While completing my Masters in Public Health studies I became very interested in international public health. The field of public health is extremely diverse and you can do just about anything from HIV/AIDS awareness campaigns and education to healthcare information technology. Despite what many people think, there is a huge public health gap within the United States. Just look at the obesity and chronic disease rate! However, throughout my studies, international public health kept grabbing my attention. In May 2011 I decided to put my interests to a test and signed up for a medical mission trip in Costa Rica and Nicaragua with International Service Learning (ISL).
About Internationsl Service Learning
ISL is a non-governmental organization (NGO) that has been offering volunteer experiences through medical, education, and community enrichment programs in developing communities since 1994. ISL is headquartered in Spokane, Washington (USA), but runs volunteer mission trips to various communities throughout Central and South America, Mexico, the Caribbean, and Africa. ISL’s mission is “to support cultural awareness, service-based learning and sustainable development projects through experiential and responsible volunteer travel programs that inspire local and global service.” Each year, ISL serves over 215,000 people and delivers over $180,000 in medical supplies across the globe.
International volunteer programs or tours, also called volutourism by some industry people, have been under fire in recent years for questionable spending and corruption. I’ve heard horror stories where an organization sends volunteers to a local community in Asia or Africa to build a school. Once the school is built, it is destroyed and rebuilt with new volunteers obliviously to the organizations deception. Obviously, that organization does not benefit the local community. Despite all the bad eggs in the volutourism industry, there are some good ones and I think ISL is one of those organizations. ISL publicly posts their financial overview on their website and claims that their CEO only makes $60,000 a year in salary compared to some organizations that pay their CEO in the millions. ISL states that they will provide more detailed spending information upon request.
My ISL Medical Miss Trip Experience
I originally signed up for the Costa Rica and Panama trip in December/January 2011, but due to a massive snow storm that closed down the East coast for several days, I had to postpone my trip until May. As sad as I was about the 5 month delay in my trip, it was actually for the best because my trip had 4 other volunteers compared to the almost 20 volunteers in my original trip group and I got to visit one of my favorite countries, Nicaragua.
A Week in Costa Rica
Prior to leaving for my trip, I received all the information I needed, such as our itinerary, contact information, and other important details. My flight was the last to land in San Jose, Costa Rica. Despite the late arrival time, I was met by our local guide for the next two weeks. We headed straight to our guesthouse where I met my two roommates who both stayed up late to meet me. The first day of the trip was a whirlwind day. I met the other two girls, both nursing students, and we spent the morning discussing the details of the trip, practicing our medical Spanish, and organizing all the medical supplies we brought from home to use at our clinics. My head was pounding and I had various Spanish words floating around in me head mish-mash of random unintelligent sentences. Luckily our guide suggested we take an afternoon break and stroll through La Sabana Metropolitan Park, Costa Rica’s largest and most significant urban park located in San Jose.
I woke up extremely early with one on my roommates. I was nervous because I wasn’t sure what to expect our on first day of home visits and clinicals. I was in a completely new environment where I didn’t understand the culture and could barely speak the language. But as soon as we entered the community and I started conversing with the locals, I began to relax and have fun. My mind was open for what was to come over the next two weeks. We spent our day conducting home visits in Concepcion de Alajuelita, one of the most dangerous communities on the outskirts of San Jose. We were told by our tour leader as we were crossing over the makeshift bride of a wooden plank, that if we were to come into the neighborhood at night, we might not make it out alive. A slight bit of fear was instilled in my chest and I realized that I wasn’t in Maine anymore. The community is located on a hillside with dusty dirt roads lined with small shacks built out of scraps of wood, metal, and concrete. Electrical wires hand dangerously close to home and trees. I come hear the telltale buzz of the electricity as it enters homes. At least they have electricity I thought. While walking near the garbage-filled river bed, I noticed someone created a beautiful tiled walkway built from broken colorful ceramic tiles. A work of art and color to a small impoverished community that brought a smile to my face. We knocked on a few doors, but were met with shy locals uninterested with the reason we were visiting. It was not until we knocked on the local church door that we learned why the community members were hesitated to talk with us. We were told that recently the local police dressed up as doctors and came into the community and arrested some of the locals. The pastor and his wife offered to accompany us through our house visits to help us gain the trust of the locals. It made all the difference that day. We spent the days walking around and talking to the locals who all greeted us with smiles and gratitude. A few even invited us into their homes to meet their families and show off their children’s schoolwork. Nothing was more satisfying than seeing a mother’s eyes lighting up and her grin as wide as her face wiht pride. We learned later that many of the families that live in the community are Nicaraguan immigrants.
