College of

Service Learning: Maggie Collison in Peru

September 2012

Maggie's story:

As we arrived in Chicama, Peru, to meet the town’s mayor for the health campaign, I saw small homes crowding the dirt road, each just one-story, some with or without roofs, lined up one next to another. While at first I was shocked to see the rural poverty, I was soon to find that my experience would be more shaped by the personalities of the people who lived there. And at the end of the visit, which was short but intense, I would understand much more about heath care, the human body and the type of physician I hope to become.

One of the most challenging experiences for me was teaching dental health education at the village school. I was nervous about communicating in a foreign language, but also explaining and teaching children how to take care of their teeth, as this is an area in which I do not have much medical knowledge. I found it helpful to learn from the dentists, as they shared information on the preferred ages to begin dental care, how often a child should be brushing his or her teeth, and what areas are at most risk for dental disease. It was also challenging for me to physically put the fluoride in their mouth because this was the first time I had been working with young people in a health care setting.  It was not comfortable for them either. As I continued the experience, I found my confidence growing.  Rather than forcing the student to sit attentively as I lectured on how to brush their teeth, I found it best to first talk with them about their other interests- such as practicing their ABCs or other songs they practice in school.  In order to make them (and myself!) feel more comfortable, I would try to speak with the kids about games, sports or songs, and then teach about dental care. While they may not often see or receive much health care, apparent as many children had teeth that actually were rotting, they were enthusiastic about the toothbrushes and supplies provided with the lesson, and responded with an eagerness to learn.

Another challenge I faced was while I was working with the audiologist. My job was to look in patients’ ears and to determine if their hearing difficulties were due to excess wax or if they had an infection or inflammation. If their hearing difficulties seemed unrelated to infection, then I performed a preliminary hearing test. At first, I lacked confidence in deciding if their ears needed testing or medication, but I found with more experience asking the learning the patients history, I was able to determine whether I should have them continue to the more advanced testing with the audiologist. This portion of the experience showed me that the best type of medicine is practiced when one listens to the patient’s story. Whether he or she had pain, associated headaches, ringing in the ears, or difficulty with sight all led to clues as to what the best next step would be in determining their treatment. One boy had ears that had been closed since he was born; the audiologist told him he would need to travel to Lima to receive a surgery to correct. We had traveled eight hours by bus to this village, but for him to travel to Lima seemed like worlds away. Seeing these types of challenges inspires to make an effort to serve rural areas with little access to health care. The basic access to care is a challenge that faces many nations, and I hope by teaming up with other countries we can find more people to work in these settings.

In addition to personal challenges, the lack of supplies, adequate facilities and time were significant challenges that we faced as a group. When I worked with the orthodontists as they performed tooth extractions, we were placed in a small room.  They were short on clean, bottled water, and there were always two patients in a room sitting next to each other in plastic chairs, a stark contrast to dental offices I have seen in the US. On the last two days of health education, we ran out of children’s toothbrushes and fluoride trays. We had to use cotton balls and give some of them adult toothbrushes.  Outside, in the hallway there were patients in droves waiting to be seen by optometrists, internal medicine and the dentists. They would most likely not be seen that day. Stray dogs roamed even within the clinic, occasionally breaking out in a fight. Many of the patients could not receive the correct medications or dosing they needed and for some conditions such as high blood pressure - having a months worth of medication is not sufficient to treat the condition. There was not the option to run labs or tests, as is available in Lima or in U.S. hospitals for diagnosis. However, despite the challenges, I still saw patients receive the treatment and care they most needed at the time.

The service learning experience taught me many lessons to use as I continue in my medical education and career. I have found that the best service I can offer to people is to listen and perform a solid physical exam. After listening to their story, understanding their health history, daily stresses and the environment they live, I can work to treat them both physically and mentally. The most positive moments I had were when I spoke with the physicians about their educational experiences and specialties. The Peruvian medical field has the strong teamwork and communication between all the areas of health care. The dentists’ train alongside the internal medicine physicians and surgeons as a part of their education, and in doing so all specialties can have a better understanding of overall health. Because space, time and resources are of limited quantity, there was less stratification based on education levels. The patients I worked with also expressed more gratitude and optimism than I had seen in other experiences. Even one woman, whose tooth broke during the extraction, had a sense of humor and was laughing throughout the procedure.

While I may continue to practice primarily in the United States, I gained an invaluable experience. I hope to have the opportunity to work again with physicians from other countries. I also will continue to have a passion to work with those patients who are underserved. Following the service-learning experience, I worked in an externship at a hospital near Detroit and many of the patients we worked with in the OB clinic, lacked health insurance, and had little to no prenatal care. After the service learning in Peru, I am committed to improving the care of patients who lack regular access to health care. I am more aware of the challenges that patients face in receiving the health care they need and hope to think of creative ways to allow easier access.  Finally, I learned how the environment of where a patient lives and works affects their health care. For instance, many of the patients in Lima suffer from asthma, especially the children who cope in this city with the high pollution, and many people in Chicama have soot in their ears, nose and lungs. By understanding these components of a patient: the environment, the medical history, and the individual physical exam, I believe that successful health care can still be provided even if all the resources are not available.



Kailyne Van Staven and Maggie
Collison were second-year
students in 2012 when they
participated in the College of
Human Medicine Service
Learning program in Chicama,