COSTA RICA – A concerned father holds his daughter’s hand as they sit down in a school room temporarily set up as a medical clinic. He explains in Spanish that she is weak, tired and has constant stomach aches. The shy 5-year-old looks curiously around the room at the students, translator and doctor who are there to help her.
“Look in her eyes,” the doctor coaxes the student volunteers. The girl’s dark brown eyes had a pale blue ring outlining the irises. “That means she has parasites.”
The doctor gives the father antibiotics for his daughter and reprimands him because children receive free health care in Costa Rica. But she realizes that it isn’t always easy to access that care. It was one of many patients and learning experiences for a group of 25 university students, including Michelle Coughlin ’11 from St. Thomas, who were volunteering with VIDA, a humanitarian program co-founded by 1992 social work alumna Sondra Payne Elizondo (below).
Volunteers for Intercultural and Definitive Adventures offers pre-medical, pre-dental and pre-veterinary college students the chance to work with local doctors, translators and guides in underserved, remote areas of Costa Rica, Nicaragua, Panama and Honduras.
In 2008 and 2009, VIDA provided free care to not only 10,700 people but also care for 800 pets and farm animals in needy communities where most individuals bring home as little as $2 a day.
Socialized medicine works in theory
Elizondo lives in Costa Rica, and although the country has socialized medicine, it’s only good in theory, according to Elizondo. “Logistically andeconomically, some people can’t make it work,” she said. “If you’re sick, you have to get in line to get an appointment. In rural areas, you may get up at 3 a.m. to start walking to a clinic or you may send someone else to stand in line for you. The indigenous people especially are left out because they have to travel far. For instance, a mother might have to walk with her children for two days and then take a bus and stay overnight in a town where there is a doctor.”
While medical and dental care in Costa Rica is of fairly high quality, patients can expect to encounter long lines and short appointments. Generally, hospitals can be overcrowded and underfunded.
Lisa Miranda, a doctor who has worked with VIDA, added, “Most of the countries where volunteers visit depend mostly on the government to address their health care issues, and even if the government does a good job, generally it is not adequate because it doesn’t cover every single person in the country, and when a group of people are not protected, disease manifests in these groups.”
VIDA joins the humanitarian effort
With her social work background, Elizondo and her friend Curtis Larsen, a teacher, wanted to address these issues. They decided to form VIDA in 2007.
Her love of Costa Rica began in the Peace Corps. A native of Benson, Minn., she was stationed from 1994 to 1996 in Cartago, a city of 150,000 in the center of Costa Rica. Sondra married Richard Elizondo and they moved back to the United States for nine years.
The Elizondos moved to the Twin Cities where Sondra became a social worker at North Memorial Medical Center in Robbinsdale and later, a director of social services at a nursing home. Richard owned an auto repair shop. When their children were 2 and 4 years old, they decided to return to Costa Rica.
“We wanted a more relaxed lifestyle,” Elizondo said, “and I didn’t intend to work full time because I wanted time with my children. I love Costa Rica. It gives me the time to talk to people and get to know them. You learn to be a more patient person. In the U.S., there’s no time for socialization. Here, family is very important. You can drop in on any Tico (as Costa Ricans call themselves) anytime with all your kids and that’s considered normal.”
“Pura vida,” which translates as “pure life,” is a common greeting and description of the attitude of many Ticos. It can mean many things, such as “full of life” or even “cool!”
Since 2004, the Elizondos have lived in Paraiso, just outside Cartago. She met Larsen, from Burnsville, Minn., when they both volunteered that year with church organizations in Costa Rica.
She worked as a translator, but her urge to help others nagged at her. Through continued discussions with Larsen, they decided to create a program that addressed some of the needs they saw in Central America. By spring 2008, VIDA offered its first free clinic.
“VIDA lets me express my spirit of giving,” Elizondo said. “I love working with children and I love health care and that’s why I once was a medical social worker.
Elizondo thinks of VIDA as a way to spread compassion throughout the world by having local doctors teach college students about working with disadvantaged people. “VIDA gives assistance to needy communities while offering volunteers from around the world hands-on experiences,” Elizondo said. “We stress cultural integration and opening of the mind and heart to global health care and human issues. We want to have an impact on the future health professionals of the world.”
