Category Archives: Nicaraguans

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.

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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.

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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.”

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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 

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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.

Jairo Rivas: ISL Team Leader and Nicaraguan Dad for Texas State Students

By Alicia Vazquez

Jairo Rivas welcomed the group of Texas State faculty and students at the Augusto C. Sandino International airport in Managua, Nicaragua, on Jan. 4. Among 38 unfamiliar faces, there was only one he recognized: Elizabeth Biggan, clinical assistant professor at St. David’s School of Nursing. This was Rivas’ third year working with Biggan and the groups of nursing students she takes every year to Nicaragua through International Service Learning.

ISL facilitates groups of volunteers to travel to different countries to provide essential community and medical services. Rivas started working with ISL in 2011 as a translator, but was immediately promoted to team leader because of his interest and enthusiasm. Since then he has worked with large groups of more than 25 people.

Rivas was formerly the associate director of the language institute at Universidad Centroamericana (Central American University). He was used to wearing a tie to work and being in an air conditioned office – a completely different environment from his work now. Through ISL, Rivas worked in Nicaragua’s poor communities for the first time.

“I saw the necessity of the communities and decided that it was time for me to change my work and do something for my country,” Rivas said. “Despite the heat, every time I work at a community I do it with a lot of enthusiasm because I know that I’m making a difference.”

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Rivas demonstrates a scenario during orientation day. Photo by Alicia Vazquez

The satisfaction of knowing that he has contributed to provide healthcare for people of scarce resources in Nicaragua has kept Rivas going throughout the years. As team leader, a few of Rivas’ responsibilities include welcoming volunteers, conducting orientation day, managing the staff and community leaders and choosing the menu. The process of getting everything ready for one group visit usually starts two to three months in advance. The job requires organization, decision making and being a step ahead of everyone else. Rivas said it takes a lot of dedication, energy and passion to make sure everything works out.

Rivas’ desire to help people and his attention to detail doesn’t go unnoticed. Adriana Hernandez has worked with Rivas for four years and although they’ve worked together in different roles, his personality is always approachable.

“It makes me feel safe and protected,” Hernandez said. “I know that we have someone who is always in the back solving the problems.”

Making everyone feel safe is something that comes naturally to Rivas. Biggan said she requests Rivas as team leader because she knows he will take care of the students.

“We’re in a foreign country where I don’t speak the language but I do feel comfortable with him,” Biggan said. “He will do anything that we ask him to. He will always go above and beyond.”

Rivas and Biggan work together to plan some of the Texas State group’s activities.

“I tell him what I want to do and he magically makes things happen,” Biggan said. “It’s great to have gotten him by luck and kept him by desire.”

The Texas State students were meeting Rivas for the first time, but it wasn’t long before they started referring to him as Dad. Student Elisha Colip became ill during the trip and said Rivas acted like a concerned father the whole time.

“He is very caring and sweet. We were walking around and I kept having to stop to throw up and he would just patiently wait,” Colip said. “When we went to the pharmacy he gave me a chair to sit and took care of everything else. I could never thank him enough for taking such great care of me when I felt like I was dying in Nicaragua.”

Rivas said the Texas State group is one of his favorites because he always feels like the objective is met with them.

“The goal is for the nursing students to interact with patients and put their knowledge into practice,” Rivas said. “The first day the students are very insecure and a little nervous, but at the end of this journey I see a radical change. They’re confident and tend to patients quickly and with energy.”

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Rivas offers tips to the students during the last recreation day. Photo by Alicia Vazquez

Something Rivas enjoys is the interaction and cultural learning that happens between the American students and Nicaraguan people.

“He’s very proud of Nicaragua and very proud that he’s a Nicaraguan,” Biggan said. “When he sees the students come and fall in love with the people, the country, the traditions and the culture then it just makes him smile. He lights up.”

Biggan said Rivas is excited to meet everyone when the group first arrives, but when it’s time to leave, he has a hard time saying goodbye.

“I think he truly gets to know all of us in the two weeks that we’re here,” Biggan said. “So he’s truly sad when we leave but he knows that we will always be friends.”

Rivas said he puts 100 percent of his effort into his work now so that he can fulfill other plans that he has in mind.

