patients in rural villages.

The 2017 inter-professional teams consisted of three medical professions –  nursing, respiratory therapy and clinical laboratory science.


“Flying in the first thing I noticed was the terrain. It was so mountainous and I could see numerous volcanos from the plane.” – From the daily reflections of Global News Team contributor, Taeler Kallmerten (TK)

Prior to their January departure, the Global News Team met three times in November and December to brainstorm story ideas and their travel itinerary.

Exsar Arguello, a senior journalism, said he researched the country’s health care and culture before leaving.

“I think it’s good to have a general understanding of the place you’re going to, but as an industry where everything changes so fast you live by experience,” he said.

Websites like Reporters Without Borders and World Health Organization provided the team with a better understanding of Nicaragua.

According to RWB, Nicaragua’s constitution allows the government to censor and restrain the press. The country is ranked 75th among 180 nations in the 2016 World Press Freedom Index. In comparison, the United States is ranked 45th and Nicaragua’s neighbor Costa Rica is ranked number six.

Two flights and a school bus ride later the team arrived at Hotel El Raizon on Jan. 2. The Global News Team assembled and began preparation for the busy on-site days.


“I overheard that Ivan, our translator, telling Jessica that in order to keep his English skills up for translating he watches Judge Judy and the People’s Court.”    -TK

The first day outside of the hotel, the teams were split into groups and sent off in different directions in the rural communities of Nicaragua.

The goal of the health professions team that day was to log information about the living conditions of the community members in the area. The health teams asked community members questions about their health while the Global News Team took notes and began looking for potential story subjects.

Monica Grice, a journalism major, said she didn’t really know where to start.

“I started taking pictures and videos not really knowing what to capture,” said Grice.  “Eventually you just kind of mold yourself into the environment and then you know what to look for as far as documenting goes.”

For the majority of the first day, the Global News Team was busy observing people, places and things.

Darcy Sprague, a journalism major, said she focused her attention on Jennifer Pemp and Andrew Pagel, a nursing student and clinical lab science student she noticed on the plane.

“I was really just observing them and taking notes about what they were doing,” said Sprague. “I didn’t ask them any questions, but for the rest of my stories I was just trying to be present in the moment and decide what would be possible.”

The Global News Team members split up into three groups and traveled with the health professions students to report on their work.

Sprague said the timing of the work amongst the health professions teams and the Global News Team was the most difficult part about producing the stories.

“It seemed like when they were working, we were off and when they were off we were working,” said Sprague. “It was also constant work even when you were sitting around you would see the person you wanted to interview and you would be thinking about questions.”

Despite the time spent observing and staying in the background, the Global News Team interacted with community members and helped the health professionals whenever possible.

When the teams traveled to a nursing home in Nicaragua, only one Global News Team member planned to create a multimedia project. The four remaining students washed dishes, sorted through moldy fruit and helped residents into their rooms.

Team Dynamic

“We walked into our room and turned on the lights and boom scorpion on the floor. Darcy screamed, I ran out of the room, but Monica flipped out. She screamed not knowing exactly what she was screaming at but that we were screaming and she should too. It was the greatest thing I experienced in Nicaragua.” -TK

The time spent working together bonded the group and at the end of long days the Global News Team would stay up and talk about their day amongst each other before having to wake up at sunrise and do it all over again.

Ally Fluker, a digital media innovation student, said it was this time together that bonded the Global News Team.

“That kind of environment strengthened our ability to work together and it wasn’t weird and there wasn’t any hostility toward each other,” said Fluker.

Fluker said the time constraint made the trip intense and immersive.

“This showed us what it’s like to be a real life journalist to get in what you need when you need it in a time constraint,” said Fluker. “Whereas if you’re on campus for a whole semester you have more time and you have a professor spoon feeding you. We were there and Holly was like ‘OK, go.’”

Overall the Global News Team produced over 30 pieces of multimedia content and written stories and were co-recipients of the Texas State University Quarterly Team Award.




College of Health Professions at Texas State University first Inter-Professional Study Abroad Program

By: Allison Fluker

The first inter-professional study abroad team from the College of Health Professions traveled to Nicaragua in January to provide healthcare in rural villages.

The 34-member team consisted of students and faculty from the nursing, clinical lab science and respiratory care programs, along with the School of Journalism and Mass Communication’s Global News Team.

The health professions students, in partnership with International Service Learning, hosted three days of free medical clinics in local villages near Masaya, Nicaragua. An average of 45 patients were seen each day at the clinics; in addition, the students cared for elderly residents in a local nursing home.

