David Torres Costales / @DavoTC (Wikimedia)

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2017 Recap: Riobamba, Ecuador

In January 2017, eleven students were accompanied by Dr. Norma Hannigan for a service-learning experience in Riobamba, Ecuador, for the Global Health Nursing elective course offered in the winter session. The class arranged the 10-day trip with MEDLIFE (Medicine, Education and Development to Low Income Families Everywhere), an organization that partners student volunteers with local agencies to improve health.

The GHN course and field experiences focused on population health, cultural awareness, social justice, and health disparities. Students were matched with health improvement projects, working with MEDLIFE teams on initiatives such as mobile clinics, building of schools, latrines, environmental safety improvements or others. The MEDLIFE program incorporated education about local health and education systems, social determinants of health, culture, and reflection on the service aspect of the activities.

In addition to classroom and in-country lectures, discussion, and guest speakers, students worked with MEDLIFE groups each day from approximately 6:30 AM to 5:00 PM while in Ecuador. The typical Mobile Clinic week includes four days volunteering on-site at the Clinic, one day working with local community members on a development project (i.e., a stair or bathroom construction project), and two days of cultural tourism. Each day, students met with MEDLIFE staff to discuss community needs around health, education, and development.

Student Reflections and Photos

How did you feel as you left your home for Ecuador?

"When I left my house to go to Ecuador, I felt great anticipation! I knew that I would be volunteering my services (to an extent) to people from underprivileged communities. I still didn't fully know what to expect. I wondered about the different culture, could I communicate with the people knowing that there was going to be a language barrier? Would I get sick eating the food? Who would my roommate(s) be, would our personalities mesh or clash? What would my specific duties entail? Pre-trip preparations made me wonder "what did I get myself into?" Needless to say, all of my anxieties were alleviated." -Michelle

Mid-week reflection: What surprised you the most about MEDLIFE, Riobamba, and the people & environment of the community?

"This is the middle of our week in Riobamba; the things that have surprised me most are MEDLIFE's ability to coordinate multiple mobile clinics with the involvement of over 100 volunteers. It took much strategic planning to run multiple clinics concurrently. While things may not have been perfect, undoubtedly, their efforts to address the health care needs of those in the rural communities of Ecuador are greatly appreciated by the community members. The fact that some women prefer to have their pap smear testing done by MEDLIFE as opposed to the public clinic or hospital is because MEDLIFE gives them their test results. To me, this speaks volumes about the consistency of the services offered to the community members." -Michelle

"...One thing that surprises me about the people of the community is their humility and appreciation for the small things we are doing to help. Although on Monday the waiting room/education station was hectic to say to least, the people were always happy to have us. ...On Tuesday, I thought it was beneficial to have the students from a nearby school come with their teacher to the mobile clinic as a 'field trip to the doctor’s office.' I witnessed the doctor perform stitches on one boy’s finger, a necessity that he likely would not have received had we not been there that day." -Julie

"MEDLIFE: With so many volunteers, they were able to keep the mobile clinics well organized and had a consistent flow from station to station with minimal hiccups. I was impressed with how the local doctors and dentist would work through the day without any breaks or lunch. During one of the meetings, to my astonishment, Sarah mentioned that MEDLIFE is not funded by grants, but by donations. I couldn’t believe how much they are able to do without a grant. I was also pleasantly surprised when I discovered that MEDLIFE had a follow up care program. My favorite patient story was that of Rodrigo. I loved that MEDLIFE not only funded Rodrigo’s surgeries but also built him and his family a house to live in.

Riobamba: I really did not expect Riobamba to be as beautiful as it was. The scenery near our mobile clinics in Guamote and Guano were just breathtaking, not forgetting the amazing view of Chimborazo. Furthermore, the culture is unlike any other culture I have seen. I am a dancer, so when I saw the different costumes and traditional dances at the parade, I was left intrigued by it all.

The people and environment of the community: The first thing I noticed was that many people from the communities would greet you with a handshake, irrespective of their age. It showed me how much they appreciated our presence. I also became fascinated with how the women would carry their babies on their backs--I had never seen this before. During my rotations through the hand hygiene and tooth brushing stations, I was impressed at how enthusiastic the children were to wash their hands and brush their teeth. From my own experience, I know that many children do not like to wash their hands or brush their teeth so it was refreshing to see this." -Sabrina

What have you seen or learned during this week that correspond to the readings from this course?