Elizondo hires all VIDA doctors, translators and guides; plans each trip itinerary (there were 49 trips this year); and purchases medical supplies. She also was the liaison with college campuses until last spring when they hired another staff member.
“Sondra is incredibly hard working and organized,” said cofounder Larsen, who led six VIDA trips this year.
Elizondo expressed her hope for the student volunteers: “Just like in the Peace Corps, through VIDA, we hope that when students return to their home country they won’t become hurried doctors. We open their eyes to a positive experience where they can engage with the local doctors and ask questions. It exposes students to the medical field in a safe environment where they learn skills and compassion; also, students gain incredible experience because they get to do things that they wouldn’t get to do in their home country at such a young age.”
‘I want to be the kind of person who can save lives’
Michelle (Shelley) Coughlin ’11, the first St. Thomas student to volunteer with VIDA, was part of a medical team in August. She volunteered with 24 other U.S. and Canadian medical, dental and veterinary students for a nine-day VIDA trip to two remote areas: Pavon, Costa Rica, and Los Chiles, Nicaragua.
“I’ve worked at United Hospital in St. Paul for more than a year and still I’d have to put in more hours just to shadow a doctor,” Coughlin said. “In Costa Rica and Nicaragua, I was able to do so much more.”
On her first day with VIDA in Costa Rica, Coughlin unpacked her newly purchased blood pressure cuff and stethoscope and practiced using them on other students. The next day, in a clinic, she honed her skills on real patients who considered her a doctor. By the end of her nine days in Central America, she had learned much more than how to use a stethoscope: she gave five injections, did a breast exam, sat in on a gynecological exam, studied urine samples, tested blood sugar, filled prescriptions, worked in an emergency room and she even practiced a suture technique.
Coughlin’s interest in medicine began as a teenager. Her sister Jamie, 16, and just a year older than Shelley, was in a car accident and airlifted to Mayo Clinic in Rochester, where she spent a month. Shelley and her family took many trips from their home in Chippewa Falls, Wis., to visit Jamie as she recovered from a cracked femur and many surgeries. Shelley spent a lot of time visiting her “best friend,” as she calls her sister. “I thought, ‘I want to be the kind of person who can save lives.’ It made me realize how doctors can give people back their best friend,” she said.
Now 21, Shelley is a neuroscience major in pre-med at St. Thomas. Her VIDA volunteer work was her first trip outside the United States. Jamie graduated from St. Thomas last May.
Costa Rica means “rich coast,” and its manyecosystems, rain forests, mountains and beaches make it a popular tourist destination. Pavon, on the other hand, is not a town tourists visit unless they are bird-watchers. The community is in the second poorest region of Costa Rica; it sits just across the river from the Nicaraguan border. Many undocumented immigrants cross the San Juan River and don’t qualify for the government-provided health care in Costa Rica. A 2005 census listed the population at 2,000 although it fluctuates.
Since this was VIDA’s first trip to the area, Elizondo personally had checked out the location beforehand.
The VIDA doctors, translators and students unloaded their supplies from their buses and set up a temporary medical, dental and veterinary clinic in three rooms of a high school. A line of women, children and men waited patiently in the heat for free medical and dental care from VIDA. For a small fee, their pets also were treated.
Dr. Graciela Fernandez oversaw the medical students in Pavon.
“Graciela was like a role model for me,” Coughlin said. “I like the way she was friendly and open with the patients and explained everything thoroughly to them. And she didn’t just talk at us. She asked us ‘What could we prescribe? What tests should be done?’ She was a great person to learn from.”
At first unsure of her Spanish, Coughlin consulted the translator often. Throughout the day the medical students met with patients who had migraines, high blood pressure, urological problems, overactive thyroids and colitis. Many had pains in their legs, back or chest from working long hours in the sun on pineapple, mango, sugar cane, rice or casawa (a root plant) plantations.
Volunteers also met with patients taking wrong medications because previous doctors had not spent enough time diagnosing them: a diabetic woman pregnant with her 10th child who should have been taking insulin shots instead of pills while she was pregnant, a 17-year old who had the wrong medicine in her inhaler and it was making her ill, and a woman taking antidepressants when she should have been taking medicine for schizophrenia.
