FROM STUDENT TO HEALTH VOLUNTEER ABROAD: Making A Positive Impact Internationally as Medical Students

By Casey Weimer & Lauren Pomerantz

Published on March 2009

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As we peered out of the windows of a Toyota pickup—perhaps the only vehicle able to navigate its way through the Chuchumatane Mountain Range just north of Huehuetenango, Guatemala—we discussed how foreign and desolate the land looked to us. Even with the varied terrain we were accustomed to seeing from our respective homes, the Colorado Rockies and the Manhattan skyline, we had never seen anything quite like this. Disembarking from the truck, bogged down with coats, gloves and cameras, we were greeted by a mixed crowd of smiles and suspicious-looking chapped faces. We joined the director of the Guatemalan non-profit that we were volunteering for on his mission to build schools in the country’s most rural and underserved communities. Five minutes after our arrival, he introduced us to our onlookers as “the girls who will be building you a school.” Unbeknownst to us, our presence carried hope to an isolated, impoverished community that had previously been promised so much with little to show for it.

Our experience is not uncommon to the many pre-medical students and medical students who have also embarked on missions to volunteer in developing countries. As inexperienced “volunteers” we are often confronted with a number of common realizations during the short-term medical volunteer trip: Why am I here? Why did I think that I would be able to help people from a culture and background so different from mine? Is it okay for me to learn much more than I am able to contribute? From our experiences both as pre-medical and medical students volunteering in Guatemala, and from what we learned from the Guatemalans with whom we worked, we can tell you that if you use your ears, your empathy, and even a few tools learned in medical school, that “yes,” you can make a positive impact – one that will resonate both within you and within the community where you work.

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The first steps that we can take as student volunteers are to listen and learn. Our goal should be to approach a community with the same zeal and apprehension that we carry with us on our journeys through medical school. We enjoy incredible opportunities for interactive learning whether in an anatomy lab or a poverty-stricken village, In both cases you need to recognize the chance to learn through observation and asking questions. Much like a physician taking the history of a patient, a volunteer who listens actively can open doors to important clues and information. If you sincerely care about “helping” someone, you must first be able to hear what he or she has to say and follow up with questions that will assist you in identifying the problem and your role in helping to resolve it.

Marco Alirio Ochoa Galicia is a Professor of Anthropology at San Carlos University in Quetzaltenango, Guatemala and the Director of Proyecto Educativo, Integral, Libertad, y Ensenañza (PEILE), a non-profit organization that receives approximately 30 foreign volunteers per year to aid in its mission to help members of Guatemala’s most underserved population through education and health related programs. In a November 2008 conversation, Galicia shared this insight: “When volunteers have little experience, their most notable contributions can be made through learning about the reality of the situation.” He stressed the importance of learning the specifics behind the social problems and understanding the culture, language, and history of the community in which you volunteer. Complex issues will not be solved in a week-long trip, especially not without a thorough understanding of those issues.

Echoing this opinion is Jessica Ohana, Director of Primeros Pasos, a non-profit located in Guatemala, which espouses the ideal that every child should have access to healthcare. Primeros Pasos provides primary care services and medical education to families in the Palajunoj valley of Quetzaltenango. Ohana emphasized the importance of dedicating sufficient time to the organization for which you volunteer. In a December 2008 letter, she stated that volunteers for Primeros Pasos should ideally commit at least three months of their time because "it takes time to adjust, learn and feel comfortable, and in a couple of weeks, that is not going to happen."

In Guatemala, as participants of the USC-sponsored language immersion program Somos Hermanos, we spent countless afternoons with Armida DeLeon, the health promoter of a clinic in Santa Rita, a rural community of approximately 1,000 residents located in the Quetzaltenango district. From these visits, we were able to learn a lot about her community. Specifically, we learned of DeLeon’s fears for the women of her community. She believes that adolescent girls face the greatest risks to their mental and physical health because they are poor, indigenous, and female. With DeLeon’s help we identified some of the major issues affecting these women including physical abuse, spousal alcohol abuse, emigration of their spouses, economic issues stemming from large families with little income, and health problems related to social determinants such as stress and poverty. Within our six-month stay, we struggled to act on this information and focused instead on gathering information. We recognized that we could not attempt to address these issues without a thorough understanding of the community members and the nature of the issues that affect them,

From listening and learning you build relationships and gain trust. With trust and commitment between the community and the volunteers, you can formally assess the needs of the community, plan ways to address the most serious or pressing needs first, and create appropriate roles for volunteers and community members. As our relationship with DeLeon grew, we began planning a project by assessing the needs and desires of the community. One of DeLeon’s dreams for the future of her community was “to see the adolescent girls develop into leaders…and through their example, be able to change the reality of other young women and the community as a whole.” We believed that an adolescent girls’ group could be sustainable in Santa Rita because the idea stemmed from a respected member of the community who was willing to cultivate the project.

