• THE BEST MEDICINE

By Hannah Halusker
Photography by Craig Mahaffey ’98

In the mountainous regions of Central America, pre-health students from Clemson University uncover what it means to be providers of health care.

APPROXIMATELY 6 MILES NORTH of the Costa Rican capital of San José is a shantytown called La Carpio. Stacked against one another on bare earth are multicolored shacks built of recycled two-by-fours and corrugated metal siding in shades of rusted brown, burnt orange, blue and steel-tone gray. Inside one, an abuela sleeps in the shack’s only bedroom, while her grandkids eat ramen noodles and watch TV. It’s the rainy season, but a beam of sunlight manages to strike the dirt floor through a tiny window.

The family is about to have visitors. Coming down one of the many alleyways in La Carpio, carrying clipboards and wearing medical scrubs, is a group of los gringos – Americans – who are knocking on every door they pass.

“¡Upe! Buenas!” they shout, announcing their presence – hello, someone is here.

A little boy steps outside. When he sees the Americans, his eyes light up, and a smile spreads across his face. He’s wearing the expression of a boy who knows that he’s adorable, his preschool uniform only adding to his charm.

“Hola!” the boy says, outstretching his hand to shake that of a gringa. His mother follows behind him, resting her hands on her son’s curly black hair.

“We are health students from the United States, and we’re holding a clinic at the community center this week,” the Americans say in broken Spanish. “Is there anyone in your residence who is sick?”

THE MOTIVATING FACTOR

EACH SUMMER, Clemson students trade in their summer jobs and internships to spend two weeks on the hillsides of Costa Rica and Panama, conducting house visits and creating pop-up clinics in the most impoverished areas. When not in clinics, they attend lectures on nutrition and natural medicines and learn how to perform injections and sutures — using fruits and sponges as test subjects.

“It’s becoming increasingly difficult to get clinical hours in the United States because of the numbers of students that are wanting to pursue health care as a career and the inability of practitioners to make themselves available,” says Vincent Gallicchio, a man who wears many hats at Clemson. He is a professor of biological sciences, microbiology and public health sciences, as well as the chief faculty adviser for pre-health professional students. He has also been director of the College of Science’s most popular study-abroad program — Health Missions in Costa Rica and Panama — since 2014.

What started in 2002 as an opportunity for pre-medical and pre-dental undergraduate students to receive global clinical shadowing experience has evolved under Gallicchio’s direction to include students interested in pharmacy, rehabilitation, physician assistant and nursing professions.

Partnering with International Service Learning, a nongovernmental organization that coordinates volunteer opportunities abroad, Gallicchio has crafted the Health Missions program to immerse students in an experience that is as culturally informative as it is educational. In Costa Rica, the students reside in a convent, where fruits of eight varieties grow in the backyard. They eat rice and beans (lots of rice and beans), and they learn Latin dance and the particulars of how coffee beans are harvested. Some groups also venture into the rainforest to experience Costa Rica’s biodiversity.

“They could be spending time at the beach or working at summer jobs,” Gallicchio says. “But if students use this trip to get out of their comfort zones and go to another country, it has the benefit of showing professional schools that they’re taking their careers seriously.”

After two weeks, the students return to the United States as changed individuals — both as human beings and as future health care professionals.

Professor Vincent Gallicchio monitors student-patient interactions at the Health Missions Clinic.

A LESSON IN QUALITY CARE

It’s impressive how quickly an operating clinic can be assembled with 19 pairs of hands to hang curtains, unfold chairs and set out medications and informational materials.

On any given day, the community center in La Carpio’s neighboring village, Guararí, serves as both a daycare for local children and a place of worship for community members. Children’s handprints in all the colors of the rainbow adorn the walls alongside Spanish biblical verses. But on this day, the entrance is transformed into a waiting area, positioned next to a makeshift pharmacy that a local pharmacist and a Clemson student will operate throughout the day.

Three other students — paired with a translator named Andrea who is a medical student from the University of Medical Sciences (UCIMED) in San José — form a triage group, ready to take in patients when they arrive. The day prior, the same students had performed house visits and handed out appointment slips to sick residents, and now they wait for patients to treat.

At 2 p.m., a patient arrives to her appointment 15 minutes early. The students ask her a detailed list of questions, stumbling over their Spanish and looking toward Andrea when their pronunciation of a word leaves their patient perplexed.

Do you have a family history of disease? What brings you here today?

“It’s becoming increasingly difficult to get clinical hours in the United States because of the numbers of students that are wanting to pursue health care as a career and the inability of practitioners to make themselves available.”

Junior nursing major Logan Young is the recorder on this case. As the woman recounts a story of falling down the stairs only two days earlier, Young takes notes, first of the pain in the woman’s back, arm and neck, then of her limited range of motion.

As the questions continue, the woman reveals a host of other symptoms, many of which seem unrelated to her fall. She has anxiety, she says, but she hasn’t been able to get medication for it in months. Her throat is sore; her eyes water; and she has persistent pelvic pain.

