The team from Niagara University gathered outside the Fundacion Humanitaria Costarricense community center in LaCarpio after a day of serving at a community health clinic. Front row (left to right): Caitlin Perkins, Gina Laurini, and Mia Faso. Back Row (left to right): Debbie Leonard, Alexandra Thomas, Lawson Castaldo, Karen Wetherell, Alexandria Gerhardy, and Dr. William Cliff.

How do you reach across cultures to help your patients?

For two weeks this summer, seven Niagara University pre-health students learned answers to that question as they assisted physicians, dentists, and veterinarians in running free pop-up healthcare clinics and conducting public health home visits and assessments in impoverished communities in Costa Rica.

It was part of a cultural immersion experience allowing students to provide help in needy communities while gaining a global perspective of the healthcare professions and learning how the history and social-political factors of a country can affect the health of its residents.

The opportunity, now in its second year, was inspired by a lecture given by Dr. David Holmes, the first in a series sponsored by the Dr. John J. Hughes,’67, Endowment. Dr. Holmes, a clinical associate professor of family medicine and director of global health education at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, challenged his audience to make an effort to participate in global healthcare, emphasizing that it “helps students and healthcare providers to remember why they wanted to go to school in the first place.” He added that “attention to the needs of the poor and underserved populations of the world may restore a sense of purpose and humanism.” 

William Cliff, Ph.D., director of NU’s pre-health professions program, accepted the challenge and reached out to a colleague at Canisius College to discuss partnering on a healthcare service learning trip. The first year, the group went to four areas in Nicaragua; this year, due to the political climate in that country, they adjusted their plans to travel to Costa Rica, instead.

Dr. Cliff is quick to point out that the trip is a rigorous experience, not a vacation. Students are selected for the opportunity based on several factors, including their desire to become healthcare professionals and their previous service experience. They are trained in basic medical techniques so they can be effective contributors to the healthcare teams, and they attend a series of meetings to learn about the host country’s history and culture and the issues related to medical mission work before they leave.

In late May, the seven students who were chosen traveled with Dr. Cliff and Dr. Deborah Leonard, faculty fellow in biology at NU, along with their Canisius College colleagues, to San Jose, Costa Rica. There, they met their host families; became acquainted with the area via a lecture, a walking tour of the city, and a visit to the National Museum; and learned about the local health issues and the various tropical diseases they might encounter before experiencing their first day in a clinic.

On day three, they began their service learning in La Carpio, a shantytown situated next to a landfill between two polluted rivers. It is an isolated location at the end of a steep pathway, where tens of thousands of Nicaraguan refugees have made their homes. Their second week was spent in Longo Mai, a rural area that was founded in the middle of a pineapple plantation for refugees from Nicaragua and El Salvador. This time, the host families were members of the refugee community, which gave the students an even greater opportunity to see the relationship between the health of the community and the way in which its citizens lived, which included organic farming and the use of local herbal medicine.

In both communities, the students rotated between a medical clinic, a dental clinic, and off-site veterinarian work, in addition to public health home visits, working alongside healthcare professionals and translators to serve patients.

The work the students did was consistent with what they would be qualified to do in the United States—taking patient information, measuring vital signs, holding medical instruments, helping provide care for farm animals and pets, assessing environmental health issues in homes—and expanded their global awareness of health issues while enhancing their cross-cultural and interpersonal skills. It also gave them an introduction to the interprofessional model of education, in which students from two or more professions learn about, from, and with each other, which fosters collaborative practice and client-centered healthcare.

Students quickly learned that, although Costa Rica provides universal healthcare to its citizens and permanent residents, access to this care was not equal for all. Even within the two communities they served, they observed differences in the healthcare experience of the residents. Whether it was the distance from one’s home to a clinic, or an injury that resulted in the loss of a job, and thus, the medical care needed to recover and work again, hundreds of thousands of immigrants and refugees are underserved.  

Dr. Cliff notes that this experience also taught the students “cross-cultural humility,” to go into a society not as an authority, but as an observer to better understand patients’ culture and environment.

This lesson resonated with Lawson Castaldo, who said, “Through my experiences in La Carpio, I’ve learned that fully treating patients does not stop after a medication is prescribed. As I move toward becoming a healthcare professional, I know that … being aware of the socioeconomic situations (my patients) may be facing will be at the forefront of my mind.”

Gina Laurini also saw the importance of compassion in healthcare through this experience. “Practicing healthcare is all about leading your patient to a better quality of life,” she said, “not just relieving their pain in the moment.”

Editor’s Note: While the group was far from home, the Niagara University connection was still evident. At the end of the trip, while in line to enter a national park, Dr. Cliff ran into a former student he hadn’t seen in years—Chelsea Recor, ’14 who is finishing her training at Jacobs School of Medicine and Biomedical Sciences and was working on a public health project in Costa Rica.

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