The following two days we set up our clinics in another local church just outside the community. Over two days we saw over 50 patients from the local neighborhood with varying complaints and medical needs. Going into the trip I was excited to see infectious diseases and conditions that are not prevalent in the United States. Malaria. Dengue Fever. Parasites. Oh, my little public health brain was swirling with the possibilities of the diseases I could see. But I was naïve. I was surprised that most patients we saw had chronic diseases such as obesity, diabetes, and heart disease. Skin rashes and parasites were also common diagnoses. In retrospect, I should have seen the signs. I mean that literally. On the drive from the San Jose airport to our guesthouse, I lost count of the number of McDonald’s, Burger Kings, and even Denny’s (Yes, Denny’s in Costa Rica!) that we drove by.
One thing that sets ISL apart from other medical mission organizations is its unique program structure. ISL partners and hires local doctors for their medical trips. Our doctor was a Costa Rican native who spent part of his medical training in the US and also in Spain. We were lucky that he spoke both Spanish and English extremely well so we did not need an additional translator. He was also around my age at the time so we were able to connect with him well and even joke around about the American culture and medical system. During clinicals we broke into pairs with the fifth person working the makeshift pharmacy. Each pair had a translator and the doctor would rotate between the two groups. As students, we took the vitals and conducted the initial assessment. The doctor would come over and ask us what we thought the diagnosis could be based on our findings and then he would either confirm it or work with us to figure out the correct diagnosis.
The clinic days were long and energy-draining, but a worthwhile learning experience. After two solid days of clinics, our fourth day in the community was spent providing public health education to the local children. We played games with the kids like Duck, Duck, Goose (Pato, Pato, Ganso) and Tag (las trais). We showed them how to properly brush their teeth and wash their hands while providing them with free toothbrushes and toothpaste. And then we brought out a piñata loaded with bags of candy purchased the previous night. Obviously, we were the hit of the neighborhood that day. After cleaning up and saying goodbye to our lovely hosts at the church, we bid our farewells and Hector, our bus driver for the week, drove around the city for a tour of San Jose, Costa Rica.
