Volunteer in San Juan del Sur, Nicaragua

 

Simmons Volunteers

For years the Newton/San Juan Sister City Project has been assisting North Americans who want to volunteer in nonprofit activities in San Juan (from a week to a year). We facilitate their living with local families, learning Spanish in one of the town’s Spanish language schools if they wish, and helping in some form of community work. In the past this has involved teaching English as a Second Language at the Free High Schol for Adults, teaching photography to kids, public health, adult literacy, helping out with the Bookmobile, constructing water filters and “EcoStoves” in the Appropriate Technology Workshop, and building schools in rural communities. Volunteers have ranged in age from 10 to 80.

Volunteers should be ready to make a contribution toward supplies and/or pay a service fee, depending on the venue and professional supervision involved

Here’s our policy:

“Unlike some organizations, we do not charge you a fee to work with our local colleagues.  We do, however, ask that you set aside funds the help cover the costs of materials and transportation for the project you’d be working on. For instance, if you’re helping Antonia Mendoza, we’d ask that you help purchase sand and gravel for the BioSand Filters, and that you set aside about $65 to rent a truck  for at least one day (and pay for diesel) to take Antonia, yourself and filter supplies out to a rural community.  Ditto if you’re working with Fidel Pavon on EcoStoves. In short, asking you to set side about $100 as a contribution to the project for which you’ll be volunteering seems to us quite fair.”

NOTE: If you are planning to travel to San Juan del Sur and are willing to carry down needed medical or educational supplies, please write david.gullette@simmons.edu

Phillippa Goodrich, an English writer who came to San Juan del Sur in 2005 with a Newton North High School contingent, wrote a subtle, informative feature on the town, the Sister City Project, and the Free High School for Adults in “Mojito Coast,” for The Independent, a distinguished British paper. “At this point I must introduce you to two stalwarts of the twinning society, David and Margaret Gullette. . . . They succumbed to the enchantments of Nicaragua and its spiritual riches some 20 years ago.

Back in town, Margaret Gullette was getting ready for the start of the new academic year at her project: the town’s free Saturday School. She invited me along for the first day of term, and I arrived just in time to listen to the birdsong accompanying almost 200 students, all in white and blue, as they sang the national anthem. The bird trilled in agreement as the headmistress addressed the students sternly about the necessity of attending every week. The school is for teenagers who have to work during the week, or for adults who have missed out on an education. As Marina, a 35-year-old with a strong, lined face told me, explaining her years out of school,  “Between food and education, we had to choose food.”

You may be thinking by now that San Juan del Sur is a destination only for the committed activist.  (“Mojito Coast”)

We also encourage parents with children to volunteer. House rentals are possible and there are good pre-schools and primary schools. One couple (a pediatrician and an internist) with two children spent a month working for Communal Medical Services. We especially encourage volunteers who come in January/February, to work with visiting groups of American students, optometrists and Newton/SJ Project Managers.

American visitors have often worked with Communal Medical Services, an NGO that has been working directly with rural and poor urban women since 1990. It provides basic health care, reproductive services, and preventive medical care, primarily to women, pregnant women, new-borns, and malnourished children through a network of 30 voluntary rural health workers (brigadistas de salud), including midwives. The new Women’s Shelter at CMS, Solidarity House, a response to violence against women and commercial sexual exploitation, needs bilingual volunteers with experience in such work. We also currently need people to teach English and computer skills at the Free High School for Adults.

Those wishing to volunteer should write to david.gullette@simmons.edu. For more detailed information about volunteering in San Juan del Sur,  go to the “Nitty Gritty for Volunteers” page. NOTE: We offer no financial support for volunteers. We can help volunteers with housing and placements, but can accept no responsibility for their safety or well-being.

Read testimonials by former volunteers whose lives were changed by their experiences in San Juan del Sur.

