No matter the remoteness of the location, time of day or soaring temperatures, when the medical mission team arrived at different villages in Guatemala, the scene always looked the same. Hundreds of adults and children were waiting – sometimes in a line so long it wrapped the length and width of a school or church.
“It never got old to see those lines,” said Amber Altstadt, a sixth-year pharmacy student from Perham, Minn.
She and classmate Jordan Wolf, a sixth-year pharmacy student from Fargo, were members of the mission team, including two doctors, a pharmacist, a nurse, three medical students and dental assistants, who traveled from village to village for six days this summer. Their mission was to provide basic health care and dental services. The line illustrated the magnitude of their visit.
During their time in Guatemala, the team treated 2,631 patients. They provided 38 referrals for more serious conditions, filled 1,625 prescriptions, extracted 219 teeth, restored 45 teeth and provided 1,139 fluoride treatments to children.
Learning by doing
For the past two years, the College of Pharmacy, Nursing, and Allied Sciences has selected two students to be part of the annual medical mission team. Students apply by submitting an essay expressing their interest and motivation for participating in the medical mission, said Amy Werremeyer, assistant professor of pharmacy practice, who accompanied the students on this year’s trip. For pharmacy students Altstadt and Wolf, the mission trip, preparation and post-trip evaluation and reflection served as one of the eight experiential rotations required to earn their doctor of pharmacy degree.
Werremeyer said the college supports the mission trip for two reasons: as an outreach service project and as an immersive student learning experience unlike any other.
“The environment before, during and after the medical mission trip is intensely focused on learning and, specifically, learning while doing. On the trip, students practice pharmacy and learn about medication; but more than that, they learn about people in the world and about themselves,” she said. “They learn that they can work harder than they thought they could, that they can use their knowledge in more ways than they ever dreamed and that they care about their patients so much that sometimes it hurts.”
The experience also gives students a rare opportunity to integrate concepts they study in a real, meaningful way. While filling a prescription for one patient in Guatemala, the students wrestled with cultural differences and competence, health care disparities, evidence-based treatment guidelines, public health problems, pharmacy workflow issues, formulary management, interdisciplinary team work, language barriers, health literacy and specification of medication treatment to the individual's need all at the same time. And they did this for hundreds of patients per day for more than a week straight.
The students encountered patients with malnutrition, anemia, headaches, musculoskeletal pain, gastrointestinal upset, heartburn, high blood pressure, high cholesterol, diabetes, infection and injury.
“We read statistics on the poor health care system they have to deal with, but it really didn’t come alive until we saw the individual stories and pain,” Altstadt said. “The fact that their health care system is reserved for the top percentage of wealth holders just didn’t make sense to us until we saw the lines day after day in relatively small villages.”
A hunger to serve
Each day the team followed a similar routine. An early breakfast was followed by a two-hour drive to the clinic where they unloaded supplies. A classroom was converted to a “clinic” by stacking desks against the wall. No signs of sterility or privacy existed. In one case, a member of the team held up a medical pad to create a barrier for a patient who was receiving a shot. “Obviously it’s not like anything you see here,” Wolf said. “We had to make do with what we had available to us.”
That mentality applied to staffing, too. Members of the medical team were quick to fill whatever roles were needed. In one case, Wolf’s only job was to hold a little boy still as a doctor gave him stitches in the back of his head while a medical student observed. “Everybody was so willing to work together, nobody got defensive,” Wolf said. “The closeness the team felt had a lot to do with our common goal and our common desire to be in this situation and help these people who needed it.”
Altstadt, Wolf and Werremeyer filled and evaluated prescriptions for accurate dosing and appropriate use, counseled patients and administered injections.
Both Altstadt and Wolf have a minor in Spanish, so they were able to counsel patients in their native language. “It made it more accurate and personal, so they are more attentive. They would say what we told them back to us to make sure they got it right,” Altstadt said.
The patients ended their visit by receiving educational materials on diet and lifestyle modifications, special instructions for their treatment and a supply of vitamins. In an area where malnutrition is common, vitamins are like gold, the students said. In all they dispensed more than 1,800 month-supply vitamin packets.
Despite the large number of patients they saw, people were turned away at the end of the day because the lines were so long. “That was never easy to do and it never really got comfortable. It was pretty powerful,” Wolf said.
“It was hard to leave knowing we could have gone to 100 more villages and had a long line waiting for us,” Wolf said. “It has motivated us to become better clinicians and to learn more this year. We understand that we aren’t ready to be the type of provider that the community needs … leaving is hard but we have something to work toward, to become better for a purpose greater than ourselves.”
Altstadt and Wolf said the experience was an invaluable opportunity to apply the skills they have gained in a diverse setting. They learned many life lessons such as overcoming language and cultural barriers, dealing with limited resources, working as a member of a collaborative health care team and recognizing their personal strengths and weaknesses.
Werremeyer saw the students transform during the experience. “I saw the students change from being somewhat reluctant initially to being confident and very capable of working independently as pharmacists by the end of the trip,” she said. “I also saw their compassion and their desire to make a difference in the world grow with each day, with each patient they encountered. As a faculty member, watching and guiding the students on this trip is incredibly rewarding.”
Altstadt and Wolf encourage support from the community and encourage all departments across campus to do something similar within their specific discipline.
Both students plan to return next year. Until then, their memories will linger. "I was touched by their gratitude for whatever we could do," Altstadt said. "Their individual stories have been a constant slideshow in the back of my mind since I returned home."