Hillside Health Care International

SOME NOTES ON PREPARING FOR YOUR MISSION TO HILLSIDE

Introduction: While the following information is not an exhaustive list of everything a person should know before coming to Belize it is designed to provide a solid background of information about health systems in other countries and cultures, diseases that are likely to be seen in Southern Belize that are relatively uncommon in the United States, and information about working in a cross-cultural environment.

What to Do Before You Leave

Preparing yourself for your trip will be invaluable. An excellent preparation would be speaking to anyone whom has already worked there. In addition speaking to faculty who has been active in the planning process is helpful. There are numerous readings related to global health in general as well as Belizean culture history and economy which are listed on the Hillside website. In particular it would be important to learn more about Mayan, Belizean Creole and Garifuna cultures. Information can be obtained by goggling those topics. Dan and Maria Thibault, the medical coordinators at Hillside have many excellent suggestions for good readings related to these topics and can be reached before your trip at thibault99@aol.com There are many testimonials regarding making the most out of an international experience that can be accessed from such sources as the AMSA website related to international health experiences for students and books such as Caring For the World Drain et al. The staff at the Hillside clinic believe that if one has never had an international health care experience it may be unclear what the goals and expectations of such an experience may be. We firmly believe that what a student gains from such an experience includes:

An understanding of how things are done in different societies
What it’s like to experience a new reality from a minority position
How to work within a setting where resources are limited
The critical role of working within a team
The importance of the environmental and social causes of health and illness

Many questions you may have about your upcoming trip to Hillside can be answered by faculty who have spent a considerable amount of time at Hillside. These include Jeff Hartman jahartman@wisc.edu Jim Shropshire James.Shropshire@UWMF.WISC.EDUor Dick Anstett dick.anstett@msn.com

What To Bring For The Clinic

It’s common for students to bring supplies and medications without making sure they are needed or can be put to good use. For example, instruments have to be repaired and there may be no one in the area to do that. Medications for chronic conditions will eventually run out and a glucometer is of no value without a steady flow of test strips. Needs for supplies and medications change as the pharmacy or supply store run low on certain things. Basically the staff at Hillside should be consulted before bringing anything. What was needed two months ago may not be needed now.An exception to this is that the clinic can always use Acetomenophin , Ibuprofen, and children’s and prenatal vitamins best purchased in large stock bottles at places like Walmart and Costco. In addition the chronic diseases for which we always need medication are limited to diabetes , hypertension and hypercholesterolemia. Therefore we are always in need of Metformin, sulfonylurea meds like glyburide, a variety of blood pressure meds and the statin medications. Permethrin 5% cream for scabies is always in demand as are a variety of inhalers for asthma and COPD. In addition, the clinic is always in need of simple things that may be hard to get locally so don’t take for granted that the clinic and it’s staff have everything they need. Simply asking about things that might be needed before coming would be very much appreciated. We are not talking about big items, just the everyday things that are needed to run an operation like Hillside. Weight is always an important consideration in deciding what to bring so things that are relatively light and compact are preferred and help you avoid paying for excess weight on your flight. The best resources for answering questions about what medications and supplies are currently needed at Hillside are Dan and Maria Thibault thibault99@aol.com

What To Bring For Yourself

There are students who enjoy traveling light “living off the land” as a way of immerging into the culture. No ipods, junk reading, computer etc. This can be a good thing. We encourage students to spend as much time as possible with local people and experiencing local realities. The truth is that many don’t take advantage of this relying more on the comfort of familiar diversions, talking primarily with other students and minimizing local contacts. We see this as a personal choice and hope there is some blending of both kinds of experiences. If you do bring things for you own diversion like DVDs light reading etc. it’s very good to be prepared to leave them in order to build up a library for future students. It is important that ther be at least two or three computers at any one time so that you have access to your email. All computers brought by students should be loaded with Adobe reader, Powerpoint 2007 and RealPlayer in order to watch the curricular material you’ll be expected to read or listen to while you’re at Hillside.

We consider essential the following items for every student

Two pairs of scrubs, light rain gear, light clothing for after hours (light pants, skirts tops etc.), sturdy walking shoes. sunglasses, personal toiletry and personal medications, a LARGE water bottle, flip flops, insect repellant. Sun block, lots of easy food ( granola bars power bars etc) for the mobiles, a hat or baseball cap, a day pack (bigger than a “fanny pack”), malaria prophylaxis, copy of passport, debit card for ATM machine, bathing suit, camera or camcorder, a diary /notebook, one large towel. Other “essential” items can be suggested by students whom you know who have been to Hillside.