Marylyn Kajs-Wyllie, a professor in the St. David’s School of Nursing, went to Nicaragua with the 2016 study abroad program which was joined by a group of mass communication students.

Marylyn Kajs-Wyllie giving a demonstration at a seminar at a local hospital near Masaya, Nicaragua.


“Since there was a mass communication team tagging along with the nursing students, there was an idea to push for an inter-professional team,” said Kajs-Wyllie.

At the time, the College of Health Professions was pushing for collaboration between its programs. An inter-professional experience abroad would provide students with a community in a work environment.

But first, Kajs-Wyllie needed to find faculty members and their students who would agree to join her on the 2017 trip. She contacted Gregg Marshall, the chair of respiratory care at Texas State University, who put her in touch with other faculty, such as Sharon Armstead, a clinical assistant professor in the respiratory care department.

“Marylyn reached out to me via email to ask if I was interested in joining nursing on the trip,” said Armstead.

During a College of Health Professions graduation ceremony, Kajs-Wyllie asked Armstead to go on the trip and Armstead agreed.

“I thought it would be a great opportunity for the therapists to go,” said Armstead.

Sharon Armstead giving a demonstration at a seminar at a local hospital near Masaya, Nicaragua.

Meanwhile, a clinical assistant professor in the clinical lab science program contacted the chair of the nursing school to see if there were opportunities for her students to work with other professions.

“I serve on the inter-professional education committee and the study abroad committee,” said Joanna Ellis. “I wanted (the clinical lab science students) to have respect for the other roles. If we learn from each other and health care together, we will impact healthcare results in the future.”

With the addition of Ellis and Armstead and the mass communication students, Kajs-Wyllie assembled her 34-member team.

Expectations and Worries

The first inter-professional health professions study abroad team came with a lot of pressure and expectations.

“I wanted the nursing students to learn focused assessments, the culture, Spanish, to appreciate the differences in nursing and the differences between what we’re used to with what they have,” said Kajs-Wyllie.

Students from the nursing school practiced focused assessments during the medical clinics in rural villages.

“It gives you a lot of confidence,” said Desiree Davis, a senior in the nursing program. “Once you start asking questions, you learn what other questions you need to ask about the information for the problem the patient is having.”

Every faculty member on the team had their own expectations for the trip, as well as expectations for the entire group.

“I wanted (the clinical lab sciences students) to get a mutual respect,” said Ellis. “If we were able to go to the labs at the hospitals, we could talk about the labs in the group debriefings and show (the other departments) that we are taught a very different skill. We have a lot to offer and wanted to show them that.”


Joanna Ellis enjoying a recreation day on a beach in Nicaragua.


In Nicaragua, healthcare specialties such as clinical lab science or respiratory care, do not exist like they do in the United States.

“They don’t have us as a profession where we were going,” said Armstead.

Without resources for the level of education required to provide specialty care in Nicaragua, there are not many doctors who can provide the care that Armstead, Ellis and their students gave.

While some professors worried about limitations in their ability to apply their knowledge and skills, others worried about how their presence would effect the lives of the residents in the communities they visited.

“I was worried about our impact on the culture and the community here whether it would be positive or not,” said Ellis. “I was worried about the emotions that would ensue during the home visits and the nursing home.”

After seeing how well the 2017 team of students worked together, the faculty members recognized many benefits of having an inter-professional team.

Students utilized their acquired skills and applied them to caring for patients. That strengthened their ability to provide healthcare and perform focused assessments. By working with other health disciplines, the students understood what the other health professional’s job entails.

“They will communicate better and have an understanding of what the nursing students have gone through,” said Ellis. “They will have a reference for what the other professionals have gone through.”

Gaining an understanding of what other healthcare professionals go through in their daily routine is paramount to making a better workplace environment.

“I had that moment where I knew I was making a difference in someone’s life,” said Davis. “You’re able to sit down with the doctor and tell them what’s going on with the patient and give your own assessment. You start to see the same illnesses and know the right questions.”

After hands-on experience and interacting with local physicians, the students were no longer timid about performing the healthcare skills needed to provide care.

“(Students) said that their confidence levels jumped,” said Armstead. “They feel comfortable approaching physicians. What we try to teach them, they already feel empowered to do it.”

Students were immersed into a new culture and learned differences in the healthcare between the United States and Nicaragua.

“It has prepared them for a multicultural world and encouraged them to give back or take part in a study abroad,” said Armstead. “Learning to learn Spanish will help better the care we can give them.”

