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Medical Students Without Borders

NicaraguaAlong with an interdisciplinary Tufts team of medical students, an environmental engineer and several physicians, fourth-year medical student David Solondz got a hands-on lesson in international medicine while spending a month in Nicaragua providing medical treatment and resources to the local community.


Itís early December 2004, and fourth-year Tufts medical student David Solondz looks both eager and anxious. He has ample reason to feel both of those emotions: in about two months, he and seven other medical students will begin a decidedly nontraditional chapter of their education.

Through an international health medical elective organized by Dr. Brian Lisse - an assistant professor of Community Health and Family Medicine at the Tufts University School of Medicine - the students will join an interdisciplinary team traveling to Nicaragua for a month to provide medical treatment and resources, as well as to improve public health conditions and awareness.

"All of us are really dedicated to this, and really value doing international medicine," Solondz says of the team, which includes the medical students (Lauren Elson, Becca Summers, Kevan Zipin, Nahid Bhadelia, Christina Kim, Montida Chowanadisai and Audrey Wen), Lisse, Environmental Engineering PhD candidate Jim Limbrunner, and Rachel Levine, a scientist from Cambridge-based Industrial Economics, among others.

"I think itís a strength of our project, having this dynamic group from different departments: it really helps us provide more than just medical care," says Solondz, a New Jersey native who majored in electrical engineering as an undergrad at Tufts. "You know, medicine is not just giving medication or dealing with a single patient - thereís a whole public health aspect: looking at water quality, looking at housing, the vet students looking at tuberculosis in the local livestock."

Solondz and his peers are in the midst of planning and fundraising for their February trip, which will largely revolve around two specific Nicaraguan communities, Hormiguero and Mangallo, and is being facilitated by Bridges to the Community, an international aid organization.

Each student must raise $2,000 for the trip - and that sum, Solondz says, "doesnít include bringing down research equipment, water testing, or medical supplies."

"We have $1,000 from last year, but we donít want to use that for our expenses - we want to build on it," says Solondz, adding that members of the group raised money through Frisbee tournaments and the medical schoolís annual Halloween party.

But even with such successful initiatives - coupled with $5,000 from the Tufts Institute for the Environment - the students, Solondz says, "are still a couple thousand short."

Planning is proving equally challenging: since the elective has only been offered once before, the students donít have a great deal of precedent to guide them.

"The first time [this elective] was offered was last year, and there were three students," says Solondz, for whom both medicine and Tufts are in his blood: his grandfather graduated from Tufts Medical School in 1926. "Being the first year, there were a lot of kinks to get worked out. Itís kind of a catch-22: you have to go down first to know what youíre doing, but youíre not there, so how do you know what youíre doing? We have more of a theme this year, on womenís and infantsí health; weíre more organized.

"Another aspect of capacity-building is education: when we work at the health clinics, weíll be able to do sex education - and even, going back to the water, we can teach about the importance of boiling water or using clean water supplies," Solondz says. "Water quality will hopefully become a research project if we get enough data. Weíre going to work with the General Clinical Research Center here at Tufts-New England Medical Center, to do some public health research with that."

In order to accomplish both its short- and long-term goals, Solondz says the team must build a foundation of trust with the local medical community.

"One of the challenges of providing medical care [in Nicaragua] is that weíre working without the resources that weíre used to," he continues. "If we can work side-by side with and learn from the local practitioners, we can kind of model our practice after what they do, while giving them the manpower and some of the resources they need."

Solondz - who at one point planned on deferring admission to medical school for two years to work with the Peace Corps - hopes that taking such an approach will help the tripís effects last far longer than the studentsí visit.

Nicaragua

"One of the challenges of providing medical care [in Nicaragua] is that weíre working without the resources that weíre used to. If we can work side-by side with and learn from the local practitioners, we can kind of model our practice after what they do, while giving them the manpower and some of the resources they need."

"You can kind of be Ďmedical SWAT teams,í where you go into a foreign country and you fix everybodyís cleft lip, or you fix everybodyís broken arm, or you give everybody eyeglasses, and you leave, and thatís it," says Solondz. "Itís good; itís acute; but itís in-and-out, done; thereís nothing sustainable. I think an important aspect of international help is not only providing immediate care, but also capacity-building; helping the local people to learn, providing the infrastructure so that they can provide care and education for themselves."

Flash forward to mid-March: itís several weeks after his return from Nicaragua, and Solondz is confident that he and his colleagues have made a positive impact on the Hormiguero and Mangallo communities.

While in Nicaragua, the team of doctors-in-training treated more than 1,000 patients. "I believe the maximum was 84 patients in one day," Solondz says. The conditions diagnosed among those 1,000 patients included everything from hypertension, stroke and pregnancy to intestinal worms, scabies, polio and epilepsy.

"One would think that providing healthcare in one of the poorest communities in the world with minimal government support in middle-of-nowhere Latin-America, you would see the Ďzebrasí of medicine and interesting tropical diseases," Solondz said. "However, a good 50 percent of the chief complaints" - including headaches, joint pain and sore throat - "were from the same top-10 reasons patients go to their primary care physician here in the U.S."

Other elements of the clinical encounter, however, were very different from their U.S. counterparts.

"For instance, when youíre doing a history, youíre gonna ask, ĎWhat kind of house do you live in? Is it a tarp roof? A tin roof? Is it a dirt floor? A tile floor? Do you have running water?í" Solondz says. "Aspects of public health and the infrastructure of the community have a lot more direct play on individual health.

"Youíre really forced to practice medicine in a different manner," he adds. "You donít have access to the resources youíre used to: no electricity, no refrigeration, and you canít order the tests you need. Youíre practicing medicine in a way that youíre just not taught in medical school."

The group also experienced emergency situations not typically found in medical school.

"[On our last day in Nicaragua] everyone had finished seeing patients and the clinic was closing up," Solondz says. "Then, someone brought in a patient who had just been shot 10 times in the chest - [and] not only had he been shot 10 times, but this happened three hours earlier! He was well outside the Ďgolden hourí of survival."

The team swung into action, starting the victim on an IV and transporting him via ambulance ("a souped-up LandRover," Solondz says) to a hospital within half an hour.

"We were in the local news that evening, and the last we heard he was most likely paralyzed from at least the waist down, but stable and alive," Solondz says.

Having returned to the U.S., Solondz is working to ensure that this "unique project" has a future.

"With this just in its infancy, there are a lot of great things to come out of this, and tons of room to grow," Solondz says of the elective. "I truly hope to see [it] become a more longstanding permanent elective for fourth-year students, with greater support."

In fact, Solondz - who throughout his impending medical career hopes to participate in the Doctors Without Borders program, set up his own family practice, and eventually become the medical director of an integrative care center - sees his own future intertwining with that of the program.

"I view this elective as a possibility for me in the future - when Iím an attending physician somewhere, even if itís not Tufts, to be one of the faculty members that goes down and helps Tufts students in this area of Nicaragua," he says.


Profile written by Patrice Taddonio, Class of 2006

Patrice Taddonio, a native of Holland, Pennsylvania, is an English major and a communications and media studies minor. Currently the Tufts Daily's head features editor, she interned with the Improper Bostonian magazine during her sophomore year, and worked as a temporary text editor with the Associated Press at this July's Democratic National Convention. A member of the Class of 2006 and a songwriter, Taddonio has also performed on guitar and vocals at on-campus venues and at Boston-area benefits.

Photos courtesy of David Solondz.

This story originally ran on April 4, 2005