Our last day in Costa Rica was spent exploring Irazu Volcano National Park and zip lining through the jungle tops. Costa Rica is a beautiful country and I was only able to experience a tiny bit of what the country offers. The people are some of the friendliest I have ever met on my travels and the food is delicious. One of the things I was most nervous about before leaving on the trip was the food. I had never had Central American food and in my naive knowledge of the region, I thought it was going to be very similar to Mexican food, which I don’t really like. Boy was I wrong though! How many ways can one eat plantains?! Not enough is the correct answer by the way! 🙂
A Week in Nicaragua
After our day of fun in Costa Rica, we had about 5 hours to sleep before we had to catch the 2am Ticabus from San Jose to Managua, Nicaragua. Hector, our favorite and slightly odd (in the creepy uncle kind of way) dropped us off at the main bus station and we began our long bus ride to Costa Rica’s northern neighbor. I managed to sleep for a few hours before the bus attendant handed out our breakfast, a Burger King breakfast sandwich. It is not something that I would normally eat, but I was hungry and probably swallowed the thing in about three bites. After a little bit longer we came to the most interesting part of our day – the border crossing between Costa Rica and Nicaragua. I was glad to have our trusty tour leader with us because the border crossing is probably one of the most craziest and confusing things that one can do in Central America. First the bus attendant comes around and collects the Costa Rican departure fee/road tax and Nicaraguan entrance fee in US dollars (about $20 USD total) plus a couple of extra dollars. I’m pretty sure the guy pocketed a couple of dollars too. Then he comes again for your passports. This was the part that really freaked me out. I never give anyone my passport unless it stays in my sight. Our tour leader assured us this was in fact standard procedure. The bus attendant actually fills out part of the custom form for you. Once we reached the Costa Rican border we all hopped off the bus as the bus attendant yelled our names so we could grab our passports to go through Costa Rican customs for our exit stamp. We all got on the bus again and drove up a little bit to the Nicaraguan border crossing. We went through customs again and got stamped in Nicaragua. We then all lined up our bags on makeshift tables in an open-air covered rain shelter where custom officers went through our belongings. When I say “went through our belongings,” I mean they glance into your bags maybe fingering something and moved on to the next bag. It was hot and humid and the process took forever. All I wanted to do is get back on our air-conditioned bus! For more information about the border crossings between Costa Rica and Nicaragua, check out Uneven Sidewalks post on “How to Cross the Border Between Costa Rica & Nicaragua.” Once everyone was loaded back on the bus, the attendant does a head count. Low and behold, about a mile down the road the attendant counted an extra person who hoped on our bus. He was quickly kicked off the bus in the middle of nowhere. Lesson learned. Buy a ticket!
A couple of hours later we were dropped off at the main bus station in Managua, Nicaragua’s capital city with a checkered past. The day was spent exchanging money, light shopping at the mall, and meeting our new driver, Roger (pronounced “Ro-hair”) who brought us to the outskirts of Managua to our new home-base for the week. The “hotel,” which was really a large hostel was pretty nice. It had multiple rooms spread out around a central courtyard with a pool. Thank goodness for that pool, which felt amazing after a long hot and humid bus ride! Two other ISL mission groups were staying there too at the same time so we got a chance to mingle with other students and hear their experiences. One group was a veterinarian group and the other a medical group staying two weeks in Nicaragua. The medical group was working in the local hospital and even got to witness a surgery!
We were up bright and early after a restless night in our new group room where bugs and geckos were climbing the walls all night freaking out the other girls. I got out relatively unscathed due to being stuck on the top bunk. Later that day we requested a new room because we found out our shower flooded the whole bathroom too. For the next 4 days we held clinics in the Hermanos en Cristo Nindiri community just outside of Managua. The Nindiri community reminded me a lot of Concepcion de Alajuelita, but with significant differences. The community was much larger in area and was located on flat ground. The houses were slightly larger and generally made of concrete with concrete floors. Livestock and stray dogs roamed the streets begging for food from various people. We were told not to touch the animals, but I would occasionally sneak in a pat here and there to the über friendly dogs that would pester us for food scraps. The community was extremely friendly and always laughing and smiling. Many families welcomed us into their homes with open arms. Few even offered us food that we politely declined. Children played in yards and roads with soccer balls and would slyly follow us from house to house saying “hola” and giggling.
After spending the day meeting families and dodging showers and thunderstorms, we had a wonderful dinner at a restaurant located near a volcano. The view was stunning and the food was even better! The following 2.5 days were spent holding clinics for families that we invited the previous day. Over 50 people came and we unfortunately had to turn a few away. We had a new doctor in Nicaragua who spoke basic English. It was sometimes hard to communicate with him, especially with difficult medical terminology that doesn’t always translate into other languages. We discovered this while our Nicaraguan doctor was trying to educate us about the anatomy of the kidney and its function. But, with two awesome translators, we managed just fine. Most patients had similar conditions that we saw in Costa Rica. Many people wanted parasite treatments as it is suggested that children take parasite treatments every 6 months. One man came in complaining of back pain so we educated him on how to correctly lift heavy objects as he worked in construction. One major difference that we found was our Nicaraguan doctor always prescribed something to the patients, even if it was just vitamins. One of the girls (who is now in medical school) challenged him why as she was slightly concerned that he shouldn’t prescribe medication to someone who doesn’t need it. The doctor explained that in their culture when you go to the doctor, you always expect to leave with something. Even if it’s just vitamins. I thought that was very interesting.