MEDICAL VOLUNTEERING:

New Clinic built by Rice Univ. Engineers Without Borders

Medical professionals from the US regularly travel to San Juan del Sur to volunteer their time and expertise and to work side by side with their Nicaraguan counterparts. Also making yearly visits to San Juan, usually in January, are the optometrists of VOSH-NECO –the New England Council of Volunteers in Optometric Service to Humanity. The folks from VOSH have been giving eye exams and distributing recycled eyeglasses to over 2,000 people a year in San Juan alone. These glasses are shipped down by the Sister City Project and held in reserve for the January Clinics, which are held in the big primary school in San Juan. For more information about VOSH, contact Dr. Joseph D’Amico, 508-829-2033, or at eyeclam@aol.com or Dr. Matt Blondin, 860-567-4543, or at mblond@aol.com.

Doctors, nurses, physical therapists, dentists, and other healthcare professionals interested in volunteering in San Juan del Sur should contact Dr. Rosa Elena Bello of Servicios Medicos Comunales (in Spanish only) at nicaraguanismo@yahoo.com.

For those interested in volunteering at the Centro de Salud (the government clinic) here are some useful tips from a 2011 volunteer  from California:

The Centro de Salud (“El Centro”) in San Juan del Sur (SJDS) serves a large catchment area and has three associated outposts, each staffed by a doctor and nurse (doctors rotate locations).  Services at the Centro, including medications dispensed, are free, as it is part of the national public health care system.  The nearest hospital is about 30 min away, in Rivas.  The next level of care is in Managua.

(The Centro de Salud has by far the most patients and therefore is ideal for medical volunteers, but I will briefly describe some excellent additional medical volunteering opportunities.)

1.  Layout:  The Centro’s main building is simple and spartan but functional.  It consists of two connected waiting rooms, off of which are several examination rooms.  There is a small pharmacy, laboratory, dental exam room, and medical records room.  Down a hall is the emergency room, with an associated inpatient room with 5 or 6 beds as well as a three bed labor room and a delivery room.   Two outbuildings serve as kitchen and admin space.

2. Staff (a hard working and welcoming crew!):

  • MD’s: Dr. “Katia”, Dr. Alvarado, Dr.Galan, Dr. Rodriguez, Dr. Guido, Dr. Martinez.  Also a dentist.
  • Director: Teresa Vasquez (nurse) (contact her by email well before you arrive, at maritere_vasquez@yahoo.com).  Her husband also has an admin position: Leonel.  Gloria is a nurse, and second in charge after Teresa. [NOTE: AS OF JULY 2013 TERESA VASQUEZ WILL NO LONGER BE DIRECTOR. WRITE DAVID.GULLETTE@SIMMONS.EDU TO FIND OUT THE NAME AND ADDRESS OF THE NEW DIRECTOR.]
  • Many nurses, maintenance crew, lab and pharmacy crew, cook, janitor, ambulance driver.

3.  Schedule:  All patients generally arrive early in the morning; their charts are pulled and given to the doctors, who start at 8:30 AM (or earlier).  The morning session usually lasts until 12 or so and everyone breaks for lunch (some eat at home others at the Centro, as food is provided for staff who live outside SJDS).  Afternoon visits start at either 1 or 2, depending on the doctor, and tend to wrap up before 5.  Nursing visits follow a similar schedule.  The ER is staffed by a nurse and doctor 24-7 but during clinic hours the doctor on call gets pulled from clinic only as needed.  The doctor on call for ER also covers OB and inpatient patients (ingresados).

4. Volunteering:  Logistics of what exactly you’ll do depend on your level of clinical experience (do you feel comfortable seeing patients on your own or prefer to “shadow”), your Spanish (the patients do not speak English), and space availability (ideal is to have your exam room separate but adjacent to the doctor working with you so that you can easily slip back and forth to ask questions and get signatures on prescriptions; the ER has several rooms and is often used to see clinic patients during the day).

We, as residents/licensed physicians, have permission (I met with Dr. Palomino to confirm this) to see patients independently, but a Centro doctor must always look over and cosign our charts at the end of the day.  Also, we can sign orders for lab tests and instructions for medications (“el método”), but prescription slips for the pharmacy must be signed by a Centro doctor, so you will be interrupting their clinic often to get signatures, even when you are otherwise acting independently.