Adjusting to a new environment didn’t keep the inter-professional students from accomplishing what their faculty wanted for them.

“I thought it was cute to see everyone working together,” said Armstead. “There was one time when a group of (clinical lab science) students sat together and I mentioned they weren’t mingling, but by the end of the week, you couldn’t tell who was in what department.”



Journey to Nicaragua: Two veteran’s paths to joining the Texas State inter-disciplinary study abroad trip

Two weeks after returning from Afghanistan – his second of two Middle Eastern deployments –  Andrew Pagel, a Texas State University nursing student, was handed his walking papers from the United States Army.

“I was absolutely destroyed and betrayed,” he said.

In 2014 the Army cut 40,000 soldiers, according to a Wall Street Journal article, “How Obama Shrunk the Military.” Pagel was one of these soldiers.

At the time, Pagel, 32, had two children, a wife, a mortgage and livestock on a hobby farm near Florence, Texas. He was preparing to become a captain and had received high praise from his superior officers.

“I had a plan that completely crumbled because of that,” Pagel said. “I didn’t handle it well.”

Two years later he would be in Nicaragua charming elder village women and cheering sick babies.

Jennifer Pemp, 34, a clinical lab science student at Texas State University, was deployed to Afghanistan in 2008 where she tended to Afghanistan nationals detained by the United States military. These individuals were being held for questioning, and many of them had been injured in conflict.

They called her “PT Doc” and “Angel.” To them, she was someone who ensured they received proper medical care. For her, this experience kickstarted her desire to work in global health.

These two military veterans, with a combined four deployments and 13 cross-country moves, recently completed a mission of a different type as part of the 2017 Texas State interdisciplinary study abroad trip to Nicaragua.

A portrait of Pagel and Pemp

On Jan. 2, 2017 Pagel began the trip talking animatedly to whoever sat by him in the terminal and on the 6:42 a.m. flight out of Austin Bergstrom International AirportHe talked about the Lego tattoos on his left arm and how he plans to add more to make a sleeve.

From his physique, to the ruck-style way he carried his Army-issued backpack, to his near-daily workout of throwing sandbags, Pagel distinguished himself from the other 29 students early on. He was older, married, a father, but perhaps more noticeably, he was well traveled, knowledgeable, worldly.

Often he gave students tips about safety or travel. In crowded areas he hung back to watch over the group, successfully stopping a man he believed was trying to pickpocket one of his female colleagues.

During the team’s orientation session in Nicaragua, Pemp, too, set herself apart. She introduced herself as a veteran and that she had served in the United States Air Force in Afghanistan. A palpable sense of surprise rippled among many of the group members. For many, going to Afghanistan seemed impossible.

Pemp fit in easily with her colleagues and quickly made friends.

Pagel, too, was quick to talk with everyone. He told anecdotes from his life and even if he was talking to just one person, it felt as if he was inviting the group to join in.

“He will strike up a conversation with anyone who sits down next to him,” said Cassie Thompson, one of Pagel’s fellow nursing students who often sat next to him on the yellow school bus that took the team all over the country.

He was often content to sit on the bus alone listening to “Winds of War” by Herman Wouk on Audible, though he indulged anyone around him in conversation or showed them pictures of his children when asked.



Pagel joined the military a few years after he graduated high school. He moved five times for the military and deployed twice – once to Afghanistan and once to Iraq. He started in infantry then became an intelligence officer. When he separated from the active Army he was a captain. As part of his separation package, he transitioned into the Texas National Guard and is now a major.

For his first deployment, Pagel was sent to Iraq in 2009. One day his squad received information about a disturbance in a pomegranate grove on the edge of their territory.

The enemy had beat them there.

Every man in the village had been beheaded and every body had been left in a shallow grave dug among the rows of trees. The bodies had been arranged by family: grandfather, father, son. These macabre rows of family lineage had been left to rot, or maybe left so that men like Pagel and his Iraqi translator who both broke down sobbing, would see.

“I saw some things…Night, day, it doesn’t matter, I see them again,” Pagel said. “I smell them.”

Pagel, who talked lovingly about TVless Sunday mornings making pancakes with his children and who danced shamelessly with elders at the nursing home, looked far off when he spoke. There was almost a look of acceptance on his face.

“It is what is is,” he said. “What happened happened.”

Pagel returned to Alaska where he was stationed in 2010. Between his return and 2014 Pagel had his first child, moved to Arizona where he joined a search and rescue team and had his second child.