Once a plan is established to meet the needs of the community, it is important to ensure that the implemented program is sustainable. Do not view your work as temporarily filling a gap—keep in mind how your work can continue once you leave. “All interventions by the volunteers must be sustainable within the historical, social, cultural and political context of the community,” said Galicia (November 2008). According to Ohana (December 2008), whether working with an established organization or starting a new project, sustainability depends on collaboration. “Volunteers are there to complement the work that is already being done in communities; they are there to learn how communities live, the community’s challenges and, most importantly, what the community identifies as its problems. After this, volunteers should help develop programs in conjunction with other local individuals and organizations that are already established.”

As medical students, we worked with DeLeon to help her realize this dream. Through an Arnold P. Gold Foundation fellowship, the commitment and support of the faculty at SUNY Downstate, DeLeon and the community, we were able to create a sustainable safe space for the adolescent girls of Santa Rita to learn about health-related issues and develop into leaders within their community.

The creation of a safe space for the adolescent girls of the community was a gradual process. The girls communicated to us early on that within their community, a place for social interaction did not really exist. Adolescent girls in Santa Rita usually spend their mornings cooking, cleaning and caring for their younger siblings and animals. In the afternoons, they are usually free from household chores, but are not allowed to leave their homes due to the protective nature of their parents. With Armida, we approached the girls’ families, explained what we were trying to do, and invited the girls to participate. Their parents agreed to let them come spend three afternoons a week with us. Initially, the girls were hesitant to open up. Among the various ice-breaker techniques we used, one of the most effective was giving them disposable cameras to allow them to express themselves through photography. Once a comfortable environment was established, we began interactive lessons centered on the topics of nutrition, hygiene and reproductive health. We emphasized that the group was open to discussing any issues that were important to them, including sexual health.

Our last piece of advice reflects back to our opening vignette. When collaborating with local leaders and their communities it is of utmost importance to honor your commitments. As we prepare for well-intentioned trips, it is hard to imagine that we could cause more harm than good or be viewed as disrespectful as we engage in these projects. However, not honoring commitments was the most frequent criticism we heard from organizations that host volunteers in Guatemala, and this problem is likely not unique to Guatemala. Ohana offers that volunteers “should understand that volunteering is a commitment like having a job.” Something as simple as punctuality becomes very important. Remember that you are representing more than just yourself. Similarly, do not over-extend yourself. When experiencing first-hand the injustices that these communities suffer, it is easy to be moved to make promises you cannot keep. Unkept promises perpetuate false hope in vulnerable populations. Galicia and his organization have experienced this phenomenon on various occasions. He said, “Volunteers, during their time in Guatemala and more specifically with PEILE, offer to support the organization by seeking out donations, but when they return to their country the promise is not kept.” This is not to say that you should ignore the urge to effect change, but do so responsibly.

The following advice from Galicia summarizes what we think is the best way to approach being an international volunteer: “Get to know the area where you are doing volunteer work, learn the native language, respect the culture, and practice human unity and solidarity.” Further remember the importance of thoughtful observation, relationship-building, collaboration with local leaders, and, ultimately, interventions that are sustainable within the context of the community. ¡Que tengan suerte!

Lauren Pomerantz is a second year medical student at SUNY Downstate in Brooklyn, New York. . In 2008, Lauren received the Arnold P. Gold Foundation Summer Service Fellowship that enabled her to launch the safe spaces program for adolescent girls in Santa Rita, Guatemala. She can be contacted for questions or comments at lauren.pomerantz@downstate.edu.

Casey Weimer is a first year medical student at the University of Colorado Denver School of Medicine. A global health track program participant at CU, she plans to return to Guatemala during the 2009 summer to continue work with the safe-space project. She can be contacted for questions or comments at casey.weimer@ucdenver.edu.

Article downloaded from http://www.globalpulsejournal.com/2009_weimer_casey_positive_impact.html