New Perspectives

For thousands of students across the nation, spring break means sunny beaches, warmer climes and a little bit of self-indulgent fun.

This March, however, more than 70 University of Louisville students and residents -- including participants from the schools of nursing, dentistry and medicine -- will pay more than $2,200 each for the privilege of working through spring break in a decidedly resort-free environment.

They'll be staffing two student-run, faculty-supervised clinics located in the Central American nation of Belize. Together, these students, residents and faculty will answer the dental and medical needs of nearly 1,000 people in the remote villages of Gales Point and Red Bank, providing the only health care that many of the Belizeans will receive all year.

In exchange, the students and residents get an unparalleled opportunity to hone their professional and diagnostic skills while learning about a rich and vibrant culture.

For many, it will be a life-changing event.

"I learned an entirely new perspective on life while I was in Belize," says Chase Reynolds, a fourth-year medical student who traveled to Gales Point in 2006. "When you first get down there, you're confronted with the very, very poor accommodations they have. Their homes are very meager, their food is pretty basic, and they're living in what we in the U.S. would consider impoverished conditions.

"But by the end of the week, you realize that they don't consider their living conditions to be impoverished. In fact, they're happier than most of the people I know here in the U.S. Quite frankly, I did not want to return to the United States. I was really enjoying my time down there, getting to know the people and gaining a new vantage point on life."

The week can be equally compelling for faculty members who serve as preceptors.

"After I returned from Belize, my wife said that the experience had changed me," recalls Brent Wright, M.D., program director of UofL's Glasgow, Ky., Family Medicine Residency Program. Wright was the first faculty member from Glasgow to participate in the program when he traveled to Belize in 2003, and he now helps select family medicine residents who want to participate.

"I think it gave me a much broader perspective on the world and about the need for all of us everywhere to understand each other, work as a team and solve problems together. It has made me a better physician, but in a broader sense, it has made me a better human being."

Unique program

The Belize clinics date to 1997 when the school's International Service Learning Program was established to give students an alternative means of studying abroad, says Bernard Strenecky, Ed.D., program co-founder and assistant to the vice president for student affairs at UofL.

As the name implies, UofL's program focuses on providing service to others.

"Our philosophy revolves around the notion that anybody who goes to a university has a responsibility to give back to society," Strenecky says. "Every one of us who has received a public education has a debt of gratitude for everything that's been provided. So we see service as a core value."

What makes the program truly unique, however, is its multidisciplinary nature -- a fact that sets it apart from other service learning programs around the country.

"This was new ground 10 years ago, and it is still new ground today," Strenecky says. "Maybe a dozen schools have international service programs, and nobody but UofL has an interdisciplinary service learning program."

Ten different disciplines are represented in Belize besides medicine, dentistry and nursing. These include communication, engineering, sociology and disaster mitigation, a component of UofL's urban affairs program.

Such a broad scope allows students to work together as part of a diverse team that can tackle a problem from multiple angles.

"Many issues are very complex, and if you address them from just one discipline, you may address only one aspect of the problem," explains Henry Cunningham, Ph.D., the project's other co-founder and a community services specialist at UofL.

"For example, the medical, dental and nursing students treat patients and provide medication in Belize, but if the patients aren't educated about their health issues, we haven't addressed the core of the problem, and the solution may be short-lived.

"So our health communication students from the Belknap campus work in collaboration with the health practitioners to run campaigns that educate people on health issues -- how to take certain medications, how to live a healthy lifestyle. We want people to be informed about their health."

Similarly, engineering students work to improve infrastructure like water treatment plants, cutting down on water-borne illnesses.

"We are addressing health care from multiple perspectives, and we are teaching our students to look at issues in a multidisciplinary way," says Cunningham, who is from Belize.
Mark Humphrey, M.D., a second-year family and community medicine resident from Glasgow who worked at Red Bank in 2006, says the multidisciplinary environment provides rich learning opportunities.

"With everybody working so closely together, we were able to observe the nursing, dental and communications folks as they provided care or met with patients each day," says Humphrey, who chose UofL for his residency because it offered the opportunity to participate in an international, interdisciplinary service program.

"I learned how to install dental blocks, which gave me a good idea of how things are done in a different facet of health care," adds Humphrey.

Wright also enjoyed the opportunity to learn about the field of dentistry.

"I was amazed to see what the dentists could do," he recalls. "I think we in our fields can become a bit egocentric, but it's important to see the interconnectivity. We can accomplish a lot more together than we can by dividing our efforts."

Sherry Jones, M.D., an assistant professor of family and community medicine in Glasgow, agrees.