Items that are not essential but you may wish you had once you get there include some good coffee and a traveler mug, foods you really like (tuna fish, candy, chocolate etc). While food is a bit expensive in Punta Gorda many things are available (Mac and Cheese, peanut butter, rice, beans, etc) so you just need to ask people who have been there. You will be given the opportunity to purchase local fruits and vegetables at both the local market and local grocery stores on a regular basis. Some good books and DVD movies ( we have an LCD projector) that you will hopefully leave. Also consider bringing reading material relevant to the local cultures or to international health in general. Pictures of where you come from, your family, your school are very nice to share with local people and give them a chance to understand you better. Also small gifts from home are a very nice way to say thank you to the many people who you will meet and will be helpful to you.

There are also things you probably don’t need to bring because they are available there or you won’t be able to use them . The best bet is to ask anyone who’s been there. There are also things that students can share (like a computer) so check with other students who are going with you about sharing. All cooking materials (pots, pans etc. and bedding, pillows etc. are provided as are laundry soap and facilities for cleaning clothing.

Deciding How to Get to Punta Gorda

You have two choices once you arrive at Belize City Airport. You can take a very cheap (about $5.00 bus that will be a little crowded and take about six hours or a flight on Tropicair that will get you there in an hour for about $200.00. If you fly be sure to get the Hillside discount by talking to the staff at Hillside before you order your tickets. Otherwise it will cost about $240.00. You will be picked up at the airport by Hillside staff.

Attitudes That Are Effective in International Settings

Be prepared for certain physical and emotional challenges particularly if this is your first international experience (other than Cancun). Examples include getting used to daily realities like the heat, unexpected power outages, a different kind of local food ( the locals eat beans and rice and tortilla almost exclusively), trying to find a place to go the bathroom when there aren’t any, long rides on bumpy roads, a certain loss of privacy, less than great internet access, etc. In addition it’s very important to recognize that you may be full of “great” ideas to improve Hillside and you’ll see patterns and ways of doing things that seem less than efficient. Diplomacy in dealing with this is important. It’s not that the staff at Hillside and others don’t appreciate your ideas but it’s wise to offer suggestions with humility and an awareness that you are the visitor. You will also see cultural patterns and behaviors (children eating candy and Coca Cola for breakfast, pigs running freely in the villages, children with no shoes) etc. that may be hard to put into context. These feelings should be discussed with your fellow students and staff. While most patients will not be “well educated” by our standards people are keenly aware of their health problems and in general good historians. They may very well have tried local “traditional” treatments prior to seeing you and these efforts should be seen in a respectful way. Finally, the temptation to hang out with your fellow students and people who look and act like you will be powerful. At the same time there are fascinating people of diverse cultures waiting to be approached and spoken to. Just going into Punta Gorda and sitting in the local central park affords many opportunities to meet local people and learn from them and their unique experiences.

Being Prepared For Clinical Work

This is a tough one in that health care while “basically” the same has many twists and turns in Belize. What may seem obvious from your previous experience is no longer so. Different etiologies need to be considered for many common problems. For example, you’ll have to ask parents if they have seen worms in a child with constipation’s stool. You’ll have to ask a woman with a cough if she has a wood-burning fire indoors. You’ll work with the medications you have rather than necessarily the best medication. You’ll see that much essential care like adequate pain medication, quality elder care or a needed surgery simply may not exist or can’t be afforded. You’ll see that most health problems are related to such issues as diet, poor hygiene and poverty that you can’t quickly reverse. If you want to read about these issues before you arrive look up material on “The Social Determinants of Disease”, “Diseases of Poverty”. Or “Malnutrition and Illness” from such sources as the World Health Organization which has a superb webpage that has all such readings available. These are also topics that will be discussed as part of your didactic curriculum at Hillside.

Preparation Resources for Hillside Health Care Center

International Health: Look at these sites and try to understand the magnitude of health issues ranging from lack of service availability to lack of cultural acceptance across the globe.

National Council for International Health

Pan American Health Organization

World Health Organization

Bringing International Health Home: A Guide to Applying International Health Principles to Underserved Communities at Home

International Health Medical Education Consortium

American Medical Student Association

Text: Oxford Handbook of Tropical Medicine: Oxford University Press ISBN: 0192627724

Cross Cultural Resources:

Book: Fadiman, Anne. The Spirit Catches You and You Fall Down ISBN: 0374525641

Tropical Disease Knowledge: Having a “book knowledge” base of diseases that you will commonly see while at HHC will enable you to better care for patients when you encounter them.

It is recommended that you read information on the following tropical diseases and their treatments:

Malaria

Dengue

Leshmaniasis

Tungiasis (AKA Pig Flea)

You should also be comfortable with diagnosis and treatment of:

Various types of intestinal worms

Fungal infections of the skin

Scabies and Lice

(In general review your learning on skin rashes)

Varicella

Suggested web resources: