The Global Health Portal recently spoke with three Northwestern undergraduates who received a John & Martha Mabie Fellowship for Public Health Research and got to spend their summer at a rural clinic in Bolivia.
Major: Psychology, Minor: Economics
Major: Economics, Minor: Spanish
Tell us about your project. What inspired your work?
When we first found out about Centro Medico Humberto Parra, we were intrigued by the low-cost health care it provided to underserved populations in Bolivia. All three of us were very interested in contributing to the clinic and its mission however; we wanted to find a specific project that targeted a need within the clinic. Before deciding on a project, we emailed the clinic for project suggestions and met with one of the clinic founders, Dr. Mark Molitch, who is also a professor at the Feinberg School of Medicine. Both identified Chagas Disease as a major health challenge facing the population served by Centro Medico, primarily because there was not a lot of public health knowledge regarding the disease. We also came across a prior study assessing the level of awareness about Chagas within the clinic population, which found significant gaps in patient knowledge. This information, along with information about Chagas disease itself and already existing health education programs at the clinic, led us to develop our final project assessing the most effective teaching methods when educating patients of CMHP about Chagas.
How did your experience on the ground vary from your expectations?
When we were first researching about existing clinic health education programs, we found that the clinic already had health promoters, one or two from each community that relayed health information to their communities. Each health promoter would attend monthly meetings at the clinic during which they would learn about a specific health issue. They would then focus on that issue in the following month when holding community meetings with patients. Our initial plan was to train the health promoters on Chagas disease and accompany them to their communities on the days that they met with patients. We would then administer surveys before and after the health promoter gave the presentation.
We were able to train the health promoters on Chagas disease at their monthly meeting and provide them with educational materials (a large presentation poster and handouts for the patients). However, going to the communities when they gave presentations proved to be difficult due to difficulties with transportation. Some of the communities were located 2-3 hours away from the clinic and clinic staff was not always available to transport us to these communities. Because of these challenges, we decided to give our own presentations in the clinic and administer the surveys during these presentations. At first it was somewhat disappointing to not travel to each community and see the health promoters in action, however, we soon realized that our adaptation did not compromise any of our objectives. The health promoters were still giving presentations, creating a sustainable educational program about Chagas, and we were still able to administer surveys and collect data. Keeping in mind these facts, we were able to move forward and successfully complete our project despite the challenges.
What was your most meaningful experience abroad, and what did it teach you?
The most meaningful experiences while abroad were when we spent time with locals and learned about their daily life. One particular example was when we went to the house of a clinic lab technician, Vicky, who lived in a nearby village. She invited us to lunch at her home to celebrate her birthday. Going to her house for lunch was unlike other lunches we had been to. The setting was very simple: we were all crowded on her tiny porch that was barely protected from the cold and wind of the outdoors. Her house seemed to consist of two rooms, one kitchen and one living room, and was filled with several family members. Yet, despite the cramped and cold environment, we found nothing but warmth at that lunch. Vicky had prepared a grand feast complete with several types of food. From her expression it was clear that she was incredibly honored to have the opportunity to host us. She smiled at us warmly as we talked about different plants that were native to Bolivia, learned more about her family, and learned more about the village. Despite the humble setting, it was one of the most welcoming lunches we had ever been to. From this experience, we learned that people have so much more to offer than material goods and that the most rewarding experiences in life come from just being open to every new person you meet, regardless of where they come from or who they are.
What was your most challenging moment, and how did you cope?
During our first week in the clinic, we noticed that there was quite a lot of downtime after giving presentations. During this time, we asked employees how we could help and tried to find projects that could engage our time. However, often times there were no projects and we found ourselves getting in the way of the clinic employees. Rather than waste time or be a hindrance, we set to work coming up with additional project ideas that could benefit the clinic, even if it was outside the scope of our existing project. We began with brainstorming the skills we had to offer to the clinic—many of which included skills in the area of technology. After talking to the clinic coordinator and the Head Nurse, we found that there was a need for a video about the clinic that could be used to attract US donors. Clinic employees could not make this video because they lacked either the time or the technological know-how. Thus, we were able to turn something that could have potentially been frustrating and unfruitful into a project that positively impacted the clinic.
Did you encounter any cultural differences that required getting used to?
At first, the slower pace of life in Bolivia was somewhat difficult to adapt to. Not every moment needed to have a product and deadlines were not as defined. It was fairly common to have quite a bit of downtime and at first, it felt like we were wasting time doing “nothing” rather than being productive. What we soon came to realize was that this was just our “American” mentalities and pace of life. The truth was that Bolivians got things done on their own time and were calmer than Americans when it came to day-to-day projects in the clinic. Furthermore, we began to see that “doing nothing” didn’t really mean doing nothing in Bolivia. It meant talking to your co-workers, helping out in the kitchen, or visiting patients. We realized that the slower pace of life did not mean less productivity but just a greater emphasis placed on community.
The other thing that was difficult to adapt to was the rural setting. We rode trucks on dirt roads and didn’t always have the cleanest facilities. Communities were often separated by acres of forest and farmland making transportation a problem. Several days the rains made the dirt roads impassable, preventing patients from farther communities from coming to the clinic. This often forced us to change our plans or objectives for the day last minute and forced us to grow more flexible on a day-to-day basis.
Has your summer experience impacted your future goals and interests at Northwestern?
All three of us are pre-med students at Northwestern and were excited to be working at a clinic this summer. After spending time at Centro Medico, we were able to see exactly how powerful medicine can be, and how much of a difference it can make for patients truly in need. Doctors play a vital role in the lives of people who don’t have access to top notch health care, and we could see how grateful they were to receive the consultations and medications provided by the clinic. After this summer, the three of us are even more convinced that being a physician will be the most rewarding career choice for each of us.
Do you have any advice for students wishing to conduct research in an unfamiliar location?
The biggest thing is to be flexible, especially if you are going to a developing country. A lot of planning goes into a project and often times we spend hours trying to hammer out every detail of a project and try to think of every possible challenge. However, the reality of the situation is that going to a different country means a new way of life accompanied by many unforeseen challenges. In the face of these unforeseen challenges it is important to think on your feet and find solutions that don’t compromise the overall goals of your project.
The other thing to remember is that though you are engaged in projects that will positively impact the community you are traveling to, you are still a guest in your host organization. These organizations are taking time from their schedule to make sure you have resources and are comfortable while also simultaneously completing their own work. In other words, do not get so married to your planned project protocols that you cannot see the burden it places on the employees of your host organization. Instead, try to find solutions that do not compromise your overall objectives or the ability of employees to comfortably complete their duties.
The last piece of advice we have for students traveling to an unfamiliar place is to embrace the culture and the people. Get to know locals as much as possible, learn the language, and seek opportunities to be absolutely immersed in that country. The relationships you build and the moments you share with people in that culture will be some of the most valuable memories and learning experiences you’ll leave with.