"Medical professionals should work as a team, regardless of what we do or where we are," says Jones, who was a resident in Belize in 2004 and 2005 and returned last year as the faculty preceptor at Gales Point.

"In this kind of close-knit environment, you get the opportunity to see that every member of the team cares about each patient as much as you do, which makes practitioners a lot less territorial. You also get to learn a great deal about the other disciplines. It's a very enriching experience."

Clinical care

The main difference between residents of the two villages is demographic: Gales Point residents are predominantly English-speaking creoles of African-British ancestry, while Red Bank residents are mostly kekchi-speaking Mayans (translators are provided by the villagers).

Overall, both patient populations are remarkably healthy given the economic conditions they face as subsistence fishermen and farmers, respectively.

Unfortunately, the remoteness of both villages means that regular medical care is a practical impossibility, and most residents see a doctor only once a year -- when the UofL program comes to visit.

Makeshift clinics are set up in each village, and students or residents see patients each day from about 8 a.m. to 4 p.m.

Under the watchful eyes of preceptors like Jones, they provide care for parasites, skin infections and wounds, as well as chronic conditions like diabetes and hypertension.

Thanks to the help of the Belizean government, UofL practitioners are able to bring enough duty-free medications with them to provide patients with a year's supply of pharmaceuticals for the management of chronic diseases.

Occasionally, a more interesting case will come along, such as the girl last year who'd had a seed lodged in her ear canal for several weeks.

"She was a very scared little girl, but the family was extremely grateful once we got that out," Jones says.

And every so often, a truly emergent case will appear, such as the time a student heard an unusual heart murmur in a patient and immediately sent the man to the nearest hospital for treatment of a life-threatening condition.

The student's diagnosis, made only with a stethoscope and a consultation with the preceptor, underscores one of the challenges of practicing medicine in rural Belize: modern technology is in short supply.

"When a patient comes in, all you have to work with is the patient in front of you, your stethoscope and a reflex hammer," Reynolds says.

"You really have to take a great history and focus on a thorough physical exam because you don't have the luxury of running a bunch of tests.

"You have to go back to the true basics of medicine and practice in a way that you aren't used to, but also in a way that makes anyone who does it a better doctor for the experience.

"It makes you think a lot more critically and work harder to determine a diagnosis, rather than just working to come up with a list of tests to run so you'll know if you're headed in the right direction."

The lack of modern equipment also means that students and residents must improvise to get the job done -- a process that helps build leadership skills.

"If you see that you can perform in a clinic in Gales Point, and you then bring that mindset back to America where we have so many more resources, you'll be a much better problem-solver and a far better leader," Wright notes.

Cultural exchange

Outside clinic hours, students, residents and faculty have the opportunity to interact with Belizeans socially. Both villages supply meals and arrange recreational activities like hiking, canoeing and manatee watching; craftsmen share the secrets of local trades; and musicians offer performances on the drums.

Even the morning walk from the students' sleeping quarters to the clinic can become a social event, Reynolds says, with residents stopping the Louisvillians to chat or offer a glass of water.

"They want to tell you about their culture and learn more about the way we see things," he says. "For our part, we really made an effort to meet them on their terms -- to understand them as completely as possible. By the end of the week, we really were beginning to feel like we were a part of their community."

That kind of exchange helps improve patient care, Humphrey says.

"We have a different approach to health care here in America and a different understanding of what it means to be healthy or sick," he says. "So if you can get a better cultural understanding, it helps you treat the patient far more effectively."

Reynolds notes that the same lesson in cultural competency can applied back home.

"Medicine is almost pointless if you can't take your medical knowledge and devise a treatment plan that not only takes care of the patient, but takes care of the patient in a way that is tune with his background and beliefs," he says.

"The treatment must take into account the whole patient; he must feel that he is a part of the treatment plan, or he won't follow it.

"So any time you get a chance to practice medicine in a situation in which you have to put your own beliefs on the back burner and really focus on the patient in front of you, it can't help but make you a better doctor.

"Even back home in the United States, that's what you have to do every day."

National awards

In 2005, UofL's International Service Learning Program was named the best of its kind in America by the National Association of Student Personnel Administrators, Strenecky says.

Since then, other schools have been seeking information on how they can develop similar programs at their campuses.

For Jones, however, proof of the program's success is much more personal.

"I've learned in the past few years that despite any cultural differences people may have, we're all the same inside. We all have the same fears. We all have the same thoughts. We all love our children and want what's best for the future.

"I feel very fortunate to be a part of this program, and I know our students and residents feel the same way."