I found that as a second year resident, once I learned the ropes it was most educational and helpful to see patients on my own and the doctors were universally happy to split their pile of charts with me and make room, even if it meant squeezing a couple chairs right into the same exam room and working in tandem (though for patient privacy I sought out separate space whenever possible).  There is a lack of any formal orientation, so getting the hang of things took me longer than it needs to for future residents.  I propose that we use this document and face to face passing on of information to help residents going down to arrive more prepared and ready to hit the road running.

Another idea I have for “giving back” to the medical community hosting us:  I think any form of CME we can put together as mini projects while down there, i.e. reviews and updates in primary care that are relevant and sensitive to local circumstances, will be welcomed by the local doctors, who generally have limited access to CME, journals or Internet.

As for where to volunteer, the Centro is obviously most convenient to get to, but I also enjoyed working at the three outposts (puestos) and joining the Centro staff for mobile clinics to very remote communities (de terreno).  The outposts are in Ostional, El Baston, and Escamequita.  They have lower volumes of patients and are staffed by one doctor and nurse each.

Hanging out in the ER in the evening/night is also fun and can be exciting.  If you have a cell you can have the on call doctor call you for deliveries, etc.

5.  Stuff to bring:

  • Required paperwork:  Teresa will submit to Dr. Palomino so bring two sets of photocopies:  letter of intent (see mine below), medical diploma, medical license, passport. E-MAIL PDFs OF THESE DOCUMENTS DIRECTLY TO TERESA VASQUEZ,BUT BRING COPIES WITH YOU.
  • For yourself (to function as a clinic doctor there): stethoscope, BP cuff, pen light, otoscope, scrub tops (bottoms optional), pens, thermometer, alcohol gel, gloves (non sterile), Spanish-English medical dictionary (there is one Spanish-English medical dictionary, left by the Newton Sister City project with the director of the Centro, Teresa), notebook for observations/etc, medical reference of some kind, reflex hammer.
  • For donating to the Centro (optional):  pens, blank paper, thermometers, gloves, alcohol gel, gauze and other wound cleansing supplies, penlights, otoscope, batteries.
  • It is very useful to have a cell phone: consider buying one for 20-30 dollars and then paying every so often to load it with minutes (you can call local or U.S.).  The other way to call the States is on Skype at many local Internet operations where using a computer for an hour costs about $1.00.

6.  Dress:  Doctors wear scrub tops and pants or jeans, occasionally scrub bottoms.  Open or closed shoes.  It is a casual environment but a tank top would feel inappropriate (but beach wear is essential for your free time!)

7.  Weather:  HOT.  Rainy in our summertime.

8. San Juan del Sur:  Spring Breaky bar scene by the beach, surfing lessons, multiple language schools, great fresh seafood, theft an issue when alone at night in certain areas.  Transport by bus is slow but available, prices for taxi should be agreed upon before you get in as they are negotiable.  Bus and taxis leave from the market (mercado).  Some taxis have been known to rob people or not deliver you safely, so consider asking people you trust.

9.  Lodging: Prof. David Gullette of the Newton Sister City arranges home-stays (david.gullette@simmons.edu) with or without meals included.  Cheap hotels and hostels range from $10-20 per night.

10. Other places to volunteer:

Alden Willard’s Diabetes/HTN groups, especially the Thurs morning San Juan group.  Alden is an American living just outside SJDS who developed and runs a program for diabetics, hypertensives, and people at risk.  You can see patients in doctor visits and help educate them about their conditions.  Call or email her to arrange in advance: tel 83655053, aldenawillard@gmail.com

“La Clinica” (Servicios Medicos Comunales) was created by a Belgian doctor and is now directed by Dr.Rosa Elena Bello, who also runs the Shelter for Battered Women, the Commission on Childhood, Adolescence, and Youth.  Useful to work there to meet the mothers of malnourished children (another program run by Dr. Bello) and the girls or women, if any, living in the shelter.  She also will arrange for you to give charlas in Spanish on sex ed to rural/barrio adolescents. Dr. Jenny Lopez staffs the clinic, which is not far from the Centro.  You can contact the director, Dr. Rosa Elena Bello (nicaraguanismo@yahoo.com) to let her know you are coming.  It is a private clinic and Dr. Lopez sees patients for $2.50 and is happy to have you work along side her, seeing patients together, but not independently as there are few patients and she gets paid per patient.  She works MWF all day, and T/Th mornings.  It provides us an interesting additional exposure but likely not as fruitful of a learning experience as the bustling Centro.