“My goal is that we are able to go into more remote places of Nicaragua,” Rivas said. “The places we visited were poor but we could go to the mountains where there’s extreme poverty; they need more help.”

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Rivas translates the nun’s words to the Texas State students. Photo by Alicia Vazquez

Mariela Gutierrez Takes Pride In Making Hotel El Raizon Feel Like Home

By: Amanda Gibson

Hotel El Raizon is a quaint, courtyard hotel that lies behind a pair of gates on the side of Carreterra Managua, a busy street that stretches from the Nicaraguan capitol city of Managua and leads into the small community of Masaya.

This is the hotel where the Texas State University St. David’s School of Nursing students have stayed every year since beginning their annual trip to host free medical clinics in Nicaragua. The hotel offers students the ability to reside at a safe place while submersing them in many aspects of the Nicaraguan culture. At the hotel, students have amenities that include a swimming pool, a basketball court that can be transformed into an area for a game of pick-up soccer, and hammocks and swings to hang out on each day after their work is over. HER3

The heartbeat of Hotel El Raizon has nothing to do with all of these amenities and everything to do with Mariela Gutierrez, the hotel owner.

Gutierrez opened the hotel on Dec. 4, 2002, and since then it has mainly housed students coming to Nicaragua on service trips, although they do have other guests that stay at the hotel too. Gutierrez loves her job and feels that she is right where she needs to be.

“I do not feel like anything is missing,” she said. “I love to help people and it feels like more of a vocation. Not everyone has this opportunity.”

There are parrots chirping and the hotel dog, Lola, wags her tail as residents pass the pavilion her leash is tied to. HER6.png

“I loved the open concept of the hotel,” said nursing student Caitlin Ortiz. “Being outside for meals and relaxing in hammocks listening to the sounds of nature was amazing.”

Gutierrez served meals to the students each morning and in the evenings that the group stayed in, so it didn’t take long for her to win over the hearts of the students.

 “She is a very sweet lady that went out of her way to help you with any problems that you may have had,” said nursing student Dalton Fierst. “She was constantly working to improve our stay by keeping up with the cooking and cleaning. Her charismatic personality was contagious and I consider her my Nicaraguan mom.”

Aside from helping with meals and offering to wash clothes for a small fee, Gutierrez could be found in the front office of the hotel in her rocking chair watching a small television. She always had a smile on her face and was ready to engage in conversation with the students visiting her country and hotel.

“You could tell that Mariela really cares about her guests,” said mass communications student Alicia Vazquez. “One night we were doing karaoke with a giraffe statue as a microphone and then she passed by, I thought she would tell us to be careful with the giraffe but instead said we needed more energy. She then said ‘This hotel needs a karaoke.’”

Gutierrez made the students feel as close to home as she could while staying at her hotel.

 “I loved how at the end of a long day the hotel atmosphere was very welcoming and very relaxing,” said Alicia Vazquez. “It really felt like I was coming home.”

 Adding to the home atmosphere were Mariela’s two kids, David and Sophia, who were always out and about on the hotel grounds looking for someone to kick a soccer ball with or say “buenas” to. HER5

“They were incredible little kids and you could find David strolling through the grounds sleepily saying ‘buenas’ with a smirk on his face almost every morning,” Ortiz said. “You really got the feeling she brought you into she home staying at Hotel El Raizon.”

Gutierrez has spent a lot of time and money investing in her hotel since opening the doors in 2002. She smiles as she thinks back and remembers how the hotel started as two small apartments before two journalists from Bridges to Community convinced her to turn it into a hotel with the big market of student volunteers they could bring.

She laughs as she reminisces on the first group of students who stayed at her hotel. When the group arrived the doors to their hotel rooms were still being screwed in. Another group paid in advance so she could have air conditioning units placed in the room by the time they arrived. Although, the hotel has come a long way since those days, students still experience a bit of culture shock when they go to take a shower and realize there is no hot water.HER1

Hotel El Raizon is no Marriott, but that was never the intention. Gutierrez’s hotel provides guests the opportunity to experience different parts of the Nicaraguan culture without ever leaving the grounds.

“My favorite part of owning the hotel is helping people,” said Gutierrez. “That way every group, every person that stays here feels like they are at home, and they don’t miss home.”

 

International Service Learning gave Massiel Acetuno more than just a job.