Then he deployed again.

This time Pagel was sent to Afghanistan as an intelligence officer. He mostly stayed on the base during his deployment. He returned to the states after three months.

Two weeks later Pagel’s superiors called him in to talk. He thought he was getting promoted. Instead, he was handed his walking papers.

“I didn’t know what I was going to do,” Pagel said. “I thought about being a vet for a few minutes.”

While Pagel served out his last few months as an activity duty Army officer, he took stock of his life. He has a degree in criminal justice, but after a number of high-profile police shootings he decided he did not want to be an officer.

He created a list of qualifications for his next job. He wanted to work in the service sector and create a tangible impact in society.

Pagel crossed paths with an army nurse and after the man told him about his travels and work, Pagel realized the career move was right for him and he enrolled in nursing school.

“The goal is flight nursing,” Pagel said. “I definitely need that adrenaline rush.”



Life wasn’t always easy for Pemp.

In 2004 she met and married a man in the army. That same year he was deployed to Iraqi as an Army Combat Engineer. He was shot in the leg a few months later and was sent home for a month—the bullet still lodged in his leg. He redeployed and Pemp deployed for the first time at the end of that month.

Though their deployments were only an hour away, they lived in different worlds.

Pemp was escorting local nationals on base and only left the wire fence once. Her husband was directly involved in combat and had his vehicle blown up by an improvised explosive device.

As her deployment ended, Pemp requested retraining to become a physical therapist. She packed up and left their apartment three weeks after she returned home. She was on her way to attend school to get her associate degree in Wichita Falls, Texas while her husband was still overseas. She was determined to get the training she needed to help him recover.

“When he came home all of the other guys had their spouses or families there and I couldn’t be there for him,” Pemp said. “It was very traumatizing to him.”

Her husband was sent to Tacoma, Washington to have his mental and physical health evaluated. They tried to reintegrate him into society but came to the conclusion that he suffered from post traumatic stress disorder.

Meanwhile, Pemp was working on her associates degree in physical medicine at a technical school in Wichita Falls, Texas. She was painfully aware of her husband’s condition. She tried to contact his superiors but was ignored. She had no choice; she put her nose in her books and focused on making it through school.

“I don’t even know how I graduated tech school,” Pemp said. “I was so stressed out.”

After she graduated, the Air Force wanted to send her to Maryland, but she applied for and received permission to go to Washington to help her husband.

She found her husband to be a changed man. He fluctuated from happy to angry to sad in minutes. He was “unhinged and erratic.”

“We were not supposed to become a statistic,” Pemp said.

They divorced in 2006, and Pemp threw herself into work.

“One of the things they teach you in the military is resilience,” Pemp said. “You have a choice: be resilient or let the world get the best of you.”

In 2008 she deployed to Afghanistan with a medical team where she worked as a physical therapy assistant in a detainee facility.

“One of the things we had to keep in mind was that we were not there to interrogate them or judge them,” Pemp said. “We were there to provide quality health care as if they were any other patients.”

The detainees were given very little – as little as just one blanket and one towel in their cell – and many of them needed medical attention. Physical therapy was hard to practice due to the limitations on their freedom to exercise.

With extra free time, Pemp began doing phlebotomy and giving immunizations. She found that the sickest patients were often not being seen first. The detainees told the religious leaders of their group who would tell guard if they were feeling sick. The guard would make a list of names for the medical center and the center would go down the list.

Pemp decided to create a program called Cell-Side Triage. She visited patients in their cells, assessed them and then helped the medical staff decide in which order the patients should be seen. This earned her the name of “PT doc” or “Angel.”

One day a detainee came in to have a medical procedure done. He did not respond to the medical staff. He just looked at Pemp and smiled. The translator explained to the man that the guard was going to have to escort him out if he was not cooperative. Still, the detainee just smiled. The guard began to pull the man out. The man stopped him and opened his hand. In it lay a small ring woven from threads carefully pulled from his blanket and towel. He asked the guard to give it to Pemp. The guard told the man that it was contraband and that he was going to confiscate it. The detainee threw himself on the floor and started yelling.  The entire floor began to riot.

Later, the guard gave Pemp the ring and said, “I hope you know this entire riot started over this ring.”

Pemp only cared that the detainees were human and that they needed help. This inspired a deep love from her. Throughout her time, they brought her many thread rings and rosaries which are now framed in her house.

“I realized I was very interested in public health then,” Pemp said. “That started my desire to want to go abroad and do this kind of stuff.”