" 'No one sets out to ignore equity, but the way we frame issues of causality and response typically fails to give it due consideration.' This Paul Farmer quote made me enter and exit this experience in a different light; that I have to believe there were more good people than not. The injustice in the health equity is not primarily caused by cold-hearted individuals willingly ignoring the issues at hand, although sometimes it is easiest to come to that conclusion. Trips like these are to help the people, yes, but also to raise awareness of the true root of the problem and to keep the injustice from continuing. Every community is different, Paul Farmer reminds us to dive deep into a global community and really seek out what it is that they specifically need, beginning with medicine and education. The well should take care of the sick because access to health care should not be a luxury but must be considered a human right." -Jessica

End of Trip: What is your greatest learning so far?

"My greatest learning so far has been knowing that we helped a total of 872 adults and 302 children during our week in the different mobile clinics. While I could acknowledge that we were busy all week, it was nice to finally put a number to it during our brief meeting during dinner on Friday. Also, knowing that 25 of those patients will receive follow-up care that most likely would have not occurred had they not come to the mobile clinic that day reassures me that our small actions did make a difference in people’s lives. I had the opportunity to witness the doctor perform an exam on one of these patients later deemed to receive follow-up care. The patient stated that she was losing sight in her left eye and then afterwards mentioned that she had been losing sensation in her left side of the body for a while now. This is an important because the hemiparesis could be attributed to a stroke and needs further care and testing. Therefore, knowing that the nurses will be checking up on her is comforting. It also demonstrates that our actions have an impact on people in the community, whether it be on the individual level as with this woman, or on the community level such as the staircase we helped build atop the mountain." -Julie

"My greatest learning so far has been to not take things for granted. You do not realize the worth of something until its gone. For example, a staircase may seem insignificant but when it is not readily accessible to you, you begin to realize the value of it. On Friday, I was at the project site and it left a great impact on me. Climbing 12,000 feet once without a staircase was quite difficult and unsafe; I cannot imagine how the people of the Llin Llin community navigated through this steep hillside every day. Witnessing women of all ages carrying sandbags from the top of the hill to the bottom and back became my strength during this developmental project. In the US, we usually have a choice between taking an escalator, an elevator, or stairs but these people do not have that choice. Stairs to this community is considered a luxury and because of this experience I now hold a higher value to stairs. Moreover, the inauguration ceremony was one of the most humbling experiences. I was brought to tears when the community leaders continuously expressed their gratitude and told us that we will be blessed in our lives." -Sabrina

Post-Trip: How has this service-learning experience affected you?

"I think it’s going to be tough going back to work tomorrow. This experience is something I will carry with me for a while. It makes me realize that I can do more and should do more, on both a “global” scale and more locally. A lot of the problems that affect the indigenous population of Ecuador are strikingly similar to problems that marginalized groups face here in the US. Even if we don’t have time to take trips like our MEDLIFE trip, we can still do our part by being more active in politics. Nurses are a giant force and it is widely known that as professionals we are considered to be trustworthy, and for that reason, people should listen to us! The work of Nurses United is a great example of this. I think it is very important that we leave the bubble of our hospitals and classrooms and see the bigger picture and get involved in any way possible." -Ellena

"...I have learned the beauty of nursing care in a holistic perspective so that when I care for my patients, I will be mindful of their religious beliefs, medical wishes, social and environmental conditions that are influencing the progression of a medical condition, rather than just providing repetitive, routine care. By advocating and being involved in nursing politics such as health care reform, international and local nursing groups, one can support or create regulations that would benefit the designated populations. Likewise, as a nurse, I need to continue to be involved in direct community health outreach programs as well as support and act on global health injustices to promote equity and equivalent medical coverage for all. The mobile clinic helps one develop intellectually, and the various tasks at each station enhanced my nursing skills. From the service, I learned the significance of being flexible, tailoring care to the population’s needs, and most importantly, in order to have advancement in communities, the inhabitants’ social determinants must be improved. I definitely look forward to participating in other global project, as it was a meaningful experience." -Jessica

View more photos on MEDLIFE's Facebook page