By: Magdalena Avila

With an emotional introduction during orientation, Massiel Acetuno, an assistant team leader from International Service Learning demonstrated her love for her country, her people and her job.

The first words that came out of her mouth the first day in Nicaragua would soon be experienced by the group of Texas State University students and faculty as they visited the rural communities in Managua.

She explained how the people from the community would offer the students a chair to sit even if that meant they had to stand as they held their child in their arms. She said they would offer them something to eat, something as little as a piece of bread and coffee because that is all they could afford.

Acetuno said the students who visited the communities and provided free healthcare meant the world to the people of the community.

IMG_1029“In their eyes you are like angels sent down from Heaven,” Acetuno said to the group.

She admits she complains about certain things like not having cell phone service but this job allows her to remain grounded and reminds her of what she has in life. She sees homes with no power, no running water and people with no shoes, but they are happy and they appreciate what they do have.

“I don’t see this as just a job,” Acetuno said. “It keeps me humble and it makes me thankful for the things I have at home.”

On the same day she was supposed to start working with ISL two years ago, Acetuno said she nailed an interview with a company she had dreamed to work for. She was torn between the two.

“This is a job that I want but I had already made a commitment to ISL,” Acetuno said.

When she started working with ISL, Acetuno was a translator. One of the first groups she worked with were veterinarians. She admits it was frightening at first because she didn’t know many medical terms. Throughout the day she wrote down words that she didn’t understand and would look them up on her own time to better herself. The country coordinator, Pavel Guevara, saw her potential and after a few months she was asked to be an assistant team leader.

“There is nothing that can stop you if you are interested in learning new things,” Acetuno said.

This was Acetuno’s second year that she worked with the group of Texas State University nursing students. Elizabeth Biggan, Texas State University clinical assistant professor of nursing, requested her to accompany them on this year’s trip.

Acetuno said she felt honored that Biggan requested her because it meant she was doing something right.

“It’s the personality and just the way she comes across,” Biggan said. “Genuinely the students fall in love with her because she is so approachable and yet so realistic.”

IMG_0707Her love for her people and her country is evident. During home visits Acetuno wanted to take a picture with every family the students encountered. She would use names of endearment to address people in the community. She wants to be their friend and show that she cares.

“These are my people,” Acetuno said. “I love my people.”

People often ask her why she buys things with ‘Nicaragua’ written on it or why she buys things with the national bird printed on them. Her response is always the same: she is proud to be from Nicaragua.

She enjoys students asking her about the culture, the history and the food because it shows her that they are curious about Nicaragua. That gives her satisfaction.

“I want the volunteers to learn not only the medical part but also the social part,” Acetuno said. “Where we come from … how we are.”

It wasn’t always joyous moments for Acetuno. When she was seven years old her dad lost his job and her mother had to go to the United States because of financial troubles. Acetuno said she understood they needed food and she understood she needed to go to school.

When her mom would visit, Acetuno said it was really hard saying goodbye. Every time they dropped her mom off at the airport she remembers trying to hold in the tears. She knew it would only make her mom’s decision that much harder, but because of her mom she finished school and has a career.

“Not having your mom with you was really hard but it also makes me love her even more for the sacrifice that she made,” Acetuno said.

There were many obstacles in the road from the time her mom left. It took a toll on her personal life, her family life and her business life and she said she became depressed. One evening Acetuno and her sister decided to go to dinner with some friends. She said a woman stood up and starting telling her story in front of the whole restaurant. Acetuno said it was so inspiring to her because the woman had the courage to share all the good times and the bad times in front of people she didn’t know.

“I remember crying the whole meeting,” Acetuno said.

Acetuno said her life story did not compare the slightest bit to the things the woman at the restaurant had gone through, but Acetuno cried for all that was going on at that moment that she had held in for so long.

As tears rolled down the side of her face, she explained how she fell to her knees and started praying the moment she got home. She said the next morning she felt at peace, she felt relieved and she opened her heart to God.

“Since that day my whole life changed,” Acetuno said. “I was upset with life and I was anti-social. Now I’m the total opposite of what I was. When my family sees me they are surprised at who I have become.”

IMG_6201ISL has given Acetuno the opportunity to be herself, to grow, learn from the people around her and remain humble she said.

