international students rotations at clinica alabama … of rudy (for) nicaraguan health, inc....

Friends of Rudy (FOR) Nicaraguan Health, Inc.

International Students Rotations at Clinica AlabamaInternational Students Rotations at Clinica Alabama --GranadaGranada

Clinica Alabama-Granada is part of the foundation Friends of Rudy (FOR) Nicaraguan Health, Inc. which is a Non Profit, 501 (c)(3) organization headquartered in Birmingham, Alabama. The clinic was founded in February 2004 to serve children and adults who cannot afford medical care. It is an outpatient medical clinic managed by one administrative director, two local physicians, and a pharmacy technician who also serves as medical technician, two secretaries and local volunteers.

The clinic operates daily Monday through Friday from 7:30 AM to about 2PM or later if needed. Fifty to eighty patients, children and adults, are cared for daily. All patients receive medical consultation and their medicines free. For empowerment and sense of participation and ownership of their treatment, a donation of about $1.25 is suggested but not mandatory from the patients. The clinic receives no support from local or US government, or from churches. The clinic is supported entirely from donations obtained among friends in Alabama and other states. All donations are tax deductible.

International Rotations at Clinica Alabama-Granada

Since its opening, the clinic has received medical and nurse students

from Holland, England, France and USA. Most from Europe have been

senior medical students ready to begin their residency training who

expended from two to three months at the clinic. We also have

agreements with the University of Alabama Honors College where we

receive two groups of six to eight pre-med students for a period of

two weeks, each during the month of May. A group of Medical

students from Vanderbilt University comes for a shorter time. We

also have many requests from nurses or medical technicians for

rotations of up to three months. These are medical professionals

who are working in USA or happen to be in Nicaragua for other

projects.

Rotations at the clinic are designed to be an experience with

opportunities to care for patients in a unique underserved

community setting including individual continuity care at a general

medicine clinic. It is an invaluable experience that students gain by

immersing themselves in an environment that Spanish language and

the Spanish medical terminology is practiced 100%. The

understanding of the language by itself will be a profound experience

in future medical field as more and more Hispanics become part of

the American society. Knowledge of basic Spanish will be highly

desirable.



Students who rotate through our clinic are exposed to different

areas where they are in contact with our personnel and direct

contact with our patients by rotating throughout the different

areas.

Reception:

At the reception area students have their first encounter with

the patient. One or two students are assigned to this area

where their permanent charts or medical records are put

together. Every patient new or repeat has a chart on which to

record.

The students get to know the importance of patient’s

demographics: where they live, urban, suburban or rural areas,

how many members in the family, whether they have a job or

not, income if any, whether they have transportation to the

clinic, what type of transport, public like buses or private

“getting a ride”. Because of family structures most patients

especially females come with one or two children, so the

number of children seen daily can be between 25 to 40% of the

total number of patients.

Triage:

At triage patients are asked about their medical problems,

chronic or acute as well as “Chief Complaints” or symptoms

that bring them to the clinic. There are two types of patients,

the new first time at the clinic who provide all the information

at Reception and the return, chronic patients who come back

for maintenance of chronic recognized problems such as

diabetes, high blood pressure, arthritis, respiratory problems,

etc.

At triage the students check weight, vital signs, pulse, BP, do

glucose blood stick test and listen to the heart, lungs, and

carotid arteries, check for skin rashes, edema etc. Do an initial

inspection of the patient’s appearance, write in the chart all

noted findings. In summary: they get all the initial information

needed by the doctors when the patient passes into the

consultation room.



Consultation Room:

Two local Nicaraguan doctors are in charge of interviewing,

examining, making diagnoses and designing the appropriate

treatments for each patient. When students rotating at

Clinica Alabama-Granada are assigned to the doctors

consultation room, they will be exposed to a whole variety of

pathology, some that are common to any part of the world

such as high blood pressure, diabetes, arthritis, Chronic

Obstructive Pulmonary disease, also some maladies mostly

seen in tropical areas such as gastrointestinal, bacterial,, viral

or parasite infections, skin fungal rashes, viral conjunctivitis

and many other conditions.

Students assigned to rotate with the doctors get to see, interview and examine up to thirty to forty patients every day. They will examine the eyes, the optic fundi, repeat blood pressures, listen to the heart, lungs, and peripheral arteries, and palpate the neck for masses or thyroid, the abdomen for tumors, the extremities for pulses or edema. They learn to perform a complete physical medical exam. Once a medical history is obtained and the physical exam is completed the student gets to discuss with the doctors the differential or possible diagnosis. Once they arrive to that point the next step is to determine what or which tests will give better results for the cost of the tests.

Once the above is completed then comes the plan of treatment. The students will learn from the staff doctors which medicines are the better choices for what reasons and more economical without causing side effects to the patient. During this part of their rotation they will learn to manage hypertension, diabetes, mostly of adult Type 2 and many other chronic ailments. It is at this point where students are taught that patients should be treated with compassion and especially with a great level of respect. They should be treated no different than we expect ourselves to be treated. Also the more or better we educate our patients about their medical conditions; the better they will respond by taking better care of themselves.

Pharmacy and outpatient treatments:

Once the patients leave the doctor’s desk with their recommendations and prescriptions they move to the pharmacy to receive their medicines. Here they get instructions of how and when to take them, education to the patient about their medicines is key to a successful treatment and to prevent disasters. The students become familiar with different medicines, their presentation whether in pill, liquid, injectables, etc. They also participate in treatments like nebulizations, bandaging, wound care, suture removals and others.



Pharmacy and outpatient treatments: (continued)

Typically, two students are assigned one week to each area

mentioned and we hope that after that experience they will have a

better or clearer idea of outpatient care in an underdeveloped

country. Not all is as movies or TV depict or even the reality of

advanced first world countries like USA, Canada, or Europe. In the

afternoons they are encouraged to take courses to improve their

Spanish skills. Likewise there are plenty of tourist attractions;

Nicaragua has a rich culture and natural attractions to offer to

those who visit it for the first time. Although we are known for

being the safest country in Latin America, common sense should

always prevail. We hope you will have a great experience in

Nicaragua and will return many more times during your life.

APPLICATION REQUIREMENTS:

Fill application form to rotate at the clinic (form provided by us)

Short CV or letter indicating your reasons for requesting the clinic rotation

ID card from school or university

Letter from School or University attesting student good standing

Documentation of health insurance

Financial contribution (tuition) according to the length of the rotation to support the clinic sustainability

international students rotations at clinica alabama … of rudy (for) nicaraguan health, inc....

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