Young looks up from her clipboard to find that the woman is crying — and at once, all the students hold their questions. The language barrier overwhelms them because in that moment, they want nothing more than to verbally express their sympathies for what brought their patient to tears.

Instead, Young holds out her hand, and the woman takes it, the slightest smile an apparent attempt to overcome her fear. She is scared, she says, because she doesn’t know what is wrong with her. She knows that her living conditions are making her sick, and she is sad that she has to expose her children to the same environment.

Dr. Gloriana Saenz, a recent graduate from UCIMED, makes her rounds. The students pull her into their group and relay their patient’s symptoms and vitals to her. Saenz asks the students what they believe the woman is suffering from, then uses the woman’s case as a teachable moment. Pelvic pain and back pain, she says, are symptoms of a urinary tract infection, which can come in two versions: complicated and non-complicated. The farther the bacteria travel up the urinary tract, the worse the infection can become.

The woman takes a urine test, which renders positive for a UTI, and Saenz sends her home with antibiotics for the infection and ibuprofen for her pain. The woman gets the drugs from the pharmacy on her way out the door. As she leaves, she turns to Andrea to relay a message to the students.

“Thank you for being so caring,” she says. “Most doctors aren’t.”

Samriddh Chandhari listens to a patient’s breathing.

CONFIRMATION OF A CALLING

Costa Rica continually ranks highest in the polls as the happiest country in Latin America, a result, in large part, of the country’s decision in 1949 to abolish its military and divert those resources into education and health care. As a result, Costa Ricans have universal access to health care and primary and secondary education, with the government providing for many of its citizens’ basic needs regardless of income. In 2018, Costa Rica even ranked higher than the United States in the World Happiness Report.

Yet for immigrants from north-bordering Nicaragua, who make up approximately 7 percent of Costa Rica’s population, health care isn’t always feasible. Many immigrants enter the country illegally, fleeing political unrest and economic oppression. Without the proper papers or a decent education, they aren’t able to find jobs that offer access to the best health care benefits. They work in physically intensive jobs as maids, shoemakers or construction workers, and when a sickness or injury occurs, they line up in the middle of night outside of the local clinic and wait for their chance to see a health care provider.

During the two weeks Clemson students work in the communities, the reality of poverty — broken-down houses, sewers running alongside children’s bare feet, the spread of illness and chronic workplace injuries — never ceases to jar them.

“For me, and for probably most everyone on this trip, you go into it expecting to be shocked,” says Megan Hays, a junior biological sciences major. “But I think the biggest part about it isn’t so much what the conditions are because you’ve prepared yourself for that. I think it’s the severity of it and the magnitude of it. Driving out to the clinic, you’re passing 10, 20 more communities just like Guararí and La Carpio, and this is only in one small area of Costa Rica.”

The people in these communities need help, Hays says, and every act of aid is met with a profound sense of gratitude from the patients.

“You go in, and your help is so appreciated,” Hays says. “You’re so welcomed, and these people that are complete strangers will let you into their home. They give you smiles, hugs, kisses, and they care about your life. And in that moment, the motivation to be a medical professional is not to build a résumé. It’s not to get clinical hours. It’s not that ‘you have to have this GPA to get into this school.’ It’s allowing yourself to be really hurt by the sad stories and really happy with the patients you can help.”

Logan Young takes a minute to listen to a young patient in the clinic.

The experience is raw and emotional, and for many students, their Health Missions trip acts as a confirmation that yes, they are meant to become health care practitioners — perhaps even better ones because of their experiences in a foreign place. In the melting pot that is America, the ability to relate across cultural divides is central to patient relationships.
Patricia Greene, a senior in biological sciences, says the clinics are a reminder to “remember where you are.”

“As a future practitioner,” Greene says, “you have to remember where your patients are coming from, what their conditions are, what resources they have available, and are they going to have insurance? Are they going to be able to eat this diet you’ve recommended to them? Can they afford the medication you prescribe them? I’m going to make a mental effort to try and remember where my patients are coming from and what they have available so that I can treat them in the best way possible for them.”

An aspiring occupational therapist, Audrey Hartis learned from her patients the value of communication.

“You might ask a question, and you have no idea why you asked it, but it might spark a conversation with the patient,” Hartis says. “They really just needed someone to sit there and listen. It’s important to me that we value our patients as humans and not just as ‘I have a patient coming in at 12 who has a shoulder problem.’ No, you have a patient coming in who is a human and needs you to be 100 percent focused on them — on what their problems are, what their needs are and how they find happiness. I hope that when I become an occupational therapist, I am the best listener that I can be.”

In a far-off culture, immersed in a language they don’t speak, these students learn quickly that they have ways to express empathy beyond words that are spoken — that sometimes, a listening ear or the sharing of stories and laughter is the best medicine a doctor can provide. A sincere “Lo siento,” — I’m sorry — paired with a hug or a hand to hold is enough to dry tears and calm a patient’s fears.

Hannah Halusker is a writer for the College of Science.