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.”
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.
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.