“Massiel loves serving people and ISL is the way she can do that,” said Adriana Hernández, ISL assistant team leader.

Acetuno said ISL provides a ‘life changing opportunity’ and she wants every team of volunteers to experience that same opportunity ISL gave her.

ISL staff Dr. Adriana Hernandez dedicates her time to serving others

International Service Learning is a non-governmental organization dedicated to providing substantial community assistance while offering voluntary practice in the areas of medicine, education and community enrichment.

The organization has serviced developing communities for over 20 years. Each country that the program assists has leaders in each field that are dedicated to service and provide their own unique learning opportunity.

Dr. Adriana Hernandez is a 32-year-old native of Managua, Nicaragua. She has practiced dentistry for 10 years. She attended Universidad Nacional Autónoma de Nicaragua-Leon. Upon completion of school, with the help of supportive parents and friends, she was able to open her own private practice.

Hernandez always knew she wanted to work in the sciences.

“Dentistry is a perfect mix between all the things that I love: art, science and helping others,” Hernandez said.

She had never been drawn to monotonous careers such as business administration or typical office positions. Because every person’s body is different, the need is always different, which is ideal for a person that hates routine.

“It is interesting to know that something as perfect as the human being is there for me to help (them),” Hernandez said.

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Dr. Hernandez cheers up the children in the community of San Joaquin during a home census. Photo by Mary Edmon

Hernandez chose dentistry because it was a unique avenue to help others. She wanted to change people’s perceptive on doctors. She believes her personality can make a difference for many people’s experiences.

“Sometimes I don’t work as a dentist, I work as a psychiatrist,” Hernandez said. “Sometimes you are only meant to be (there for someone) only to hear what is going on, and that is fine with me.”

Hernandez’ volunteer work began long before ISL.

During school she worked as a volunteer in a local health center annually for three months during her breaks from school. She was never paid, but took on any task that was needed, from cleaning to serving water to patients. The center admired her hard work and was so proud of her completing school that they donated many items to the opening of her clinic.

“Adriana has this personality that rubs off on the people around her,” said Magdalena Avila, Texas State University mass communication student. “You can tell that she loves what she does.”

Dr. Hernandez has been working with the Nicaragua ISL team for four years. As each group changes, the staffing needs change, giving them opportunities to explore different roles of leadership.

It is unusual for guest doctors to take the leadership positions for group assignments; however, Dr. Hernandez expressed her concerns and passion for the organization with the country’s coordinator and was given the chance to spend more time with the visiting volunteers.

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Dr. Hernandez (right) pictured with ISL staff at the orphanage Hermanas Sierras del Divino Rostro. Photo by Mary Edmon

Hernandez soon went on to attain her master’s degree and decided to take time away from the ISL program to focus. Shortly after completion, she contacted her ISL director.

“Pavel, please rescue me,” Hernandez said. “I am forgetting where I come from!”

Hernandez continues to volunteer outside of her ISL groups. Although the staff members are paid, the income does not meet many of their financial needs, causing them to have secondary jobs as well. The career is still very much volunteer work for them.

Leaders are exposed to many places and opportunities they would otherwise not have known. It was when she serviced an unknown community only two kilometers from her house that she realized there was much more to be done. It was an eye-opening experience for her that has continued to humble her.

Hernandez spends much of her free time with her loved ones and enjoys time with her niece. She has no children of her own, but prides herself on the care she provides for her two dogs. They are both three years old and have never been to a veterinary clinic because she is dedicated to them.

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Dr. Hernandez (right) laughing with student Amanda Gibson (center right) and ISL staff on top of Volcano Masaya. Photo by Mary Edmon

She is very independent, which is proven in several different aspects of her life.

“Sometimes it’s a load on my back,” Hernandez said. “I want to be able to say I can do it, but I can’t.”

Because of her success and independence, she is looked at as invincible.

Hernandez believes that the organization is a
good experience for students and professional development, but also for personal growth.

There are many different tools that are taken away from each group experience. Her time with the program has not only taught her to humble herself, but given her many lessons on working with others.

“Her friendly personality helped make people feel comfortable around her which helped us as students to learn as much as we could from her,” said Amanda Gibson, mass communication student.