We ended our 2.5 days of clinics with an afternoon of fun with the local children complete with games, a piñata, and learning sessions similar to our day in Costa Rica. The kids were wild with excitement and energy and I had a blast playing with the kids and watching them all jump for a chance to hit the pinata with a stick. Oh, the simple things that bring you joy as a child! Their joy and pure happiness was infectious and I was sad to leave them by days end, but it was time for us to end our trip on a fun note. Our fearless leader has an uncle that works for the Nicaraguan government who offered to take us out to dinner (paid by him which is absolutely amazing and generous!) and take us on a history and culture tour of Managua at night. I loved it and asked about 101 questions about Nicaragua’s history as I find its history and politics fascinating. After the nighttime tour, he brought us to a karaoke bar and to our very first discoteca. It was an experience to say the least.
On our last day in Nicaragua we explored the colonial town of Granada on the shores of Lake Nicaragua in the morning and the Masaya Volcano National Park in the afternoon. The Masaya Volcano National Park became Nicaragua’s first national park in 1979. The park has an area of 54 square kilometers and contains two volcanoes and five craters. Fun fact: it is the only volcano in North America where you can drive to the rim. The park features two caves, which is actually two underground tunnels formed by old lava flows. Now, I’m a wee bit claustrophobic so I was nervous walking into the cave, but the cave is large with high ceilings. No issues for me! The second cave is considered the “bat cave.” We walked up near the mouth of the cave and our tour guide shined a light so we could see the thousands of bats flying into the dusk sky. It was incredible!
Masaya Volcano is stunning. The landscape is unreal because you still see the effects of the last eruption in 2008. However, you might want to bring a scarf to cover your mouth and nose. The sulfur smell is strong and often carries in the wind. One of the best features of the park is being able to look into an active crater and seeing red-hot lava!
The Verdict: Is ISL Right for You?
I enjoyed my experience with ISL and recommend the organization if you was a pre-medical student looking to get hands on medical experience and enjoy travel and learning about new cultures. And I made some amazing life-long friends on the trip who now actively work in the medical field. The organization hires locals in every country and the finances of the organization are transparent. Those are key signs to look for when researching international volunteer organizations.
I broke down my experiences and opinions into a pros and cons list.
- Hands on medical, dental, or veterinarian experience
- Experience and interact with new cultures and people
- ISL hires locals in country
- Reasonable costs and numerous availability
- Meet students and people from across the United States that share similar interests as you
- Learn skills such as sutures and vaccines
- No follow-up after you are done working in the community (i.e., are they still working in the community? Is the community benefiting from the clinics?)
- No public health specific projects (at least the time I was there in 2011)
- I’m unsure if there is an “exit plan” once ISL is done working in the community (i.e., is the program sustainable?)
- Targets the student demographic
At the end of the day I really enjoyed my experience with ISL and I would consider another trip with them in the future. However, at close to 30 years old, I would feel like the grandma of the trip. I enjoyed doing a two-week trip in two different countries. It allowed me to work in two different cultures and observe the similarities and differences of each culture and the medical culture in each country. One of my main reasons for my trip with ISL was to test myself to see if I could work on publich health projects in developing countries. I think I passed my own “test” and caught the travel bug!
Have you done any medical mission trips or development projects abroad? What are your thoughts on volunteer tourism?
Disclaimer: All the above opinions and experiences are my own personal thoughts and opinions of my experience with ISL. If you have any experience with ISL or other non-profit and NGO organizations working in developing countries I would love to hear your experiences and thoughts.