The dental students, who were supervised by two dentists, also were very busy. Their three fold-up dental chairs always were occupied. The volunteers cleaned teeth and assisted with extractions and fillings.
“We only extract one tooth per patient, because if they have bleeding or other problems later, there is no follow-up care,” explained Dr. Walter Urbina.
Veterinary volunteers, overseen by two veterinarians and an assistant, performed spaying and neutering of many breeds of dogs and one cat. Some animals were just given a check-up with vaccinations, deworming pills or flea spray because they already had been neutered or the owner refused the surgery.
It was a productive two days in Pavon: Fernandez and her seven medical students treated 92 adults and children.
The two dentists and their eight dental students saw 89 patients.
The two veterinarians, the assistant and 10 students treated 23 dogs and one cat, of which several were neutered or spayed.
“The clinic in Costa Rica is like training for Nicaragua,” Fernadez told her students. “Unlike Costa Rica, where the water is clean and school children are vaccinated, in Nicaragua, clean water and even soap are scarce, so you will see more fungal diseases, dermatitis and parasites.”
Los Chiles, Nicaragua, the second clinic site, is a small farming community that takes 10 hours to reach by dirt road. To save time, VIDA volunteers took a one-hour boat ride across the San Juan River.
The medical volunteers worked in a government health center. VIDA provided free care in collaboration with the Nicaraguan Ministry of Health. Students worked rotations in the emergency room, gynecology, general medicine and vaccinations, although the vaccines ran out almost immediately, according to Coughlin.
She was particularly impressed with the stoicism of the patients. One little girl with deeply infected burns between her toes didn’t even flinch when the doctor cleaned it out. Even young dental patients didn’t fidget. Other medical patients included one with pustules all over his skin, a boy with a large cyst under his chin and a 10-day-old with the flu. One patient stuck in her mind: a 20-year-old anemic woman who was 33 weeks pregnant and refused help.
Coughlin admitted, “The living situation in Nicaragua was kind of a shock. The electrical power went out as soon as we checked into our hotel and it was out for six hours. Unlike Pavon, here pigs, chickens and stray dogs roamed the streets. Homes had dirt floors and some didn’t have running water.” She enjoyed the people of Los Chiles, who were friendly and appreciative of the volunteers.
“I’m glad that this was my first experience outside the United States,” she said. “Lots of my friends go on vacations but I think it’s important for people to see the real culture, how the people really live.”
Why work with students with little experience?
Elizondo thinks students have much to learn and much to offer.
“At VIDA, we believe that serving and learning complement each other and that when the volunteer learns more, the patient benefits and what benefits the patient, enriches the experience for the volunteer,” Elizondo said.
VIDA volunteers work side by side with local licensed health care professionals. It’s an opportunity for pre-professionals to test the waters in a highly supervised environment.
Coughlin added, “It was incredible to be given responsibility and be trusted and to give your own input and be taken seriously.”
Elizondo explained that full-time doctors usually don’t have time to volunteer until after they’ve retired. Students, however, need the training and have the time. “What will happen when these young college students return to their homes? It’s an experience they’ll never forget. Think of the possibilities. I hope they will carry the compassion they show on this trip back to their practices.”
Coughlin described her four clinic days as “very full. I was bummed out at the last clinic. I felt like I could stay for at least a month. It felt right to be there – in a community where they need help and they are appreciative. Some patients would grab my hand or give me a hug. I didn’t know how to do anything when I left the U.S. and they looked up to me.”
‘VIDA’s work will never be over’
Coughlin looked at Elizondo and said, “I can’t believe someone from St. Thomas started this program.”
What started with a $5,000 personal loan is a thriving humanitarian organization. Approximately 1,000 volunteers have participated in VIDA in the past year. VIDA has two offices in Costa Rica and one in Nicaragua, and next year another will be added in Guatemala.
Elizondo wants to expand offerings to volunteers who are not in the health professions.
“VIDA’s work will never be over. We will always work to serve more communities in more ways,” Elizondo said.
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