Key clinical terms:

  • EXPEDIENTE (=paper chart)
  • Nombre:
  • Numero (de expediente):
  • Fecha (hoy):
  • Edad:
  • Pulso (frequencia cardiac):
  • FR (frequencia respiratoria):
  • P/A (presion arterial):
  • Peso:
  • Temp:
  • Subjetivo: describe the pt’s problems, symptoms, ROS, treatments tried thus far, etc.
  • Objetivo: General: (alerta, obesa, bien hidratada, etc)
  • Garganta normal sin enrojacimiento ni exudato
  • Cuello sin adenopatia.
  • Corazon regular sin soplos
  • Pulmones claros sin sibilancias ni crepitus
  • Abdomen suave sin masas ni dolor
  • Extremidades sin edema, rellena capilar <2 seg
  • Etc (other exam findings depending what’s pertinent)
  • Resultados de examines:
  • EGO = examen general de orina (UA)
  • EGH = examen general de heces (stool O&P and leuks)
  • BHC = biometrica hematic completa (CBC)
  • Impression: numbered. Diagnoses, DDX, what you are ruling out, and include pertinent negatives to support management decisions, such as “diarrhea without dehydration”
  • Plan: numbered.  Always include meds dispensed with dosages, when to come for f/u apt, and advice given regarding reasons to return immediately, self care in home, natural remedies, lifestyle changes

You can admit pt for IV hydration, IV abx, monitoring, etc, and continue to add addendums to this note until pt d/c-ed (alta)

Orders for nurse (ER nurse covers) must be written on pharmacy slips and nurse will also write updates in chart

How to write prescriptions:  one stamped slip of paper per drug, goes to pharmacy, must include patient name, date, numero de expediente, indication, drug name, pill/syrup/capsule (tableta/jarabe/ovula), # (number pills or “frasco” or “tubo”), Centro MD signature.  Then on an additional stamped slip write “Metodo por [pt name]” and number it, include each med with dosage instructions on how to take it, include natural remedy suggestions if made.  You sign and date.

I recommend making yourself a copy of the list of meds available in the Centro pharmacy by using the inventory print out they take “de terreno”.

How to order labs: on stamped slip write pt name, “Examenes:” then EGO, EGH, BHC as needed (others can be written, to be done elsewhere).  You sign and date.

Here’s a model of what your letter to the health officials in Nicaragua could look like (MINSA=Ministerio de Salud):

Estimadas colegas de MINSA,

Soy una doctora en los EE.UU y me gustaría trabajar en el Centro de Salud y en la clinica de San Juan del Sur.  Mi deseo es servir y aprender.  Soy medica nueva, en mi “residencia”, y los doctores en los consultorios van a supervisarme y enseñarme como sea necesario.  Las fechas que voy a estar en San Juan del Sur son desde el 10 de enero hasta el dos de febrero.

Estoy en mi segundo ano (de tres total) de residencia en medicina familiar, en Santa Rosa, California.  Recibí mi “MD” (doctorado) de la escuela de medicina de Harvard en 2009.  Mi experiencia en medicina familiar ya ha incluido rotaciones en obstetricia, genealogía, pediatría, medicina general, emergencia, y cirugía.  Hablo español (no perfectamente pero suficiente para comunicar en la mayoria de situaciones–y me gustaría mejorarlo).

Si necesite contactarme, mi correo electrónico esta’ debajo.

Atentamente,
[nombre]

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