She left the military in 2013.

“Sometimes I wish I would have stayed in, but I wanted to see more than I was seeing,” Pemp said. “After both my deployments I felt like I fulfilled the reason I joined and that why I got out.”

Ever since, she has worked as a physical therapist in Texas attending Texas State University to get a degree in clinical laboratory science.

“I’m going to be a successful veteran,” she said.

Gear from her time in the Air Force is currently being displayed in the “Memories from my Duffle bag” display at Alkek Library.

For Pemp, the trip to Nicaragua was a no-brainer.

“I don’t like ‘out of sight, out of mind,” she said. “I feel like (the health care conditions in Nicaragua) should be acknowledged. I think there is a lot of stuff we ignore because we are afraid to feel the emotions, but I’m not afraid.”

Nicaragua and beyond

For Pagel and Pemp, their stories make them who they are. For Pemp, her hardships caused her to experience life a little more. She laughs easily and smiles readily. She is happy to talk to anyone.

“I really do enjoy life,” Pemp said. “I mean, there is so much to enjoy and learn and take in. I don’t feel like we should spend our lives just going to work and coming home and sitting in front of the TV. I want to explore the world and meet new people and learn new things.”

Pemp’s fellow classmates notice her hard working spirit.

“She always wants to learn more,” said Ashley Wells, a clinical lab science student who worked with Pemp in Nicaragua. “She’s never content. She always wants to go further.”

Patients in Nicaragua

The most memorable patient for Pagel was a 90-year old woman who wandered in during one of the clinic days.

She peaked her head in the side door and asked to be seen. She explained she had walked quiet a distance. She was so thin that her bones showed and she was so elderly that snow white patches of hair grew out of her ears.

The woman in charge of the clinic agreed to let her be seen. Pagel offered to see her during lunch.

While everyone else ate—by that point the group was starving as lunch had arrived late—Pagel examined the woman. He listened to her medical history, which included possibly being cursed—and good naturedly looked at the fungus on her feet and in her ears every time she requested.

The woman, in turn, told him that his Spanish was bad. Despite her griping, the woman stared at Pagel like he had come to personally save her.

“This woman is built like a tank,” Pagel said, as he examined her back. “She’s as crazy as a bat though.”

The woman was given a meal and when she finished, she left the clinic.

“Everyone here has a good heart,” the woman told a translator while smiling at Pagel.

The next day Pagel looked out of the school bus window as it rolled down the dusty road out of the village. The woman was walking through a field.

“Hola abuela,” Pagel yelled through the window at her.

Later, Pagel said this was the most memorable part of the trip.

“I enjoyed working with him because he is very confident,” said Chelsea Fowler, a nursing major who has worked in clinical groups with him before. “His strong personality is going to make him a very good patient advocate.”

International Service Learning: Preparing for Service Teams in Nicaragua

By: Allison Fluker

Texas State University’s 34-member inter-professional team spent 12 days in Nicaragua. International Service Learning spent 60 preparing for them.

The team’s trip was divided into three days of medical clinics, two recreation days, one day of house visits, one day of sharing with the community, a service day in the nursing home, a service day in the orphanage, plus group dinners at six restaurants and two trips to the grocery store.

None of that happens without obsessive planning.

In order for ISL staff to decide where to take a medical team, they first have to connect with a community that doesn’t have easy access to healthcare. Some villages are hours away from the nearest health clinic.

“It takes a lot of hours and effort to check on partners from health centers and community leaders to set up or choose a community to work with,” said Pavel Guevara, the ISL country coordinator for Nicaragua.

ISL receives hundreds of requests for their assistance every day. The organization takes these requests and calculates the best fit for the incoming team to provide their services.

“I consider the level of poverty by conducting local visits, checking on the needs of the community, conducting interviews and checking risk factors that are present,” said Guevara.

Harold Mojica, an ISL assistant team leader, said the community leaders, who are typically doctors or pastors, send word to ISL that they’re interested in having a service team come to their town.


In Nicaragua, there are private and public healthcare outlets. If someone has a steady paying job, they more than likely qualify for private care.

“The company you work for covers 16.75 percent of your costs; 6.25 percent is taken out of your earnings from your salary and the government covers the rest of the costs,” said Mojica.

Basic care is covered, but if patients need an MRI or an X-ray they have to pay out of pocket. Often, rural residents cannot afford specialized health services. The GDP for 2015 in Nicaragua was $1,849 and a large number of residents cannot afford private healthcare. They receive only basic care, such as check ups, through public health services.