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Dr. Hernandez led a group of nursing students on a tour in a local hospital in Masaya. Photo by Mary Edmon

“If you have tolerance with others, others will have tolerance with you. It is an easy way to live. You will enjoy life more when you realize you need other people,” said Hernandez.

 

 

 

 

Dr. Camilo Gutierrez teaches American nursing students in Nicaragua

International Service Learning in Nicaragua takes English-speaking doctors and pairs them with student nurses from America that go to Nicaragua to set up clinics in poor communities.

Dr. Camilo Gutierrez, 32, is one of the doctors. Born in Masatepe, Nicaragua and is a general practice doctor that works with ISL two to four times a year.

In January, he went into rural communities with nursing students from the St. David’s Nursing School at Texas State to treat patients and teach the students about medical care in Nicaragua.

Just like Dad

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Dr. Gutierrez discusses potential diagnosis with nursing student, Bridgette Young.

When Gutierrez was young, his father was a gynecologist in Nicaragua. Gutierrez would always play with his dad’s stethoscopes and echoscopes that he brought home from work.

During high school, he realized his fascination with his father’s work and decided to begin his path to becoming a general practice doctor.

Throughout his career, he has had the chance to do great things with his medical talent. In 2011, he began working with ISL in Nicaragua and in 2015 he was a medic on Discovery Channel’s Naked and Afraid.

Gutierrez said that the experience was fun but working with the poor communities is what he enjoys doing to make him a better doctor.

“What helps me become a better doctor is to help people who really need it,” Gutierrez said. “It helps spiritually because it satisfies me helping people with what I have chosen to do with my life.”

Serving the Underserved

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Dr. Gutierrez examines a patient with a potential throat infection.

With the Texas State nursing students Dr. Gutierrez went to two communities. Both were rural, impoverished communities where most people had little-to-no education and no medical insurance.

The patients in those communities were grateful to have seven days of vitamins and ibuprofen.

Gutierrez heard about ISL when his mother was selling medicine to ISL back in 2011. When she asked why they ordered medicine in bulk, she told them her son was a doctor that spoke English.

Now Gutierrez is able to practice medicine in the places that keep him motivated as a doctor. When Gutierrez works with International Service Learning, he also gets to give a better quality medical attention in the rural clinic setting.

“A quality medical attention is at least 15 minutes. In my own clinic, I spend half an hour with any patient,” Gutierrez said. “At the hospital, we are told only to spend 10 minutes on a patient because we can see as many as 70 patients a day.”

However, working in the clinics, the students and the doctors are able to spend enough time with the patient to go through every step of an assessment.

 Teaching American Nurses

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Dr. Gutierrez working on a patient assent with student, Michelle Wali.

The Texas State nursing students who spent two weeks learning from Gutierrez were responsive to his method of teaching.

Gutierrez interacted and laughed with the students when they weren’t seeing patients. This helped the relationship when assessing patients because the students weren’t afraid to ask questions about their diagnostic opinion.

Emily Estes was one of the students who learned from Gutierrez in the clinic setting during her time in Nicaragua.

“In the states, many doctors are passive and will dismiss you,” Estes said. “Here, I never have to feel bad about asking the doctors questions.”

Michelle Wali, a nursing student who is always asking questions and eager to learn, was astounded by how in-depth the teaching moments were with the doctors.

“All of the doctors here are asking me how I feel and how I am doing in the assessment,” Wali said. “They steer me in the right direction, which is really showing of how it’s a different relationship between doctors and nurses here.”

Wali and Estes both said there can be a lack of communication between doctors and nurses in the hospitals in the states.

Gutierrez said he thought it was absolutely ridiculous that those frontiers were up in the states.

“Doctors and nurses are a team,” he said. “I learn from the nurse at my private clinic just as much as she learns from me, and after five years together we have learned a lot.”

The Only Way to be Immortal

Gutierrez works with teams when the chief of International Service Learning in Nicaragua calls him anywhere from two to four times a year.

“I like the way American students show interest on the job,” Gutierrez said. “Most of the Americans want to learn new things and how to examine the patients.”

Gutierrez’s passion to teach medicine to students comes from the same place where he found his passion to be a doctor: his father.

“In the words of my father ‘the only way to be immortal is sharing what you know,’” Gutierrez said. “ ‘Any person who is listening to the things you explain will have a part of you, so you will live in their brains with what you taught them.’ ”