“Public care is for someone who doesn’t have a steady paycheck or can’t afford the costs of private health care,” said Mojica. “The people in the villages don’t pay for insurance. They live day by day on the earnings from their work that they bring home that day.”

Families who live in rural communities must choose between healthcare or buying food and supplies they may need. That’s where service organizations, like ISL, come in.

“We choose communities that don’t have health centers nearby,” said Massiel Vilchez, an ISL assistant team leader. “That shows that they don’t go to the hospital to check on their health often.”

Community visits

To prepare for the service team’s arrival, ISL staff members visit the communities to meet with the leaders and to check if there are safety concerns. They also inspect the buildings where the clinics will be held.

“We go to the communities a couple of times to see the space (in the building) and to figure out the placement for distributions and where the teams will be going,” said Vilchez.

Mojica said churches or school buildings are typically used because people in the villages can easily identify them.

“We use the church because it creates a good atmosphere with good benefits for the communities,” said Vilchez.


Guevara consults with the Ministerio de Salud de Nicaragua representatives to obtain approval for ISL to host health clinics.

“We need to go to the ministry of health to get their permission since we’re doing clinics that are involving medicine,” said Guevara. “They give us permission in the area that they think would benefit the most.”

After getting approval from the government, ISL explains to the community leaders what the service team will be doing while in their town.

“We meet with the pastor and explain the dates the team will be there,” said Vilchez. “Then we explain the procedure and that we need guides for the clinic days. We also tell them the average number of people that would be seen.”

Planning after approval

Approval from the health ministry is one of the first steps in the process when placing teams within local communities. The planning process after obtaining approval is lengthy and thorough.

“I make a budget and order which medicines we are going to be giving out for free to patients,” said Guevara. “We have to calculate how many patients per day will be our goal. I have to make sure there will be enough supplies and medicine to give out.”

At the Texas ISL headquarters, staff collects information about the incoming participants of the new service team. Once the team’s information is uploaded into a database, an itinerary can be formed for the trip, which is dependent upon the objective of the incoming team.

“Once the community is selected, we start sending the information (about the community) to the teams,” said Vilchez.

ISL wants to accommodate the team’s needs to ensure its members have the opportunities they want, for example, the Texas State health professions students visited local public hospitals to understand the differences between western medicine and Nicaragua’s.

“The hospital visits are special opportunities because it’s really hard to get the permission from the hospitals,” said Vilchez. “We need to select the staff for the teams. We tell them the specific details of the team’s itineraries and need them to talk to the doctors.”

Tables for 34, please

Part of the planning includes deciding where to take the team to eat.

The ISL staff in the destination country contacts restaurants in advance to receive their menus. ISL visits every restaurant they plan on dining at before the volunteers arrive to determine if they are sanitary and in good condition. They sometimes teach the wait staff keywords or phrases in English to help make the experience flow smoothly. If needed, they teach the staff how to seat and wait on a group of more than 30 people – and each paying their own ticket.

“We need to make sure we go to different types of restaurants with different types of food,” said Vilchez. “The hardest part is the budget. We have to find places that aren’t costly.”

When the volunteers were out working in the clinics, ISL provided lunches. The team members collected information on dietary restrictions from each volunteer before planning the week’s meals.

“We included vegetables and different things so it would have a good balance and try to change the protein every other day,” said Vilchez.

Meticulous itinerary 


The ISL team plans recreation days for the volunteers to enjoy during their trip. The Texas State health professions team spent a couple of days exploring the Masaya Volcano, Granada City, and spending a morning at Miramar, a local zip-lining company.

Every detail of the team’s itinerary has to be approved by the ISL headquarters before the trip. Any changes made to the itinerary during the trip must be reported to the headquarters office in Texas. When the team decided to eat at the hotel instead of going to a restaurant, that had to be reported.

“We do a report after every day talking about what we did and what happened for the day,” said Vilchez. “If someone gets sick, we have to report it. If there are changes in the itinerary, we have to report it.”

A large amount of thought goes into the selection process of who will be on the team.

Most of the people who work with the ISL team, like doctors and bus drivers, have volunteered their time or their resources. Eight translators and three bus drivers were employed for their services while the Texas State University team was in Nicaragua.

“You always see translators and doctors and transportation providers because its people that have a great sense of service; it’s not a matter of business,” said Guevara. “I chose them because they love what they’re doing.”

Read more about some of the ISL staff members in Nicaragua.